Presentación del Prof. Armando Peruga en el TCSeminar de la UCT-ICO

1. WILL EUROPE
SUCCEED IN REDUCING
SMOKING PREVALENCE
BY 30% BY 2025 ?
Armando Peruga
Programme Manager Tobacco Free Initiative

2. WHY 30% BY 2025 ?
• In 2010 WHA endorsed the WHO
Global Action Plan for the Prevention
and Control of NCDs 2013-2020
• Target 1.- 25% relative reduction in risk
of premature mortality from CVDs,
cancer, diabetes, chronic respiratory
diseases
• Target 5.- 30% relative reduction in
prevalence of current tobacco use in
persons aged 15+ years

3. OUTLINE
1. SMOKING PREVALENCE IN
EUROPE IN 2010
2. PROJECTION FOR 2025
3. P OF ACHIEVING TARGET BY 2025
4. BARRIERS TO ACHIEVING TARGET
• POLICY IMPLEMENTATION
• THE TOBACCO INDUSTRY

4. PREVALENCE OF
CURRENT
ADULT
SMOKERS
IN EU 2010

5. 2%
6%
12%
0%2%
17%
8%
0%
32%
41%
16%
64%
0%
10%
20%
30%
40%
50%
60%
70%
LMI MEN HI MEN LMI WOMEN LMI WOMEN
% EURO COUNTRIES BY
PREVALENCE IN 2010 BY SEX
31%+
<21%
21-30%prevalence
31%+
<21%
21-30%
prevalenceMEN
11%+
<4%
4-10%
prevalence
11%+
<4%
4-10%
prevalence
WOMEN
%OFCOUNTRIES

6. PROJECTIONS 2010-2025
BASED ON
EXPERIENCE
FROM 2000 TO
2010
IF
NOTHING
CHANGES
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)

7. RELATIVE CHANGE IN AGE-STANDARDISED
PREVALENCE OF CURRENT SMOKING 2010 -2025
(15+)
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)

8. The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
PROBABILITY OF 30% REDUCTION IN TOBACCO USE
2010-2025
ASSUMING CURRENT TRENDS CONTINUE

9. The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)
RELATIVE CHANGE IN AGE-STANDARDISED
PREVALENCE OF CURRENT SMOKING 2010 -2025
(15+)

10. PROBABILITY OF 30% REDUCTION IN TOBACCO USE
2010-2025
ASSUMING CURRENT TRENDS CONTINUE
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)

11. PERCENTAGE OF COUNTRIES THAT WILL
ACHIEVE THE SMOKING TARGET BY 2025
LMIC
MEN
HIC
MEN
LMIC
WOMEN
HIC
WOMEN
AFR 5% - 50% -
AMR 55% 4% 60% 38%
EMR 0% 0% 74% 0%
EUR 9% 16% 10% 13%
SEAR 80% - 96% -
WPRO 1% 8% 82% 2%
SUBTOTAL 38% 25% 85% 40%
TOTAL 35% 76%
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)

12. NUMBER OF CURRENT TOBACCO SMOKERS
(15+) IN EUROPE FROM 2000 TO 2025

13. IF NOTHING
CHANGES
ONLY 7 EU
COUNTRIES
WILL REACH
THE 30%
REDUCTION
TARGET IN
2025
COUNTRY
30% REDUCTION
IN SMOKING
PREVALENCE
COUNTRY
30% REDUCTION
IN SMOKING
PREVALENCE
Austria Italy
Belgium Latvia
Bulgaria Lithuania
Croatia Luxembourg
Cyprus Malta
Czech R. Netherlands
Denmark Poland
Estonia Portugal
Finland Romania
France Slovakia
Germany Slovenia
Greece Spain
Hungary Sweden
Ireland UK
The Lancet 2015 385, 966-976DOI: (10.1016/S0140-6736(15)60264-1)

14. GLOBAL CONCLUSIONS
• During 2000–10, the prevalence of tobacco use in
– men fell in 125 (72%) countries
– women fell in 156 (88%) countries
• If these trends continue, countries on
track to achieve their targets are for
– men only 37 (21%)
– women 88 (49%)
• Rapid increases are predicted in Africa for men
and in the eastern Mediterranean for both sexes

15. IS THERE ROOM FOR TOBACCO
CONTROL POLICY ACTION
IMPROVEMENT?
WHAT CAN BE CHANGED?

16. EU COUNTRIES WITH HIGHEST LEVEL OF
ACHEIVEMENT IN MPOWER POLICIES
SMOKEFREEPOLICY
CESSATIONPOLICY
LARGEPICTORIAL
WARNINGS
MEDIA
CAMPAIGNS
TAPSBANS
HIGHTOBACCO
TAXES
SMOKEFREEPOLICY
LARGEPICTORIALWARNINGSTAPSBANSHIGHTOBACCO
TAXES

17. EU COUNTRIES WITH HIGHEST LEVEL OF
ACHEIVEMENT IN MPOWER POLICIES
SMOKEFREEPOLICY
CESSATIONPOLICY
LARGEPICTORIAL
WARNINGS
MEDIA
CAMPAIGNS
TAPSBANS
HIGHTOBACCO
TAXES
SMOKEFREEPOLICY
HIGHTOBACCO
TAXES

18. WILL THE POPULATION BE
RESPONSIVE TO POLICY
IMPROVEMENT?
THE HARDENING HYPOTHESIS
THERE IS ROOM FOR
TOBACCO CONTROL
POLICY IMPROVEMENT

19. CORRELATION SMOKING PREVALENCE
/ HEAVYNESS OF SMOKING INDEX
Fernández E. et al. Preventive Medicine, Volume 81, December 2015, Pages 314–319

20. CORRELATION SMOKING PREVALENCE
/ HEAVYNESS OF SMOKING INDEX
Fernández E. et al. Preventive Medicine, Volume 81, December 2015, Pages 314–319

21. WILL THE TOBACCO INDUSTRY
REACT?
THERE IS ROOM FOR
TOBACCO CONTROL
POLICY IMPROVEMENT
AND THE POPULATION IS
NOT HARDENING

22. …Tobacco use is unlike other threats to
global health. Infectious diseases do not
employ multinational public relations
firms. There are no front groups to
promote the spread of cholera.
Mosquitoes have no lobbyists.
Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny, PhD, Fazel Randera, MD
THE MAIN VECTOR OF THE TOBACCO
EPIDEMIC IS THE TOBACCO INDUSTRY

23. THE TI ITERFERES TO AVOID
EFFECTIVE REGULATION
• fabricating support through front groups;
• discrediting proven science; and
• intimidating governments with litigation
or the threat of litigation.
• manoeuvering to hijack the political and
legislative process;
• exaggerating the economic importance of the
industry;
• manipulating public opinion to gain the
appearance of respectability;

24. EVOLUTION OF POLICY CONTENT OF TPD
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
RAND
TECHNICAL
REPORT
EC
PROPOSAL
FINAL
LEGISLATION
SWEDISH
MATCH
ALLEGATION
HEALTH
COMMISSIONER
Publichealthpolicyposition
calendar
EUROPEAN COMMISSION EUROPEAN PARLIAMENT AND COUNCIL
PMI alone
used 160
lobbyists
PMI met
with 1/3 of
MEPs
High
nonhealth
Officials met
with TI 12
times
TI mobilized
>150 third-
parties
TI sent 85000
comments , mostly
duplicates
Costa H, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051822
Peeters S, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051919

25. POLICY POSITION ON TPD
ORGANIZATION
TYPE
EU
DOCUMENT
Health Industry Original Final
Health* 1.71% 0.87% 1.50% 1.21%
Warn* 1.68% 0.69% 1.57% 1.18%
Econo* 0.05% 0.14% 0.00% 0.25%
% OF KEY WORDS IN DOCUMENTS
Costa H, et al. Tob Control doi:10.1136/tobaccocontrol-2014-051822

26. EU RULES ON DEALING WITH
TOBACCO INDUSTRY INADEQUATE
The Commission should ensure that the
proactive transparency policy put in
place by DG Health, requiring the
publication online of all the meetings its
staff have with tobacco industry
representatives and the minutes taken
of those meetings, should apply across
all of the Commission's services
irrespective of the seniority of the
official concerned and including,
specifically, members of its Legal Service.

27. THREE THINGS TO REMEMBER
1.THERE IS SUBSTANTIAL
PROGRESS
2.A LOT REMAINS TO BE DONE IF
WE WANT TO ACHIEVE OUR
TARGETS
3.THE MAIN VECTOR OF THE
TOBACCO EPIDEMIC IS THE
TOBACCO INDUSTRY

28. Thank you
perugaa@who.int

29. ORGANIZATION TYPE EU DOCUMENT
Health Industry Original Final
Health* 1.71% 0.87% 1.50% 1.21%
Warn* 1.68% 0.69% 1.57% 1.18%
Econom* 0.05% 0.14% 0.00% 0.25%

30. EVOLUTION OF POLICY CONTENT OF TPD
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
RAND
TECHNICAL
EC
PROPOSAL
FINAL
LEGISLATION
SWEDISH
MATCH
ALLEGATIONS
HEALTH COMMISSIONER
RESIGNS
Publichealthpolicyposition
calendar
EUROPEAN COMMISSION EUROPEAN PARLIAMENT AND COUNCIL
PMI alone
used 160
lobbyists
PMI met
with 1/3 of
MEPs
High nonhealth
Officials met
with TI 12
times
TI mobilized
>150 third-
parties
TI sent 85000
comments , mostly
duplicates