Portugal at the tail of Europe in measures to prevent smoking
Data from the updated Tobacco Control Scale for 2021, presented this month of December 2022 at the Collaborating Center of the World Health Organization (WHO) in Barcelona, indicates that public policies for integrated tobacco control in 37 countries, in year 2021, (27 countries of the European Union, Bosnia and Herzegovina, Iceland, Israel, Norway, Russia, Serbia, Switzerland, Ukraine, United Kingdom and Turkey), show that Portugal is in the final platoon, in measures for the prevention of smoking .
The ranking is led by Ireland, the United Kingdom and France, while Serbia, Switzerland and Bosnia and Herzegovina had the worst results. Portugal occupies the 30th place, out of the 37, after having dropped 10 positions compared to the previous report, published in 2019.
The policies recommended by the WHO Framework Convention on Tobacco Control include, inter alia, price increases through tobacco taxation; comprehensive smoking safety in public places; better consumer information, including public information campaigns, media coverage and dissemination of study results; comprehensive bans on advertising and promotion of all tobacco products, logos and brand names; big, impactful health warnings on tobacco product packaging; treatment to help smokers quit, including greater access to medication.
According to a statement from the Portuguese Society of Pulmonology (SPP), the report includes, for the first time, the interference of the tobacco industry in the implementation of policies in several countries, using an objective index developed by researchers from the English University of Bath. Remember that WHO considers tobacco industry interference in policy negotiation and implementation of tobacco control measures as the main barrier to combat in order to achieve robust implementation of these policies.
Position of the Portuguese Society of Pulmonology
Sofia Ravara, pulmonologist and coordinator of the SPP Smoking Commission, said, quoted in a statement, that “Portugal needs to consistently fulfill its commitments to promote and protect the health of the Portuguese population, as explained in the Portuguese Constitution, in the Charter of Fundamental Rights of the European Union, in the WHO Framework Convention on Tobacco Control, and in the new National Health Plan aligned with the objectives of sustainable development. It is not possible to build a healthy and productive society and move towards sustainable development in Portugal with this stagnation in public tobacco control policies and their monitoring. She adds that the vast majority of the Portuguese population approves of tobacco control measures, according to various epidemiological studies. For example, more than 85% of Portuguese people agree with a comprehensive policy of tobacco-free, unwanted public spaces.”
The Portuguese Society of Pulmonology announced that, together with the health community and patient associations, it will soon propose an action plan of priority and urgent measures to control tobacco.
“To make progress in tobacco control, concerted action by governments and civil society is crucial, in addition to excluding interference from the tobacco industry. We think that the recent change in the Ministry of Health is an opportunity”, says Sofia Ravara.
“The Minister of Health, as a Member of the European Parliament, has been involved in tobacco control policy activities, has this privileged experience and the responsibility to do more and better for Portugal. He adds that, for the first time, the Ministry of Health includes health promotion in its organic. Of course, it is not enough to fight for the intervention of the Minister of Health in a pediatric way, other ministries such as Finance, Economy, Environment, Education, Internal Administration, etc. must be involved, according to the principle of “health in all policies”. We want to involve civil society and help the Government to advance in the control of smoking in Portugal, for the good of the health of all Portuguese people”, added the pulmonologist.
Tobacco Control Scale
The Tobacco Control Scale was created in 2006 by Luk Joossens of the European NGO Smoke Free Partnership (SFP) and Martin Raw, Director of the International Center for Tobacco Cessation, indicated the SPP. The scale is based on six strategies to prevent and control tobacco consumption that have been studied as the most cost-effective by the World Bank, and which are used to assess the level of implementation of tobacco control policies in each country. Scores can go up to 100 points and are determined using validated data available from scientific studies or accredited reports, in addition to information provided by national experts.
For the SPP, Portugal is a country that urgently needs to accelerate the implementation of tobacco control policies, starting with a comprehensive policy of tobacco-free public spaces, without waiting and with surveillance and surveillance.
At the launch of the 2021 report, Portugal was highlighted as a bad example of public policies for tobacco control, despite having ratified the WHO Framework Convention on Tobacco, advancing only when binding measures from the European Union are imposed.
The Ranking
Ireland and the UK are the highest scoring countries (both 82 out of 100 points), along with France, which ranks third with 71 points. These countries are on the right track when it comes to implementing measures to control smoking: for example, Ireland has the highest tobacco prices in Europe (€15.40 a pack of Marlboro, in 2022).
At the bottom of the ranking are Switzerland and Bosnia and Herzegovina, countries with the lowest scores (respectively, 35 and 25 points). It appears that Switzerland is under strong influence from tobacco companies and fails to make progress on tobacco personality or support for smoking cessation.
Among the countries that have significantly improved tobacco control are the Netherlands and Denmark, which improved by 9 points. A position that is mainly due to the consistent increase in taxes, the implementation of the display of tobacco products in visible windows at points of sale, and the adoption of “white or simple” tobacco packaging, that is, without cores, logo or brand design.
Eleven countries (UK, France, Ireland, Norway, Turkey, Slovenia, Belgium, Israel, Hungary, Netherlands and Denmark) have already adopted and implemented legislation for tobacco packs and packages without any branding design, while Finland will implement plain packaging in 2023.
“Plain tobacco packs already exist in more than ten European countries and should be the standard for all countries in the European region”, says Luk Joossens, lead author of the report, quoted by the SPP.
The document highlights the lack of funding for tobacco control, intensified by the COVID-19 pandemic. “None of the 37 countries spends 2 euros per capita without tobacco control and some countries have even witnessed a reduction in funding,” said Esteve Fernández, director of the WHO Collaborating Center for Tobacco Controlat the Catalan Institute of Oncology and co-author of the report, cited by the SPP.
Tobacco industry interference remains the main problem preventing countries from making progress in not controlling tobacco use. “Raising taxes on tobacco products is one of the most effective strategies to protect young people from tobacco, but taxes and prices in some countries are very low. The forthcoming revision of the tobacco acceptance directive is critical to ensure that taxes are raised,” said Lilia Olefir, director of the Smoke Free Partnership, quoted in the SPP statement.