Challenges ahead to reach the goal set up in Tobacco End Game 2025

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1 Challenges ahead to reach the goal set up in Tobacco End Game 2025 Dr Vera Luiza da Costa e Silva Head of the Convention Secretariat WHO FCTC 12 June 2018

2 Towards the end game 1. Where are we? 2. What do we want to achieve and by when? 3. What do we need to do? 4. What will be the challenges?

3 1. Where are we? Tobacco epidemic in Sweden Male Female Total Current smokers Daily smokers Current smokeless tobacco users Daily smokeless tobacco users WHO FCTC Global progress report for Sweden Source: Public Health Agency of Sweden (2016)

4 2. What do we want to achieve and by when? - Reduction in daily smoking to 5% in men and women by 2025

5 Trends in daily tobacco smoking among persons 15 and older in Sweden Source: WHO Global report on trends in prevalence of tobacco smoking

6 Trends in daily tobacco smoking among persons 15 and older in Sweden Men 15 Women 10 Voluntary target: 30% reduction between 2010 and Source: WHO Global report on trends in prevalence of tobacco smoking (2018)

7 Age specific rates of current daily smoking in Sweden Source: WHO Global report on trends in prevalence of tobacco smoking (2018)

8 Trends in daily tobacco smoking among persons 15 and older in Finland and Norway Finland Norway

9 35 Trends in daily tobacco smoking among persons 15 and older in Finland and Norway and Sweden Sweden Finland Norway

10 Price (International dollars) Taxes (most sold brand) Smoke free Policies Health warnings cigarettes Health warnings smokeless Some tobacco control measures in these 3 countries Sweden Finland Norway % 84.9% 66% Smoking allowed enclosed public places 65 (F65,B65) 15 rotating 30 (F30, B30) Only 1 Smoking allowed enclosed public places 65 (F65,B65) 15 rotating Smokeless banned Banned in all indoor public places 48 (F43-B53) 16 rotating PP 15 (F30-B0) Only 1 Illicit trade protocol Signed. Not ratified Signed. Not ratified Signed. Not ratified Point of sale advertising Not banned Banned Banned

11 With the exception of Sweden, the sale of snus is prohibited in the European Union (EU). Article 17 of the 2014 EU Tobacco Products Directive

12 3. What do we need to do? First step: Fully implement the WHO FCTC

13 The WHO FCTC Legally binding global Treaty Aims at protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke (Article 3) Comprehensive and multisectoral approach to tobacco control

14 Parties to the WHO FCTC 180 countries and the European Union Sweden is a Party since % of the world s population covered by the treaty provisions

15 Supply reduction measures WHO FCTC & Guidelines Sweden signed the Protocol on 6 Jan 2014 but has not yet ratified

16 Other obligations under the WHO FCTC International cooperation Reporting

17 Article 8 & Guideline Implementation of the WHO FCTC provisions - Sweden Smoking is allowed in designated smoking areas in most workplaces and public places and public transport. There are only limited outdoor smoking restrictions; namely, in outdoor areas of premises intended for childcare, school activities, or other activities for children or young people WHO FCTC Global progress report for Sweden

18 Article 13 & Guideline Implementation of the WHO FCTC provisions - Sweden Advertising and promotion is allowed at points of sale, provided it is not visible from outside the point of sale. Tobacco product displays are also allowed at points of sale. There are some restrictions on tobacco sponsorship and the publicity of such sponsorship WHO FCTC Global progress report for Sweden

19 Proposed end game strategies Product-focused endgame proposals Regulate nicotine levels to make tobacco products non-addictive or less addictive Redesign the cigarette or tobacco products to make them unappealing Harm reduction strategies User-focused endgame proposals Smoker's license Prescription to purchase tobacco Restrict sales by year born-tobacco free generations Source: adapted from Malone et al, 2015

20 Proposed end game strategies (II) Market/supply-focused endgame proposals Licensing, outlet restrictions, display bans and price controls Quota/ sinking lid Price caps for wholesale prices Institutional structure-focused Tobacco control agency Regulated market model State takeover of tobacco companies Performance-based regulation Integrated endgame strategies Public support for endgame proposals

21 Endgame considerations Short term 1. Develop an endgame dialogue, narrative, and communications plan 2. Take specific actions to constrain the tobacco industry Longer term 3. Create a tobacco regulatory authority with monitoring and regulatory powers 4. Develop incentives to gradually reduce the number and density of tobacco retail outlets 5. Create a national plan for addressing gradual reductions in tobacco company workforce and tax receipts. Source: Cancer Research UK

22 Endgame: Finland example

23 What will be the challenges? We need to change permanently the structural, political and social dynamics that sustain the epidemic - Consensus and unity amongst public health community - The public must be prepared to believe in and support ending the tobacco epidemic - The policy makers must be willing and be prepared for tobacco Industry attacks - We should target communities that are more affected

24 Challenges faced by Parties to the WHO FCTC WHO FCTC GLOBAL PROGRESS REPORT 2016

25 Forms of Tobacco Industry Interference Manoeuvering to hijack the political and legislative process Exaggerating the economic importance of the industry Manipulating public opinion to gain the appearance of respectability Fabricating support through front groups Discrediting proven science Intimidating governments with litigation or the threat of litigation

26 Source : ACS Tobacco Atlas, 2018

27 E-cigs dollar sales worldwide ENDS Sales globally Source: The Statistics Portal

28

29 Possible next steps Fully implement the WHO FCTC provisions and Guidelines Become Party to the Protocol to Eliminate Illicit Trade in Tobacco Products Decide whether the Endgame comprises other tobacco products such as narguiles, snus and heated tobacco products? Address social determinants of the tobacco epidemic

30

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