GLOBAL PROGRESS REPORT. on implementation of the WHO Framework Convention on Tobacco Control

Transcription

1 GLOBAL PROGRESS REPORT on implementation of the WHO Framework Convention on Tobacco Control

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3 global progress report on implementation of the WHO Framework Convention on Tobacco Control

4 WHO Library Cataloguing-in-Publication Data global progress report on implementation of the WHO Framework Convention on Tobacco Control. 1.Tobacco Industry legislation. 2.Smoking prevention and control. 3.Tobacco Use Disorder - mortality. 4.Tobacco adverse effects. 5.Marketing - legislation. 6.International Cooperation. 7.Treaties. I.WHO Framework Convention on Tobacco Control. II.World Health Organization. ISBN (NLM classification: WM 290) Acknowledgements This report was prepared by the Convention Secretariat, WHO Framework Convention on Tobacco Control. Dr Tibor Szilagyi led the overall work on data analysis and preparation of the report. The following colleagues from the Convention Secretariat contributed to data analysis and drafting of the report with respect to various articles of the Convention: Guangyuan Liu, Karlie Brown, Ulrike Schwerdtfeger and Fanny Groulos. Paula de Beltran Gutierrez provided invaluable assistance in the analysis and presentation of data. Important contributions were made by Edouard Tursan d Espaignet and Alison Louise Commar of WHO s Department for Prevention of Noncommunicable Diseases to the section on the prevalence of tobacco use, and by Roberto Iglesias and Konstantin Krasovsky of the World Bank to the section on price and tax policies. The report benefited from the guidance and coordination provided by Dr Haik Nikogosian. Their assistance and contributions are warmly acknowledged. World Health Organization All rights reserved. Publications of the World Health Organization are available on the WHO website ( or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: ; fax: ; bookorders@who.int). Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO website ( The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Graphic design and layout by: Sophie Guetaneh Aguettant

5 Contents Foreword Executive summary v vii 1. Introduction 1 2. Overall progress in implementation of the Convention 3 Current status of implementation 3 Progress in implementation between reporting periods 3 Time-bound measures 5 Strong achievements and innovative approaches 5 Priorities, needs and gaps, challenges and barriers to implementation 8 3. Implementation of the Convention by provision General obligations (Article 5) Reduction of demand for tobacco Reduction of the supply of tobacco Other provisions (liability, research and reporting) Prevalence of tobacco use and related health and economic consequences 65 Annexes 4.1 Prevalence of tobacco use Tobacco-related mortality Economic burden of tobacco use 68 Annex 1: Reports received from the Parties status as at 30 May 69 Annex 2: List of indicators deriving from the reporting instrument used in assessing the current status of implementation 75 Annex 3: Current status of implementation of substantive articles by the Parties, by income group 79 Annex 4: Progress in implementation between the and reporting periods 87 Annex 5: Implementation rates of indicators used in the reporting instrument 89 Annex 6 : Changes in tobacco use prevalence across the last two reporting cycles 99 Annex 7: Estimated averages for tobacco use prevalence by who region and country income group 107 iii

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7 Foreword In February 2015 the Parties will celebrate 10 years since entry into force of the first global public health treaty. The WHO Framework Convention on Tobacco Control (WHO FCTC) marked a milestone in public health and provided new legal dimensions for international health cooperation. Furthermore, the first Protocol to the WHO FCTC, to Eliminate Illicit Trade in Tobacco Products, was adopted by the Conference of the Parties (COP) at its fifth session, held in November in Seoul, Republic of Korea. The Protocol complements the WHO FCTC in the fight against illicit trade, and is a new international treaty in its own right. This report on progress made globally in implementation of the WHO FCTC is the last before the celebration begins. The analysis is based on the latest official reports of the Parties submitted in the reporting cycle. The Parties themselves have been taking extraordinary steps in tobacco control through their implementation of the Convention. Nearly 80% of Parties adopted or strengthened tobacco control legislation after ratifying the WHO FCTC. These achievements are helping to protect the citizens of countries around the world, and are an inspiration to everyone involved in tobacco control. The report describes the areas in which significant progress has been made by the Parties in implementation of the treaty and reveals the impact it has had on generating momentum for tobacco control in many countries and supporting others in continuing their advances and strengthening further their stands on tobacco control. The lessons learnt during implementation described in this report not only contribute to our global knowledge of best practices, but should be beneficial for the Parties that have not yet taken the necessary steps to achieve full implementation of the treaty. Parties should be praised for contributing to this global knowledge, sharing their experiences and collaborating with each other for their mutual benefit. The same thanks should go to all the partners that have assisted with and contributed to treaty implementation. This includes WHO and its regional offices, the observers to the COP, including civil society organizations, as well as donors and all other stakeholders and international partners, including United Nations system organizations, that have not spared the technical and financial means required to assist countries in need. The WHO FCTC, through exemplifying how an international legal regime could become an appropriate response to the effect of globalization on health, opened a new phase in global health policy as well as in global health governance. Recent years have seen growing political recognition of the role of the WHO FCTC as a catalyst in the global health and development agendas, including through its promotion of multisectoral and international cooperation, with regard to a range of health challenges in the 21th century, such as the prevention and control of noncommunicable diseases and their controllable risk factors. The instruments developed under the guidance of and adopted by the COP, such as the new Protocol to Eliminate Illicit Trade in Tobacco Products and the seven guidelines for implementation of specific requirements of the Convention, could give further impetus and strengthen, when implemented fully and comprehensively, the impact of the Convention on the health of nations. V

8 GLOBAL PROGRESS REPORT Under the direction of the COP, and the leadership of two outstanding individuals, Dr Douglas Bettcher, who coordinated the WHO Interim Secretariat for four years, and Dr Haik Nikogosian, who served as the first Head of the Convention Secretariat for seven years, the staff of the Secretariat have made significant contributions to putting implementation of the Convention high on not only the public health but also the political agendas of the Parties. This is also the time to learn about the challenges Parties are facing in their implementation efforts, including the still very powerful multinational tobacco companies, their allies, and the novel and emerging products that pose new threats. The COP should stand firm and ensure that the successes achieved so far will lead us towards an endgame for tobacco and, ultimately, to tobacco-free societies. The Convention Secretariat September vi

9 Executive summary The reporting cycle was the second cycle in which Parties were required to submit their implementation reports at the same time, in a designated reporting period. Parties in general complied with their reporting obligations under the Convention. Nearly 73% of Parties submitted their implementation reports in, a slight increase over, and 168 Parties have submitted at least one implementation report since There is also a steady and substantial improvement in the completeness of the reports. However, reporting requires constant and, for many Parties, increased attention, to ensure that reporting, exchange of information and monitoring of progress, achievements and challenges, which are key functions and obligations of Parties under the Convention, are fully complied with to the benefit of all Parties. Implementation of the Convention has progressed steadily since entry force in 2005, with the average implementation rate of its substantive articles approaching 60%, compared with just over 50% in Progress is, however, uneven between different articles, with implementation rates varying from less than 20% to more than 75%. Implementation is also uneven between Parties and regions. Recent years have witnessed several strong achievements, innovative approaches and positive trends, which demonstrate the strong commitment of Parties to achieve full implementation of the Convention. They cut across almost all substantive articles, and include measures such as large increases in tobacco taxes, expanding smoke-free policies to include outdoor areas, banning additives in tobacco products, tobacco display bans at points of sale, very large health warnings, plain packaging, and using mobile and Internet technologies for promoting smoking cessation. In most cases, such advanced measures inspire similar action in other countries. Another bold development of recent years is the declaration of plans, by several Parties and regional groups, for smoke-free societies in the near future, a sign of the growing determination of Parties to end the tobacco epidemic. Most Parties have now reached the implementation deadlines that exist for some timebound provisions of the Convention, namely those in the area of health warnings and advertising bans. Although substantial progress has been made in recent years, one third of Parties have not reached full implementation of one or both of those time-bound measures. Strengthening national capacity and legislation for tobacco control, general obligations under the Convention, have an overarching impact on its full implementation. Overall, 80% of the Parties have strengthened their existing or adopted new tobacco control legislation after ratifying the Convention, but one third of the Parties have still not put in place legislative measures in line with the requirements of the Convention. In terms of national capacity, it is still the case that not all Parties have designated a national tobacco control focal point, and even fewer Parties have increased full-time capacity in tobacco control. Strengthening of the national coordination mechanism and international cooperation are other obligations with overarching impact. Weakness of multisectoral coordination and insufficient support from sectors outside health remain challenges in a large number of Parties. As far as international cooperation is concerned, Parties in general report more extensively on examples of cooperation with other Parties, international agencies and other partners. The reported rates for provision of assistance have actually decreased compared with, however, which vii

10 GLOBAL PROGRESS REPORT may be a sign of growing assistance from development partners other than States Parties. This aspect nevertheless requires more attention from Parties. In addition, the potential to mobilize assistance through international organizations of which Parties are members, as outlined in Article 26.4, remains largely underused. Concerning data on smoking prevalence reported by the Parties, the number of countries in which comparable prevalence data over time are available has increased, and more than two thirds of Parties with comparable data experienced a decrease in smoking prevalence in adults. Parties also reported on tobacco products that are expanding their global reach (such as electronic nicotine delivery systems, smokeless tobacco and shisha) and expressed their concerns about the rapid growth in the use of such products, particularly electronic nicotine delivery systems. More Parties are reporting on research specifically addressing these products and also on regulatory steps they have taken to prevent further expansion of use of such products (such as bans on importation, use, and advertising of electronic cigarettes). viii

11 1. INTRODUCtion 1. Introduction This global progress report for is the sixth in the series. It has been prepared in accordance with the decisions taken by the Conference of the Parties (COP) at its first session (FCTC/ COP1(14)), establishing reporting arrangements under the WHO Framework Convention on Tobacco Control (WHO FCTC), and at its fourth session (FCTC/COP4(16)), harmonizing the reporting cycle under the Convention with the regular sessions of the COP; furthermore, the COP requested the Convention Secretariat to submit global progress reports on implementation of the WHO FCTC for the consideration of the COP at each of its regular sessions, based on the reports submitted by the Parties in the respective reporting cycle. This scope of this global progress report is threefold: first, it provides a global overview of the status of implementation of the Convention, on the basis of the information submitted by the Parties in the reporting cycle; 1 it also identifies strong achievements, innovative approaches and good practices used by the Parties to comply with the requirements of the Convention; second, it tracks progress made in implementation of the Convention between different reporting periods; third, it draws conclusions on overall progress, opportunities and challenges, and also proposes desirable key actions to be taken, by article, in the near future. In the reporting cycle, Parties were requested to use the core questionnaire adopted by the COP in 2010 and further adjusted based on Parties feedback in the reporting cycle. In addition to the core questionnaire, which is mandatory for all Parties, a set of additional questions on the use of implementation guidelines adopted by the Conference of the Parties was added to the reporting instrument for the first time in the cycle. The additional questions aim to facilitate voluntary submission of information on the use of implementation guidelines by the Parties, and were developed in consultation with the Parties under the mandate of the COP (in decision FCTC/COP5(11)). The questionnaires used in the reporting cycle are available in the public domain on the WHO FCTC web site. 2 In the reporting cycle the Secretariat received reports from 130 Parties (73%) of the 177 that were due to report, a slight increase over the previous, reporting cycle, when 126 Parties (72% of those that were due to report) had sent reports by the deadline. Throughout this report, unless otherwise mentioned, the information concerning the status of implementation of the Convention is based on the reports submitted by those 130 Parties 3 (which represent 65% of the world s population). In addition, 18 Parties 4 submitted information on their use of implementation guidelines adopted by the COP by completing the additional questions, and this information is also used in the report. The status of submission of reports by the Parties is provided in Annex 1. The report follows as closely as possible the structure of the Convention and that of the reporting instrument. References 1 The period for submission of Parties implementation reports was from 1 January to 15 April. The Secretariat has been able to include, in this global progress report, the reports received within this period, as well as reports submitted by the Parties up to 30 April. 2 See reporting_instrument/ 3 Afghanistan, Albania, Algeria, Armenia, Australia, Austria, Azerbaijan, Bahamas, Bahrain, Bangladesh, Barbados, Belarus, Belgium, Belize, Benin, Bhutan, Bosnia and Herzegovina, Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Cameroon, Canada, Chile, China, Colombia, Congo, Cook Islands, Costa Rica, Côte d Ivoire, Croatia, Cyprus, Czech Republic, Djibouti, Ecuador, Estonia, European Union, Fiji, Finland, France, Gabon, Gambia, Georgia, Germany, Ghana, Grenada, Hungary, Iceland, Iran (Islamic Republic of), Iraq, Ireland, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kyrgyzstan, Lao People s Democratic Republic, Latvia, Libya, Lithuania, Luxembourg, Madagascar, Malaysia, Maldives, Mali, Malta, Marshall Islands, Mauritania, Mauritius, Mexico, Micronesia (Federated States of), Mongolia, Montenegro, Myanmar, Nepal, Netherlands, New Zealand, Nigeria, Niue, Norway, Oman, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Republic of Korea, Republic of Moldova, Romania, Russian Federation, San Marino, Sao Tome and Principe, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Slovakia, Slovenia, Solomon Islands, South Africa, Spain, Suriname, Sweden, Tajikistan, Thailand, the former Yugoslav Republic of Macedonia, Togo, Tonga, Tunisia, Turkey, Turkmenistan, Tuvalu, Uganda, Ukraine, United Kingdom of Great Britain and Northern Ireland, United 1

12 GLOBAL PROGRESS REPORT Republic of Tanzania, Uruguay, Uzbekistan, Venezuela (Bolivarian Republic of), Viet Nam and Yemen. 4 Bahrain, Brunei Darussalam, Colombia, Costa Rica, Gabon, Ghana, Jamaica, Japan, Kyrgyzstan, Latvia, Nigeria, Norway, Pakistan, Panama, Spain, Tonga, Turkey and Ukraine. 2

13 2. Overall progress in implementation of the convention 2. Overall progress in implementation of the Convention Current status of implementation 1 The status of implementation was assessed on the basis of information contained in the Parties implementation reports. A total of 148 indicators of implementation as reported by Parties through the reporting instrument were taken into account across 16 substantive articles 2 of the Convention. The indicators used are presented in Annex 2. Implementation rates of each indicator were calculated as the percentage of the reporting Parties that provided an affirmative answer in respect of implementation of the provision concerned. The implementation rates of each article are calculated as the average of all indicators considered under that article. The overall implementation rate of the Convention was calculated as the average of implementation rates of all substantive articles. Fig. 2.1 presents the average implementation rate of each substantive article as reported by the Parties in. The articles attracting the highest implementation rates, with an average implementation rate of 65% or more, across the 130 Parties analysed, are, in descending order: Article 8 (Protection from exposure to tobacco smoke); Article 16 (Sales to and by minors); Article 11 (Packaging and labelling of tobacco products); Article 12 (Education, communication, training and public awareness); and Article 5 (General obligations). They are followed by a group of articles for which the implementation rates are in the middle range of 41% to 64%, namely, and again in descending order: Article 13 (Tobacco advertising, promotion and sponsorship); Article 6 (Price and tax measures to reduce the demand for tobacco); Article 15 (Illicit trade in tobacco products); Article 10 (Regulation of tobacco product disclosures); Article 14 (Demand reduction measures concerning tobacco dependence and cessation); Article 20 (Research, surveillance and exchange of information); and Article 9 (Regulation of the contents of tobacco products). The articles with the lowest implementation rates, of 40% or less, are: Article 18 (Protection of the environment and the health of persons); Fig Article 8 Article 16 Article 11 Article 12 Article 5 Article 13 Article 6 Article 15 Article 10 Article 14 Article 20 Article 9 Article 18 Article 22 Article 19 Article 17 Average implementation of substantive articles of the Convention by the Parties reporting in Average implementation rate (%) Article 22 (Cooperation in the scientific, technical and legal fields and provision of related expertise); Article 19 (Liability); and Article 17 (Provision of support for economically viable alternative activities). Current status of implementation of the Convention by the Parties, assessed through the 148 indicators as mentioned above, is presented in Annex 3. 3 Based on the implementation rates by article as shown in Fig. 2.1, the overall implementation rate of the Convention was 54% in. Progress in implementation between reporting periods With a view to assessing the progress made in implementation of the Convention between 2005 and, information collected in the initial reporting period (i.e. in reports received up to 2010, before the transition to the biennial reporting cycle) was compared with information collected in the two biennial ( and ) reporting periods. To assess such progress, a

14 Article GLOBAL PROGRESS REPORT Fig Implementation rate of the WHO FCTC across all comparable indicators, 2010 Fig Implementation rates of substantive articles across the three reporting periods Average implementation rate (%) subset of treaty-specific indicators from 13 articles 4 of the Convention were used, encompassing demand- and supply-side measures as well as general obligations, which consistently appear across all reporting periods. This lower number of indicators (59), which allowed for such a comparison, are presented in Annex 2. Overall, the average rate of implementation of the treaty, when calculated by indicators comparable across all reporting cycles, increased steadily from 52% by 2010 and 56% in to 59% in (see Fig. 2.2). The changes in the implementation rates over the three above-mentioned reporting cycles is presented in Fig. 2.2 As described above, the implementation rates of each article were calculated as the average of all indicators considered under that article. Fig. 2.3 presents the implementation rates of substantive articles across the three reporting periods. There are four articles that attracted positive changes of more than 10 percentage points across those cycles: Article 8 (Protection from exposure to tobacco smoke): +18 percentage points increase; Article 16 (Sales to and by minors): +13 percentage points increase; Article 12 (Education, communication, training and public awareness): +11 percentage points increase; and Article 13 (Tobacco advertising, promotion and sponsorship). Progress in regard to several articles was less notable, of between 5 and 10 percentage points (Articles 5, 9, 11, 14, 15 and 20, as well as Article 22 in relation to assistance that Parties reported receiving for implementation of the treaty). There Average implementation rate (%) By are a few articles, however, for which the changes across the reporting cycles are minimal or nonexistent (for example Articles 9, 10 and 19) and there is one area in which the implementation rate has decreased (Article 22, in relation to the assistance that Parties reported that they have provided). When the reporting cycle in which the positive changes took place is considered, in several areas steady progress can be seen across the three reporting periods (for example Articles 13, 14, 16 and 20, as well as Article 22 in relation to assistance that Parties reported receiving for implementation of the treaty). In some cases, most of the change materialized before (Articles 8, 12 and 13). Another comparison, between the findings from the two most recent reporting cycles ( and ), can also be made. Due to the stability of the core questionnaire of the reporting instrument after 2010, a higher number of indicators can be used to assess progress between these reporting cycles, enabling a more Assistance received Assistance provided Compr. advertising ban 4

15 2. Overall progress in implementation of the convention comprehensive assessment of implementation status in and to be made, as well as of progress between the two cycles. In addition, the fact that reports of the Parties are now submitted in pre-defined reporting periods, almost at the same time, means that there is a high degree of comparability between the data, allowing an assessment of trends in implementation to be made. This assessment has been carried out by using the same 148 indicators that were used to assess the current status of implementation of the Convention. Such a comparison is made in Section 4 of this report, when describing detailed implementation progress by article. The findings are also presented in Annex 4, and the indicators used are presented in Annex 2. In addition, a more detailed summary of implementation by substantive article in the latest two reporting cycles can be found in Annex 5. Time-bound measures Two articles (11 and 13) of the Convention require that several provisions be implemented within a specific timeline. These requirements are also reflected in the reporting instrument. There are several indicators under Article 11 (concerning the size, rotation, content and legibility of health warnings, banning of misleading descriptors, etc.) and Article 13 (concerning adoption of a comprehensive ban and coverage of crossborder advertising, promotion and sponsorship) to which timelines of three and five years after entry into force of the Convention for each Party, respectively, apply. In addition, in relation to Article 8 of the Convention, although there is no timeline imposed in the treaty itself, the guidelines for implementation of this article recommend that comprehensive smoke-free policies be put in place within five years of entry into force of the Convention for that Party. In general, implementation of most timebound requirements under Article 11 of the Convention was reported on by more than three quarters of the Parties, and substantial improvements were registered, particularly since the last reporting period in. However, only half of the Parties include pictures/pictograms in their warnings and even fewer Parties require warnings covering 50% or more of principal display areas of the outside packaging of tobacco products. In relation to Article 13, only 70% of the Parties consider their advertising bans to be comprehensive and only two thirds of those Parties include cross-border advertising entering their territory in their bans. In relation to Article 8, the comprehensiveness of the bans on smoking in various public places varies greatly by setting, with only half or fewer of the Parties requiring a complete ban on smoking in all indoor settings, including hospitality establishments. The time-bound measures were addressed in detail in the global progress report. 5 Since then, for most of the Parties the three-year deadline for implementation of Article 11 passed as did the five-year deadlines in relation to Articles 8 and 13. The sections concerning implementation of Articles 8, 11 and 13 of this report further illustrate the level of implementation of the timebound provisions of those articles, and also refer to the challenges related to their implementation. It is still important for Parties that have not yet implemented the time-bound requirements of the Convention to take note of them and include them in national legislation as early as possible. Strong achievements and innovative approaches Several Parties have taken significant steps in implementation of the Convention, whether through new legislation or by strengthening existing measures. In some cases, Parties have put into effect particularly advanced or innovative measures, in line with the Convention and its guidelines, which have often inspired similar action in other countries. They include those described below. Tax and price policies Several countries have taken measures to implement large increases in tobacco taxes in general, increases of 50% or more (examples include Afghanistan, Brazil, Kazakhstan, Philippines, Spain, Turkmenistan and Ukraine). As some of these counties have demonstrated, such increases may lead to a substantial reduction in consumption and associated health gains. Protection from exposure to tobacco smoke Several Parties reported extending smoke-free policies to cover certain outdoor settings, such as beaches, transport stops, public parks, outdoor cafes (Australia, Canada and some others), sheltered walkways and hospital compounds (Singapore), outdoor markets (Fiji) and even some 5

16 GLOBAL PROGRESS REPORT Source: European Union, European Union. streets (New Zealand). Reports also indicate that some Parties have extended smoke-free policies to other settings traditionally not covered by such regulations, such as prisons (New Zealand) and private vehicles when carrying children (Australia, 6 Bahrain, Canada, Cyprus and South Africa). Tobacco product regulation Some relatively new trends have emerged in the area of product regulation. Some Parties (such as Republic of Korea and South Africa) have introduced reduced ignition property standards. Other Parties (such as Brazil, European Union and Turkey) have banned or restricted the use of additives in tobacco products, in line with the guidelines adopted by the COP in With regard to disclosure, Canada has replaced numerical values for emissions with text-based statements that provide concise and easy to understand information about the toxic substances found in tobacco smoke. Packaging and labelling of tobacco products There has been a move towards very large pictorial warnings (occupying, in general, more than 60% of principal display areas) on tobacco packages (most recently Australia, European Union, Fiji, Nepal, Sri Lanka and Thailand). Another bold development in this area has been the adoption and implementation of a law requiring plain packaging of tobacco products. Australia was the first country to do so in, with some other countries considering a similar measure. Tobacco advertising, promotion and sponsorship Several Parties in recent years have banned the display of tobacco products at points of sale one of the last remaining means of advertising tobacco products (Canada, Finland, New Zealand, Norway, Palau, Singapore and Thailand). Others have extended advertising bans to cover electronic nicotine delivery systems, such as electronic cigarettes (for example Norway and Turkey, with other countries also reporting a ban on sales of electronic cigarettes, for example Bahrain, Panama and Suriname). In another advanced measure, Australia extended the ban on tobacco advertising to cover the Internet and other electronic media (for example mobile phones). Treatment of tobacco dependence A relatively new measure, text messaging on mobile phones as a means of promoting tobacco cessation, was recently introduced by Costa Rica and Panama. Norway has launched a smartphone application supporting the cessation of tobacco use. Illicit trade In, Parties adopted the Protocol to Eliminate Illicit Trade in Tobacco Products, which is the first protocol to the WHO FCTC and a new international treaty in its own right. The Protocol builds upon and complements Article 6

17 2. Overall progress in implementation of the convention 15 of the Convention, and when in force will substantially strengthen the action in this important area of tobacco control. National legislation Parties now tend to enact legislation in areas that were previously implemented predominantly through other means, such as national action plans and strategies. Examples include protection from interference by the tobacco industry, communication and awareness raising, treatment of tobacco dependence, and surveillance. Several Parties have also demonstrated comprehensive application of the WHO FCTC when developing new legislation, ensuring that it covers almost all key provisions of the Convention (recent examples include the legislation adopted by Gabon, Kiribati, Russian Federation, Senegal and Turkmenistan). Bhutan has adopted legislation requiring a comprehensive ban on the sale of tobacco in the country. Protection from the interests of the tobacco industry Parties are paying increasing attention to implementation of Article 5.3 of the Convention and the guidelines for its implementation. Some novel approaches include divesting governmental funds of tobacco industry investments (most recently Australia and Norway). More and more countries are adopting codes of conduct and guidelines for government employees in relation to interaction with the tobacco industry; one innovative approach in this area was the adoption by the Government of the United Kingdom of Great Britain and Northern Ireland, in, of revised guidance for the country s overseas posts (such as embassies) on interactions with the tobacco industry in line with Article 5.3. Enforcement Interesting initiatives emerged in strengthening enforcement of national legislation, which in general remains a challenging issue for many Parties. One innovative approach in this area is the one employed by Bangladesh, through the establishment of mobile courts to enforce national legislation, particularly advertising bans and smoke-free provisions (see Box 2.1). Tobacco-free societies Several Parties and regional groups have declared their visions and plans for tobacco-free societies. Finland was the first country to include such a target in national legislation. Government plans for their countries Box 2.1. Enforcement of tobacco-control measures through mobile courts in Bangladesh Since 2005, district and subdistrict officials in Bangladesh have created more than 1000 mobile courts. When the courts were first established, the focus was largely on the enforcement of bans on tobacco advertising and promotion. Power under the court is limited to a relatively small fine of 50 taka (less than US$ 1) for public smoking violations and 1000 taka (about US$ 15) for illegal advertising. However, violators may also be subject to a short jail sentence. The National Assembly of Bangladesh passed the Tobacco Control Law Amendment Bill on 29 April 2013, closing many loopholes in the country s previous tobacco control law. Restaurants and indoor workplaces have now been included among the public places that are required to be completely smoke-free. Under the guidance of Ministry of Health and Family Welfare, and with the collaboration of several nongovernmental organizations (NGOs) working in tobacco control, many more mobile courts have been established to help with enforcement of the legislation, including its smoke-free provisions. to become tobacco-free by 2025 were declared by Ireland and New Zealand and a similar target for a tobacco-free Pacific was set by the health ministers of Pacific island countries at the Tenth Pacific Health Ministers Meeting in July European countries stated their ambition to work towards a tobacco-free Europe in the Ashgabat Declaration. 7 This trend, first highlighted in the global progress report, demonstrates the growing determination of Parties to achieve tobacco-free societies through full implementation of the WHO FCTC. Some of the strong or innovative achievements by Parties are described in more detail under the relevant sections of this report. To provide Parties with best practices and to reinforce and sustain implementation assistance and exchanges of information under the Convention, the Secretariat has prepared a series of technical publications. These publications are grouped into three series covering, respectively, matters of global importance, matters of regional importance, and national best practices deriving from regional implementation meetings. They can be found at: 7

18 GLOBAL PROGRESS REPORT Priorities, needs and gaps, challenges and barriers to implementation In their reports, Parties provide information about their priorities and needs identified, challenges and barriers to implementation. Priorities Over 90% (119) of the Parties reported that they have have at least one priority area for implementation of the WHO FCTC. More than half of the Parties reported a priority under the scope of Article 5, with over a third mentioning adoption of new or strengthening of existing tobacco control legislation. Several other Parties reported that they focus on preventing interference by the tobacco industry and reinforcing their national coordinating mechanisms or focal points for tobacco control. Other priorities cited in relation to Article 5 were development and strengthening of a national tobacco control strategy, enforcement of penalties, and capacity building of stakeholders. Many Parties mentioned implementation of specific articles of the Convention as being their priorities. The most frequently reported priority articles were: Article 14 (Demand reduction measures concerning tobacco dependence and cessation), Article 8 (Protection from exposure to tobacco smoke), Article 11 (Packaging and labelling of tobacco products), Article 6 (Price and tax measures to reduce the demand for tobacco), and Article 15 (Illicit trade in tobacco products). Some Parties cited other, specific priorities. For example, Barbados, Ecuador and Panama referred to prioritizing policy responses to the increasing use of electronic cigarettes. Needs and gaps Over half (69) of the Parties referred to gaps between the resources available and the needs assessed for implementation of the WHO FCTC. Most of these Parties indicated that they lack the financial resources to implement the WHO FCTC; on the other hand, 11 Parties (Algeria, Bhutan, Croatia, Fiji, Myanmar, Panama, Papua New Guinea, Serbia, Slovenia, Thailand and Togo) reported a lack of human resources, while the need for training of focal persons and capacity building were cited by Bosnia and Herzegovina, Georgia, Montenegro, and Myanmar. Several Parties also reported a lack of resources apart from the financial and human. Bahrain reported that there are no certified laboratories available in their country. Bhutan cited the unavailability of drugs for treatment of tobacco dependence. The Czech Republic mentioned a limitation in resources for monitoring and evaluation of cessation services. Hungary also stated that it requires adequate resources for prevention activities and research concerning tobacco cessation, as well as for surveys as well as for the infrastructure required for testing of tobacco products. Thailand referred to budget constraints hindering efforts to raise social awareness through mass media and other campaigns. In addition, gaps reported by the Parties were linked to wider economic constraints in their countries (for example Albania, Cyprus, and Spain), and insufficient support by legislators (for example Philippines and Senegal). Brunei Darussalam and Paraguay noted that tobacco control was not seen as a high priority issue by some non-health agencies. Gaps were also linked to several other factors, such as a low level of public awareness, lack of a comprehensive and integrated tobacco-control programme, the influence of the tobacco industry, the disparity between progress made in several areas of tobacco control and the lack of progress in the areas of taxation, insufficient coordination of public education programmes, and increasing public interest in quitting tobacco use. Challenges, constraints or barriers Around two thirds of the Parties responded to questions on constraints or barriers that they have encountered in implementing the Convention. The most frequently mentioned challenges were interference by the tobacco industry, insufficient political support and weak intersectoral coordination. Other constraints reported were limited expertise, lack of awareness of the importance of tobacco control, low priority given to tobacco control in non-health sectors and institutions, paucity of data, weak monitoring, discrepancies between policies and the implementation guidelines adopted by the COP, and lack of research systems. Other challenges concern specific articles: for example, difficulties in enforcing smoke-free measures or lack of national testing capacity. The tobacco industry continues to use legal challenges (often without success) to tobaccocontrol measures to prevent, delay or weaken 8

19 2. Overall progress in implementation of the convention implementation of those measures; both the threat and active pursuit of legal challenges appear to be becoming more prominent as Parties continue to implement stronger and more innovative measures. In recent years, increasing attention has been paid to the relationship between the WHO FCTC and international trade and investment agreements and the implications of this relationship for effective implementation of the Convention. This occurs against a background of legal challenges to implementation of tobacco-control measures in WTO dispute settlement proceedings and under international investment agreements, as well as in domestic forums. In, both Australia and Uruguay reported ongoing international legal disputes relating to implementation of tobacco-control measures. In addition to trade- and investment-related challenges, many governments are being challenged by the tobacco industry in domestic courts in relation to WHO FCTC implementation. Some of these challenges incorporate claims related to international trade law, highlighting the relationship between international and domestic disputes. Domestic disputes are initiated in relation to measures implemented under various articles of the Convention. In, Brazil and the Philippines reported legal challenges in relation to tobacco product regulation (Articles 9 and 10). Several Parties reported legal challenges relevant to implementation of graphic health warnings (Article 11), with ongoing cases in Canada and Thailand. A challenge relating to regulation of tobacco advertising and promotion (Article 13) was also initiated in Pakistan. Several Parties also reported that the tobacco industry had threatened legal challenges in relation to consideration or development of draft tobacco-control laws, in an attempt to intimidate governments and dissuade them from acting. It is important to note that, despite industry tactics, Australia, Nepal and South Africa reported successfully defending domestic legal challenges brought in relation to implementation of Articles 11 and 13. Sri Lanka also successfully defended a legal challenge to implementation of graphic health warnings. The WHO FCTC has been an important factor in the positive outcome of some of these decisions. More details about some of the difficulties Parties face in implementing provisions of the Convention are provided in the sections on the respective articles. References 1 As at 30 April. 2 Due to the specific nature of data on tobacco taxation and pricing and related policies, the status of implementation of Article 6 is described in the section on that article. 3 By World Bank income group. 4 The following three articles were excluded from this analysis (progress in implementation of these articles is described in the relevant parts of section 4): Article 6, due to the specific nature of data on tobacco taxation and pricing and related policies; and Articles 17 and 18, due to the fact that almost half of the Parties reported that measures under these articles are not applicable to them. 5 See pages of the report (available at www. who.int/fctc/reporting/summary_analysis/en/). 6 At subnational level. 7 Endorsed by the WHO Ministerial Conference on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 in December

20

21 3. Implementation of the Convention by provision 3. Implementation of the Convention by provision 3.1 General obligations (Article 5) Key observations Based on the reports received in the reporting cycle, the average of the implementation rates for the Article 5 provisions 1 is 65%, up from 60% in. Over two thirds of the Parties reported recent development, adoption and implementation of national tobacco-control programmes/strategies, a significant increase since the previous reporting period. Steady progress continued concerning the development and adoption of national tobacco control legislation, with Parties starting to include in such legislation several areas of the Convention traditionally covered by action plans, indicating an increasing scope of treaty measures to be given legislative strength. There is still a weakness of multisectoral coordination and insufficient support from sectors outside health in a large number of Parties. It is also still the case that not all Parties have designated a national tobacco control focal point, and even fewer Parties have increased the number of staff working full time in tobacco control. Interference by the tobacco industry remains significant and loopholes in Parties legislation often allows such interference to take place. Parties reported on creating synergies in the prevention and control of all risk factors related to noncommunicable diseases, for example by including tobacco control in their national plans and programmes that have broader scopes, as well as at the level of institutional capacity/infrastructure. This article requires Parties to establish essential infrastructure for tobacco control, including a national coordinating mechanism, and to develop and implement comprehensive multisectoral tobacco control strategies and plans, as well as tobacco-control legislation, and to ensure that public policies with respect to tobacco control are protected from the interests of the tobacco industry. The article also calls for international cooperation and refers to raising the necessary financial resources for implementation of the Convention. Comprehensive, multisectoral tobacco-control strategies, plans and programmes (Article 5.1) Over two thirds (88) of the Parties reported having in place such strategies, plans and policies, which have an overarching importance and impact on implementation of the Convention. The share of Parties reporting the development and implementation of comprehensive multisectoral national strategies, plans and programmes has increased consistently from 49% in 2010 to 59% in and 68% in. Of the 88 Parties, more than a third reported having developed and implemented new programmes or strategies since the previous reporting cycle. Twenty-five of them reported new, standalone national tobaccocontrol programmes or strategies, 2 and an additional 13 Parties reported that they have integrated tobacco-control programmes into either noncommunicable or cardiovascular disease prevention programmes/strategies 3 or programmes/strategies covering addictions to tobacco, alcohol and other drugs. 4 Brazil indicated that it has implemented obligations under the WHO FCTC as part of other national policies, such as those on consumer protection, agriculture, empowerment of women, and protection of the environment. When providing additional details, several Parties also indicated challenges or setbacks. For example, Paraguay and Senegal reported that the budget allocated to the national programme/strategy has decreased considerably in comparison with previous years. Sierra Leone and Uzbekistan reported that, although the programmes had been adopted, their coordination had not been assigned or funded, while Tajikistan indicated that it had developed the draft of its national programme in 2011 but was still awaiting approval by the Government. 11

22 GLOBAL PROGRESS REPORT Infrastructure for tobacco control (Article 5.2(a)) Parties reported on whether they have established or reinforced and financed a focal point for tobacco control, a tobacco-control unit and a national tobacco-control coordinating mechanism. Most (113) of the Parties reported that they have designated a national focal point for tobacco control, and two thirds (85) of the Parties indicated that they have established a tobacco-control unit, with more than one person working full time in tobacco control. In most cases, such units are hosted by the health ministry or a public health agency under the supervision of the health ministry. Several Parties provided additional details. For example, in Malaysia, the Tobacco control and WHO FCTC unit has been strengthened and divided into subunits so that additional capacity can be dedicated to several areas under the Convention. In Portugal, additional capacity for tobacco control has been established in the regions. Three quarters (98) of the Parties reported having put in place a national coordinating mechanism for tobacco control (see also Box 3.1). In most cases this mechanism takes the form of a high-level multisectoral committee, involving all relevant government departments and agencies, as well as other stakeholders, and which is established by law or by another executive or administrative measure. Kenya, for example, indicated that membership of its Tobacco Control Board is to be extended to include donors and other stakeholders that provide funding for tobacco control activities. An emerging trend within the Parties demonstrates the synergies that exist between prevention and control of the main risk factors for noncommunicable diseases. For example, several Parties reported that they have placed the focal point responsible for tobacco control or the tobacco Tobacco and other risk factors in noncommunicable disease prevention and control. Poster courtesy of the Department of Health, Philippines. 12

23 3. Implementation of the Convention by provision control unit wihin the organizational structure dealing with prevention of noncommunicable diseases in the line ministry. In addition, three Parties (Barbados, Marshall Islands and Tonga) reported that a committee with a broader scope (responsible for noncommunicable diseases in general) will also cover implementation of the Convention. Parties also reported, with respect to Article 22(c) of the Convention, on cooperation in and provision of technical, scientific, legal and other expertise to establish and strengthen national tobacco-control strategies, plans and programmes. A quarter (32) of the Parties reported having provided and more than half (77) of the Parties having received assistance from other Parties or donors for such programmes. In spite of the progress reported in this area, challenges still exist in many countries: 17 Parties reported that they do not have a national focal point for tobacco control and in some other cases the responsibilities of the focal point cover several other areas, which may indicate that national capacity for tobacco control at administrative and technical levels remains insufficient. When reporting on challenges and barriers in implementing the treaty, most Parties referred to weaknesses in multisectoral coordination and insufficient support from non-health sectors of the government. Adopting and implementing effective legislative, executive, administrative and/or other measures (Article 5.2(b)) Parties reports show that most progress in implementation of the Convention is achieved through the adoption and implementation of new legislation or the strengthening of already existing tobacco-control legislation. Several Parties (Gabon, Iraq, Kiribati, Russian Federation, Senegal, Suriname, Turkmenistan and Viet Nam) have reported adopting new comprehensive tobacco-control legislation since the last reporting period in, while others (Bangladesh, Chile, Hungary, Mexico, Mongolia, Montenegro and Singapore) have reported amending parts of their tobacco-control legislation to strengthen and further align it with the requirements of the Convention. In total, 49 Parties 5 adopted national legislation after ratifying the Convention; of those that already had legislation in place at the time of ratification, 86 Box 3.1. Government of Georgia establishes coordinating mechanism for tobacco control The Government of Georgia adopted a decree on the creation of the State Committee on Tobacco Control on 15 March The Committee is chaired by the Prime Minister and the deputy chair is the Minister of Labour, Health and Social Affairs. All relevant Government ministries are represented. The Committee also includes members of Parliament, the Patriarchate of Georgia, media consortiums, the Georgian Public Broadcaster and relevant NGOs. The National Centre for Disease Control and Public Health serves as the Secretariat of the Committee. Since its establishment, the committee has developed a national strategy and an action plan and on tobacco control (approved by the Government on 30 July 2013 and 29 November 2013, respectively), as well as six amendments to laws, which are currently being processed by the Parliament. reported that they strengthened their legislation after ratification (see Fig. 3.1). Overall, 135 (80%) of the Parties 6 have strengthened their existing or adopted new tobacco control legislation after ratifying the Convention, of the 168 Parties that have submitted at least one implementation report since entry into force of the Convention. In many jurisdictions, regulations or implementation decrees are required to implement legislative and executive measures adopted by national parliaments. Parties experiences indicate that the time lag between the adoption of legislation and the development of such regulations or decrees varies substantially, and that the process may be delayed by internal factors (e.g. lack of technical capacity) or challenged by the tobacco industry. As shown in Fig. 3.1, in 16 Parties tobaccocontrol legislation is still missing; in addition, 17 Parties have not revised their pre-treaty tobaccocontrol legislation to meet their obligations under the treaty since ratifying the WHO FCTC. At the same time, an interesting trend is emerging concerning the content of tobaccocontrol legislation: Parties have started including in such legislation several areas of the Convention that, in most countries, were traditionally covered by national strategies or action plans (e.g. Article 5.3 preventing tobacco industry interference; Article 12 education and communication; Article 14 tobacco 13

24 GLOBAL PROGRESS REPORT Fig Strengthening of national legislation after ratifying the Convention 103 Parties (61%) had legislation 168 Parties submitted report 65 Parties (39%) did not have legislation Prior to ratification 86 Parties (83%) strengthened national legislation 17 Parties (17%) have not revised their legislation 49 Parties (75%) adopted legislation 16 Parties (25%) still not adopted national legislation After ratification 135 Parties (80%) strengthened or adopted legislation cessation; Article 19 litigation; and Article 20 research and exchange of information). This fact indicates that there is an increasing scope of treaty measures being given legislative strength at the national level. The current reporting instrument does not allow an assessment to be made of the comprehensiveness of such legislation and its degree of compliance with the Convention. Additional research will be needed in this area 7. Protection of public health policies from commercial and other vested interests of the tobacco industry (Article 5.3) Over two thirds of the Parties (89) reported that they have taken steps to prevent the tobacco industry from interfering with their tobacco-control policies, a significant increase in comparison with the reporting cycle. However, only around a quarter of the Parties (37) reported taking measures to make information on the activities of the tobacco industry available to the public, as referred to in Article 12(c). Almost two thirds of the Parties also provided additional information on the progress they have made in implementing Article 5.3. Eight Parties mentioned including measures under Article 5.3 in their recently adopted tobacco-control legislation or draft legislation currently under consideration, and four Parties reported including references to Article 5.3 in their national tobacco-control, health or development plans. For example, Gabon dedicated a section in its legislation to measures on the protection of tobacco control from commercial and other interests of the tobacco industry, as did Gambia and the Republic of Moldova in draft legislation (see also Box 3.2). Of the measures recommended in the guidelines, the two most frequently mentioned areas of progress, reported by 14 Parties each, were promoting and raising awareness of the need for implementation of Article 5.3 within governments, and the development of codes of conduct, ethical guidelines or administrative policies for civil servants. Panama, Philippines and Thailand reported on a comprehensive set of measures that they have implemented covering almost all areas referred to in the guidelines on this topic. Moreover, eight Parties (Jordan, Ghana, Federated States of Micronesia (Federated States of), Myanmar, Nepal, Solomon Islands, Thailand and Turkey) reported that they have developed or are in the process of developing national guidelines, policies or regulations on the implementation of Article 5.3 in their jurisdictions. For example, in Thailand, the guidance for civil servants on How to contact tobacco entrepreneurs and related persons entered into force in April Norway reported that in its National Tobacco Strategy attention is given to assessing the need for national guidelines on matters covered in Article 5.3 of the Convention and the related implementation guidelines. Ministries of health usually take the lead in informing other ministries of their countries obligations under Article 5.3, by sending them 14

25 3. Implementation of the Convention by provision Honourable Minister for Public Health Dr Suraya Dalil speaking at a meeting on tobacco industry interference. Photo courtesy of the Ministry for Public Health, Afghanistan. a copy of the implementation guidelines. The United Kingdom developed specific guidance to its overseas posts on interactions with the tobacco industry in line with Article 5.3 (see box). Solomon Islands reported on the development of a teaching module for public servants, and the Republic of Korea reported on the commissioning of an academic study on an effective strategy to implement Article 5.3, which also included recommendations on measures required nationally. Parties reported that they used the opportunity of World No Tobacco Day to raise awareness of tobacco industry interference. Several Parties reported banning sponsorship by the tobacco industry as a means of barring the industry from undertaking activities described as corporate social responsibility, requiring public notification of meetings from tobacco industry representatives and exclusion of the industry from tobacco-control related activities. A group of Parties also reported on the role that NGOs are playing in monitoring and raising public awareness of tobacco industry activities. For example, Finland mentioned that NGOs disseminate information on industry activities, interests and methods. Uruguay reported that meetings with tobacco industry representatives are only held if they are seen to be strictly necessary, and take place in the presence of representatives of civil society. Finally, some Parties Box 3.2. United Kingdom of Great Britain and Northern Ireland: guidance for overseas posts In March, the Government published revised guidance for the United Kingdom s overseas posts (such as embassies) on interactions with the tobacco industry in line with Article 5.3. The document notes that posts should encourage and support full implementation of the WHO FCTC, and should limit interactions with the tobacco industry, including interactions with any person or organization that is likely to be working to further the interests of the industry; in the event that such interactions are considered necessary, these should be conducted with maximum transparency. The document lists the activities that overseas posts must not undertake, including being involved in activities with the specific purpose of promoting the sale of tobacco or tobacco-related products; encouraging investment in the tobacco industry; accepting any direct or indirect funding from the tobacco industry; attending or otherwise supporting receptions or high-profile events, especially those of which a tobacco company is the sole or main sponsor and/or which are overtly to promote tobacco products or the tobacco industry; or endorsing projects that are funded directly or indirectly by the tobacco industry. Further details can be found at: tobacco-industry-guidance-for-uk-overseas-posts 15

26 GLOBAL PROGRESS REPORT reported that they do not accept donations from the tobacco industry, ban donations by tobacco companies to political Parties and divest public funds of tobacco industry investments. Parties that have not yet banned tobacco industry sponsorship are still facing interference by the tobacco industry. For example, in Jamaica, which in the past has concluded a voluntary arrangement with the tobacco industry prohibiting advertising of tobacco products in print media targeting children, the tobacco industry still implements youth smoking prevention programmes in schools. In Latvia, the tobacco industry organized a campaign calling on tobacco users not to choose illicit tobacco products. Such loopholes in existing legislation need to be eliminated not only to ensure full compliance with the requirements of the Convention but also to prevent the tobacco industry from running activities that are described by them as socially responsible. 16

27 3. Implementation of the Convention by provision 3.2 Reduction of demand for tobacco Price and tax measures to reduce the demand for tobacco (Article 6) Key observations Several positive trends that had been observed previously continued in the current reporting period. First, the proportion of countries levying excise taxes has further increased (to 92%, up from 67% in 2010 and 85% in ). Second, a combination of specific and ad valorem type taxes has become more widely used. Finally, the average proportion of all taxes in the retail price of tobacco products has further increased (to 67%, compared with 57% in ). However, there are still significant differences between Parties and regions in terms of levels of taxation and prices of tobacco products. More than two thirds of Parties increased tax rates since. The majority of Parties reported an increase in the nominal prices of tobacco products. Parties that have increased tobacco taxes in general experience a corresponding increase in tobacco prices and in some of those countries a tax-driven reduction in tobacco consumption has been documented. The overall number of countries that reported using some form of tobacco tax earmarking for health and other purposes did not change when compared to findings from the reporting cycle. There is also an increasing number of countries that prohibit or restrict sales to and imports by international travellers of taxand duty-free tobacco products. This trend was not observed in the previous reporting cycle. However, around half of the Parties have yet to implement such measures. Despite the substantial improvements observed, the collection of data related to tobacco taxation and pricing, as required by the Convention (in Article 6.3), remains a challenge in several Parties, especially in the case of tobacco products other than cigarettes. Under this article Parties are expected to implement tax policies that contribute to the health objectives aimed at reducing tobacco consumption; the article also refers to prohibiting or restricting sales of tax- and duty-free tobacco products. Of the 130 Parties providing an implementation report, 129 provided some information for analysis of taxation and/or pricing of tobacco products. 8 Most of the data used for such analysis refer to cigarette 9 taxes and prices. For other tobacco products, data were insufficient for the calculation of price indices or average tax rates. Taxation A total of 119 (92%) of the Parties stated that they levy some form of excise tax on tobacco products. The other 10 countries, which do not have local cigarette production, apply only import duty. Value-added tax (VAT) or sales taxes are applied in the majority of the Parties, but usually the same VAT rates are used for all kinds of products and therefore could not be considered to be part of tobacco-control policy. VAT rates were used in the current analysis only to calculate the proportion of all taxes in the retail sale price of cigarettes. Information on the type of taxation applied to cigarettes, by region, is presented Table 3.1. There are notable differences in the predominant type of cigarette taxation that the Parties in different regions impose. For example, the most-reported form of tax in the Parties of the African Region was ad valorem only; on the other hand, most Parties in the Western Pacific Region reported that they levy specific taxes only; Parties in the European Region (approximately 80% of the respondents) favoured a combination of ad valorem and specific excise taxes. Changes in taxation across reporting cycles For 115 countries, information about tax rates in and in the year of the previous report ( for most countries) is available. Only three countries reported changes in taxation type since the previous report: Kenya changed taxation from specific only to combination of taxes, while Chile and Costa Rica changed from ad valorem tax to combination of specific and ad valorem. Overall, of these 115 Parties, 82 (which apply either specific or ad valorem tax alone or a combination of the two) have changed the tax rates they apply, while 33 have not. The changes are presented in Fig

28 GLOBAL PROGRESS REPORT Table 3.1. Parties levying excise tax or import duty for cigarettes in, by WHO region WHO region Excise tax Import duty Specific % Ad valorem % Both specific and % only % Total only only ad valorem African Americas South-East Asia European Eastern Mediterranean Western Pacific Overall Fig Percentage of Parties changing the tax rates they apply between the and reporting periods Change in the specific and/ or ad valorem component of a system 31 7 Increased both specific and ad valorem Increased ad valorem tax 9 No change Increased specific tax More than half of Parties in the Region of the Americas and the Eastern Mediterranean Region kept the same tax rates, while more than half of the countries in the Western Pacific Region increased their rates. None of the countries with mixed types of tax systems decreased specific rates, while 21 countries (mainly in the European Region) decreased ad valorem rates and increased specific rates. In most cases such changes of tax structure increased the average cigarette tax burden. In general, the weight of the specific component in the combined tax increased between and. A higher specific component reduces the relative price of higher- to lower-priced brands, thus discouraging downward substitution by smokers. Several countries implemented substantial tobacco tax increases (by 50% or more) during the reporting period, including Afghanistan, Brazil, Kazakhstan, Mauritania, Palau, Philippines, Spain, Turkmenistan and Ukraine. Total tax burden on cigarettes Half (51%) of the Parties provided data on total tax proportion (excise plus other taxes) in their average cigarette prices. The average proportion among the reporting countries is 67%, which is higher than in (59%). The proportions vary from 20 25% to more than 75%. The latter were reported by some Parties in the Eastern Mediterranean and European Regions and the Region of the Americas. Forty-nine Parties, mainly those from the European Region, also provided data on changes of the total tax proportion in their average cigarette prices since the previous report. The proportion of taxes in cigarettes prices had not changed in eight of those countries, while it had increased in 20 countries and declined in another 21. Declines in the tax proportion were caused by several factors. For example, Bulgaria, Brunei Darussalam and Seychelles did not increase their specific tax rates during the reporting cycle and as cigarette prices increased at least in line with inflation, the proportion of taxes became lower. Prices Data on cigarette prices were reported on by 121 countries in the reporting period; for 102 countries, data on prices for and are available. 10 An increase in nominal price was reported in 86 countries (84%), with more than half of those reporting an increase in nominal price of more than 20%. The price was stable in 18

29 3. Implementation of the Convention by provision 13 countries and had declined in three countries (Bahamas, Bahrain and South Africa 11 ). Prices of topbacco products can have an impact on smokers behaviour if they reduce affordability of those products. To estimate a reduction in affordability, the nominal prices should be adjusted for inflation and income, but these indicators are not readily available for many countries. So prices were converted into US dollars using the official exchange rates in and (using data from the reports or International Monetary Fund exchange rates) to obtain another indicator for estimating the direction of tobacco tax policies. Table 3.2 presents minimum and maximum cigarette prices in US dollars for by WHO region. 12 There are large differences in prices within each region. The European Region has the largest difference. The price differences are mainly caused by taxation policy. Sierra Leone has the lowest price among the reporting countries, while in Norway the price is the highest, with the excise tax exceeding US$ 11 per pack. When recalculated in US dollars, 20 countries have seen the price of cigarettes remain stable or decline since the last reporting period in. This can be explained by changes in the currency exchange rate, but the decline was mainly observed in those countries which had no or a very small increase in tax rates. For many countries some correlation is observed between the increment of tax increase and price increase. In counties with low tax rates, even high increments of tax increase might have only a small impact on prices.. Impact of tobacco taxation policy on tobacco consumption As stated in Article 6 of the WHO FCTC, the Parties recognize that price and tax measures are an effective and important means of reducing tobacco consumption. Unfortunately, few countries provided information on tobacco product sales during past years to allow for an assessment of trends in consumption. Some other factors, besides tobacco taxation, have an impact on volumes of tobacco sales and usually some time lag is observed between a tax hike and a reduction in consumption. However, some countries that have recently undertaken a large tax increase have already experienced a reduction in sales: for example, in Iceland the 20% increase on tobacco tax in contributed to a reduction in cigarette sales of 10% in Other examples include Brazil (the average excise tax amount per pack increased by 117% in real terms between 2006 and 2013, and, as a result, domestic cigarette sales decreased by one third); Hungary (the average tax yield increased by one third between 2013, resulting in a reduction in sales of about 50% in 2013 compared with ); and Ukraine (a ninefold increase in the weighted average of cigarette excise tax between was accompanied by a drop in cigarette sales of 40% and by a threefold increase in tobacco excise revenues during the same period). Analysis of longer time periods is needed to explore the impact of tobacco taxation on tobacco sales and consumption; the effect of other tobacco-control policies being implemented in parallel should also be taken into account. Other measures concerning prices and taxation of tobacco products and the economics of tobacco Tax- and duty-free tobacco products Nearly half (57) of the Parties reported that they prohibit or restrict duty-free sales to international travellers and 59% (77) of the Parties prohibit or restrict imports by international travellers of taxand duty-free tobacco products, both reflecting notable increases as compared with, when Table 3.2. Minimum and maximum prices for a pack of 20 cigarettes in US dollars by WHO region in WHO region Minimum (country) Maximum (country) Ratio Number of countries African Americas South-East Asia European Eastern Mediterranean Western Pacific

30 GLOBAL PROGRESS REPORT 38 and 57 Parties, respectively, reported implementing such policies. Earmarking tobacco taxes for health Some Parties add a given percentage to the excise tax on tobacco products order to collect revenues for special purposes, including health, while others earmark a given share of collected tobacco taxes. Several Parties (Algeria, Austria, Bulgaria, Costa Rica, Iceland, Islamic Republic of Iran (Islamic Republic of), Jamaica, Lao People s Democratic Republic, Marshall Islands, Mongolia, Panama, Philippines, Republic of Korea and Thailand) provided information on earmarking in. Examples from those countries listed above include the following: in Bulgaria, in accordance with the Health Act, 1% of the State revenue from excise taxes on tobacco products and spirits is used to finance national programmes to restrict smoking and alcohol abuse; in Costa Rica, an act adopted in provides for the distribution of funds raised by tobacco excise, with 60% going towards diagnosis, treatment and prevention of tobacco-related diseases, and 20% going to the Ministry of Health to fulfil its functions as mandated by the act, while the remainder will be used for alcohol and drug control programmes and sports and recreational activities; in Jamaica, 5% of a special consumption tax and 20% of a consumption tax on tobacco are channelled into public education and treatment of noncommunicable diseases, including tobacco control, through the National Health Fund; in Lao People s Democratic Republic, the Tobacco Control Fund Decree, approved in May 2013, imposes the collection of a special tax of 200 Laotian Kip (approximately US$ 0.02) per pack of both local and imported cigarettes to be used for health-care and tobacco-control activities; and in the Philippines, in, the Sin Tax Law increased tobacco and alcohol taxes and established that 85% of the additional revenues will go to provide health cover for lowest-income segments of the population; the remaining amount will be used to finance health promotion programmes and expansion of the health infrastructure. 20

31 3. Implementation of the Convention by provision Protection from exposure to tobacco smoke (Article 8) Key observations Based on information received from the Parties in the reporting cycle, Article 8 has the highest average implementation rate (84%) by all substantive articles, up from 78% in. If, however, only complete smoking bans are taken into account, the average implementation rate is lower (61%), though still higher than in (53%) owing to the fact that a higher number of Parties have introduced a complete ban. Many Parties reported that they have introduced legislation requiring a complete ban on smoking in various public places since submission of their previous reports; one related notable trend is the extension of smoking bans to public outdoor areas and to the use of novel products such as electronic cigarettes. The hospitality sector remains one of the least-regulated for smoke-free policies; however, the increase in inclusion of bars and restaurants in smoke-free areas by more than 10 percentage points compared with shows the increasing attention that Parties are paying to smoke-free policies. Enforcement of smoke-free policies remains a challenge in many Parties; however, encouragingly, enforcement is seen as being vital in many Parties following the adoption of legislation in this area; others have reported putting in place new approaches to enforcement. Efforts to strengthen enforcement benefit from clear assignment of responsibilities to the relevant agencies, as well as strengthened cooperation between them. Article 8 addresses the adoption and implementation of effective measures to provide protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places. In 2008, the COP adopted guidelines for implementation of Article 8, 13 which include a five-year recommended timeline for Parties to achieve universal protection from exposure to second-hand tobacco smoke. Data on levels of exposure to tobacco smoke in Parties reports More than three quarters (101) of the Parties that reported in included data on exposure to tobacco smoke in their reports. The most often mentioned source of data are international data collection systems and tools. 14 The remaining Parties reported that data were collected through a combination of international data collection tools, independent national health surveys, and work undertaken with local/ international universities or through collaboration with national associations and societies. While many Parties provided high-quality information, there is a need to further improve data collection in this area. Furthermore, the most frequently reported single source of information for exposure data is the Global Youth Tobacco Survey, but this survey is limited to the narrow age group of 13 to 15 year olds. It would be useful for Parties to further strengthen collection of national data on exposure to tobacco smoke by, inter alia, integrating questions on exposure to tobacco smoke into their national data collection initiatives, including national surveillance systems or any household surveys that are repeatedly conducted. Overall implementation A total of 125 (96%) of the Parties reported that they implement measures to protect their citizens from exposure to tobacco smoke by applying a ban (either complete or partial) on tobacco smoking in indoor workplaces, public transport, indoor public places and, as appropriate, other public places. In the majority of cases (111) this is undertaken through national legislation, in other cases (65) by administrative and executive orders 15 or a combination of the two. Twenty-nine Parties still report using voluntary agreements to ensure protection from exposure to tobacco smoke. Three quarters (97) of the Parties also reported on further progress made in implementation of Article 8. The most common response (29 Parties) concerned adoption and entry into force of new legislation or the strengthening of previously existing smoke-free legislation. Several Parties explicitly mentioned that in developing the relevant legislation, the content of the Article 8 guidelines was taken 21

32 GLOBAL PROGRESS REPORT into account. Twelve other Parties reported that they have expanded the scope of their existing smoke-free rules, and 11 Parties indicated that they are currently developing new policies towards this end. At the same time, two Parties (Brazil and Gabon) indicated that although the relevant legislation had been adopted, the regulations were still to be developed to ensure enactment of the law. Among Parties amending their legislation, there is a notable trend towards extending the coverage of bans on tobacco smoking to partly covered or outdoor areas at national and subnational levels. Examples include Norway, where the use of all forms tobacco (smoking and smokeless) is now forbidden on school premises, both indoors and outdoors, and students are not allowed to use any form of tobacco products during school hours (see also Box 3.3). Several Parties also acted at subnational level. For example, in most of the states in Australia smoking is banned in private motor vehicles when minors are present, and in some cases in vehicles being used for business if anyone else is in the vehicle. Numerous municipalities in Canada have adopted bylaws or policies to prohibit smoking in public places such as patios, playgrounds and parks. In China, 12 cities have introduced local laws creating smoke-free environments, as well as putting in place mechanisms for their enforcement and imposition of penalties. Local authorities in New Zealand have continued to extend smoke-free areas within their jurisdictions. Smoke-free parks, playgrounds sports grounds, etc. are common. Recently some local councils have begun to extend smoke-free areas to include selected streets/areas of town and bus shelters. In Paraguay, new bylaws creating 100% smoke-free environments were developed, one of them enacted in the capital, Asunción. A new subnational-level policy was also reported by Germany. One of the setbacks mentioned in the previous global progress report, the exemption of small pubs from the smoking ban in the Netherlands in 2011, is currently being reversed. A complete ban is planned to be enforced from early As recommended in the Article 8 guidelines, an education campaign leading to the implementation of newly adopted legislation will increase the likelihood of smooth implementation and high levels of voluntary compliance. Fourteen Box 3.3. Further extending the scope of the smoking ban in Singapore The Smoking (Prohibition in Certain Places) Act seeks to provide a clean, safe and healthy environment for the public and to safeguard them from the harmful effects of second-hand smoke. Smoking prohibitions in Singapore were first introduced in 1970 and have been progressively extended to cover virtually all indoor places and areas where the public congregates. The smoking prohibition was last extended on 15 January 2013 to include common areas of any residential premises or building (e.g. corridors, void decks and staircases); any covered or underground pedestrian walkway, whether permanent or temporary; any pedestrian bridge; any bus stop or bus shelter, including any area within a radius of five metres from the outer edge of the shelter; and hospital compounds. The long-term policy goal of Singapore is to prohibit smoking in all public places. Parties reported that they have undertaken such campaigns. Settings covered by various degrees of bans on tobacco smoking Parties that reported taking measures to protect their citizens from exposure to tobacco smoke were required to indicate the types of public places to which their bans apply, and whether their bans are complete or partial. The reporting instrument covers 16 settings, including indoor workplaces, public transport facilities and indoor public places. The comprehensiveness of the applied regulations in various settings was compared across the and reporting cycles. The findings of this comparison are presented in Fig Fig reveals that apart from aeroplanes and ground public transport, health-care facilities, educational facilities (universities excluded), government buildings and universities are the settings most frequently covered by a complete ban on tobacco smoking, while private workplaces, pubs and bars and especially private vehicles are the least covered. At the same time it is encouraging to observe higher implementation rates of smoke-free policies in all settings, compared with the findings of. Mechanisms/infrastructure for enforcement Over three quarters (104) of the Parties reported that they have put in place a mechanism/ 22

33 3. Implementation of the Convention by provision Feel free! Every day we have more smoke-free places. Photo courtesy of Ministry of Health, Ecuador. infrastructure for the enforcement of measures to protect their populations from exposure to tobacco smoke, a significant increase compared with. Most Parties provided details, to various extents, of these infrastructures. Some Parties also reported challenges relating to monitoring of implementation and enforcement, including the application of administrative penalties. In relation to enforcement infrastructure, observations concerning variations in the organization and operation of such systems made in the global progress report remain valid. The extension of smoking bans to outdoor areas and private vehicles has required new approaches to monitoring compliance. In general, there is a shared responsibility between various actors, most often local government, health, food and work safety authorities, and the police, to enforce smoke-free regulations in both indoor and outdoor areas. For example, Australia reported that at subnational level council inspectors are empowered to enforce the smoking bans on patrolled beaches and at outdoor children s playgrounds, skate parks, public swimming pool complexes and sporting venues during underage sporting events, while the police enforce the ban on smoking in cars with minors. The Republic of Korea reported providing legal grounds, through the amended National Health Promotion Act, to mayors or governors to appoint so-called smoking-surveillance officers to monitor compliance with smoke-free regulations. These measures are scheduled to enter into force in July. The United Kingdom reported that across the country, smoke-free legislation is enforced by local authorities. The Chartered Institute of Environmental Health has developed guidance for enforcement officers in England. 16 In line with the recommendations of the guidelines on Article 8, to ensure compliance with the law, enforcement programmes should include a telephone complaint hotline or similar system to encourage the public to report violations. Such systems have been reported to be in place by several Parties, including Colombia, Ecuador, Hungary, Iceland and Venezuela (Bolivarian Republic of). Turkey reported that the use of mobile Global Positioning System devices by inspection teams has helped with the timely notification of violations and has increased the overall efficiency of its smoke-free inspection system. Challenges concerning implementation and enforcement of smoking bans are still reported by several Parties. In Austria, which strengthened 23

34 GLOBAL PROGRESS REPORT Fig Percentage of Parties applying various degrees of bans on tobacco smoking in and, by setting Aeroplanes Ground public transport Health-care facilities Educational facilities Government buildings Cultural facilities Universities Motor vehicles used for work Shopping malls Trains Ferries Restaurants Nightclubs Private workplaces Pubs and bars Private vehicles (%) Complete Partial None No answer/not applicable 24

35 3. Implementation of the Convention by provision the enforcement of smoke-free measures, including by increasing fines, an authentic interpretation issued by the Parliament concerning the Austrian National Tobacco Act entered into force in February, stating that it is reasonable for guests of hospitality venues to pass through smoking rooms/areas in order to enter non-smoking rooms/areas or restrooms. Islamic Republic of Iran (Islamic Republic of) reported that due to the lack of administrative infrastructure needed to deal with individual offences concerning smokefree bylaws, the responsibility for implementing the smoking ban in public places and other places mentioned in the law rests with managers or employers of these places, which may hamper effective action in cases of non-compliance. 25

36 GLOBAL PROGRESS REPORT Regulation of the contents of tobacco products (Article 9) and regulation of the tobacco product disclosures (Article 10) Key observations The average implementation rates of Articles 9 and 10 have increased slightly compared with the previous reporting period (from 45% to 48% and from 51% to 58%, respectively) and these articles still fall in the middle range of implementation of substantive articles of the Convention. Almost half of the Parties still lack legislation or other regulatory measures requiring the testing and measuring of the contents and emissions of tobacco products and the disclosure of such information to the public. Several Parties that have already developed relevant regulations reported on the shortage of independent (not run or influenced by the tobacco industry) testing facilities or laboratories and/or lack of access to such testing facilities; Parties also referred to recent legal challenges filed by the tobacco industry in this area. Reports also indicated that new, advanced measures, such as banning additives in tobacco products and introducing reduced ignition propensity standards, have been introduced. Article 9 refers to the need for Parties to test, measure and regulate the contents of tobacco products, and Article 10 refers to the regulation of tobacco product disclosures. The purpose of testing and disclosing product information is to give regulators sufficient information to take action and to inform the public about the harmful effects of tobacco use. The COP adopted partial guidelines for implementation of Articles 9 and 10 in 2010, which were further amended in, and which will again be reviewed by the COP at its sixth session. Regulating contents and emissions of tobacco products While progress has been made by the Parties in implementation of requirements under Article 9, only slightly over half of the Parties reported that they regulate the contents and the emissions of tobacco products (70 and 66 Parties, respectively). Fig. 3.4 illustrates the status of implementation of Articles 9 and 10, compared with the implementation rates observed in the previous reporting cycle. Several Parties reported developments in these areas, including new or updated laws. South Africa and the Republic of Korea reported having established new standards for reduced ignition propensity cigarettes. Malaysia and Singapore reported having enacted laws to provide for a lowering of the permissible standard emissions of cigarettes. Brazil reported banning additives in tobacco products, a measure which, however, has been suspended pending the outcome of a legal challenge brought by the tobacco industry against this measure. The revised Tobacco Products Directive of the European Union represents a significant policy development, including, inter alia, for the implementation of Articles 9 and 10 through a ban on products with characterizing flavours, prohibition of certain additives (vitamins, caffeine, etc.), strengthened reporting obligations for all ingredients, and enhanced reporting obligations for additives on a priority list. Twelve Parties that are Member States of the European Union provided additional information regarding their compliance with the previous European Union requirements, or indicated their intention to update their regulations to bring them into compliance with the Directive. 17 While Canada revised its legislation to remove quantitative statements about tobacco constituents and emissions from the outside packaging and labelling of tobacco products as recommended in the guidelines for implementation of Article 11 some other Parties, such as Benin, Bhutan, Myanmar, Kazakhstan and Tonga, reported that quantitative statements are required under their national legislation. Two Parties (Kenya and Maldives) reported that tobacco industry interference had affected progress in implementation of new regulations. In addition to Brazil, the Philippines also reported that the tobacco industry had filed a legal challenge in relation to legislation covering Articles 9 and 10. Testing and measuring of the contents and emissions of tobacco products Fewer than half of the Parties reported that they require testing of contents and measurement of emissions of tobacco products (54 and 60 Parties, respectively). 26

37 3. Implementation of the Convention by provision Fig Percentage of Parties implementing provisions under Articles 9 and 10 in and 100 (%) Contents Emissions Contents Emissions Disclosure of contents Disclosure of emissions Disclosure of contents Disclosure of emissions Testing Regulating To the government To the public Yes No/no answer Lack of testing capacity was reported by Colombia, Ecuador, Islamic Republic of Iran (Islamic Republic of), Montenegro, Myanmar, Panama and Suriname. In addition, Georgia reported that no laboratory facility under the control of the Government is available, while Pakistan reported that it is considering the establishment of an internationally accredited laboratory. When providing additional details, Sierra Leone reported that it has the capacity to test tobacco products but no legal requirement or policy is yet in place that would require such testing. Bahrain reported that it requires tobacco companies to provide an annual report containing information on tobacco product contents from a certified laboratory. Jamaica, Panama, and Tonga indicated that they conduct such tests and measurements overseas. Disclosure to governmental authorities and the public Approximately two thirds (86) of the Parties require manufacturers or importers of tobacco products to disclose information on the contents and emissions of tobacco products to governmental authorities, and slightly more than half of the Parties require such disclosures to be made available to the public (see Fig. 3.4). Passing or developing laws requiring the disclosure of information about contents and emissions remained the most commonly mentioned area of progress under Article 10, as was Box 3.4. Bulgaria, Republic of Korea and South Africa implement legislation on fire safer cigarettes Canada became the first country to implement a nationwide cigarette fire safety standard in Since then, several countries have followed suit. Since 17 November 2011, only cigarettes with reduced ignition propensity have been legally sold in Bulgaria. All cigarettes on the market must conform to the standard EN :2010. The standard was developed under a mandate from the European Commission and the European Free Trade Association and supports essential requirements for the general safety of products in accordance with Directive 2001/95/EC. Compliance with the standard is mandatory for manufacturers and for retailers; the conformity assessment of cigarettes needs to be proved with a document certifying the results of laboratory tests. On 16 May 2011, South Africa amended its Tobacco Products Control Act whereby, starting from November 2013, all cigarettes sold in the country have to comply with reduced ignition propensity standards. The Republic of Korea introduced similar legislation on 21 January through two provisions of its Tobacco Business Act. Articles 11(5) and 11(6) of the Act stipulate that only reduced ignition propensity cigarettes can be manufactured in or imported into the country, and that these cigarettes must obtain certification of fire prevention performance standards. The measure entered into force on 22 July

38 GLOBAL PROGRESS REPORT also the case in the previous reporting cycle. Fiji, Jamaica, Solomon Islands and Suriname indicated that they have relevant new legislation in place. Other Parties noted that new or updated laws are under development or consideration, including Australia, Bahamas, Colombia, Georgia, Maldives, 18 Panama, Papua New Guinea, Republic of the Republic of Moldova, Senegal, Thailand, Turkmenistan and Yemen. the Netherlands reported the launch of a comprehensive web site by the National Institute for Public Health and the Environment with a databank of information on tobacco products and ingredients, including fact sheets created in the framework of the European Union project, Public Information on Tobacco Control (PITOC). 19 Tobacco product disclosures are regulated by Government decision. 28

39 3. Implementation of the Convention by provision Packaging and labelling of tobacco products (Article 11) Key observations Parties reported making good progress in revising their national legislation to comply with the requirements of Article 11 and the associated implementation guidelines. Based on the reports received in the reporting cycle, the average of the implementation rates for Article 11 provisions is 70%, placing this article among those with the highest implementation rates. However, it should be noted that most provisions under this article have a three-year deadline, which has already passed for the majority of the Parties. While almost 90% of the Parties (up from 84% in ) require health warnings on tobacco product packages, only half of the Parties require pictorial warnings, and even fewer mandate that the health warnings must occupy 50% or more of the principal display areas. Several Parties have, however, introduced very large pictorial health warnings, occupying, on average, 60% or more of principal package areas. One notable breakthrough was the adoption by Australia of the first ever legislation requiring plain packaging for tobacco products. Some reports indicate that there is improved exchange of information among the Parties in this area, especially in the sharing of pictorial warnings and the granting of licences for the use of such warnings to other Parties. Interference by the tobacco industry remains intense in the area of health warnings and aims both at weakening legislation and delaying its application. As an important development of recent years, some Parties won legal cases filed against them by the industry. Strengthened international exchange and cooperation will be important to meet the challenges posed by the tobacco industry in this area. Article 11 stipulates that each Party shall adopt and implement effective measures concerning packaging and labelling, some of them within three years of the entry into force of the Convention for that Party. The COP at its third session adopted guidelines for the implementation of this article to assist Parties in addressing these requirements of the treaty. Health warnings Implementation rates of measures under Article 11 concerning health warnings to which the three-year deadline applies are presented in Fig. 3.5, including the progress Fig Requirements Percentage of Parties implementing the time-bound provisions under Article 11 in the past two reporting cycles Health warnings exist Clear, visible and legible Approved by authority Misleading descriptors banned Warnings rotated No less than 30% Pictures/pictograms required 50% or more of principal dislay area (%) Yes No/no answer

40 GLOBAL PROGRESS REPORT Photo courtesy of Ministry of Health, Madagascar. made in their implementation across the past two reporting cycles. The reports show that close to 90% of Parties require health warnings. For most requirements characterizing such warnings, e.g. their size, requirement for rotation, and prohibition of misleading messages, there is an increase of a few percentage points in implementation rates; this is also reflected in the increasing number of Parties reporting that they have addressed and strengthened their packaging and labelling regulations through national legislation or other regulatory measures to put the adopted legislation into effect. Notably, the percentage of Parties requiring that health warnings cover 50% or more of the principal display area had increased to slightly more than 40%, compared with approximately one third in. More than 70 Parties provided additional information on progress made in implementing Article 11, most of them reporting notable progress. Use of pictorials Half of the reporting Parties indicated that they require pictorial health warnings on tobacco product packaging. Twenty-two of them reported that they have recently adopted legislation to introduce pictorial health warnings or to enforce the previously adopted legislation on this matter. In a notable development, several Parties, such as the European Union, Fiji, Mauritius, Nepal, Sri Lanka, Thailand and Uruguay, legislated for or introduced very large pictorial warnings, covering more than 60% of principal display areas. The introduction of a new round of pictorial warnings was reported by a few Parties, such as Brunei Darussalam, Ecuador and Panama. An additional seven Parties reported that they are in the process of developing legislation to implement Article 11. Introduction of pictorial health warnings remained particularly low in Africa. The Convention Secretariat facilitated a South South cooperation project to promote the filling of this gap, which resulted in a library of images to be made available for use in the region by mid- (see also Box 3.6). Plain packaging Australia s legislation already reported in the global progress report has now entered into force, and all tobacco products manufactured in Australia for domestic consumption were required to be sold in plain packs, effective 1 October, and the same requirement is applied to all tobacco products, effective 1 December. The legislation prohibits tobacco industry logos, brand imagery, colours and promotional text other than brand and product names in a standard colour, position, font style and size on retail packaging. Following Australia s example, Ireland and New Zealand have started the legislation process to introduce plain/standardized packaging, and the United Kingdom is considering the introduction of such a requirement. Other measures under this article are the following: Constituents and emissions The core questionnaire was reviewed with regard to this subject, and Parties are now required to report on whether each unit packet or package of tobacco product contains information on constituents and emissions. Through this change a significant 30

41 3. Implementation of the Convention by provision difference became evident between the number of Parties requiring such information: while 80% of the Parties reported requiring information concerning emissions on the packages, only half of the reporting Parties require the same in case of the constituents. Language of warnings and attractive package design features More than two thirds of the Parties (105) reported requiring that the warnings and other textual information on tobacco packaging appear in the principal language(s) of the country and 90 Parties reported that they prohibit tobacco product packaging from carrying advertising or promotion, including design features that make such products attractive, in line with the recommendation of the guidelines for implementation of Article 13. Parties also shared some other details and developments in relation to implementation of Article 11. Challenges Some Parties reported facing legal challenges, difficulties in coordinating with sectors of government responsible for trade and commerce, or interference from the tobacco industry in blocking or delaying the implementation of pictorial health warnings. In March 2013, Thailand adopted new regulations to increase the size of pictorial health warnings to cover 85% of both sides of cigarette packages, but the measures were challenged by the tobacco industry and implementation has been delayed. Earlier, both Nepal and Sri Lanka faced legal challenges, but they both won the legal cases, enabling them to implement pictorial health warnings; a legal challenge by the tobacco industry continues in Uruguay. New research Several Parties shared data from recent research conducted in this area. For example, research conducted by Health Canada has shown that the numerical values displayed on packs were not clearly understood by some smokers and most had little idea what the range of numbers displayed for each chemical meant. Panama also shared findings of two surveys it conducted related to pictorial warnings: the 2013 Global Adult Tobacco Survey found that 77% of adults aged 15 years and above noticed the health warnings and that four out of 10 smokers considered quitting because of them. Regional cooperation Finally, some Parties also reported on regional efforts to facilitate implementation of Article 11 and the guidelines for its implementation. The Caribbean Community Box 3.5. The who fctc health warnings database A web-based WHO FCTC Health Warnings Database designed to facilitate the sharing of pictorial health warnings and messages among the Parties was developed in line with decision FCTC/COP3(10). So far, 20 Parties Australia, Brazil, Brunei Darussalam, Canada, China, Djibouti, Egypt, European Union, India, Islamic Republic of Iran (Islamic Republic of), Jordan, Latvia, Malaysia, Mauritius, Pakistan, Singapore, Thailand, Turkey, Uruguay and Venezuela (Bolivarian Republic of) have made their pictorial warnings available through the Database. The Convention Secretariat has promoted the use of the database among the Parties. The database is maintained by WHO and is available at healthwarningsdatabase/ The Convention Secretariat facilitates, upon request, the granting of licences to Parties, where a licence is required for the use of pictorial health warnings and messages. The Secretariat has facilitated the granting of licences to use pictorial health warnings to 22 Parties since Australia, Brazil, Brunei Darussalam, Canada, European Union, Mauritius, Peru, Thailand, and Venezuela (Bolivarian Republic of) have kindly granted licence permissions to other Parties. Box 3.6. Nepal implements 75% graphic health warnings On 4 November 2011, the Nepalese Government passed the Directive on Pictorial Health Warnings, making it obligatory for tobacco manufacturers to include graphic warnings about the adverse effects of smoking to packaging of all tobacco products, including smokeless tobacco products. The warnings are required to cover at least 75% of the total pack area. This directive is part of a suite of strong measures included in the Tobacco Control and Regulatory Act 2011, which aims to curb the poverty, disease and untimely deaths caused by tobacco use. The law was contested by a group of tobacco companies, which argued among other things that it was far more stringent than rules in neighbouring countries. The Nepalese Supreme Court on 29 December 2013 quashed the appeal and ruled in favour of complete implementation of the Directive with immediate effect. 31

42 GLOBAL PROGRESS REPORT adopted a Regional Standard on Packaging and Labelling of Tobacco Products in 2013 (see more details in the section on Article 22). The Russian Federation reported that it is working on technical regulations of the Eurasian Economic Union of Belarus, Kazakhstan and the Russian Federation to increase the size of pictorial health warnings. Madagascar reported that it held an international workshop to share experiences and promote implementation of Article 11 and its guidelines in francophone countries in Africa. 32

43 3. Implementation of the Convention by provision Education, communication, training and public awareness (Article 12) Key observations Based on the reports received in the reporting cycle, the average of the implementation rates of Article 12 provisions is 70%, one of the highest implementation rates of all substantive articles, but this is a minimal increase in comparison with the findings of the global progress report. The messages of communication programmes still strongly focus on the health risks of tobacco use and benefits of cessation, while economic and environmental consequences of tobacco use and especially tobacco production receive less coverage. The trends concerning the targeting of different segments of society with communication programmes have also remained unchanged since, and the messages of communication programmes continue to unevenly target and reach specific groups. Only slightly more than half of the Parties aim their awareness and sensitization programmes at decision-makers, administrators and the media. Targeting of different ethnic groups is particularly underused. It is notable that several Parties indicated that they have recently adopted or developed a comprehensive national tobacco control communication plan, some of them for the first time. Parties also stressed the importance of coordination among different sectors of government and relevant agencies and organizations within the country and of international cooperation in this matter. awareness programmes since submission of their previous report. Nine Parties reported that they either had a comprehensive national tobacco control communication plan in place or were in the process of developing one. Seven Parties reported that they had used social media as a novel platform to conduct communication campaigns and raise awareness. Target groups and messages of educational and public awareness programmes All Parties that reported having such educational and public awareness programmes indicated that they target children, and almost all of them also target young people or the general public. Other groups were targeted less often (see Fig. 3.6). In addition to the groups targeted with educational programmes set out in the reporting instrument, the following other groups were referred to by the Parties in their reports: health professionals; customs, immigration, police and port health officers; hospitality industry employees; officials of health ministries; parents; people living with disabilities, mental illnesses or living in disadvantaged areas; unemployed people; prisoners; law enforcement personnel; hospitality industry staff; and tourists. For example, in Australia the National Tobacco Campaign More Targeted Approach provides activities and tailored information for Australians, including selected culturally and linguistically diverse groups, pregnant women, prisoners, people with mental illness, and socially Fig Percentage of Parties that reported targeting specific groups in educational and public awareness programmes Children 100 Article 12 concerns raising public awareness of tobacco control issues through all available communication tools, such as media campaigns, educational programmes and training. The COP at its fourth session adopted guidelines for the implementation of this article. Implementation of educational and public awareness programmes A total of 125 Parties have implemented educational and public Adults or the general public Women Men Pregnant women Ethnic groups (%) Yes No

44 GLOBAL PROGRESS REPORT Poster from the "Sponge" campaign in Senegal. Photo courtesy of Ministry of Health and Social Action. disadvantaged groups. In Senegal, the first ever anti-tobacco media campaign was launched in April The campaign, called Sponge, developed by the Ministry of Health and Social Action and World Lung Foundation, graphically depicted the tar that collects inside an average smoker s lungs and was aired on television and radio, at outdoor venues and through telephone messaging systems. Almost two thirds of the Parties (82) reported that the development, management and implementation of communication, education, training and public awareness programmes are guided by research and that they undergo pretesting, monitoring and evaluation, as suggested in the Article 12 guidelines. Other Parties reported that while some research had been conducted, the education and communication materials were not usually pretested and the results of the campaigns were not evaluated. One of the areas that needs to be covered by research before the launching of communication programmes is the analysis of key differences between targeted population groups, in line with the implementation guidelines. Most Parties consider age and gender in their programmes (94% and 75% of Parties, respectively), but fewer take into account educational, cultural background and socioeconomic status (63%, 45% and 42% of Parties, respectively). In addition, Parties reported on the areas covered by their educational and public awareness programmes, including messages used 20 (see Fig. 3.7). More than 90% of the reporting Parties cover the health risks of tobacco use and exposure to tobacco smoke, and the benefits of cessation. Fewer than half of the Parties use messages on the economic and environmental consequences of tobacco production; a much larger proportion reported that they address the economic and environmental consequences of tobacco use. With respect to the content of their messages, developed country Parties with low tobacco prevalence tend to focus more frequently on quitting and on messages aimed at increasing quit attempts than other Parties. Targeted training or sensitization programmes The most frequently targeted groups are presented in Fig In addition to the categories 34

45 (%) 3. Implementation of the Convention by provision set out in the reporting instrument, 13 Parties also reported targeting other, less frequently targeted groups, such as religious, social, community and youth leaders; legal professionals (lawyers and magistrates); police and local authorities; women s organizations; universities; Fig Health risks of exposure to tobacco smoke Economic consequences of tobacco use Environmental consequences of tobacco use Economic consequences of tobacco production Environmental consequences of tobacco production Areas covered in Parties educational and public awareness programmes Health risks of tobacco use Benefits of cessation of use (%) Yes 65 No representatives of the hospitality sector; and high-risk populations. In terms of education, most of the Parties reported that they had conducted some sort of education activities. Twelve Parties reported that they included topics related to tobacco control in school or university curricula. The school-based approach remains popular; 23 Parties reported organizing school-based programmes in the area of tobacco prevention. Awareness and participation of agencies and organizations According to the Parties reports, it is mostly public agencies and NGOs that participate in and run communication programmes (reported by 92% and 88% of the Parties, respectively). Slightly over half of the Parties (74) reported on the participation of private organizations. Twenty Parties also reported on the participation of other organizations in communication campaigns, such as: religious and faith-based organizations; academic, higher education institutions and hospitals; community and scientific groups, and professional colleges; municipalities; the media; and international organizations, including WHO. In their progress notes, eight Parties mentioned that coordination among different sectors of government and relevant agencies and organizations played an instrumental role in promoting educational and public awareness programmes. For example, the Ministry of Health in the Fig Percentage of Parties indicating specific targets of their training and sensitization programmes in and Health workers Educators Decision-makers Community workers Media professionals Administrators Social workers Yes No/no answer 35

46 GLOBAL PROGRESS REPORT Sticker used in the anti-tobacco media campaign. Photo courtesy of Prevention Unit Ministry of Health, Palau. Marshall Islands works closely with other ministries and agencies and television and radio channels which have been providing free air time for the broadcasting of educational tobacco control messages at the request of the Ministry. In terms of government funding for implementation of education and public awareness programmes, 12 Parties reported that the government provided financial support or allocated a budget to the conduct of relevant activities. However, a few Parties reported that lack of sustainable funding from the government for implementation of Article 12 and its guidelines is the major obstacle to conducting routine and regular activities. Parties also reported, with respect to Article 22(c) of the Convention, on cooperation and provision of mutual support for training or sensitization programmes for appropriate personnel, in accordance with Article 12. Less than one fifth (22) of the Parties reported having provided and fewer than half (55) of the Parties having received assistance from other Parties or donors for such programmes. Some Parties mentioned the importance of receiving further support and assistance from international organizations in implementing Article 12 and following the guidelines for its implementation. 36

47 3. Implementation of the Convention by provision Tobacco advertising, promotion and sponsorship (Article 13) Key observations Based on the reports received in the reporting cycle, the average of the implementation rates for Article 13 provisions is 63%, 21 up from the 59% of. Of the reporting Parties, 70% consider their advertising, promotion and sponsorship bans to be comprehensive, up from 66% in. However, a significant percentage of the Parties are still to comply with this timebound requirement of the Convention. The findings indicate that Parties devote more attention to strengthening their laws and regulations concerning tobacco advertising, promotion and sponsorship, with special regard to indirect tobacco advertising. One quarter of the Parties still only apply restrictions rather than a comprehensive ban, and only restrict some direct forms of tobacco advertising, promotion and sponsorship. As regards advertising media, the most significant improvements are observed in the areas of product placement, depiction of tobacco in the media and cross-border advertising entering a country s territory; the highest rate of increase in the percentage of Parties reporting inclusion in their bans of a selected provision concerns advertising on the domestic Internet. Despite some improvements in comparison with the previous reporting period, implementation of bans on cross-border advertising, promotion and sponsorship, particularly with regard to advertising originating from their own territory, remains a challenge for a substantial number of Parties. References were also made to difficulties in enforcement of advertising bans in some settings, especially at points of sale. Several Parties mentioned the importance of strengthening international cooperation and information exchange in this area. Recent reports show that an increasing number of Parties are legislating for and implementing bans on displays of tobacco products at points of sale, thus eliminating the last form of point-of-sale advertising. Article 13 refers to the banning of tobacco advertising, promotion, and sponsorship. To be effective, the ban should cover all types of advertising, promotion and sponsorship conducted by the tobacco industry. Effective monitoring, enforcement and sanctions supported by strong public education and community awareness-raising programmes facilitate implementation of such a ban. The guidelines adopted by the COP at its third session assist Parties in implementing this important provision of the Convention. Comprehensive ban on advertising, promotion and sponsorship (time-bound provision) Over two thirds (91) of the Parties reported that they had introduced a comprehensive ban, while 39 Parties reported that they had not; 59 of the Parties with a ban in place include cross-border advertising, promotion and sponsorship originating from their territory in the ban. Six Parties (Canada, Japan, Lao People s Democratic Republic, Marshall Islands, Poland and Uzbekistan) that reported not having introduced a comprehensive ban explained that they are precluded from doing so by their constitutions or constitutional principles. Parties definitions of a comprehensive ban on advertising, promotion and sponsorship vary and do not always cover all of the specific measures called for by the guidelines for implementation of Article 13. It is therefore more appropriate to analyse the media covered under each Party s ban to assess the progress made under this article. For example, 90% of Parties that consider their ban to be comprehensive actually cover tobacco sponsorship of international events or activities and/ or participants therein, while fewer than half of them ban displays of tobacco products at points of sale. In spite of these limitations, Fig. 3.9 indicates that progress has been made in almost all media as far as the percentage of Parties requiring the respective measures are concerned. Six Parties reported including advertising bans in their comprehensive tobacco control legislation (Ecuador, Pakistan, Republic of the Republic of Moldova, Russian Federation, Turkmenistan and Ukraine). Georgia and Venezuela (Bolivarian Republic of) reported that they are preparing for the introduction of a complete ban on tobacco advertising, promotion and sponsorship. Among the Parties recently strengthening their regulations concerning tobacco advertising, Chile, Suriname, Togo and Ukraine reported that they 37

48 (%) GLOBAL PROGRESS REPORT Fig.3.9. Percentage of Parties reporting inclusion of selected provisions in their ban on tobacco advertising, promotion and sponsorship in and Tobacco sponsorship Product placement Depiction in media Domestic Internet Cross-border entering territory Brand stretching Cross-border originating from territory Corporate social responsibility Display at points of sale Global Internet Yes No/no answer have used the guidelines for implementation of Article 13 during the process. Concerning selected advertising media, the most significant changes are observed (all increasing by 6 percentage points from rates) in the areas of product placement, depiction of tobacco in the media and cross-border advertising entering a country s territory; the highest rate of increase can be seen in the case of the domestic Internet (9 percentage point increase). Extending the bans to new media Parties with existing advertising and promotion bans reported that they have extended such bans to media which had not been covered previously, including the Internet (Australia and Chile) and other electronic media, such as mobile phones (Australia), and television (Senegal). Chile, Colombia and Malaysia now also ban indirect advertising. In Norway, tobacco surrogates and tobacco product imitations, such as electronic cigarettes, are now also covered by the ban on tobacco advertising. Croatia, Finland, Norway and Palau have reported that they prohibit the display of tobacco products in retail sale facilities, thus addressing one of the last remaining means of advertising and promotion (see box on the case of Palau). In a related move, Hungary has prohibited the display of images relating to tobacco products or smoking on the outer walls of tobacco stores, and South Africa has improved its regulations to restrict displays at points of sale (see also Box 3.7). To eliminate the last forms of advertising, promotion and sponsorship, Australia has required plain packaging of tobacco products since 1 December ; some other Parties are considering similar measures. More details are provided in the section on Article 11. Two Parties reported that they have conducted research with regard to tobacco advertising, promotion and sponsorship. The Dutch Government commissioned a study on the effects of reducing the number of points of sale and introducing a ban on the display of tobacco products at points of sale. Sweden commissioned a study on the marketing of tobacco products and alcohol particularly in digital media, and proposals for measures for more effective surveillance are expected as a result of the observations contained in this study. Regarding enforcement, Parties reported on some advances that they have made: Colombia reported the full enforcement of its existing ban and Jordan reported increasing fines. Some Parties also reported facing challenges in the implementation of Article 13. Parties mentioned most frequently that advertising still occurred at points of sale, that there were attempts to circumvent existing bans on tobacco advertising, promotion and sponsorship, including through distribution and use of promotional 38

49 3. Implementation of the Convention by provision Box 3.7. Strengthening the ban on tobacco advertising, promotion and sponsorship in Palau Significant progress has been made in Palau since February, when the country s tobacco act entered into force. A notable achievement has been the ban on point-of-sale advertising. The law states that no person shall advertise or otherwise promote any tobacco brand, manufacturer or seller by any means, directly or indirectly that is intended to have or is likely to have the direct or indirect effect of promoting the purchase or use of tobacco or a tobacco brand, or of promoting a tobacco manufacturer or seller. Advertisements and promotions include words, messages, mottos, slogans, letters, numbers, pictures, images, graphics, sounds or any other auditory, visual, or sensory matter, in whole or part that are commonly identified or associated with a tobacco brand, manufacturer or seller. The prohibition includes a total ban on any display and on the visibility of tobacco products at points of sale. Brand stretching, tobacco sponsorship, sweepstakes, contests, and rebates are also prohibited. Cigarettes cannot be sold as single sticks and it is illegal to manufacture or distribute any product designed for or likely to appeal to children that evokes an association with a tobacco product, including but not limited to, candy or gum cigarettes or other sweets or snacks in the form of tobacco products. materials like signage, boards, ashtrays (Maldives) or at music events for young people (Portugal). tobacco advertising be accompanied by health warnings. Cross-border advertising, promotion and sponsorship As was also the case in the reporting period, among the problematic areas reported by Parties in the implementation of Article 13, the provisions relating to cross-border advertising, promotion and sponsorship were frequently mentioned. Despite some improvement since, this particular aspect of Article 13 generally remains underimplemented, as only close to two thirds of Parties that have reported having a comprehensive ban in place reported that they also include cross-border advertising originating from their territory in their bans. Restrictions on all tobacco advertising, promotion and sponsorship Parties that do not apply a comprehensive ban pursuant to the requirements of Article 13 are expected to report on those restrictions that are applied. The majority of the 39 Parties without a comprehensive ban in place restrict advertising on radio, television and in print media, and approximately half restrict tobacco sponsorship of international events and the use of direct and indirect incentives for tobacco purchases, or require that all remaining Photo courtesy of the Norwegian Directorate of Health. 39

50 GLOBAL PROGRESS REPORT Measures concerning tobacco dependence and cessation (Article 14) Key observations Based on the reports received in the reporting cycle, the average of the implementation rates of indicators under this article is 51%, slightly up from (45%) and in the middle range of implementation when compared with all substantive articles of the Convention. There is a growing body of experience among the Parties on effective measures to promote tobacco cessation, including development of national cessation guidelines, and integration of tobacco cessation into national programmes and strategies and even into national tobacco legislation. Fifteen Parties reported establishing their first cessation clinics. More than half of the Parties reported integrating treatment of tobacco dependence into their primary health-care systems, but only half of those Parties also reported that these programmes are covered by public funding or reimbursement schemes; in addition, many Parties still report limited availability of pharmaceutical products used for the treatment of tobacco dependence. The inclusion of tobacco dependence treatment in the curricula of health professional training is still largely underused, with no more than half of the Parties reporting that they have done so. Some Parties reported recently introducing new and innovative approaches to promote tobacco cessation, including through cell phone text messaging and Internet-based behavioural support. Article 14 concerns the provision of support for reducing tobacco dependence and cessation, including counselling, psychological support, nicotine replacement, and education programmes for youth. Parties are encouraged to establish sustainable infrastructure for such services. At its fourth session the COP adopted guidelines for implementation of this article. Programmes to promote tobacco cessation Local events, such as those held on World No Tobacco Day (WNTD), are considered by 115 Parties to be the most attractive opportunities to convey messages concerning cessation of tobacco use. Other options are also presented in Fig Most improvements concern the programmes using media campaigns, which 75% of Parties reported to be in place (compared with fewer than half of the Parties in ), with positive changes, although at much smaller scale, observed in other areas such as the use of quitlines and programmes for women and girls. Specific programmes were reported by several countries. For example, the Czech Pharmacists Chamber launched a programme called Smoking Cessation in Pharmacies to utilize the inherent opportunities provided by this sector. A focus on youth and school-based tobacco cessation was reported by Singapore and Suriname. Workplace-based programmes for health professionals were reported by Malta, while Singapore reported on specific programmes for uniformed services and Canada reported on new guidance on cessation at the workplace. Australia reported on a new programme to reach out to indigenous communities. In, Norway launched a national plan for systematic and evidence-based services for tobacco cessation. Healthy living centres were established in all regions, and cessation counsellors were trained to provide individual or group counselling. Settings Parties also reported on settings used to promote programmes/messages on cessation of tobacco use. Three quarters (98) of the Parties reported designing and implementing cessation programmes in health-care institutions, indicating the widespread recognition of the opportunities inherent in these settings. Around half of the Parties also reported implementing cessation programmes in educational institutions and workplaces (68 and 66 Parties, respectively) and one third (44) of the Parties include sporting environments in the list of venues used for promoting such programmes. Other settings referred to by the Parties include: the military; government institutions; civil society organizations; prisons; cultural centres; and religious and workplace settings. 40

51 % 3. Implementation of the Convention by provision Fig Percentage of Parties reporting a specific programme to promote cessation of tobacco use in and Local events, e.g. WNTD Media campaigns Programmes for pregnant women Telephone quitlines Programmes for women Programmes for underage girls Yes No/no answer National guidelines Twelve Parties reported having developed (or updated) their integrated national cessation guidelines based on scientific evidence and best practices, and eight Parties indicated they are in the process of doing so. Bahamas and Sierra Leone reported that they have included provisions in draft legislation for the implementation of Article 14, and four other Parties (Colombia, Fiji, Lithuania and Republic of the Republic of Moldova) reported that they include tobacco cessation in their health or cancer control programmes. Inclusion in national programmes, plans and strategies Almost three quarters (95) of the Parties reported including tobacco dependence diagnosis and treatment and counselling services in their national tobacco-control strategies, plans and programmes. Fifty-six Parties reported that they include these items in educational programmes, plans and strategies. Fig Primary health care Specialist health care Secondary and tertiary health care Cessation counselling treatment centres Percentage of Parties reporting integration of cessation services into various levels of their health-care systems in and Integration of cessation into health-care systems Regarding the integration of diagnosis and treatment of tobacco dependence into healthcare systems, almost three quarters (95) of the Parties reported doing so, and more than half of these Parties reported having established specialized centres for cessation counselling and dependence treatment (see Fig. 3.11). Rehabilitation centres (%) Yes No/no answer 41

52 GLOBAL PROGRESS REPORT Advertisements from the "Health Benefits" campaign. Commonwealth of Australia. Most often, diagnosis and treatment of tobacco dependence is dealt with by existing health-care infrastructure, including primary, secondary and tertiary health-care systems in line with the recommendation of the Article 14 guidelines. The proportion of Parties reporting integration of cessation programmes into these health facilities has remained almost unchanged from the levels of the previous reporting period. Parties also reported on other structures within their existing health-care systems that participate in tobacco dependence treatment, for example centres providing psychiatric and neurological, drug treatment, and lung and chest care. Several Parties reported that private universities, private medical services, and NGOs also provide counselling and/or dependence treatment services. Several Parties reported on the progress they have made in strengthening their cessation services. Fifteen Parties reported that they have established their first cessation clinics or made available cessation consultations/services. Public funding or reimbursement schemes More than one third (39) of the Parties reported that services integrated into the primary healthcare system are fully reimbursed (a notable increase from when only one quarter of Parties reported full reimbursement), 33 Parties indicated that reimbursement is partial and 24 Parties that such services are not covered by public funding. In the case of specialized centres for cessation counselling, 24 Parties reported full, 20 partial and 28 no reimbursement. Several Parties reported that they provide free cessation services through their existing national health service infrastructures, including the national public health system (Brazil and Bolivarian Republic of Venezuela), regional health inspections (Bulgaria), primary health care (Islamic Republic of Iran) and all levels of the health-care system (Panama). Involvement of health professionals Physicians, nurses and family doctors are the most involved health professionals (see Fig. 3.12). Nineteen Parties reported having implemented training programmes targeted at health professionals in providing cessation advice. Colombia and Sweden reported that such programmes were also being conducted through the Internet. 42

53 3. Implementation of the Convention by provision Fig Physicians Nurses Family doctors Pharmacists Dentists Social workers Midwives Community workers Practitioners of traditional medicine 0 Percentage of Parties that reported the involvement of various health and other professionals in treatment and counselling services in and (%) No/no answer Curricula for health professionals Almost half of the Parties (60) reported that they include tobacco dependence treatment in the curricula of medical professionals. Surprisingly, while four fifths of the Parties report involving nurses in providing treatment and counselling services, only one third of the Parties report that tobacco dependence is incorporated into curricula at preand post-qualification levels of nurses training. These figures drop to around one quarter and even less in the case of pharmacists and dentists. Accessibility and affordability of pharmaceutical products for the treatment of tobacco dependence More than half (77) of the Parties stated that they seek to ensure the accessibility and affordability of treatment for tobacco dependence, including relevant pharmaceutical products. Eighty-seven Parties reported the availability of nicotine replacement therapy (NRT); however, only 60 reported the availability Yes of varenicline and 66 of bupropion. This represents an improvement since (74, 55 and 52 Parties, respectively). Other pharmaceutical products available for tobacco dependence treatment were also reported by the Parties, including cytisine/tabex, nortriptyline and escitalopram. Many Parties have reported that certain NRT products, such as patches and gum, are available over the counter, while other products, such as bupropion and varenicline, require a prescription. Pharmacies were the most widely reported venue at which NRT products could be purchased, with 16 Parties specifying that prescriptions were needed, 12 Parties reporting that over-the-counter sales were permitted; 10 Parties also reported that NRT was provided at hospitals, clinics, or other medical facilities. NRT was reported to be available for sale without prescription in additional outlets such as supermarkets and restaurants in Finland, and in retail stores in Norway. Ten Parties reported that NRT is available either free of charge or at a minimal price, at least for a certain segment of the population, such as people with low income. For example, Jordan reported that it provides free NRT therapy to all its citizens. Australia reported providing financial support to its citizens by listing NRTs on the Pharmaceutical Benefit Scheme. Bahrain and Malaysia reported including NRTs in their national essential drugs lists and Thailand reported that a similar measure is being considered. In Ireland, NRT products can be purchased in pharmacies both over the counter (paid for privately) and by prescription, with a minimal cost of 1.50 to those with entitlement to free health care. In Panama, pharmacy outpatient facilities and cessation clinics within hospitals provide NRT free of charge. In Malaysia, NRT and varenicline are available at primary healthcare centres as are all the medications on the Ministry of Health essential drugs list. In the United Kingdom, NRT is widely available, and the applicable sales tax has been reduced to the lowest amount permissible to encourage use. In New Zealand, NRT products such as patches and gum are available free of charge through the government-funded quitline and by approved providers, as well as through prescription from a medical practitioner. In Brazil, within the public health-care system, NRT products are prescribed and distributed at health-care units that offer treatment for smoking cessation; otherwise, they 43

54 GLOBAL PROGRESS REPORT can be purchased in pharmacies, either over the counter or by prescription, depending on the product. In Bulgaria, pharmaceutical products for the treatment of tobacco dependence can be purchased in pharmacies, with many pharmacies offering their customers cessation advice. Some Parties have reported that although certain medications are legally available, they are not easy to access, particularly outside capital cities, and must sometimes be specially ordered. There was also a distinction by some Parties, such as Costa Rica, Libyan Arab Jamahirya and Iraq, that NRT is available for purchase in private pharmacies only. Benin reported that NRT is only available for personal import through pharmacies and that its cost is prohibitive. Fiji, Mongolia and Swaziland also reported that such products are inaccessible to the majority of smokers due to their high price. New and innovative approaches Some Parties reported recently introducing new and innovative approaches to tobacco cessation and tobacco dependence treatment. Examples include cell phone text messaging (Costa Rica and Panama), Internet-based behavioural support (Iceland, Ireland and Panama) and a smartphone application (Norway). Jamaica and the Netherlands reported developing a directory/registry for tobacco cessation service providers (see also Box 3.8). Box 3.8. Comprehensive approaches to and recent advances in implementation of Article 14 In Islamic Republic of Iran (Islamic Republic of), Article 9 of the Tobacco Act obligates the Ministry of Health and Medical Education to integrate preventive, curative and rehabilitative measures for smokers and consultative services for cessation into primary healthcare services and to provide support to NGOs that are active in tobacco cessation and treatment. Based on this mandate, the Ministry has introduced a comprehensive set of measures. More than 150 smoking cessation clinics have been established and integrated into primary health-care services. In addition, several public and private firms have established smoking cessation clinics for their employees. These cessation services and treatments are provided free of charge. Training of trainers for health professionals has been carried out throughout the country, and tobacco cessation was integrated into the curriculum of dental students. An NGO has helped to establish a quitline in the capital. NRT is freely available in the public health service and a domestic pharmaceutical company recently began production of a new product containing bupropion. New Zealand has published smoking cessation guidelines for all health-care professionals, setting out the ABC approach Ask, Brief advice, Cessation support. One of the Government s six priority health targets is providing better help for smokers to quit. Measures of success include: 95% of hospitalized patients who smoke and are seen by a health practitioner in public hospitals and 90% of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking; and 90% of pregnant women are offered advice and support to quit. NRT and other quit aids have become more readily available than previously. For example, all medical practitioners can now prescribe NRT. In Panama, 36 free-of-charge smoking cessation clinics have been established. These services are available in the facilities of the Ministry of Health and Social Insurance, and have been integrated into the country s health system at primary health-care centres, public hospitals and polyclinics. Professionals providing cessation advice need to undergo special training to acquire the necessary skills. The clinics provide group therapy, with an average of 10 smokers per group. The clinics are equipped with the support of the Ministry of Health by using revenue from the special consumption tax applied to tobacco products. The Ministry also invests in smoking cessation medications. These services were advertised in the media. 44

55 3. Implementation of the Convention by provision 3.3 Reduction of the supply of tobacco Illicit trade in tobacco products (Article 15) Key observations Based on the reports received in the reporting cycle, the average of implementation rates for Article 15 provisions is 60%, up from the 54% seen in, but it remains in the middle range of implementation of substantive articles. Slightly more than two thirds of Parties reported having legislation in place to act against illicit trade in tobacco products Around half of the Parties report a lack of data in this area. Measures attracting notable increases compared with include the enabling of confiscation and subsequent destruction of proceeds derived from illicit trade in tobacco products, measures to monitor and control storage and distribution of tobacco products held or moving under suspension of taxes and duties, and information exchange and cooperation in investigations within the country and internationally. However, the share of Parties reporting on the adoption of practical tracking and tracing regimes and requiring tobacco packages to carry a statement indicating that sales are only allowed in their domestic market is still low and has not increased since the previous reporting cycle. More than 50 Parties have signed the Protocol to Eliminate Illicit Trade in Tobacco Products, and several Parties reported that they are in the process of ratification. Strengthening multisectoral awareness and coordination between sectors such as health, customs and law enforcement will be vital for early entry into force of the Protocol. Article 15 concerns the commitment of Parties to eliminate all forms of illicit trade in tobacco products. The Protocol to Eliminate Illicit Trade in Tobacco Products builds upon and supplements the Convention in this area (see also Box 3.9). Enacting or strengthening legislation against illicit trade More than two thirds (92) of the Parties reported that they had enacted or strengthened legislation against illicit trade in tobacco products (see Fig for implementation rates of selected measures). Canada, Ireland and the United Kingdom have multiyear strategies to combat illicit trade. Several Parties referred to the new Tobacco Products Directive of the European Union, which, inter alia, provides for measures on illicit trade. Share of illicit tobacco products on the national tobacco market Twenty-one Parties commented on changes in the percentage of smuggled tobacco products on the national tobacco market. Just over half (11) of the Parties replied that there had been no notable change. Seven Parties reported that the illicit share of the national market had Fig Legislation against illicit trade enacted Marking is legible Destruction of proceeds Promoting cooperation in investigations Marking that the product Marking to determine the origin of product Confiscation of proceeds Information exchange facilitated Collection of data on cross-border trade Carry the statement sales only alowed... Tracking and tracing Percentage of Parties reporting on implementation of provisions under Article 15 in and Licensing is legally sold Control of storage and distribution (%) Yes No/no answer

56 GLOBAL PROGRESS REPORT decreased, three reported an increase. It should be noted that many Parties do not provide information on illicit trade. Burkina Faso and Senegal indicated that data exist, but that they are difficult to access. Marking of packaging Two thirds (86) of the Parties reported that they require the marking of tobacco packaging to assist in determination of the origin of the product and marking determining whether the product is being legally sold on the domestic market. Ninety-one Parties reported that the marking must be legible and/ or presented in the principal language or languages of the country. However, only around one third (49) of the Parties require that unit packets and packages of tobacco products for retail and wholesale use carry the statement Sales only allowed in or have any other effective marking indicating the final destination of the product. Tracking and tracing Over a quarter of the Parties (34) responded affirmatively to the question of whether they have developed a practical tracking and tracing regime that would further secure the distribution system and assist in the investigation of illicit trade. More than half of the Parties (69) indicated that they require monitoring and collection of data on cross-border trade in tobacco products, including illicit trade. Several Parties reported that they have taken new measures regarding the marking or tracking and tracing of tobacco products. Singapore requires a revised SDPC mark on cigarette sticks, which features a series of vertical bars around the stick. Colombia introduced a new tracking system for consumer goods subject to excise tax, including tobacco products, and Canada has a new enhanced tobacco stamping regime for cigarettes, tobacco sticks and fine-cut tobacco. Confiscation and destruction Almost two thirds of Parties (83) reported that they enable the confiscation of proceeds derived from illicit trade in tobacco products to take place and that they monitor, document and control the storage and distribution of tobacco products held or moving under suspension of taxes and duties. Ninety-one Parties reported that they require the destruction of confiscated equipment, counterfeit and contraband cigarettes and other tobacco products derived from illicit trade, using environmentally friendly methods where possible, or their disposal in accordance with national law. Many Parties reported that they have introduced or strengthened enforcement measures, including increased penalties for tobacco smuggling (Australia and Canada), increased use of non-intrusive inspection methods like scanners (Serbia, South Africa and Venezuela (Bolivarian Republic of)) and established new offences related to tobacco smuggling (Australia). Palau has introduced web-based customs software, which will enable customs to connect with other relevant systems, such as quarantine and immigrations. Licensing Regarding the requirement for licensing or other actions to control or regulate production and distribution of tobacco products to prevent illicit trade, more than two thirds (88) of the Parties responded affirmatively. In Armenia, manufacturers of tobacco products must hold a licence. Furthermore, while distribution of tobacco products does not require direct licensing, points of sale must pay local duties to obtain a certificate to sell tobacco products. Box 3.9. Protocol on illicit trade On 12 November, the Parties to the WHO FCTC adopted the Protocol to Eliminate Illicit Trade in Tobacco Products 22 at the fifth session of the COP in Seoul, Republic of Korea. It is the first protocol to the WHO FCTC and a new international treaty in its own right. The Protocol was open for signature between 10 January 2013 and 9 January. During that time, the Protocol was signed by 54 Parties to the WHO FCTC. As at June, one State Nicaragua had also ratified to become the first Party to the Protocol. The Protocol will enter into force after ratification by 40 Parties. 23 The new treaty provides tools for both preventing illicit trade through securing the supply chain of tobacco products and counteracting it by establishing offences that bear proportionate and dissuasive sanctions. As part of the comprehensive control of the supply chain, Parties will establish a global tracking and tracing regime for tobacco products within five years of entry into force of the Protocol, which will comprise national or regional tracking and tracing systems in all Parties. The Protocol also established the legal basis and requirements for international cooperation among Parties on matters such as information sharing, technical assistance, law enforcement cooperation, mutual legal assistance and extradition. 46

57 3. Implementation of the Convention by provision Promoting cooperation Eighty-seven Parties responded that they promote cooperation between national agencies and relevant regional and international intergovernmental organizations with a view to eliminating illicit trade in tobacco products. Mali, Myanmar and Poland reported that they have improved multisectoral cooperation on illicit trade within their jurisdictions. In their implementation reports, many Parties referred to the negotiations, adoption and signature of the Protocol to Eliminate in Illicit Trade in Tobacco Products. Several Parties are either already in the process of ratification or are working towards ratification. 47

58 GLOBAL PROGRESS REPORT Sales to and by minors (Article 16) Key observations Fig Percentage of Parties reporting implementation of Article 16 provisions in the and reporting cycles Based on the reports, the average of the implementation rates for the provisions under Article 16 is 73%, the second highest among all substantive articles of the Convention, and further up from the 67% seen in. Most progress has been achieved through adopting new or strengthening existing legislation, including by increasing the legal age of majority and hence further limiting the access of young people to tobacco products. Fewer than two thirds of Parties reported that they prohibit sales of tobacco products from vending machines and only two thirds of the Parties still allowing vending machines reported that they ensure that they are not accessible to minors. Enforcement remains a challenge in this area; recent examples of enforcement campaigns and measures employed by several parties could accelerate progress if implemented internationally. This article requires Parties to adopt and implement measures to prohibit sales of tobacco products to and by minors as well as other measures limiting the access of underage persons to tobacco products. Sales to and by minors Most Parties (118) reported that they have prohibited sales of tobacco products to minors. The legal age of majority was specified as ranging from 16 to 21 years. Four Parties reported increasing the legal age of majority through amendments of their national legislation: Italy and the Netherlands from 16 to 18 years and Mongolia and Palau from 18 to 21 years. Three quarters (99) of the Parties reported that they prohibit sales of tobacco products by minors, up from two thirds of the Parties in the reporting cycle. Implementation rates of other requirements under this article, in comparison with implementation rates measured in, are shown in Fig Sales to minors prohibited Distribution of free samples to minors prohibited Distribution of free samples to the public prohibited Penalties against sellers provided for Sales by minors prohibited Placing prominent indicator at POS Sale in small packs prohibited Sellers to request proof of age Tobacco vending machines not accessible to minors Sweet, snacks, toys in form of tobacco prohibited Sales of tobacco from vending machines prohibited Sales from open store shelves banned (%) No/no answer Fifty-two Parties reported making progress in implementation of this article since the last reporting period, and 17 Parties reported adopting new or upgrading existing legislation to strengthen measures under this article (see also Box 3.10). Circumstances of tobacco sales One of the provisions under this article for which notable progress has been recorded since the previous reporting period is the prohibition of tobacco vending machines or ensuring that vending machines are not accessible to minors and/or do not promote the sale of tobacco products to minors. Three Parties (Germany, Malta and San Marino) reported upgrading their measures concerning sales of tobacco through vending machines, either by requiring an adult to supervise sales through such instruments (Malta) or Yes

59 3. Implementation of the Convention by provision Box Reducing young people s access to tobacco in Hungary In September the Hungarian Parliament adopted Act CXXXIV, Reducing Smoking Prevalence among Young People and Retail of Tobacco Products, also known as the Tobacco Shop Law. As a result of the Act, tobacco products may only be sold in supervised tobacco stores to people above 18 years of age. In addition to selling tobacco, these stores are only permitted to sell a limited range of other products such as alcohol, energy drinks, and newspapers. From 1 July 2013, around 7000 such stores began to operate, a significant reduction from the more than selling points that existed before implementation of the legislation. Images relating to tobacco products or smoking may not be displayed on the outer walls of the stores, and the interiors of the shops must be invisible from outside. Penalties against sellers There has also been notable progress in providing for penalties against sellers and distributors to ensure compliance (see Fig. 3.14). Full and effective enforcement has traditionally been difficult to achieve in this area. It is therefore laudable that six Parties (Bahrain, Barbados, Jordan, New Zealand, Panama and Tonga) reported ongoing enforcement campaigns or improved enforcement of measures to prevent sales to and by minors, and the Netherlands increased penalties in cases of non-compliance by sellers. On the other hand, eight Parties (Czech Republic, Georgia, Iceland, Kiribati, Lao People s Democratic Republic, Libyan Arab Jamahirya, Myanmar and Solomon Islands) reported that enforcement of policies to prevent sales to and by minors remains difficult. allowing the machine to check the age of buyer through smart card reading systems. Finland reported forbidding sales of tobacco from automatic vending machines, with the ban to enter into force on 1 January 2015, thus joining the 79 Parties that have already banned the use of vending machines in their jurisdictions. Another area of notable progress is the placement of a prominent indicator inside points of sale about the prohibition of tobacco sales to minors, which saw a 9 percentage point increase since the previous reporting cycle. 49

60 GLOBAL PROGRESS REPORT Tobacco growing and support for economically viable alternatives (Article 17) and protection of the environment and the health of persons (Article 18) Key observations Based solely on the reports of Parties indicating that measures under Articles 17 and 18 of the Convention are applicable to them, the average of the implementation rates of measures under these articles are 13% and 40%, 24 respectively. In spite of a notable increase in the implementation rates of these articles as compared with, they still remained two of the least implemented articles of the Convention. In the meantime, new evidence is emerging as Parties pay greater attention to these areas, with several Parties providing examples of how alternative livelihoods to tobacco growing have been promoted and the environmental consequences of tobacco growing and production addressed. Promotion and sharing of good practices could be the focus of future work in these areas to improve implementation of these challenging requirements of the Convention. With respect to the action to be taken, it should be noted that the report submitted to the COP at its sixth session by the working group on Articles 17 and 18 (document FCTC/COP/6/12) contains policy options and recommendations on economically sustainable alternatives to tobacco growing. Article 17 aims to ensure the provision of support for economically viable alternative livelihoods to tobacco workers, growers and individual sellers, while Article 18 addresses concerns regarding the serious risks posed by tobacco growing to human health and to the environment. Tobacco growing Seventy-four Parties reported that tobacco is grown in their jurisdictions, 75% of them providing some statistical data, mostly on the number of workers, farms or families producing tobacco. The amount of people involved in tobacco cultivation varies widely, from a few hundred in Georgia, Jamaica, Romania and Mauritius, to several hundreds of thousands in Turkey ( ) and Brazil ( ) and 1.8 million in China. Thirty-eight Parties submitted information on the value of raw tobacco, production of raw tobacco or the share of the value of tobacco leaf production in their national gross domestic product (GDP). The share of tobacco leaf production in the GDP of the majority of the Parties remains around or below 1%. A few countries (Benin, Gabon and Papua New Guinea) reported that tobacco is cultivated mostly for personal use and the amount is insignificant, while other Parties saw significant reductions in the demand for locally grown tobacco due to the closure of major manufacturing facilities in the country, followed by a natural transition towards the growing of other crops (such as Mauritius and Sierra Leone). Economically viable alternative activities Parties were required to provide information as to whether they promote economically viable alternatives for tobacco growers, tobacco workers and sellers of tobacco products. Nineteen Parties reported that they have established programmes to promote viable alternatives for tobacco growers, with 11 Parties enforcing replacement of tobacco farming with other agricultural programmes, and 58 Parties responding that this question is not applicable to them. Only seven Parties (Austria, Italy, Malaysia, Nepal, Philippines, Spain and Tunisia) reported that they promote alternative activities for tobacco workers; furthermore, only four Parties (Austria, Kiribati, Nepal and Spain) indicated that they have established specific programmes for individual sellers of tobacco products. Some Parties provided information on their approaches to implementing Article 17 in their jurisdictions. For example, Bulgaria supports tobacco growers in two different directions: diversification into non-agricultural activities in rural areas, and diversification into other agronomic activities within the farm. In Canada, while Agriculture and Agri-Food Canada does not have specific programmes related to tobacco production, tobacco producers may qualify for support under its Business Risk Management programmes. In Jordan, the Support Fund for tobacco farmers was cancelled in 2002 and resulted in the eradication of tobacco growing in the country. Malaysia established the National Kenaf and Tobacco Board in 2009, which resulted 50

61 3. Implementation of the Convention by provision in a reduction in the number of tobacco growers over the following years (see also Box 3.11). Protection of the environment and the health of persons As regards tobacco cultivation, 25 Parties responded that they consider the protection of the environment and 28 Parties indicated that they consider the health of persons in relation to the environment. Unlike the previous reporting period, several Parties refer to specific measures on the protection of the environment and the health of persons in relation to tobacco growing, manufacture and use. In relation to tobacco manufacturing, 32 Parties indicated that they consider the protection of the environment, and 34 Parties indicated that they consider the health of persons in relation to the environment. Several Parties reported making recent progress in the implementation of Article 18. Environmental and occupational health and safety legislation, regulations, and policies were cited by eight Parties, namely Australia, Canada, Ghana, Hungary, Nigeria, Pakistan, Senegal and Turkey. Adoption of good agricultural practices for cultivation and production of tobacco regarding use of fertilizers, plant protection products, and water consumption was championed by Canada, European Union, Italy, Pakistan and Thailand. Kenya reported requiring that 10% of the land used for the cultivation of tobacco be reserved for planting trees. Colombia and the European Union cited providing aid to reforestation and soil water management. China implements measures to improve energy savings and reduce emissions in the cigarette manufacturing process. Standards for reduced ignition propensity cigarettes are enforced in Bulgaria, Republic of Korea and South Africa. Costa Rica Box Supporting tobacco farmers in Brazil to switch to alternative crops The National Programme for Activities Diversification in Tobacco Growing Areas, under the coordination of the MDA, was established in It aims to reduce the economic dependence of tobacco growers on tobacco by supporting the implementation of projects of rural extension, training and research to implement strategies for productive diversification that create new opportunities for income generation. Between 2011 and, 75 projects were implemented in six tobacco growing states in partnership with 50 NGOs and civil society organizations, universities, research centres, and associations of producers, benefiting more than families. The programme invested more than US$ 12 million between 2005 and to provide technical assistance and rural extension training and research to support the diversification process. In, the Ministry of Agrarian Development (MDA) in Brazil launched a call for projects of Technical Assistance and Rural Extension (Ater) to promote diversification in tobacco growing areas, prioritizing 95 major tobacco growing municipalities and benefiting households that were producing tobacco with investments of over US$ 5 million. In, the MDA also sponsored a survey on the situation of tobacco farmers in the tobacco supply chain and their interest in shifting to other crops or activities. is currently working on legislation to classify cigarette butts as special waste. In Islamic Republic of Iran (Islamic Republic of) and The former Yugoslav Republic of Macedonia, periodical medical check-ups were carried out on farmers, including tobacco growers. In Italy and Kenya, wearing of protective gear is required for tobacco farmers and tobacco industry workers. 51

62 GLOBAL PROGRESS REPORT 3.4 Other provisions (liability, research and reporting) Liability (Article 19) Key observations Based on the reports, the average of the implementation rates for the Article 19 provisions is 14%, the second-lowest among all substantive articles of the Convention, but up from the 10% of. Implementation of Article 19 is lower in relation to the implementation or use of liability frameworks to seek compensation from those involved in manufacturing, supplying or marketing tobacco products than it is for civil and criminal liability for breaches of tobacco-control measures. Although many Parties report having in place legislation for criminal and civil liability, fewer than one fifth of the Parties report that those laws provide for compensation, and fewer Parties report that they have taken any liability action within the scope of those laws, indicating that challenges are faced in the implementation and use of liability frameworks. In, only 18% of Parties reported that any person in their jurisdiction had launched a criminal and/or civil liability action against any tobacco company in relation to the adverse effects of tobacco use. Fewer Parties (10%) reported having taken any legislative, executive, administrative and/or other action against the tobacco industry for full or partial reimbursement of medical, social and other relevant costs related to tobacco use in their jurisdictions. All of the actions described by Parties were taken within civil liability frameworks, as follows: Two Parties (Canada and Republic of Korea) reported having legislation in place to allow public health-care providers to seek to recover the costs of health-care resulting from disease caused by tobacco. Canada reported that litigation is ongoing in several its provinces, and Republic of Korea reported that the first health-care cost recovery action by a governmental agency was being prepared (see box). Three other Parties (Marshall Islands, Panama and Spain) reported that liability actions have been initiated in the past in relation to health-care costs. Seeking compensation, where appropriate, is an important component of actions taken by Parties to pursue liability for the purposes of Under Article 19, Parties agree to consider taking legislative action or promoting their existing laws to deal with liability and, inter alia, to afford one another assistance in legal proceedings relating to liability, as appropriate and mutually agreed. Implementation of Article 19 presents Parties with an opportunity to collaborate in their efforts to hold the tobacco industry liable for its abuses. The importance of liability as part of comprehensive tobacco control is also recognized in Article 4.5. More than one third of the Parties reported having in place general civil liability measures that could apply to tobacco control, and 28% reported separate criminal liability provisions. While still relatively low, this is an increase in implementation from the reporting period, in which one quarter of the Parties reported having implemented any measures to tackle liability (see also Box 3.12). Box Republic of Korea prepares litigation against the tobacco industry In April, the National Health Insurance Service (NHIS) of the Republic of Korea announced that it is preparing litigation against the tobacco industry to offset treatment costs for diseases linked to smoking. It will be the first litigation in the country by a governmental agency against the tobacco industry. The state insurer has estimated that it spends more than US$ 1.6 billion each year on treating smoking-related diseases, and is seeking an initial US$ 51.9 million from three tobacco companies two global manufacturers and the former state-run tobacco company which was privatized in The NHIS has stated that the damages were calculated on the basis of data on payments by state insurers for patients with three types of cancer associated with smoking. The lawsuit is the first undertaken by a State organization against tobacco firms among the Parties in the Western Pacific Region. 52

63 3. Implementation of the Convention by provision Article 19. In fewer than one fifth (18%) of the Parties reported having civil or criminal liability provisions that stipulate compensation for adverse health effects of tobacco and/or for reimbursement of medical, social or other relevant costs. Criminal liability was most commonly identified as being available as recourse for breaches of tobacco-control legislation. Almost half (48%) of the Parties reported having measures regarding criminal liability in place in their tobacco control legislation, and around one quarter (26%) reported having civil liability measures specific to tobacco control in place. Grenada also reported that criminal liability is included in its draft comprehensive tobacco control legislation. In addition, eight Parties also identified the fact that administrative penalties are used to ensure compliance with tobacco-control legislation, rather than civil and criminal liability frameworks. Parties reported that civil and criminal liability were available in relation to offences against a wide range of tobacco control laws, including laws relating to smuggling, advertising prohibitions, packaging and labelling measures, outdoor smoking bans and taxation measures. 53

64 GLOBAL PROGRESS REPORT Research, surveillance and exchange of information (Article 20) Key observations Fig Percentage of Parties reporting implementation of research activities, by topic, in and The average of the implementation rates of the indicators under Article 20 (51%) places this article in the middle range of implementation. More than two thirds of Parties reported that they have carried out research on the determinants and consequences of tobacco consumption, with the latter seeing a significant increase since ; there is also a notable increase in the number of Parties covering tobacco-related social, economic and health indicators in their national surveillance systems. A promising development is the increasingly frequent integration of tobacco-related questions into national surveys with broader scopes. In several areas (for example those related to exposure to tobacco smoke, and identification of effective programmes for the treatment of tobacco dependence or in relation to alternatives to tobacco growing) research is still to be strengthened in around half of the Parties, not least because of lack of capacity and financial resources for undertaking such research. In this article the Parties undertake to develop and promote national research and to coordinate research programmes internationally, as well as to establish and strengthen surveillance for tobacco control and to promote exchange of information in relevant fields. Research activities Findings indicate that research programmes most often address the determinants, consequences, and social and economic indicators related to tobacco consumption. As in, the area of research in which the fewest Parties reported that they have carried out research was the identification of alternatives to tobacco growing (see Fig. 3.15), an area indicated under Article 20.1 as requiring promotion and encouragement. Determinants of tobacco use Consequences of tobacco use Social and economic indicators Exposure to tobacco smoke Tobacco use among women Treatment of dependence Alternative livelihoods (%) Yes No/no answer Parties reported that they have conducted research on key issues related to strengthening tobacco control and implementation of the Convention. Seven Parties have conducted research on how to implement national policies, legislation and regulations more effectively. Three Parties have conducted public opinion surveys on support for their legislation, five Parties reported conducting research related to tobacco taxation and fiscal policies, and four Parties have conducted research on second-hand smoke. In Sweden, the Government commissioned a study of water pipe-smoking among adolescents in the country, including prevalence, risk assessment and the surrounding culture, and Australia reported that research in relation to Article 9 of the Convention has been conducted on the possible impact of options for further regulation of the contents of tobacco products

65 3. Implementation of the Convention by provision Other areas of research reported by the Parties include: health warnings; cessation of tobacco use; tobacco use in pregnancy; smoking-attributable mortality; and tobacco industry surveillance. Six Parties reported that they share research and information on their policies and legislation with other countries, including at regional and international meetings. The Republic of Korea reported that it has conducted a wide range of research projects in the last few years with financial support from the National Health Promotion Fund, including on policies related to electronic cigarettes, smoking cessation motivation programmes for young people, and effective implementation of Article 5.3. The European Union reported on several studies published in the area of health warnings. For example Eurobarometer, which monitors implementation of tobacco policies and legislation in Europe, published a qualitative study in March investigating a second generation of tobacco packaging health warnings. Several Parties mentioned that an important obstacle is the lack of funding to conduct research. Training and support for research More than half (71) of the Parties reported that they have in place programmes to support people engaged in tobacco-control activities, including research, implementation and evaluation, a slight increase as compared with. Five Parties (Australia, Finland, Mexico, Sweden and the United Kingdom) reported on training programmes and on the approaches they use to strengthen tobacco-control capacity in their jurisdictions. Finland reported that it has strengthened cooperation between the National Institute for Health and Welfare and the Regional State Administrative Agency to raise awareness of tobacco-control programmes in subnational jurisdictions and local authorities. In Mexico, the National Institute of Respiratory Diseases promoted information exchange and collaboration between stakeholders. In Sweden, the National Tobacco Control Commission financed several projects aimed at developing methods for tobacco prevention and supporting dissemination of evidence-based methods. National systems for epidemiological surveillance Over two thirds (89) of the Parties reported that their national epidemiological surveillance systems cover patterns of tobacco consumption, 74 Parties that they cover exposure to tobacco smoke, 62 Parties that they cover the determinants of tobacco consumption, and 59 Parties that they cover the consequences of tobacco consumption. There is a significant increase since the previous reporting period in the number of Parties that reported covering social, economic and health indicators related to tobacco consumption. Many Parties provided additional information on their regular collection of tobacco-related data. Most of them are conducting surveys assessing the prevalence of tobacco use among adults as well as youth, including the Global Youth Tobacco Survey (GYTS), the Global Adult Tobacco Survey (GATS) and surveys targeting health professionals. Other Parties reported recently implementing WHO STEPS surveys; China reported that it has collected data on smoking rates as well as on the effectiveness of tobacco-control measures already taken as part of the International Tobacco Control project. In December 2013, by resolution of the Government, the Russian Federation established a procedure for monitoring and evaluating the effectiveness of measures to prevent exposure to environmental tobacco smoke and reduce tobacco use. A similar programme was reported by Belarus. An increasing number of Parties (13 in ) include questions on tobacco use in national health surveys and repeat these types of surveys on a regular basis so that trend data is available. In some cases, these surveys are part of broader surveillance of substance use. Fewer Parties reported that they conduct surveys among young people on tobacco use and/or attitudes about tobacco, on tobacco use among pregnant women, and on exposure to second-hand smoke. Exchange of information Almost two thirds (81) of the Parties reported that they have promoted the exchange of publicly available scientific, technical, socioeconomic, commercial, or legal information; fewer than half (56) and a quarter (36), respectively, of the Parties exchange information on the activities of the tobacco industry and on the cultivation of tobacco. Implementation rates of these indicators have increased by 2 3 percentage points compared with. Database on laws and regulations Around two thirds (89) of the Parties reported that they maintain a database of national laws and regulations 55

66 GLOBAL PROGRESS REPORT on tobacco control and slightly above half (69) of the Parties reported that the database also contained information on the enforcement of those laws and regulations. Panama reported, in relation to Article 20.4(a), having two national databases of laws and regulations, one under the auspices of the National Assembly, and another being the Official Gazette, both containing a category for tobacco-control laws and regulations. In addition, the Supreme Court s web page makes available all its rulings on pertinent jurisprudence, by subject matter, including rulings relevant to tobacco control. 56

67 3. Implementation of the Convention by provision Article 21 (Reporting and exchange of information) Key observations The transition to the revised, biennial reporting cycle has been completed smoothly, with more than 70% of the Parties submitting their and implementation reports, which tend to be of better quality and more complete than those of earlier cycles. Nevertheless, around one quarter of the Parties have reported with delays or have not reported at all, and there is a lack of data in several areas of the report form, such as tobacco manufacturing, taxation and pricing of tobacco products, tobacco-related mortality and economic costs. Cooperation between all relevant sectors of the government and other actors that could contribute data to the implementation reports needs to be strengthened to ensure that preparation of national reports becomes a joint and coordinated exercise. Parties are required under Article 21 of the Convention to submit to the COP, through the Secretariat, periodic reports on implementation of the Convention. The COP determines the frequency and format of such reports. Status of reporting by the Parties Before, the start of the standardized biennial cycle, each Party was requested to present its reports after two and five years of entry into force of the Convention for that Party. Since, Parties reports are expected biennially, in designated reporting periods, with deadlines of six months before the next regular session of the COP. In, the first reporting period according to the revised cycle, 126 Parties (72% of the 174 Parties that were due to report) submitted an implementation report by the deadline. These reports were reflected in the global progress report. Additionally, 20 Parties reporting for the reporting cycle submitted their reports after the deadline, and they were counted as reports. 25 In the reporting cycle, between 1 January and 30 April, 130 Parties (73% of the 177 that were due to report) submitted an implementation report. 26 Though the reporting rate remained nearly the same, there was a notable improvement in the completeness of the reports; in particular, more information was provided by the Parties in areas such as tobacco-related social costs, tobaccorelated mortality and exposure to tobacco smoke, more details were provided in the open-ended questions, and more documents were submitted to support responses provided in the reports. Nevertheless, data collection and reporting of information in several areas, such as tobacco manufacturing, seizures of illicit tobacco products, tobacco growing, taxation and prices of tobacco products, tobacco-related morbidity, mortality and economic costs, need to be strengthened. Some Parties have indicated that such information is either not available or is difficult to obtain, or that it reaches the reporting officer with a delay. It should be noted that most of the Parties that submitted their first implementation reports in the reporting cycle provided good quality and complete reports (for example, Czech Republic, The former Yugoslav Republic of Macedonia, Turkmenistan and Uzbekistan). As mandated by the COP, the Secretariat provides feedback to reporting Parties on the content of their reports, including, inter alia, proposing corrections, and requesting clarification, and submission of other relevant documents; almost 60% of Parties responded to the comments by the Secretariat in its feedback note, thus improving the quality and completeness of their reports. Overall, since the start of the first reporting period in February 2007 and up until June, when this document was finalized, the Secretariat had received at least one implementation report from 168 out of the 178 Parties 27 (94%). Only nine Parties that were due to report at least once had not submitted any implementation report, down from 15 Parties at the end of the previous reporting cycle. For the first time in the reporting cycle, the Parties to the Convention have had the opportunity to report on their use of the implementation guidelines adopted by the COP. The Convention Secretariat developed, with input from the Parties, an online questionnaire to facilitate voluntary submission of information 57

68 GLOBAL PROGRESS REPORT of the Parties on their use of the guidelines. Eighteen Parties have submitted reports on their use of the guidelines through this instrument in the reporting period. Information received therein was reflected in this report. The status of reporting by the Parties, including the number of reports and submission dates, is provided in Annex Survey among the non-reporting Parties At its fifth session, the COP mandated the Convention Secretariat to perform a survey, among Parties that had not reported or reported with a substantial delay, concerning their reasons for not/ delayed reporting (decision FCTC/COP5(11)). To comply with the request made by the COP, the Convention Secretariat approached the concerned Parties in April 2013, requesting them to respond to a few questions concerning their reasons for not/delayed reporting. Of the 31 Parties contacted, two responded by sending their outstanding reports and a further six responded to the questions. The responding Parties listed three main reasons that had prevented them from submitting their implementation reports late or not at all, nmely: lack of data or capacity for national data collection and completion of the report; lack of key information to be reported or not enough progress to be reported; and lack of information on the modalities of reporting and on the reporting instrument. Assistance to Parties in reporting and further development of the reporting instrument While the overall reporting rates are comparable to the experiences of most other treaties, the figures indicate that reporting is still a challenge for several Parties. Article 21.3 of the Convention requires the COP to consider arrangements for assisting developing country Parties and Parties with economies in transition, at their request, in meeting their obligations under Article 21. The Secretariat has used various mechanisms to promote the reporting system of the Convention and to train officers responsible for reporting, for example by holding reporting sessions within regional meetings on implementation of the Convention. The Secretariat has also established an Internet-based forum for discussing reporting and exchange of information. In addition, at the beginning of the reporting cycle, web-based training sessions were held to further inform and train interested officials. About half of the Parties received assistance through web-based and face-to-face training and invidualized advice through telephone or electronic means ( or the information exchange platform). The assistance and clarifications provided to a large number of Parties promoted the timely submission of reports and their compliance with reporting requirements. Moreover, the Secretariat has provided feedback to Party counterparts upon submission of their reports, further promoting a common understanding of the requirements. The reporting system of the Convention has evolved over time. The reporting instrument allows Parties to comment and advise on the future development of the reporting system of the Convention. Comments received from several Parties are directed at further improving the user-friendliness of the system. The Secretariat will analyse these comments along with its own experiences and lessons learnt from the and earlier reporting cycles with a view to making further improvements, under the guidance of the COP, as appropriate. To promote the use of standardized indicators used in the reporting instrument of the WHO FCTC by the Parties, the Secretariat, under the mandate of the COP 29 and in cooperation with WHO, developed and made available to Parties, for their use in the reporting cycle and beyond, a WHO FCTC Indicator Compendium. Integrating WHO FCTC-specific indicators into Parties national data collection systems will certainly improve the collection of comparable data during the next reporting cycles. Further progress in reviewing Parties reports by the COP can be expected at the sixth session of the COP, based on consideration of the Secretariat s report, which contains recommendations on the establishment of a mechanism to facilitate such review. 58

69 3. Implementation of the Convention by provision International cooperation (Article 22) Key observations The average implementation rate of this article is 37%, 30 among those with the lowest implementation rates globally. More Parties reported that they have received than provided assistance, with the latter amount dropping slightly since the last reporting cycle, which may indicate the role of non-party donors, including international and NGO donors, in providing resources to support Parties in their implementation efforts. While more than half of the Parties received assistance to establish or strengthen national tobacco-control programmes, much less attention is given to other areas, such as assistance in training of personnel, provision of equipment and supplies, and treatment of nicotine addiction. Strengthened international cooperation and continuing efforts to assist countries in assessing their needs in implementation of the Convention, as called upon by the COP, have resulted in the provision of more targeted assistance by international partners and a growing trend of integration of treaty implementation into United Nations Development Assistance Frameworks. The potential to mobilize assistance through international organizations of which Parties are members, as outlined in Article 26.4, remains largely underused. Paying increased attention to this important mechanism could contribute substantially to strengthened implementation of the Convention. Article 22 the Convention requires Parties to cooperate directly or through competent international bodies to strengthen their capacity for implementing obligations arising from the Convention. In connection with that matter, Article 26 requires that Parties promote the utilization of bilateral, regional, subregional and other multilateral channels to provide funding for the implementation of national activities. In addition, Article 21.1(c) of the Convention requires Parties to report on any technical and financial assistance provided or received for specific tobacco-control activities. Areas of assistance Parties were requested to provide information on technical and financial assistance provided or received in specific areas linked to the provisions of Article 22. Fig presents the areas of assistance and the percentage of Parties reporting on assistance provided or received in these areas. A total of 89 Parties provided additional information on the assistance that they have received or provided. On average, slightly over half of the Parties, and notably more than in, reported receiving assistance to establish and strengthen national tobacco-control strategies, plans and programmes and for the development and acquisition of knowledge, skills, capacity and expertise related to tobacco control, pursuant to Article 22.1(a) and (b), while the other areas such as training and sensitization of personnel did not attract the same level of attention. The least reported areas, with results comparable to those of, are the requirements under Article 22.1(e) and (f), on identification of methods for tobacco control, including treatment of nicotine addiction, and research to increase the affordability of comprehensive treatment of nicotine addiction. In the meantime, the proportion of Parties that reported providing assistance has not changed considerably over time, and has even dropped in some areas. The assistance reported by the Parties has not been limited to assistance to developing country Parties through traditional developments partners. Thailand and Uruguay, for example, reported providing assistance to other Parties, while Italy and Norway reported receiving assistance. Several developed country Parties also reported on assistance received from WHO and the Convention Secretariat. Several Parties reported on needs assessments and regional meetings conducted by the Convention Secretariat as assistance received. Parties reports also reveal that both bilateral and multilateral cooperation enhance technology transfers and exchanges of information among Parties. The European Union reported providing a grant to the Convention 59

70 GLOBAL PROGRESS REPORT Fig Percentage of Parties reporting on assistance they provided or received, by areas of assistance, in and Assistance received Assistance provided Expertise for tobacco control programmes Assistance on transfer of skills and technology Training and sensitization of personnel Equipment, supplies, logistics Methods for tobacco control, e.g. treatment of nicotine addiction Assistance on research into affordability (%) (%) Yes No/no answer Ceremony at the opening of the Center for International Cooperation in Tobacco Control in Montevideo, Uruguay. Photo courtesy of Ministry of Health, Uruguay. 60

71 3. Implementation of the Convention by provision Box Cook Islands Joint Needs Assessment leads to strengthened tobacco-control measures The COP requested the Convention Secretariat to assist developing country Parties and Parties with economies in transition in conducting joint needs assessments, on request, with the aim of assisting the Parties to fully meet their obligations under the Convention. In March, a joint needs assessment mission was conducted in Cook Islands, and this has proven to be an important catalyst in building capacity and strengthening tobacco-control policies in accordance with provisions of the Convention in that country. Following the needs assessment, and reflecting upon the recommendations contained in the report, Cook Islands developed a National Tobacco Action Plan 2016, which was adopted in December. Cook Islands is significantly increasing taxation rates on tobacco products, with a 33% increase each year. As a result, the overall tax rates on tobacco products will double between August and August The first such increase in raised the price of an average pack by 2.10 New Zealand Dollars. From 2016, a 2% per annum increase is foreseen. Part of this increased revenue is being used to support noncommunicable disease prevention and tobacco-control programmes, including the provision of free tobacco cessation services. Based on the guidelines on cessation and treatment of tobacco dependence, provided by New Zealand, starting from February smoking cessation clinics were established in the capital, with NRT products made available to smokers free of charge. The Government is working to expand this service to outer islands as well. The Government has also taken steps to implement a comprehensive ban on the promotion, advertising, and sponsorship of tobacco products. With support from the Convention Secretariat, Cook Islands will conduct a further review of its tobacco control legislation in with a view to strengthening it, based on the recommendations of the needs assessment report. Although there is currently no local production or manufacturing of tobacco products, it is also planned that the amended legislation will include provisions to prohibit tobacco growing and manufacturing in the future. There will be an additional focus in the future on priority areas identified in the report, such as enforcement of smoke-free policies and monitoring of their implementation. Box Providing support to strengthen implementation of the Convention In Kyrgyzstan, with financial support from the Finnish Ministry for Foreign Affairs, the Finnish Lung Health Association and ASH Finland have been implementing a community-based tobacco control project since The long-term development objective of the project is strengthening of a combined public health and health system approach to tobacco control in Kyrgyzstan. The current project will run from to 2016 and activities are carried out in four oblasts (regions) of Kyrgyzstan. The project, which is being undertaken in collaboration with the Ministry of Health and the Ministry of Education, supports primary health care, village health committees, teachers, media and local authorities in their work to reduce tobacco use, exposure to second-hand smoke, and to change the social norms around tobacco. The project aims to influence attitudes and knowledge levels of the target population and to develop a model for reducing tobacco use that can serve as a model for broader national and international use. The Australian Government has provided a range of financial and technical assistance to support tobacco control in developing country Parties and Parties with economies in transition. Graphic health warnings and social marketing materials have been shared with many Parties, and financial support has been provided to the Convention Secretariat to assist in adapting these materials for use in low-resource settings. Targeted financial support has also been provided by Australia for implementation of the Convention in Pacific island countries and some Commonwealth countries. In addition, in 2013 Australia provided funding to the WHO Regional Office for the Western Pacific for the development of technical resources and guidance materials on tobacco plain packaging for use by other countries that may be considering adopting this measure. The European Commission has provided a 5.2 million grant to the Convention Secretariat to be used to support low- and middle-income countries in their tobacco-control efforts through effective implementation of the WHO FCTC. The funding being used to scale up work already undertaken by the Secretariat on joint needs assessments, capacity building and enhancement of international cooperation. The work under the grant assists Parties in fully meeting their obligations under the Convention and better integrating tobacco-control policies into their national health and development strategies and programmes. The funding comes from the European Union s Investing in People programme, which pursues a broad approach to development and poverty reduction in partner countries as part of efforts to achieve the Millennium Development Goals. 61

72 GLOBAL PROGRESS REPORT Box Regional cooperation on implementation of specific measures under the Convention On 12 December, the Caribbean Community (CARICOM) 31 Council for Trade and Economic Development (COTED), at its Thirty-Fifth Meeting, adopted the Regional Standard for the Labelling of Retail Packages of Tobacco Products. The standard will require the Caribbean countries to adopt rotating graphic warning labels on tobacco products in line with the requirements of the WHO FCTC. All manufacturers, importers, retailers and others engaged in the production and or trade of tobacco products within any CARICOM Member State must comply with the standards. Caribbean countries have been taking steps to incorporate the CARICOM standards into their national legislation. On 9 August 2011, the Gulf Cooperation Council (GCC) 32 adopted a standard on labelling of tobacco product packages, which includes a requirement for pictorial warnings to cover 50% of the front and back of pachages, with a warning in Arabic on the front and an English warning on the back. The standard replaced the 1994 GCC standard, which required text-only bilingual (Arabic and English) warnings on the front of packages. The graphic warnings have been mandatory on cigarette packages since 9 August in all GCC countries. Two pictorial warnings, which are part of the new standard, have been specifically designed for water pipe tobacco. The new standard also contains a specific ban on misleading terms, including light, mild, low tar, extra light, low. The implementation reports of Bahrain, Oman and Saudi Arabia indicate that they are putting in place the requirements concerning pictorial warnings as mandated by the GCC. Secretariat to support and enhance implementation of the Convention internationally, with a particular focus on the needs of developing country Parties. Uruguay inaugurated, in May, a new center for international cooperation in tobacco control. With respect to assistance received or provided the main areas include the following: developing national tobacco-control legislation; developing a national tobacco-control strategy/ action plan; conducting a needs assessment or regional meeting on implementation of the WHO FCTC; granting a license for use of pictorial health warnings; conducting surveys such as GYTS and GATS; conducting smoking cessation programmes, education, communication, training and advocacy campaigns; and implementing policies such as those on tobacco taxation, smoke-free areas; and implementing tobacco product regulations. When reporting on assistance needed, Parties call for more technical and financial support to be made available to them. Benin, Niue and Tonga mentioned that they require needs assessments to be conducted with the support of the Convention Secretariat (see box on the example of the Cook Islands). Another important aspect promoted during the needs assessment exercise is the integration, at national level, of implementation of WHO FCTC implementation into United Nations Development Assistance Frameworks. It is also important to note that in three subregional settings the strengthening of implementation of the WHO FCTC by the Parties has resulted from approaching the relevant matters through regional organizations (see boxes for examples). Some Parties indicated that they require more support in conducting research and surveys, capacity building, developing or enhancing national tobacco-control strategies/action plans, and running tobacco cessation programmes, and through provision of technical expertise and experiences, training and support to attend technical meetings. Encouraging implementation assistance through membership in international organizations (Article 26.4) Twenty-six Parties reported using this mechanism; 19 Parties also provided additional information. Specifically, Australia reported it has actively promoted implementation of the WHO FCTC as a key public health priority for relevant regional and international intergovernmental organizations including the United Nations General Assembly and the Commonwealth. Gabon reported that the country s President spoke on the burden of noncommunicable diseases and tobacco control in the United Nations General Assembly and that the Ministry of Foreign Affairs and International Cooperation is committed to promoting the Convention in international forums. However, it is important to note that the scope of organizations and institutions in which Parties can raise the profile of the Convention could be further widened and Parties attention could be further drawn to fulfilling this obligation. 62

73 3. Implementation of the Convention by provision References 1 The given implementation rate includes measures under Article 5 (paragraphs 1 3) of the Convention. 2 Australia, Azerbaijan, Bangladesh, Belarus, Burkina Faso, Canada, Cook Islands, Côte d Ivoire, Costa Rica, Croatia, Cyprus, Ecuador, Georgia, Jamaica, Malaysia, Nepal, Norway, Palau, Portugal, Republic of Moldova, United Kingdom of Great Britain and Northern Ireland (Scotland), Thailand, Turkey, Turkmenistan and Viet Nam. 3 Benin, Bulgaria, Colombia, Congo, Federated States of Micronesia, Gambia, Sao Tome and Principe, Spain, Tajikistan, Togo and Uzbekistan. 4 Gabon and Sweden. 5 Out of the 168 that have submitted at least one implementation report. 6 Representing 79% of the world s population. 7 Such research is foreseen as part of the impact assessment of the Convention (see document FCTC/COP/6/15). 8 Bhutan has banned the sale of tobacco products, so it has no tobacco taxes. 9 In the case of countries that have different tax rates for filter and non-filter cigarettes, only filter cigarette taxes were considered. In cases in which several tiers for filter cigarettes are applied, the lowest tier was used. 10 Weighted average prices (WAP) would be the best indicators of price changes, but WAP are rarely available outside the European Union Member States. For the rest of the reporting countries, nominal prices were compared for those brands that were reported on both in and, and average cigarette prices calculated per pack of 20 cigarettes for such brands. These calculated prices cannot be considered as WAP, and they are mainly used to make hypotheses regarding price trends. 11 In South Africa in 2013 cigarette tax rates were increased in line with inflation, while the tobacco industry decreased its prices for some popular brands. Increasing tobacco tax rates only by the inflation rate was therefore not sufficient to ensure a tobacco price increase 12 Worldwide average cigarette prices were not calculated, as many developing countries have not reported prices and European countries with high prices dominate among the reporting countries; the calculated average would therefore be much higher than the real one. Moreover, to obtain correct weighted calculations, the numbers of daily smokers for each country should be taken into account, and this number is currently not available for many countries. 13 See 14 These include the Global Youth Tobacco Survey (GYTS) or similar international surveys targeted at youth (e.g. the Global School-based Student Health Survey (GSSHS) or the European School Survey Project on Alcohol and Other Drugs (ESPAD). Adult exposure data derive either from the Global Adult Tobacco Survey (GATS) or from the WHO STEPwise approach to Surveillance (STEPS). 15 For example, the national legislation is accompanied by executive decrees or orders to put the requirements of the legislation into effect. 16 See html 17 Further information can be found at eu/health/tobacco/docs/dir_40_en.pdf. 18 Maldives also referred to tobacco industry interference in the process. 19 See PITOC_factsheets 20 An indicative (non-exhaustive) list of areas to cover in education, communication and training programmes is contained in Appendix 3 of the guidelines for implementation of Article The calculation of the average implementation rate of this article took into account responses to questions and , including references to a ban on cross-border advertising, promotion and sponsorship originating from the Party s territory in line with Article 13.2, as well as questions and For the text of the Protocol and more information see 23 See for the status of ratification. 24 Parties that indicated that these measures are not applicable to them were excluded from the calculation. 25 Thus a total of 146 Party reports were counted for the reporting cycle (covering 80% of the world s population). 26 This includes four Parties that submitted their reports in 2013 (Mauritius, Poland, Slovakia and Venezuela (Bolivarian Republic of)) and that were requested to provide updates in the reporting cycle without sending a full report again. 27 Ethiopia, for which the Convention entered into force in, will need to report for the first time in the 2016 reporting cycle. 28 See also the information contained on the WHO FCTC website, at: reporting_timeintro/ 29 Decision FCTC/COP/5(11). 30 Concerning assistance received. 31 Members of the Caribbean Community that are also Parties to the Convention: Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Saint Lucia, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Suriname, and Trinidad and Tobago. 32 The GCC consists of six member countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates. Yemen is not a GCC member, but became a member of the GCC Standardization Organization in

74

75 4. Prevalence of tobacco use and related health and economic consequences 4. Prevalence of tobacco use and related health and economic consequences 4.1 Prevalence of tobacco use Key observations The comparability of reported prevalence data is increasing relative to the previous reporting cycles, and the number of Parties identified as having two comparable data sets on tobacco use prevalence has almost doubled in compared with the reporting cycle (45 and 25 Parties, respectively); this indicates that monitoring of tobacco use has been strengthened by an important number of Parties, although it is still to be expanded to cover all Parties. However, comparable data on smokeless tobacco use have not become more broadly available since the previous reporting cycle. More than two thirds of the Parties with comparable data experienced a decrease in prevalence of smoking in adults, and more than half of the Parties experienced the same among young people. There has also been a notable increase in the number of Parties reporting on tobaccorelated mortality data, while the number of Parties reporting on research on the economic burden of tobacco use has more than doubled. With the number of Parties conducting such research increasing, it is important to align methodologies for such studies to improve comparability of data. The use by the Parties of the new WHO FCTC Indicator Compendium may facilitate the collection of internationally comparable data, through the use of standardized indicators on prevalence of tobacco use and related health and economic consequences. The prevalence data reported by the Parties are analysed in this section in terms of changes occurring in individual Parties over the reporting periods. In addition, for the purpose of global and regional comparisons, comparable estimates by WHO are presented at the end of this section. Of the 130 reports received, 112 (86%) contained recent data on smoking among adults and 44 (34%) recent data on young people. Data reported by the Parties were checked against the supporting documents submitted, or directly with the quoted data source. The data were then used for the analysis of changes in prevalence across the reporting cycles. Prevalence in adults Changes in adult tobacco use prevalence were assessed for those Parties that submitted at least two comparable data sets across the reporting cycles, that used the same data collection methodology across the two compared periods, and in which the latest data were collected in or later. Full data on prevalence of tobacco use, as reported by the Parties, can be found in table format in Annex 6 of this report. Smoking tobacco Forty-five Parties with two such data sets were identified, a significant increase since the reporting cycle when 25 Parties had such comparable sets of data. The figures show that tobacco use decreased by more than 1 percentage point over recent years in 32 of these 45 Parties, 1 twice the number than was the case in, with decreases ranging from 1 percentage point (Luxemburg, Singapore and Sweden) to 8.49 percentage points (Hungary) for total adult prevalence (current or daily smoking, whichever was collected in the country). In 12 Parties 2 prevalence remained stable (change of less than 1 percentage point), and only one Party (Bosnia and Herzegovina) was identified as having seen an increase in total adult smoking prevalence rates, an increase that was higher among women. In Parties that have two comparable data sets by gender, the reported male current or daily smoking prevalence was observed to have decreased in 30 Parties, increased in five Parties and remained stable (with a change of less than 1 percentage point) in five Parties. Twenty-three Parties had lower female current or daily smoking, while in 11 Parties it remained stable (change of less than 1 percentage point) and five Parties reported an increase in female prevalence. For most Parties, reported prevalence figures followed the same trend for both males and females. However, it was observed that for four Parties (Netherlands, Republic of Korea, Republic of the Republic of Moldova and Seychelles) reported 65

76 GLOBAL PROGRESS REPORT It is more dangerous than you think. Photo courtesy of Ministry of Health, Oman. Poster of the mass media campaign related to the Brazilian National Day Against Smoking Photo courtesy of the Brazilian National Cancer Institute (INCA). female smoking prevalence increased while male prevalence decreased. Prevalence among young people In a similar exercise for young people, 32 3 Parties were identified as having two comparable data sets. Total youth smoking prevalence decreased in 19 Parties by between 1.0 and percentage points. In six Parties, however, an increase in reported total youth smoking prevalence ranging from 1.2 to 6.5 percentage points was observed. The remaining seven Parties identified showed a stable reported prevalence rate. In a separate analysis by gender, smoking prevalence among boys and girls decreased in 21 and 19 Parties, respectively, by more than 1 percentage point; increased in nine and 11 Parties for boys and girls, respectively, and was observed to be stable for the remaining Parties identified. Smokeless tobacco Forty-three Parties (33%) provided data on use of smokeless tobacco products by adults in their reports, and 41 provided these data broken down by gender, but very few countries have available comparable data allowing for trend analysis. Among the Parties that did not provide information on smokeless tobacco consumption, some stated that sales of smokeless tobacco were prohibited by law in their jurisdictions, while others indicated that they have not yet collected data on smokeless tobacco use. Some Parties provided observations on the trends in smokeless tobacco use. For example, Sweden reported that comparing and 2013 data, the share of daily snus/moist snuff users had increased slightly among women and decreased slightly among men, even though daily use rates remained significantly higher among men than women; and that observing over a longer period of time, daily snus use among men seemed to be declining whereas daily use among women was fluctuating. Norway reported an increase in daily use of snus during the last two years in most age groups, mainly concentrated among those younger than 45 years, and with the highest prevalence among the age group. In Poland, an increase in the prevalence of smokeless tobacco 66

77 4. Prevalence of tobacco use and related health and economic consequences use (chewing tobacco, oral and nasal snuff) both in male and female populations was also reported for the period On the other hand Panama saw a decrease from regarding consumption of snuff in the adult population from 1.3% to 0.8% overall, with similar decreases for both female and male smokeless tobacco use prevalence. In Nepal, smokeless tobacco use was observed to be decreasing from 2008 to /13. Tobacco use in ethnic groups 4 Twenty-eight of the 130 reporting Parties presented data on tobacco use by ethnic groups. Data in this section were not sufficient to enable conclusions to be drawn on the basis of comparisons between prevalence rates in different ethnic groups. Sixteen out of the 28 Parties reported an overall higher smoking prevalence among the studied ethnic groups than that of the general population. In Australia, Benin, Italy, Kazakhstan, Lao People s Democratic Republic, New Zealand, Singapore and Spain, specific ethnic groups showed significantly higher smoking prevalence rates. In seven Parties, smoking prevalence among ethnic groups was at the same level as the general population; and in five Parties the reported prevalence for the studied ethnic groups was below that of the general population. The differences observed between female and male smoking prevalence rates by ethnic groups were consistent with those observed in the general population in the majority of Parties, with the exception of New Zealand s indigenous community, where smoking prevalence was higher among women than men. In Sweden, prevalence by ethnic groups showed opposite trends by tobacco product, with snus use more prevalent among those with a Swedish origin, as opposed to smoking tobacco use, which was more prevalent among those with an origin other than Sweden. Variations in tobacco use among ethnic groups call for the development of specific approaches targeting such groups. In summary, while prevalence data collection and thus monitoring of tobacco use in the Parties has increased encouragingly, there is still a need for further strengthening of programmes in this area as required under Article 20.2 of the Convention. The collection of comparable data may now be strengthened in the Parties by using the WHO FCTC Indicator Compendium, 5 developed by the Convention Secretariat in consultation with the Parties, which could further promote the use of standardized indicators of the WHO FCTC reporting instrument in countries to ensure that data collected are comparable and can be analysed at regional and international levels. Comparable estimates for prevalence of smoking and smokeless tobacco use Apart from the analysis of data reported by the Parties, for the purpose of global and regional comparisons another exercise was completed with the assistance of WHO s Department for Prevention of Noncommunicable Diseases. In this exercise, data reported by the Parties, along with other prevalence data obtained by WHO, were used to calculate weighted average prevalence rates for all Parties to the WHO FCTC. 6 Indicators were disaggregated by adults and by youth and within each category by sex and by smoking and smokeless tobacco use. Globally, the weighted average adult smoking prevalence rates estimated for the year showed that 36% of males and 8% of females were current smokers. Rates were found to vary by regional groups of Parties as well as by country income groups. Current smoking rates among males was the highest in the WHO Western Pacific Region, and in the case of females in the European Region. By country income groups, the middle-income countries were found to have the highest smoking rates among males and high-income countries the highest rates among females. Weighted average prevalence rates of smokeless tobacco use showed that globally 12% of males and 7% of females currently use smokeless tobacco. Although the availability of data around smokeless tobacco use are slowly improving, there are still large data gaps globally and therefore these results are indicative only and should be used with caution. In terms of weighted averages among youth, globally the proportion of boys who smoke (16%) is almost three times that of girls (6%). In addition, 8% of boys and 6% of girls consume smokeless tobacco. Further details, including breakdown of figures by WHO region and country income group, can be found in Annex Tobacco-related mortality Around half of the Parties (68) reported that they have information on tobacco-related mortality in their jurisdictions, up from 50 and 15 67

78 GLOBAL PROGRESS REPORT Parties reporting the same in the and 2010 reporting cycles, respectively. Of the 68 parties, 45 actually gave the number of deaths attributable to tobacco use in their populations, and in most of these cases reported data originate from national studies. The reported figures show broad variations depending on the size of the country. The highest figures were reported by Parties with large populations such as China, with million tobacco-related deaths, the European Union (total of tobacco-related mortality cases in its 28 Member States) with deaths, and the Russian Federation, reporting tobaccorelated deaths. Seventeen Parties reported comparable data on mortality in both the and reporting periods (providing the latest figures available to them), a significant improvement since, when there were only two countries for which a comparison was possible. Of the 17 Parties, nine saw a decrease in the number of tobacco-related deaths (Brazil, Colombia, Estonia, Finland, Italy, Netherlands, Republic of Korea, Thailand and Ukraine), in two the figures were stable (Hungary, New Zealand) and six saw an increase in the number of tobacco-related deaths (China, Chile, Costa Rica, Cyprus, Malta and Spain). For example, China reported tobaccorelated deaths in, but only in. The increasing number of Parties reporting on tobacco-related mortality is encouraging. Nevertheless, research involving patterns of tobacco-related morbidity and mortality needs to be strengthened in many Parties, including through alignment of the methodologies employed to ensure international comparability of data. 4.3 Economic burden of tobacco use Two thirds (80) of the Parties indicated that they have developed and promoted research in the area of social and economic indicators related to tobacco use as required under Article 20.1(a) of the Convention but only one third of the Parties (41) actually provided data on economic costs related to tobacco use. Of these 41 Parties, three provided information on economic costs of tobacco-related diseases, without calculating the tobacco-related share; the remaining 38 Parties provided specific information on the tobacco-attributable costs. Most of those Parties provided numerical information with regard to direct and indirect costs of tobacco use on their societies. Four Parties (Chile, Islamic Republic of Iran (Islamic Republic of), Republic of Korea and Sweden) reported that new studies based on methodologies which provide solid ground for later comparative analyses with newer data have been carried out in their jurisdictions. Two Parties (Finland and Panama) reported the planning of comprehensive studies on the matter in. As tobacco-related costs continue to rise and impose heavy burdens on health systems, devoting resources to monitoring these costs and reporting reliable data will be increasingly important and related research should be strengthened in all Parties to the Convention. The sharing of know-how and the most suitable methodologies among the Parties, including formulae for the calculation of social costs, using tobacco-related morbidity and mortality available in national registries and databases, as well as further promotion of standard indicators used in the reporting instrument of the WHO FCTC, will contribute to making progress in this important area of research. References 1 Armenia, Australia, Belarus, Bulgaria, Congo, Finland, Germany, Hungary, Iceland, Ireland, Italy, Japan, Lithuania, Luxembourg, Mali, Marshall Islands, Mongolia, Montenegro, New Zealand, Norway, Pakistan, Poland, Republic of Korea, Russian Federation, Singapore, Spain, Sweden, Thailand, Tonga, Turkey, Ukraine, and United Kingdom of Great Britain and Northern Ireland. 2 Azerbaijan, Brunei Darussalam, Canada, Estonia, Islamic Republic of Iran (Islamic Republic of), Kazakhstan, Latvia, Netherlands, Panama, Republic of the Republic of Moldova, Seychelles and Slovenia. 3 Only Parties for which the most recent data were collected in 2011 or later were included in the analysis. 4 No formal definition of ethnic groups is provided in the reporting instrument, leaving the interpretation of which groups to include open to Parties. In some cases, Parties have referred to prevalence of tobacco use among indigenous populations whereas in other cases different nationalities, countries of origin, places of residence or birthplaces have been used as an indicator of ethnicity. 5 Available at: Compendium. 6 This work was carried out by WHO s Department of Prevention of Noncommunicable Diseases, which kindly provided such estimates to the Convention Secretariat. 68

79 Annex 1 Reports received from the Parties status as at 30 May Parties Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 1 Afghanistan 11-Nov-10 NA NA 15-Apr Apr-14 2 Albania 25-Jul Aug Apr Apr-14 3 Algeria 28-Sep Feb Apr Apr-14 4 Angola 19-Dec Antigua and Barbuda 03-Sep Sep Apr-12-6 Armenia 27-Feb Feb Jun Nov Apr-14 7 Australia 27-Feb Feb Oct Apr Apr-14 8 Austria 14-Dec Dec Apr Apr-14 9 Azerbaijan 30-Jan May Mar-11 NA 09-Apr Bahamas 01-Feb-10 NA NA 23-May Apr Bahrain 18-Jun Jun Apr Apr /13 Apr 12 Bangladesh 27-Feb Feb Mar May Apr Barbados 01-Feb Jul Apr Apr Belarus 07-Dec Apr Dec Apr Apr Belgium 30-Jan Nov Jan-11 NA 15-Apr Belize 15-Mar Apr Apr Benin 01-Feb Feb-11 NA 20-Mar Bhutan 27-Feb Feb Nov Apr Apr Bolivia (Plurinational State of) 14-Dec May Bosnia and Herzegovina 08-Oct-09 - NA 27-Apr Apr Botswana 01-May Dec Apr Brazil 01-Feb Jun Aug-11 NA 16-Apr Brunei Darussalam 27-Feb Jul Mar Mar Mar /5 Apr 24 Bulgaria 05-Feb Apr Feb-11 NA 17-Apr Burkina Faso 29-Oct Feb Apr Mar Burundi 20-Feb Jan Oct Cambodia 13-Feb Sep Feb-11 NA - continues... 69

80 GLOBAL PROGRESS REPORT... continued Parties Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 28 Cameroon 04-May Nov Oct Apr Canada 27-Feb Feb Mar Feb Apr Cabo Verde 02-Jan Central African Republic 05-Feb Jan Jun Chad 30-Apr Sep Apr Chile 11-Sep Jul May Feb China 09-Jan Apr Jul-11 NA 15-Apr Colombia 09-Jul Sep-10 NA 30-Apr Apr /30 Apr 36 Comoros 24-Apr May Apr Mar Congo 07-May May Apr Apr Cook Islands 27-Feb Feb Mar Feb Apr Costa Rica 19-Nov Mar-11 NA 25 Mar /12 Apr 40 Côte d Ivoire 11-Nov-10 NA NA 16-Aug Apr Croatia 12-Oct Jan-11 NA NA 25-Apr Cyprus 24-Jan Jul Aug-11 NA 15-Apr Czech Republic 30-Aug Apr Democratic People s Republic 26-Jul Apr-12 - of Korea 45 Democratic Republic of the 26-Jan Sep Congo 46 Denmark 16-Mar Apr Jul Apr May Djibouti 29-Oct Aug Apr Apr Dominica 22-Oct Ecuador 23-Oct Nov Apr Apr Egypt 26-May Apr Aug May Equatorial Guinea 16-Dec Estonia 25-Oct May Apr Apr Ethiopia* 23-Jun European Union 28-Sep Dec Nov Nov Apr Fiji 27-Feb May Apr Apr Finland 24-Apr Jul Apr Apr Apr France 27-Feb Jun Jul May Apr Gabon 21-May 09 - NA 22-Apr-12 6 Apr /27 Dec 59 Gambia 17-Dec Dec-09 NA 04-May Apr Georgia 15-May May Feb Apr Germany 16-Mar Jun Feb Apr Mar Ghana 27-Feb Feb Apr Jun Apr /30 Apr 70 continues...

81 ANNEX 1... continued Parties Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 63 Greece 27-Apr Oct May Grenada 12-Nov Apr Guatemala 14-Feb Apr Mar Guinea 05-Feb Guinea-Bissau 05-Feb Guyana 14-Dec Dec Jan-11 NA - 69 Honduras 17-May May Apr-11 NA - 70 Hungary 27-Feb Mar Feb Apr Apr Iceland 27-Feb Oct May Apr India 27-Feb Feb Jun Nov Islamic Republic of Iran (Islamic 04-Feb Apr Oct Apr-14 Republic of) 74 Iraq 15-Jun Jun May Apr Ireland 05-Feb Jul Mar-11 NA 15-Apr Israel 22-Nov Jul May Italy 30-Sep Oct-10 NA 27-Apr Apr Jamaica 05-Oct Jul Apr /15 Apr 79 Japan 27-Feb Feb Feb Apr Mar /1 Apr 80 Jordan 27-Feb Feb Feb Feb Apr Kazakhstan 22-Apr May Apr Apr Kenya 27-Feb Apr Sep Apr Kiribati 14-Dec Apr Kuwait 10-Aug Jun Jun-11 NA - 85 Kyrgyzstan 23-Aug Aug Apr Apr Lao People s Democratic 05-Dec Mar Feb Nov-13 Republic 87 Latvia 11-May Jul Mar Feb Apr /15 Apr 88 Lebanon 07-Mar Aug Mar-11 NA - 89 Lesotho 14-Apr Nov May May Liberia 14-Dec Libyan Arab Jamahirya 05-Sep Jun Apr Apr Lithuania 16-Mar Jan Apr Apr Apr Luxembourg 28-Sep Sep Nov Oct Apr Madagascar 27-Feb Feb Jan Feb Apr Malaysia 15-Dec Dec Dec Apr Mar Maldives 27-Feb Feb Apr Mali 17-Jan Mar Apr Apr Malta 27-Feb May Jan-11 NA 15-Apr-14 continues... 71

82 GLOBAL PROGRESS REPORT... continued 72 Parties Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 99 Marshall Islands 08-Mar Apr Mar Nov Apr Mauritania 26-Jan Dec Oct Apr Mauritius 27-Feb Feb Mar Aug Mar Mexico 27-Feb Feb Jun May Apr Federated States of Micronesia 16-Jun Jun Sep Apr Apr-14 (Federated States of) 104 Mongolia 21-Jan Feb Jan Jun Mar Montenegro 27-Feb Nov Nov-11 NA 04-Apr Myanmar 05-Feb Jan Apr Namibia 27-Feb Oct Oct-11 NA Nauru 05-Feb May Nepal 27-Apr Feb Apr Apr Netherlands 27-Feb Sep Apr Mar Apr New Zealand 08-Jul Feb Feb Jun Apr Nicaragua 23-Nov Niger 18-Jan Jan Apr Nigeria 01-Sep Nov Apr Niue 27-Feb Aug Nov Apr Norway 07-Jun Feb Mar Apr Apr /15 Apr 117 Oman 27-Feb Jun Oct Apr Apr Pakistan 27-Feb Feb Sep Jul Apr /24 Apr 119 Palau 27-Feb Feb Mar May Apr Panama 23-Aug Jun Feb Apr-12 7 Apr /7 Apr 121 Papua New Guinea 25-Dec Jun-09 NA - 16-Apr Paraguay 28-Feb Feb Apr Jan Peru 04-Sep May Mar Apr Philippines 14-Dec Sep Oct-11 NA 15-Apr Poland 06-Feb Jun May Apr Portugal 27-Feb Jun Apr-11 NA 08-Apr Qatar 14-Aug Feb Jul Mar Republic of Korea 04-May Sep Feb Jul Apr Republic of the Republic of 27-Feb-05 - NA 08-May Apr-14 Moldova 130 Romania 27-Apr Jun Apr Russian Federation 01-Sep Oct Apr Apr Rwanda 17-Jan Sep Apr Saint Kitts and Nevis 19-Sep-11 NA NA 25-May Saint Lucia 05-Feb Sep-12 - continues...

83 ANNEX 1... continued Parties Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 135 Saint Vincent and the Grenadines 27-Jan-11 NA NA 01-Jun Samoa 01-Feb Oct San Marino 27-Feb May Feb Apr Sao Tome and Principe 11-Jul Jul May Apr Saudi Arabia 07-Aug Oct Feb Apr Senegal 27-Apr Apr Apr Apr Serbia 09-May May May 11 NA 08-Apr Seychelles 27-Feb Mar May Mar Apr Sierra Leone 20-Aug-09 - NA 18-Jun Apr Singapore 27-Feb Apr Oct May Apr Slovakia 27-Feb Feb Mar Jun Apr Slovenia 13-Jun Nov Jun Apr Apr Solomon Islands 27-Feb Dec-11 NA 30-Apr South Africa 18-Jul Jul Dec May Mar Spain 11-Apr Jun Oct Apr Mar /2 Apr 150 Sri Lanka 27-Feb Feb Apr-11 NA Sudan 29-Jan Jan May Suriname 16-Mar-09 - NA 19-Mar Apr Swaziland 13-Apr Sep Mar Sweden 05-Oct Feb Nov Apr Apr Syrian Arab Republic 27-Feb Feb Apr Tajikistan 19-Sep Apr Thailand 27-Feb Feb Mar Nov Apr The former Yugoslav Republic 28-Sep Apr-14 of Macedonia 159 Timor-Leste 22-Mar Feb Togo 13-Feb Feb Apr Apr Tonga 07-Jul Jun Nov-11 NA 15 Apr /21 Apr 162 Trinidad and Tobago 27-Feb Apr Oct May Tunisia 05-Sep-10 NA NA 30-Apr Apr Turkey 31-Mar Jun Mar Apr-12 9 Apr /15 Apr 165 Turkmenistan 11-Aug-11 NA NA - 26-Mar Tuvalu 25-Dec Feb Jun Apr Uganda 18-Sep Sep Oct Apr Ukraine 04-Sep Sep Sep-11 NA 23 Mar /15 Mar 169 United Arab Emirates 05-Feb Jan Mar-12 - continues... 73

84 GLOBAL PROGRESS REPORT... continued Parties 170 United Kingdom of Great Britain and Northern Ireland Reports submitted in the initial ( ) reporting period Entry into force First (twoyear) report submitted Second (five-year) report submitted report submitted report/ additional questions submitted 16-Mar Feb Nov Apr Apr United Republic of Tanzania 29-Jul Nov Apr Uruguay 27-Feb Feb May Jul Apr Uzbekistan 13-Aug Apr Vanuatu 15-Dec Apr Venezuela (Bolivarian Republic 25-Sep Mar Sep Sep-13 - of) 176 Viet Nam 17-Mar Jun Sep-11 NA 15-Apr Yemen 23-May Nov-09 NA 19-Apr Apr Zambia 21-Aug-08 - NA - - * Due to report for the first time during the next reporting cycle. NA = Not applicable. - = Report not submitted. 74

85 Annex 2 List of indicators deriving from the reporting instrument used in assessing the current status of implementation Article 5 development and implementation of comprehensive, multisectoral, national tobaccocontrol strategies, plans and programmes* 1 existence of a focal point for tobacco control* existence of a tobacco-control unit existence of a national coordinating mechanism for tobacco control* protection of public health policies from commercial and other vested interests of the tobacco industry* public access to a wide range of information on tobacco industry activities required* Article 6 tax policies to reduce tobacco consumption implemented sales to international travellers of tobacco products prohibited or restricted tobacco imports by international travellers prohibited or restricted Article 8 tobacco smoking banned in indoor workplaces, public transport and indoor public places * comprehensiveness of protection in government buildings* 2 comprehensiveness of protection in healthcare facilities* comprehensiveness of protection in educational facilities* comprehensiveness of protection in universities comprehensiveness of protection in private workplaces* comprehensiveness of protection in aeroplanes comprehensiveness of protection in trains comprehensiveness of protection in ground public transport comprehensiveness of protection in ferries comprehensiveness of protection in motor vehicles used as places of work comprehensiveness of protection in private vehicles comprehensiveness of protection in cultural facilities* comprehensiveness of protection in shopping malls comprehensiveness of protection in pubs and bars* comprehensiveness of protection in nightclubs* comprehensiveness of protection in restaurants* Article 9 testing and measuring the contents of tobacco products required* testing and measuring the emissions of tobacco products required* regulating the contents of tobacco products required* regulating the emissions of tobacco products required* 75

86 GLOBAL PROGRESS REPORT Article 10 disclosure of information to government authorities about the contents of tobacco products required* disclosure of information to government authorities about the emissions of tobacco products required public disclosure of the contents of tobacco products required public disclosure of the emissions of tobacco products required Article 11 requiring that packaging of tobacco products does not carry advertisement or promotion misleading descriptors required* health warnings required* requiring that health warnings be approved by the competent national authority* rotated health warnings* large, clear, visible and legible health warnings required* health warnings occupying no less than 30% of the principal display areas required* health warnings occupying 50% or more of the principal display areas required* health warnings in the form of pictures or pictograms required* warning required in the principal language(s) of the country* Article 12 educational and public awareness programmes implemented* public agencies involved in programmes and strategies* nongovernmental organizations involved in programmes and strategies private organizations involved in programmes and strategies programmes are guided by research training programmes addressed to health workers implemented* training programmes addressed to community workers implemented training programmes addressed to social workers implemented training programmes addressed to media professionals implemented training programmes addressed to educators implemented training programmes addressed to decisionmakers implemented training programmes addressed to administrators implemented Article 13 comprehensive ban on all tobacco advertising promotion and sponsorship required* ban on display of tobacco products at points of sales required ban covering the domestic Internet required ban covering the global Internet required ban covering brand stretching and/or sharing required ban covering product placement required ban covering the depiction/use of tobacco in entertainment media required ban covering tobacco sponsorship of international events or activities required ban covering corporate social responsibility required ban covering cross-border advertising, promotion and sponsorship originating from the country s territory required* ban covering cross-border advertising promotion and sponsorship entering the country s territory required cooperation on the elimination of crossborder advertising penalties imposed for cross-border advertising Article 14 evidence-based comprehensive and integrated guidelines developed* media campaigns to promote tobacco cessation implemented programmes designed for underage girls and young women implemented programmes designed for women implemented programmes designed for pregnant women implemented telephone quitlines introduced local events to promote cessation of tobacco use implemented programmes to promote cessation in educational institutions designed 76

87 ANNEX 2 programmes to promote cessation in healthcare facilities designed programmes to promote cessation in workplaces designed programmes to promote cessation in sporting environments designed diagnosis and treatment included in national tobacco-control programmes diagnosis and treatment included in national health programmes diagnosis and treatment included in national education programmes diagnosis and treatment included in the health-care system tobacco dependence treatment incorporated in the curricula of medical schools tobacco dependence treatment incorporated in the curricula of dental schools tobacco dependence treatment incorporated in the curricula of nursing schools tobacco dependence treatment incorporated in the curricula of pharmacy schools accessibility and affordability of pharmaceutical products facilitated* Article 15 marking that assists in determining the origin of product required* marking that assists in identifying legally sold products required* statement on destination on all packages of tobacco products required tracking regime to further secure the distribution system developed legible marking required* monitoring of cross-border trade required information exchange facilitated legislation against illicit trade enacted* destruction of confiscated manufacturing equipment required storage and distribution of tobacco products regulated confiscation of proceeds derived from illicit trade enabled* cooperation to eliminate illicit trade promoted licensing actions to control production and distribution required* Article 16 sales of tobacco products to minors prohibited* clear and prominent indicators required requirement that sellers request evidence of full legal age ban on sale of tobacco in any directly accessible manner manufacture and sale of any objects in the form of tobacco products prohibited sale of tobacco products from vending machines prohibited distribution of free tobacco products to the public prohibited* distribution of free tobacco products to minors prohibited* sale of cigarettes individually or in small packets prohibited* penalties against sellers provided for* sales of tobacco products by minors prohibited* Article 17 viable alternatives for tobacco growers promoted viable alternatives for tobacco workers promoted viable alternatives for tobacco sellers promoted Article 18 measures in respect of tobacco cultivation considering the protection of the environment implemented measures in respect of tobacco cultivation considering the health of persons implemented measures in respect of tobacco manufacturing for the protection of the environment implemented measures in respect of tobacco manufacturing considering the health of persons implemented Article 19 any recorded launch of criminal and/or civil liability action legislative action taken against the tobacco industry for reimbursement of various costs 77

88 GLOBAL PROGRESS REPORT Article 20 research on determinants of tobacco consumption promoted* research on consequences of tobacco consumption promoted research on social and economic indicators promoted research on tobacco use among women promoted research on exposure to tobacco smoke promoted* research on identification of tobacco dependence treatment promoted research on alternative livelihoods promoted* training for those engaged in tobacco control provided* national system for surveillance of patterns of tobacco consumption established* national system for surveillance of determinants of tobacco consumption established national system for surveillance of consequences of tobacco consumption established national system for surveillance of indicators related to tobacco consumption established national system for surveillance of exposure to tobacco smoke established scientific and technical information exchanged* information on tobacco industry practices exchanged information on cultivation of tobacco exchanged database of laws and regulations on tobacco control established* database of information about the enforcement of laws established database of the pertinent jurisprudence established Article 22 assistance received on transfer of skills and technology assistance received on expertise for tobaccocontrol programmes assistance received in training and sensitization of personnel assistance received in equipment, supplies and logistics assistance received in tobacco control methods, e.g. treatment of nicotine addiction assistance received in research on affordability of addiction treatment international organizations encourage to provide support to developing country Parties. 1 Those indicators marked with an asterisk constitute the 59 that were also used for a comparative analysis as explained in section 2 of the report. 2 Those indicators in italics and bold constitute the time-bound measures. 78

89 Annex 3 Current status of implementation of SUBSTANTIVE ARTICLES by the Parties, by income group Parties with low-income economies 1 Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13* 2 (13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Afghanistan NA NA Bangladesh Benin Burkina Faso Gambia NA Kenya Kyrgyzstan Madagascar NA Mali Myanmar NA NA Nepal Sierra Leone Tajikistan NA NA Togo NA Uganda United Republic of Tanzania Number in parenthesis is the number of indicators considered under that article, and this is the maximum number (or score) which a Party can be given for complying with the requireemnts of that article. 2 Those articles marked with an asterisk include only the number of Parties to which the question in the reporting instrument was applicable. NA = Not applicable 79

90 GLOBAL PROGRESS REPORT Parties with lower-middle-income economies Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13* (13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Armenia NA Bhutan NA Cameroon Congo Côte d Ivoire Djibouti NA Georgia Ghana Kiribati Lao People s Democratic Republic Mauritania NA Federated States of Micronesia (Federated States of) Mongolia NA Nigeria Pakistan Papua New Guinea Paraguay Philippines Republic of the Republic of Moldova Sao Tome and Principe Senegal NA Solomon Islands Ukraine Uzbekistan Viet Nam Yemen

91 ANNEX 3 Parties with upper-middle-income economies Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13* (13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Albania Algeria Azerbaijan Belarus Belize NA NA Bosnia and Herzegovina Brazil Bulgaria China Colombia Costa Rica Ecuador Fiji Gabon Grenada NA NA Hungary Islamic Republic of Iran (Islamic Republic of) Iraq Jamaica NA Jordan Kazakhstan Libyan Arab Jamahirya NA NA Malaysia NA continues... 81

92 GLOBAL PROGRESS REPORT... continued Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13* (13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Maldives NA Marshall Islands NA NA Mauritius Mexico Montenegro Palau NA Panama NA NA Peru Romania Serbia Seychelles NA NA South Africa Suriname NA Thailand The former Yugoslav Republic of Macedonia Tonga NA NA Tunisia Turkey Turkmenistan NA Tuvalu NA Venezuela (Bolivarian Republic of)

93 ANNEX 3 Parties with high-income economies Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13*(13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Australia Austria NA Bahamas NA NA Bahrain Barbados NA NA Belgium Brunei Darussalam NA Canada Chile Croatia Cyprus NA NA Czech Republic NA Estonia NA NA Finland France Germany Iceland Ireland NA NA Italy Japan Latvia NA Lithuania NA NA Luxembourg NA NA Malta NA continues... 83

94 GLOBAL PROGRESS REPORT... continued Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13*(13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Netherlands NA New Zealand NA Norway NA Oman Poland Portugal Republic of Korea Russian Federation NA San Marino NA Saudi Arabia NA Singapore NA Slovakia NA NA Slovenia NA NA Spain Sweden United Kingdom of Great Britain and Northern Ireland NA NA Uruguay

95 ANNEX 3 Parties not classified by the World bank Article 5 (6) Article 6 (3) Article 8 (17) Article 9 (4) Article 10 (4) Article 11 (10) Article 12 (12) Article 13*(13) Article 14 (20) Article 15 (13) Article 16 (11) Article 17* (3) Article 18* (4) Article 19 (2) Article 20 (19) Article 22 (7) Country Cook Islands NA NA European Union Niue NA The European Union does not have competency in all areas considered in this calculation. 85

96

97 Annex 4 Progress in implementation between the and reporting periods 84 Article Article 16 Article 11 Article Article 5 Article Article Article 15 Article Article 14 Article Article Article 18 Article Article Article (%) (%) 87

98

99 Annex 5 Implementation rates of indicators used in the reporting instrument 1 Article/indicator name Article 5. General obligations Yes No Yes No comprehensive multisectoral national tobacco control strategy developed focal point for tobacco control exists tobacco control unit exists national coordinating mechanism for tobacco control exists interference by the tobacco industry public access to a wide range of information on the tobacco industry Article 6. Price and tax measures to reduce the demand for tobacco Yes No Yes No existence of information on tobacco-related mortality existence of information on the economic burden of tobacco use only specific tax levied only ad valorem tax levied combination of specific and ad valorem taxes levied tax policies to reduce tobacco consumption tobacco sales to international travellers prohibited tobacco imports by international travellers prohibited Article 8. Protection from exposure to tobacco smoke Yes No Yes No availability of data on exposure to tobacco smoke tobacco smoking banned in all public places national law providing for the ban subnational law(s) providing for the ban administrative and executive orders providing for the ban voluntary agreements providing for the ban mechanism/infrastructure for enforcement provided reports were included in the analysis for the reporting cycle and 146 were included for the reporting cycle. (%) (%) 89

100 GLOBAL PROGRESS REPORT Article 8. Comprehensiveness of measures applied (%) (%) Complete Partial None No answer Complete Partial None No answer comprehensiveness of protection in government buildings comprehensiveness of protection in health-care facilities comprehensiveness of protection in educational facilities, except universities comprehensiveness of protection in universities comprehensiveness of protection in private workplaces comprehensiveness of protection in aeroplanes comprehensiveness of protection in trains comprehensiveness of protection in ferries comprehensiveness of protection in ground public transport comprehensiveness of protection in motor vehicles used for work comprehensiveness of protection in private vehicles comprehensiveness of protection in cultural facilities comprehensiveness of protection in shopping malls comprehensiveness of protection in pubs and bars comprehensiveness of protection in nightclubs comprehensiveness of protection in restaurants

101 ANNEX 5 Article 9. Regulation of the contents of tobacco products Yes No Yes No testing and measuring the contents of tobacco products testing and measuring the emissions of tobacco products regulating the contents of tobacco products regulating the emissions of tobacco products Article 10. Regulation of tobacco product disclosures Yes No Yes No requiring disclosure of information about the contents of tobacco products requiring disclosure of information about the emissions of tobacco products requiring public disclosure on the contents of tobacco products requiring public disclosure on the emissions of tobacco products Article 11. Packaging and labelling of tobacco products Yes No Yes No packaging of tobacco products does not carry advertising or promotion misleading descriptors banned health warnings required health warnings approved by the competent national authority rotated health warnings large, clear, visible and legible health warnings required law mandates, as a minimum, a style, size and colour of font health warnings occupying no less than 30% required health warnings occupying 50% or more required health warnings in the form of pictures or pictograms required copyright to pictures owned by the Government granting of license for the use of health warnings information on constituents required on packages NC NC information on emissions required on packages NC NC warning required in the principal language(s) of the country (%) (%) 91

102 GLOBAL PROGRESS REPORT Article 12. Education, communication, training and public awareness Yes No Yes No implemented educational and public awareness programmes implemented educational programmes targeted to adults or the general public implemented educational programmes targeted to children and youth implemented educational programmes targeted to men implemented educational programmes targeted to women implemented educational programmes targeted to pregnant women implemented educational programmes targeted to ethnic groups age differences reflected in educational programmes gender differences reflected in educational programmes educational background differences reflected in educational programmes cultural differences reflected in educational programmes socioeconomic differences reflected in educational programmes programmes covering the health risks of tobacco consumption programmes covering the risks of exposure to tobacco smoke programmes covering the benefits of cessation of tobacco use programmes covering economic consequences of tobacco production programmes covering economic consequences of tobacco consumption programmes covering environmental consequences of tobacco production programmes covering environmental consequences of tobacco consumption public agencies involved in programmes and strategies NGOs involved in programmes and strategies private organizations involved in programmes and strategies programmes guided by research training programmes addressed to health workers training programmes addressed to community workers training programmes addressed to social workers training programmes addressed to media professionals training programmes addressed to educators training programmes addressed to decision-makers training programmes addressed to administrators (%) (%) 92

103 ANNEX 5 Article 13. Tobacco advertising, promotion and sponsorship Yes No Yes No comprehensive ban on all tobacco advertising, promotion and sponsorship instituted ban on display of tobacco products at points of sale ban covering the domestic Internet ban covering the global Internet ban covering brand stretching and/or sharing ban covering product placement ban covering the depiction/use of tobacco in entertainment media ban covering tobacco sponsorship ban covering corporate social responsibility ban covering cross-border advertising originating from the country ban covering cross-border advertising entering the country precluded by constitution from undertaking a comprehensive ban all tobacco advertising, promotion and sponsorship restricted cross-border advertising originating from the country restricted advertising by false and misleading means prohibited use of warnings to accompany all advertising required use of direct or indirect incentives restricted disclosure of advertising expenditures required advertising restricted on radio advertising restricted on television advertising restricted in print media advertising restricted on the domestic Internet advertising restricted on the global Internet sponsorship of international events and activities restricted tobacco sponsorship of participants therein restricted cooperation on the elimination of cross-border advertising penalties imposed for cross-border advertising (%) (%) 93

104 GLOBAL PROGRESS REPORT Article 14. Demand reduction measures concerning tobacco dependence and cessation Yes No Yes No evidence-based comprehensive and integrated guidelines developed implemented media campaigns on the importance of quitting implemented programmes specially designed for underage girls and young women implemented programmes specially designed for women implemented programmes specially designed for pregnant women implemented telephone quitlines implemented local events to promote cessation of tobacco use designed programmes to promote cessation in educational institutions designed programmes to promote cessation in health-care facilities designed programmes to promote cessation in workplaces designed programmes to promote cessation in sporting environments included diagnosis and treatment in national tobacco-control programmes included diagnosis and treatment in national health programmes included diagnosis and treatment in national educational programmes included diagnosis and treatment in the health-care system primary health care providing programmes on diagnosis and treatment secondary and tertiary health care providing programmes on diagnosis and treatment specialist health-care systems providing programmes on diagnosis and treatment specialized centres for cessation providing programmes on diagnosis and treatment rehabilitation centres providing programmes on diagnosis and treatment physicians offering counselling services dentists offering counselling services family doctors offering counselling services practitioners of traditional medicine offering counselling services nurses offering counselling services midwives offering counselling services pharmacists offering counselling services community workers offering counselling services social workers offering counselling services tobacco dependence treatment incorporated into the curricula of medical schools tobacco dependence treatment incorporated into the curricula of dentist schools tobacco dependence treatment incorporated into the curricula of nursing schools tobacco dependence treatment incorporated into the curricula of pharmacy schools accessibility and affordability of pharmaceutical products facilitated nicotine replacement therapy available treatment with bupropion available treatment with varenicline available (%) (%) 94

105 ANNEX 5 Article 14.2(b) and (c) services and treatment costs provided covered by public funding or reimbursement schemes (%) (%) Fully Partially None Fully Partially None programmes in primary health care covered by public funding programmes in secondary and tertiary health care covered by public funding programmes in specialist health-care systems covered by public funding programmes in specialized centres for cessation covered by public funding programmes in rehabilitation centres covered by public funding nicotine replacement therapy costs covered by public funding bupropion costs covered by public funding varenicline costs covered by public funding Article 15. Illicit trade in tobacco products Yes No Yes No marking that assists in determining the origin of product required marking that assists in identifying legally sold products required statement on destination required on all packages of tobacco products tracking regime to further secure the distribution system developed legible marking required monitoring of cross-border trade required information exchange facilitated legislation against illicit trade enacted requiring that confiscated manufacturing equipment be destroyed storage and distribution of tobacco products monitored confiscation of proceeds derived from illicit trade enabled cooperation to eliminate illicit trade promoted licensing required Article 16. Sales to and by minors Yes No Yes No sales of tobacco products to minors prohibited clear and prominent indicator required required that sellers request evidence that potential purchasers have reached full legal age ban of sale of tobacco in any directly accessible manner manufacture and sale of any objects in the form of tobacco products prohibited sale of tobacco products from vending machines prohibited tobacco vending machines not accessible to minors distribution of free tobacco products to the public prohibited distribution of free tobacco products to minors prohibited sale of cigarettes individually or in small packets prohibited penalties against sellers stipulated sale of tobacco products by minors prohibited (%) (%) 95

106 GLOBAL PROGRESS REPORT Article 17. Provision of support for economically viable alternative activities Yes No NA Yes No NA viable alternatives for tobacco growers promoted viable alternatives for tobacco workers promoted viable alternatives for tobacco sellers promoted Article 18. Protection of the environment and the health of persons Yes No NA Yes No NA measures implemented in respect of tobacco cultivation considering the protection of the environment measures implemented in respect of tobacco cultivation considering the health of persons measures implemented in respect of tobacco manufacturing for the protection of the environment measures implemented in respect of tobacco manufacturing considering the health of persons (%) (%) Article 19. Liability Yes No NA Yes No measures on criminal liability contained in the tobacco control legislation NC NC separate liability provisions on tobacco control outside the tobacco control legislation exist NC NC civil liability measures that are specific to tobacco control exist NC NC civil liability measures that could apply to tobacco control exist NC NC civil or criminal liability provisions that provide for compensation exist NC NC criminal and/or civil liability action launched by any person actions taken against the tobacco industry on reimbursement of costs related to tobacco use

107 ANNEX 5 Article 20. Research, surveillance and exchange of information Yes No Yes No research on determinants of tobacco consumption promoted research on consequences of tobacco consumption promoted research on social and economic indicators promoted research on tobacco use among women promoted research on exposure to tobacco smoke promoted research on identification of tobacco dependence treatment promoted research on alternative livelihoods promoted training for those engaged in tobacco control provided national system for surveillance of patterns of tobacco consumption established national system for surveillance of determinants of tobacco consumption established national system for surveillance of consequences of tobacco consumption established national system for surveillance of social, economic and health indicators established national system for surveillance of exposure to tobacco smoke established scientific and technical information exchanged information on tobacco industry practices exchanged information on cultivation of tobacco exchanged database of laws and regulations on tobacco control established database of information about the enforcement of laws established database of pertinent jurisprudence established Articles 22 & 26 International cooperation and assistance Yes No Yes No assistance provided on transfer of skills and technology expertise for tobacco-control programmes provided training and sensitization of personnel provided equipment, supplies, logistics provided methods for tobacco control, e.g. treatment of nicotine addiction provided assistance on research on affordability provided assistance received on transfer of skills and technology expertise for tobacco-control programmes received training and sensitization of personnel received equipment, supplies, logistics received methods for tobacco control, e.g. treatment of nicotine addiction received assistance on research on affordability received development institutions encouraged to provide financial assistance for developing country Parties specific gaps identified (%) (%) 97

108

109 Annex 6 Adult smoking prevalence 1 reported by the parties Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Afghanistan Albania NA Algeria Armenia 2009, Australia NC 2007, 2010/11, 2011/ Austria Azerbaijan 2009, Bahamas Bahrain Bangladesh continues... References 1 Whenever reported by the Parties, current smoking prevalence were included in the table. NC=datasets not comparable. NA=data not reported. 2 The list contains Parties that have submitted a report in the reporting cycle. 99

110 GLOBAL PROGRESS REPORT... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Barbados 2000, Belarus 2009, 2011, Belgium Belize 2006, NC Benin Bhutan Bosnia and Herzegovina 2007, /2010, NC Brazil Brunei Darussalam NC 2001, Bulgaria 2008, Burkina Faso 2007, NC Cameroon?, Canada 2008, 2010, Chile 2003, China Colombia Congo 2008, NC Cook Islands 2004, NC continues

111 ANNEX 6... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Costa Rica Cote D Ivoire Croatia NC 2007, Cyprus Czech Republic Djibouti 2006, NC Ecuador Estonia 2010, European Union 2010, Federated States of Micronesia Fiji Finland 2008, 2010, France 2005, Gabon NA Gambia Georgia continues

112 GLOBAL PROGRESS REPORT... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Germany 2006, 2009, Ghana Grenada NA Hungary Iceland 2007, 2009, , 2011, NC NC (with 2009) Iran 2009, Iraq Ireland Italy Jamaica , , 2011, , 2007/ NC NC (with 2009) NC Japan 2008, 2009, Jordan Kazakhstan NC 2007, Kenya 2008/ Kiribati 2004/ Kyrgyz Republic , NC Lao PDR 2003, NC Latvia 2008, 2010, continues

113 ANNEX 6... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Libya Lithuania 2008, Luxembourg 2009, 2011, Madagascar Malaysia 2006, NC Maldives Mali 2007, Malta Marshall Islands 2010, Mauritania Mautitius Mexico NC 2009, Mongolia 2009, Montenegro 2008, Myanmar Nepal 2008, / NC Netherlands 2009, 2011, New Zealand 2008, 2009, / continues

114 GLOBAL PROGRESS REPORT... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment Nigeria Niue 2006, 2011/ NC Norway 2009, 2011, Oman 2004, Pakistan NC 2006, / Palau NC Panama NC 2007, 2010, Papua New Guinea Paraguay 2003, NC Peru 2006, NC Philippines Poland 2009/10, Portugal Republic of Korea 2008, 2010, Republic of Moldova 2005, NC Republic of Serbia Romania Russian Federation 2009, continues

115 ANNEX 6... continued Parties 2 Year By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles 2004, Sierra Leone Singapore 2007, 2010, Slovakia Slovenia 2007, 2011/ Solomon Islands South Africa 2003, Spain 2006, 2009, 2011/ Suriname 2007, Sweden 2004, 2011, Tajikistan 2009/ Thailand 2009, 2011, Comment NC continues

116 GLOBAL PROGRESS REPORT... continued Parties 2 Year The Former Yugoslav Republic of Macedonia By 2010 Male Female Combined Percentage point change By 2010 Percentage point change By 2010 Percentage point change Comment NA Togo 2007, Tonga 2006, Tunisia Turkey 2008, 2010, Turkmenistan Tuvalu 2002, NC Uganda 2006, Ukraine 2008, United Kingdom of Great Britain and Northern Ireland 2008, 2010, United Republic of Tanzania 1992, NC Uruguay Uzbekistan Venezuela Viet Nam 2001/2002, NC Yemen

117 Annex 7 Estimated averages for tobacco use prevalence by WHO region and country income group Estimated averages for prevalence of smoking and smokeless tobacco use among adults by WHO region (%) WHO region Current smokers Male Daily smokers Current smokeless tobacco users Current smokers Female Daily smokers Current smokeless tobacco users African Americas South-East Asia European Eastern Mediterranean Western Pacific Global Estimated averages for prevalence of smoking tobacco use among adults by country income group (%) Country income groups Current smokers Male Daily smokers Current smokers Female Daily smokers Low-income Middle-income High-income Global

118 ISBN