Figure 1-2. Estimated cumulative tobacco deaths 1950–2050 with different intervention strategies
Peto and others estimate 60 million tobacco deaths between 1950 and 2000 in developed countries. The figure estimates an additional 10 million between 1990 and 2000 in developing countries. It assumes no tobacco deaths before 1990 in developing countries and minimal tobacco deaths worldwide before 1950. Projections for deaths from 2000 are based on Peto (personal communication [1998]). Sources: Peto, Richard and others.
1994. Mortality from Smoking in Developed Countries 1950–2000. Oxford University Press; and Peto, Richard, personal communication.
Source: World Bank – Curbing the Epidemic (1999) 65
1.5 The development of tobacco control policy in the UK
The previous sections have outlined the importance of encouraging smokers to quit and preventing new smokers from starting to smoke.
These are the primary aims of tobacco control policy. It also aims to reduce exposure to environmental tobacco smoke (ETS) and smoking-related health inequalities. In the UK, tobacco control policy is primarily determined by the government, with additional influence in terms of both policy and legislation from the European Union and the Framework
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Convention on Tobacco Control. The role of each of these in shaping tobacco control policy in the UK is described in this section.
1.5.1 Government tobacco control policy in the UK
In 1998 the UK government published the first White Paper on tobacco control, ‗Smoking Kills‘.66 It defined a strategy which has shaped the comprehensive set of tobacco control policies implemented in the UK since then. The majority of the decrease in smoking prevalence in the UK in the past decade is attributed to ‗Smoking Kills‘. Its objectives were to:
Reduce smoking in children and young people
Help adults to stop smoking
Reduce smoking in manual groups as a step towards reducing inequalities
Offer particular help to pregnant smokers
It detailed a range of policy measures, most of which were implemented and remain in place today. These included:
A ban on tobacco advertising and sponsorship
Tobacco taxes rises
Enforcement of under-age sales
Reducing point-of-sale tobacco advertising
Introducing smoking cessation services
Facilitating access to smoking cessation medication
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Devolution since 1998 means that tobacco control policy is largely dealt with separately in England, Scotland, Wales and Northern Ireland, although some policy areas related to tobacco control, such as taxation, remain the responsibility of the UK government. However, ‗Smoking Kills‘
related to the whole of the UK, and as such many of the same steps to reduce the burden of smoking have been taken throughout the UK, albeit at somewhat different times.
In March 2011, a new tobacco control strategy, ‗A Tobacco Control Plan for England‘ was published.67 It committed to:
implementing legislation to end tobacco displays in shops
looking at whether the plain packaging of tobacco products
could be an effective way to reduce the number of young people who take up smoking and to support adult smokers who want to quit, and consulting on options by the end of the year
continuing to defend tobacco legislation against legal challenges
by the tobacco industry, including legislation to stop tobacco sales from vending machines from October 2011
continuing to follow a policy of using tax to maintain the high price of tobacco products
promoting effective local enforcement of tobacco legislation
encouraging more smokers to quit by using the most effective forms of support, through local stop smoking services
publishing a three-year marketing strategy for tobacco control
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The implementation of this plan is in its infancy, but the measures that have already been taken are described later in this chapter.
1.5.2 The EU and tobacco control in the UK
Health policy and the organisation, financing and management of healthcare are a national responsibility of EU member states. As such, the EU has limited powers in the area of tobacco control as well as broader health policy. It nonetheless has substantial influence on tobacco control policy in the UK and other Member States.
Article 168 of the Lisbon Treaty underlines the EU‘s role in fostering
cooperation and coordination in health policy between member states. Its most notable steps in this regard related to tobacco control have been two Council Recommendations, one on the prevention of smoking and on places, reduce prevalence and use cigarette price as a smoking deterrent.
The EU has also funded an EU-wide stop smoking campaign targeted at young people, HELP.
Due to the broad scope of tobacco control policy in the UK (which is described in detail in section 1.6), where smokefree legislation, mass media campaigns and other policies aimed at reducing smoking are in place, and the lack of power it has in health policy, it may appear that the
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EU has a limited role in tobacco control in the UK. However, its most substantial contribution to tobacco control has come in other policy areas.
The EU treaty states a requirement that all EU policies should protect health and, as a result, EU legislation has frequently incorporated aspects of tobacco control. Most notably, the EU single market rules have permitted (though not without resistance from the tobacco industry)70 the EU-wide implementation of legislation banning tobacco advertising (2003/33/EC) and on the manufacture, packaging and labelling of tobacco products (2001/37/EC, known as the Tobacco Products Directive (TPD), which is currently under review).71, 72
1.5.3 The WHO Framework Convention on Tobacco Control and MPOWER
Tobacco control policy in the UK and the EU is in line with the tobacco control policy framework set out by the World Health Organisation Framework Convention on Tobacco Control (FCTC). The FCTC is a global public health treaty, the objective of which is ―to protect present and
future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke‖.73 It was signed by the UK in 2003 and came into force in 2005.
The convention calls for parties, inter alia, to:
enact and undertake comprehensive bans on tobacco advertising, promotion and sponsorship
ban misleading and deceptive terms on cigarette packaging such as ‗light‘, ‗low-tar‘ and ‗mild‘
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implement rotating health warnings on tobacco packaging that cover at least 30 percent (ideally 50 percent or more) of the display areas
protect people from tobacco smoke exposure on public transport, and in indoor work and public places
adopt or maintain taxation policies aimed at reducing tobacco consumption
combat illicit trade in tobacco products
Further to this, in 2008 the World Health Organisation (WHO) published a report on the worldwide tobacco epidemic which proposed six policies to be implemented in order to achieve comprehensive and effective tobacco control, collectively named MPOWER.1 These policies are in line with the framework set out by the WHO FCTC.
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco,
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
These policies, and others, have been implemented in the UK in recent years.
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