Tobacco Control: What is being done to reduce global tobacco use?

Globally, tobacco is responsible for over eight million deaths every year. That is without counting the on-point-two million deaths related to second-hand smoke exposure. Needless to say, these numbers indicate the sheer size of the problem. Tobacco remains one of the biggest public health challenges worldwide. 

Despite decades of efforts to curtail tobacco use, smoking-related diseases remain a global burden. This is particularly expressed in low-income and middle-income countries. This article is an overview of regulations, policies, public health campaigns, and challenges in the ongoing battle to reduce tobacco use worldwide.

Is there a global strategy for tobacco control?

The efforts to reduce tobacco use are a global phenomenon. The health hazards of smoking have been known and scientifically confirmed for years. As a result, most nations have at least attempted to deal with this problem. More importantly, in 2003, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was adopted. Today it is the basis of international tobacco control efforts, ratified by 182 countries.

The WHO’s FCTC is the first global public health treaty. It is envisioned as a framework for the reduction of tobacco supply and demand through the use of evidence-based measures. According to FCTC, the key means to achieve this are:

• • Price and taxation increase

• • Smoke-free environments

• • Packaging and labeling

• • Advertisement bans

• • Support for smoking cessation

One of the most effective ways to reduce tobacco consumption is to increase the price of tobacco products through taxation. This works especially well in low-income and younger populations. Research results support this measure. Some studies show that a ten percent increase in price can lead to a four percent decrease in consumption in high-income countries and an eight percent decrease in low and middle-income countries.

Prohibiting smoking in public areas does not only protect non-smokers from second-hand smoke, it also de-normalizes smoking. It turns it into a socially unacceptable and segregated activity. Additionally, medical data shows that heart attack rates can go down by seventeen percent in the first year of smoke-free laws implementation. 

Health-related messages and graphic warnings on tobacco products can successfully raise awareness about the health risks and discourage use. Plain packaging is another effective idea. In Australia, for example, the introduction of plain packaging (2012) led to a twenty percent drop in smoking prevalence over five years. 

Advertising bans can reduce the appeal of tobacco products, especially among youth. Without flashy marketing campaigns, promotions, and sponsorship tobacco looks far less attractive. Norway is a great example of this. A complete ban on tobacco advertising there, between 2000 and 2020, led to a fifty percent decline in youth smoking rates.

A widespread and easy access to cessation programs and resources can help smokers to quit. It can also reduce the risk of relapse. Free cessation services, provided by the National Health Services (NHS) in the United Kingdom, include counseling and nicotine replacement therapy and have helped over a million people quit smoking since 2000.

Are there any positive examples of tobacco control?

Tobacco control strategies are very successful when implemented properly. However, this implementation requires financial resources, efficient and enforced legislation, and widespread availability of quitting services. Unfortunately, these are usually only available in high-income countries. Here are some examples of countries with a significant smoking decline due to tobacco control measures:

Australia

As of 2023, only eleven percent of adults in Australia are smokers. This is a historic low. The success is mainly attributed to a comprehensive strategy that includes:

• • High tobacco taxes

• • Advertisement bans (graphic warnings, plain packaging, etc.)

• • Public health campaigns

• • Enforcement of smoke-free laws

United Kingdom

We’ve already mentioned the invaluable role of the UK’s National Health Services in smoking cessation. However, the UK also introduced strict smoke-free laws (2007) and standardized packaging (2016). The result is only fourteen percent of adult smokers in 2023. 

Brazil

Brazil is not in the top ten richest countries in the world, and it was not in the top twenty when the first tobacco reduction efforts began. However, due to strong political will, partnerships with civil and international organizations, aggressive taxation, and advertisement bans smoking rates in this country went from thirty-nine percent in 1989 to only twelve percent in 2023.

Does the awareness of health risks matter?

In general, most of us are aware that smoking is bad for our health. But this has proven not to be enough. Cleverly designed public health campaigns have a much greater effect in educating the public about the dangers of tobacco use. 

Two great examples of such campaigns are Don’t Make Smokes Your Story (Australia) and Tips from Former Smokers (USA). Both have successfully increased attempts to quit and reduced initiation. These campaigns use personal stories of people affected by smoking-related illnesses for an emotional appeal to audiences. The USA campaign is attributed with 500.000 quit attempts. 

Why is the global adoption of the Framework Convention on Tobacco Control important?

A global problem requires a same-level response. Tobacco use qualifies perfectly for this analogy. The burden of smoking-related diseases deserves a coordinated and well-designed strategy and the widespread ratification of FCTC is just that. It represents a unified global effort to reduce tobacco use. 

Statistics also favor the implementation of FCTC measures. They show measurable improvements in public health. This includes healthcare costs and smoking-related death rates. Here’s an example. In Turkey, a traditional smoking society, the implementation of FCTC measures has reduced smoking rates in adults from thirty-one percent to twenty-seven percent since 2008. The measures included smoke-free laws and advertisement bans. But more importantly, the successful strategy required, included, and showcased the importance of political will to achieve tobacco control goals.

What are the main challenges in tobacco control?

Significant successes in global tobacco control often cast a shadow over the remaining challenges. But this does not mean they are not alive and well. Here’s an overview:

Tobacco Industry Interference

Tobacco is still a big and profitable business. Where’s business, there’s interest, and the interest of tobacco companies does not match the interest of public health. So, tobacco manufacturers use every opportunity to undermine tobacco control efforts. They use different tools and strategies, including marketing tactics, lobbying, and litigation. These are some examples:

Low and Middle-Income Countries (LMIC)

In low and middle-income countries, tobacco industry interference is the most common, and most expressed. These markets are usually targeted with aggressive advertising and affordable tobacco products. The regulatory frameworks also tend to be weaker in these places, and the political will can be swung more easily (e.g. corruption). Countries with large populations like Indonesia and India are good examples of this. In these countries, tobacco companies sponsor public events, use colorful packaging to attract new consumers and spend billions of dollars on marketing annually to target rural and low-income populations.

Innovative Products

Tobacco manufacturers market innovative alternatives to traditional smoking like heated tobacco products and e-cigarettes as “safer”. Thanks to new vaping aromas, such as mint and mango, more young people have decided to take on vaping. It has been described as an epidemic in the United States, with over five million new users as of 2023. These are worrying numbers since there are no studies about the long-term health effects of vaping.

Uneven Implementation of Policies

While high-income countries are making notable progress in tobacco reduction, LMICs struggle due to a lack of infrastructure and resources. In some places, the authorities struggle with implementing basic tobacco reduction strategies, such as taxation and law enforcement.

Dependence on tobacco farming and concerns about illicit trade are common causes of low tax rates. When tobacco is your main export, it is politically challenging to increase taxes, to say the least. Malawi is a great example. Tobacco export constitutes over sixty percent of the Eastern African country’s foreign exchange. 

Some countries have adopted smoke-free laws and advertisement bans but there’s little to no enforcement. Pakistan, for example, has smoke-free laws since 2002, yet smoking in public places remains widespread. 

Emerging Trends and Products

Technological advances and rapid expansion of e-cigarettes and vaping products are challenging tobacco reduction efforts. These products are appealing to the younger population in a way cigarettes could never be. Consequently, they are causing a surge in nicotine addiction in the general population.

The challenge for the legislative bodies now is to regulate these products without harming the tobacco reduction efforts. After all, e-cigarettes also help some cigarette smokers to quit. The United States has banned flavored e-cigarettes to prevent youth initiation. Similarly, the EU implements strict regulations on e-cigarette advertising and nicotine content.

Cultural and Social Factors

When we talk about tobacco, we cannot focus only on the physical addiction. The use of tobacco is deeply rooted in certain societies and cultural practices. Here are some examples:

Indigenous Communities

Indigenous communities in some places tend to have disproportionately higher smoking rates, compared to the national average. This phenomenon is usually attributed to broader cultural, social, and economic disparities. In Australia, for example, tobacco use rates among Indigenous people are double the national average.

India and South Asia

In this part of the world, smokeless tobacco products (gutka, paan) are a specific issue. Their wide cultural acceptance makes it almost impossible to introduce any control, regardless of the high percentage of oral cancers associated with their use. 

What are the biggest innovations in tobacco control?

Now that we’ve discussed the challenges, it is a good time to look at innovative approaches to tobacco control. The most important ones include:

• • Digital quitting tools

• • Endgame strategies

• • Global collaboration

Digital Quitting Tools

Digitalization made quitting more accessible. Various mobile applications, text messaging services, and online support groups offer motivational support, progress tracking, and personalized quit plans. The NHS has developed its app, Smokefree, that’s helping people quit smoking in the UK. However, these digital platforms and services remain more appealing to the younger population. 

Endgame Strategies

New Zealand has an ambitious strategy to ban tobacco sales by 2025. The goal of this “tobacco endgame” approach is to create a smoke-free generation, by prohibiting tobacco sales to anyone born after 2008. This is an example of bold tactics with a clear purpose, eliminating tobacco use for good!

Global Collaboration

Some privately-funded organizations offer support to low and middle-income countries in their efforts to reduce tobacco use. They usually provide technical support and funding. The Philippines showcases one successful example of such collaboration. The Sin Tax Reform Law, implemented there in 2012, significantly increased tobacco taxes and used part of the revenue to boost universal healthcare.

What is the role of public health campaigns?

Public health campaigns are a vital part of tobacco control efforts worldwide. All effective campaigns share certain characteristics, these are:

• • Emotional appeal

• • Targeted messaging

• • Consistency 

Fear, empathy, and similarly strong emotions resonate best with audiences. That’s why public health campaigns featuring individuals suffering from smoking-related illnesses are usually successful. 

Tailored messages aimed at specific demographics, equals best campaign outcomes. An anti-tobacco message for youth cannot be the same as the one intended for pregnant women. That is the bottom line.

Long-lasting, consistent campaigns do far better than one-off attempts. The highly successful Tips from Former Smokers (USA) campaign, which we mentioned earlier, has been running for over a decade. 

The Bottom Line

Tobacco control is potentially the greatest public health challenge of the last century. Despite everything, it is a success story. The global community has made huge steps in tobacco use reduction. However, we are still waging a war. But the good news is we know the winning strategy, and which tools we need to ultimately emerge victorious. We’ve achieved a lot and built a foundation to stand on. So, if we continue rising to the new challenges, we can free the world from the burden of tobacco-related illnesses. 

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