Recently launched MPOWER factsheets show uneven progress against the tobacco epidemic in the WHO European Region

WHO/Europe has released its much-anticipated MPOWER factsheets. These short briefs provide refreshed information on progress in the Region on the MPOWER measures – 6 critical routes by which countries can tackle the tobacco epidemic.

The breakdown of these measures is as follows:

• 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 advertising, promotion and sponsorship
• raise taxes on tobacco.

Need to tackle threats posed by new nicotine and tobacco products

Much of the data in the MPOWER factsheets are drawn from the eighth WHO report on the global tobacco epidemic published in 2021, which tracks the progress in adoption of evidence-based measures in tobacco control. The report focuses on new and emerging products, specifically on electronic nicotine delivery systems (ENDS), also known as e-cigarettes, providing up-to-date information on the ways in which different countries regulate these products. It also gives extensive guidance and recommendations on best practice for tackling ENDS.

The latest global report notes the new threat to tobacco control in the form of new and emerging products like ENDS. The European Region presents a varied picture of current e-cigarette use, with prevalence ranging from 0.7% in Spain (2020) to 10.5% in Estonia (2018) among adults, and from 2.8% in Kyrgyzstan (2019) to 41% in Monaco (2019) among adolescents. These products are harmful, they contain nicotine – a highly addictive substance – and other chemicals that can have deleterious impacts on brain development, leading to long-term consequences, in particular for children and adolescents. Despite this, they tend to be marketed as “clean” or “safer” alternatives to smoking by their manufacturers (mainly the tobacco industry) and their supporters, and often target young people and children. The report urges policy-makers to remain vigilant in their opposition to the tobacco industry and calls for strict regulation of these harmful products for the benefit of all.

Tobacco control efforts vary in impact among WHO European Region countries

The MPOWER measures cover a suite of interventions for the tobacco control community. They were introduced to assist in country-level implementation of effective interventions to reduce demand for tobacco. MPOWER measures only go so far, and implementing the WHO Framework Convention on Tobacco Control (WHO FCTC) in full provides a solid foundation for countries to implement and manage tobacco control.

Nonetheless, updates on the European Region’s progress with the MPOWER measures are extremely helpful in mapping successes and failures towards global goals, such as the target of a 30% relative reduction in tobacco use prevalence by 2025, compared to 2010.

In some cases, the European Region is a shining example to the rest of the world – such as its efforts to raise taxes on tobacco, with 53% of the European Region countries doing so at recommended high levels compared to 21% globally. However, nearly half of the European Region countries do so below best-practice level, representing a missed opportunity to deter smokers and raise revenue for tobacco control and the health sector more broadly.

In other areas, the European Region lags behind the global average, such as comprehensive smoke-free laws. Only 26% of countries in the Region ban smoking in public places (compared to 34% globally) and in 25 countries in the Region the laws are only partial. This is a crucial measure to protect bystanders from second-hand smoke, particularly in government facilities, indoor offices, restaurants, pubs and bars, and on public transport.

Elements of progress

Nonetheless, it is worth celebrating the advances that have been made: 14 countries now have completely smoke-free public spaces compared to just 4 in 2007. More countries are also monitoring tobacco use, offering help to quit tobacco, and ensuring larger health warnings on packaging than ever before. The elements of progress detailed in the MPOWER factsheets should serve as inspiring examples for other countries to follow suit.

With regard to progress on tobacco use amongst women and girls, the European Region is the only WHO region not expected to reach the female 30% relative reduction target by 2025. The picture is bleak for girls, too – according to the most recent surveys, in 26 out of the 42 countries in the Region that survey youth tobacco use, rates of current cigarette smoking among girls are similar to, or higher than, those of boys. This calls for gender-transformative policies to be woven through all tobacco control interventions, as well as for sensitivity to social determinants of health that may predispose some groups to take up smoking or e-cigarettes. Tobacco control efforts must remain focused on reducing tobacco use and avoiding distractions created by tobacco and related industries.

In the light of this uneven progress, it is more important than ever to emphasize the benefits of implementing the WHO FCTC in full. Almost every Member State in the Region is a signatory to the Convention, yet many have failed to fulfil their commitments within the time frames outlined by the Convention. Delivering on these commitments is therefore an urgent public health concern.

Source: WHO Europe