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European Commissioner for Health and Consumer Protection

Changes in the air

Tobacco Control Conference
Limerick, 17-18 June 2004

It is a great honour and indeed a pleasure for me to open this important conference alongside my colleague and compatriot, Micheál Martin.

Tobacco control has been the central public health battleground for me throughout my term as European Commissioner for Health and Consumer Protection.

My role today is to provide the European dimension to improving the health and well being of citizens through effective tobacco control. I will first take stock of the key European achievements in tobacco control over recent years. I will then provide some thoughts for the elements of a possible European tobacco control road map for the future.

But before that – a reminder of the gravity of the tobacco problem: smoking remains the largest single cause of preventable death and disease in Europe.

At a conservative estimate tobacco kills over 650,000 people each year in the European Union. And this does not include deaths from passive smoking.

The European dimension to the fight against tobacco effectively began in 1987 with the establishment of the European Against Cancer Programme.

This programme heralded the start of the Community’s public health competence and acted as an important catalyst for Community action on tobacco control. In those days, many European countries had smoking rates, particularly for men, in excess of 50%.

Since those early days, Community tobacco control has developed in three broad areas – legislation; mobilising European and international action; and programme actions.

Of these, legislation remains the Community’s strongest suit.

Take the Tobacco Products Directive adopted in 2001. The EU was the first in the world to ban the use of misleading terms on cigarette packets that sought to convince consumers that some products were healthier than others.

The European Community and its Member States can also boast the most comprehensive advertising legislation in the world. The Advertising Directive adopted in 2003 comes close to offering Member States a complete ban on the advertising of tobacco products. The advertising ban only stops at the very limit of Community competence.

A complementary Council Recommendation on the prevention of smoking takes up where the Advertising Directive leaves off – such as by encouraging Member States to ban poster and billboard advertisements.

To get this far has been a long and difficult journey. Unfortunately it is not entirely over as there is now a legal challenge to the new Advertising Directive. I am, however, fully optimistic that the Court will find in our favour.

This leads me to a perhaps less visible area of achievement, but one which I think is just as important. I refer to the role played over the years by the positive influence and encouragement for tobacco control actions between the Member States and the Community.

This positive force flows both ways. For example it is hard to imagine that the Advertising Directive could have come into being without the example set in the early nineties by Italy, Portugal and France.

Similarly one achievement of the Community has been to provide a common forum where the national initiatives can be presented, disseminated and rolled out across the European Union.

Not only this – but also, most importantly, to provide minimum standards for those tobacco control activities that fall within the Community’s legal competence.

Nowhere is the positive power of influence better highlighted than in the Community’s involvement in the Framework Convention for Tobacco Control – the world’s first international health treaty.

Three weeks ago the Council of Ministers agreed to ratify the FCTC. Through our involvement in the development of the FCTC we have succeeded in propelling our high legislative standards relating to the marketing, sale and advertising of tobacco products into the international arena.

The FCTC is particularly important as the tobacco industry steps up its campaign in the developing world.

Beyond the legal sphere, a major area of Community effort and achievement has been its support to large scale tobacco prevention campaigns. The “Feel free to say no” campaign has been a valuable force in Europe to dissuade young people from taking up smoking.

The Community can also reflect proudly on its continued support to European programmes, particularly the networks which select and manage a series of large-scale actions in the area of prevention and cessation.

And the list of achievements goes on. Minimum values for excise tax on cigarettes were introduced in 1993 and increased in 2002. And by the end of 2004 the Commission will have created a library of colour photographs for use as warnings on tobacco products across the Union.

Last, but by no means least, I am delighted by the Council agreement of April this year to phase out production related subsidies to EU tobacco growers by 2010. This brings much needed coherence to European tobacco policy and gives a valuable boost to the Community’s tobacco control credibility.

Clearly we have achieved a great deal.

I mentioned that nearly two decades ago, smoking rates for men were often around 50%. Although results vary from country to country, many Member States have reduced their prevalence of male smokers, and some by as much as 15-20%. This translates into thousands of lives saved and sends out the important message: tobacco control works.

These are not the achievements of any one organisation or group. They represent the combined efforts of a tireless civil society, a number of very wise health professionals and academics, a small handful of extremely brave politicians, as well as committed civil servants at national and European level.

But now – back to business. Whilst we have won many individual battles we have yet to win the war against smoking. In parts of Europe, the average age for starting smoking is eleven. In many countries, smoking rates for women are actually increasing. Despite our many achievements it is clear that we simply cannot afford to rest on our laurels. We must keep up the momentum.

So where do we go from here? What should be our focus of activities for the years ahead?

To help answer these questions, I commissioned a consortium of leading European tobacco control experts to develop a Strategic Tobacco Control Report.

The Report, due to be published in this autumn, is shaping up to be a thorough, frank and hard hitting look at Tobacco Control in Europe. While recognising successes, it will be outspoken in identifying where the Community and the Member States can do more to prevent future deaths and morbidity from tobacco use.

We need greater efforts in the ‘denormalisation’ of tobacco and smoking. Such an approach is fundamental to a strategy that aims to prevent a new generation of children taking up smoking. And one that aims to help current smokers to quit.

I would like to see a special emphasis on cessation as it is often prevention alone that is highlighted. It is vital that we address the needs of the millions of smokers in Europe today, many of whom wish to stop – and wish they had never fallen into the tobacco trap in the first place.

We must step up our actions here. This means targeted awareness raising through information campaigns and better support services.

The widespread use of colour photographs on cigarettes packets would also play a valuable role in alienating the tobacco habit. There is evidence from Canada and other countries that pictorial warnings are effective in persuading people to attempt to quit.

And simply limiting the visibility of smoking is also a powerful way to reduce the social acceptability of tobacco.

And I would urge governments to follow the excellent example set by countries such as Ireland and Norway (and soon Sweden) by introducing smoking bans in all public places and workplaces.

The future of Europe must be smoke free. Countries face not just a public health, but also a moral imperative to protect their workers from the dangers of second-hand smoke.

In other parts of the world we can see the impact of more aggressive tobacco control measures. In California for example a tough mix of policies has been implemented. This includes widespread smoking bans, cessation services and simply reducing the availability of tobacco products.

At the same time, awareness raising campaigns have sought to inform the public of the behaviour of the tobacco industry. As a result, Californians are happier to accept tighter laws. As a result more smokers are making more attempts to stop and these attempts are more successful. And as a result, adult smoking prevalence is now below 17%.

Closer to home, health economists stress that raising the price of tobacco products is the most cost effective way to reduce the prevalence of smoking. For this reason, I urge the Community to continue to work together to raise the price of tobacco products.

In this area the European dimension is also important – a collective approach is essential if the efforts of individual countries are not to be undermined by cross border traffic.

If Member States are serious about addressing the escalating health costs that we face in our societies – these actions are the obvious starting point.

According to the economists, that money spent on awareness raising in tobacco control is the second most effective way to spend health funds, the most effective being childhood immunisation.

I mentioned the success of California. This has been achieved with a budget of roughly €4 per head of the population per year. The majority of Member States currently spend considerably less than €1 per head.

We must step up our investment. Otherwise we risk letting the tobacco industry off the hook. In the draft Strategic Report, experts will call for significantly more resources to be devoted to the regulation, research and communication of tobacco control.

Tobacco is one of the least regulated products in the world. This is incredible given the harm it causes. Very limited measures are in place and these are easy for industry to undermine.

Take the case of ingredients. How often do we see new reports of ingredients added to cigarettes to make them more appealing to children? The tobacco industry must be forced to comply with full disclosure for the contents of its products. After all, we expect nothing less from the food we buy.

It is clear that so many of these future policy directions are quite obvious. They should not require a moment’s thought. The scientific evidence behind them is absolutely robust. They are amongst the most cost-effective health interventions governments can ever make.

Strengthening tobacco control policies will help reduce the appalling burden of death and painful suffering for thousands of people cross Europe. In the process, they will have a major impact on the problem of crippling health care costs in most European countries.

So why are such policies not more widespread?

The answer of course is the pernicious influence of Big Tobacco and political vested interests. Europe urgently needs more of the brave politicians who are prepared to raise their heads above the parapet and put the health of citizens over the ruthless interests of the tobacco industry.

The more we do to help them by convincing citizens of our ideas, the easier will be their task.

Finally, I know that some politicians, whilst sympathetic to the broad aims of tough tobacco control, fear that they might be accused of “over control” – of creating a “nanny state” if they pursue bold and aggressive anti-tobacco policies. But I think the social climate is changing and the time is right to be courageous.

For example, last week the results of a UK opinion poll on attitudes to tobacco revealed widespread support for banning smoking in the workplace – including nearly two thirds of smokers. This is remarkable. It appears that we may be pushing at an open door. I would appeal to politicians across Europe to be bold – to force the pace of change – to fight hard towards the goal of a smoke-free Europe.

Thank you for your attention. I wish you all a successful conference.

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