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GLOBAL PROGRESS REPORT

on implementation of the WHO Framework Convention on

Tobacco Control

2014

2014 global progress report

on implementation of the WHO Framework Convention on Tobacco Control

WHO Library Cataloguing-in-Publication Data

2014 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 978 92 4 150777 6 (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 2014

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). 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 (www.who.int/about/licensing/copyright_form/en/index.html).

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

Contents

iii

Foreword v

Executive summary 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 11

3.1 General obligations (Article 5) 11

3.2 Reduction of demand for tobacco 17

3.3 Reduction of the supply of tobacco 45

3.4 Other provisions (liability, research and reporting) 52

4. Prevalence of tobacco use and related health and economic consequences 65

4.1 Prevalence of tobacco use 65

4.2 Tobacco-related mortality 67

4.3 Economic burden of tobacco use 68

Annexes

Annex 1: Reports received from the Parties – status as at 30 May 2014 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 2012 and 2014 reporting periods 87

Annex 5: Implementation rates of indicators used in the 2014 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

Foreword

V

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 2012 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 2014 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 organiza-tions, 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 fur-ther impetus and strengthen, when implemented fully and comprehensively, the impact of the Convention on the health of nations.

GLOBAL PROGRESS REPORT ■ 2014

vi

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 implemen-tation 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 implemen-tation 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 2014

executive summary

vii

The 2014 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 2014, a slight increase over 2012, and 168 Parties have submitted at least one implementation report since 2007. 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 infor-mation 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 2010. Progress is, however, uneven between different articles, with imple-mentation 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 posi-tive trends, which demonstrate the strong commitment of Parties to achieve full implementa-tion 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 promot-ing 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 time-bound provisions of the Convention, namely those in the area of health warnings and advertis-ing 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 insuf-ficient 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 exam-ples of cooperation with other Parties, international agencies and other partners. The reported rates for provision of assistance have actually decreased compared with 2012, however, which

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 con-cerns about the rapid growth in the use of such products, particularly electronic nicotine deliv-ery 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


1. INTRODUCTION

1

1. Introduction

This global progress report for 2014 is the sixth in the series. It has been prepared in accord-ance with the decisions taken by the Conference of the Parties (COP) at its first session (FCTC/COP1(14)), establishing reporting arrange-ments 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 implemen-tation 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 2014 reporting cycle;1 it also identifies strong achievements, innova-tive approaches and good practices used by the Parties to comply with the requirements of the Convention;

■ second, it tracks progress made in imple-mentation of the Convention between differ-ent reporting periods;

■ third, it draws conclusions on overall pro-gress, opportunities and challenges, and also proposes desirable key actions to be taken, by article, in the near future.

In the 2014 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 2012 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 2014 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 2014 reporting cycle are available in the public domain on the WHO FCTC web site.2

In the 2014 reporting cycle the Secretariat received reports from 130 Parties (73%) of the 177 that were due to report, a slight increase over the previous, 2012 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 implemen-tation of the Convention is based on the reports submitted by those 130 Parties3 (which represent 65% of the world’s population). In addition, 18 Parties4 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 pro-vided in Annex 1.

The report follows as closely as possible the structure of the Convention and that of the reporting instrument. ■

References1 The period for submission of Parties’ implementa-

tion reports was from 1 January to 15 April 2014. The Secretariat has been able to include, in this 2014 global progress report, the reports received within this period, as well as reports submitted by the Parties up to 30 April 2014.

2 See http://www.who.int/fctc/reporting/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


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

2. Overall prOgress in implementatiOn Of the cOnventiOn

3

2. overall progress in implementation of the Convention

Current status of implementation1

The status of implementation was assessed on the basis of information contained in the Parties’ 2014 implementation reports. A total of 148 indi-cators of implementation as reported by Parties through the reporting instrument were taken into account across 16 substantive articles2 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 con-cerned. The implementation rates of each article are calculated as the average of all indicators considered under that article. The overall imple-mentation rate of the Convention was calculated as the average of implementation rates of all sub-stantive articles.

Fig. 2.1 presents the average implementa-tion rate of each substantive article as reported by the Parties in 2014. 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 disclo-sures); 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);

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 pre-sented 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 2014.

Progress in implementation between reporting periods

With a view to assessing the progress made in implementation of the Convention between 2005 and 2014, 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 (2012 and 2014) reporting periods. To assess such progress, a

Fig. 2.1. Average implementation of substantive articles of the Convention by the Parties reporting in 2014

Article 17

Article 19

Article 22

Article 18

Article 9

Article 20

Article 14

Article 10

Article 15

Article 6

Article 13

Article 5

Article 12

Article 11

Article 16

Article 8

0 25 50 75 100

Average implementation rate (%)

84

73

70

70

65

63

62

60

58

51

51

40

48

37

14

13


subset of treaty-specific indicators from 13 arti-cles4 of the Convention were used, encompass-ing 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 com-parison, are presented in Annex 2.

Overall, the average rate of implementation of the treaty, when calculated by indicators compa-rable across all reporting cycles, increased stead-ily from 52% by 2010 and 56% in 2012 to 59% in 2014 (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 calcu-lated 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 percent-age 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

are a few articles, however, for which the changes across the reporting cycles are minimal or non-existent (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 posi-tive 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 2012 (Articles 8, 12 and 13).

Another comparison, between the find-ings from the two most recent reporting cycles (2012 and 2014), can also be made. Due to the stability of the core questionnaire of the report-ing instrument after 2010, a higher number of indicators can be used to assess progress between these reporting cycles, enabling a more

4

Fig. 2.2. Implementation rate of the WHO FCTC across all comparable indicators, 2010–2014

2010 2012 2014

Aver

age i

mpl

emen

tatio

n ra

te (%

)

40

45

50

55

60

52

56

59

Fig. 2.3. Implementation rates of substantive articles across the three reporting periods

5

8

9

10

11

12

13

14

15

16

19

20

22

0 25 50 75 100

Average implementation rate (%)

20142012By 2010

5757

61

4459

62

6663

66

6767

9191

5668

5154

59

6663

68

6875

81

3236

39

45

5256

2928

30

2420

17

80

73

70

47

46

48

Compr. advertising ban

Assistance provided

Assistance received

el ci tr A


5

comprehensive assessment of implementation status in 2012 and 2014 to be made, as well as of progress between the two cycles. In addition, the fact that reports of the Parties are now submit-ted 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 indica-tors 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 (concern-ing the size, rotation, content and legibility of health warnings, banning of misleading descrip-tors, etc.) and Article 13 (concerning adoption of a comprehensive ban and coverage of cross-border 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 guide-lines for implementation of this article recom-mend 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 time-bound requirements under Article 11 of the Convention was reported on by more than three quarters of the Parties, and substantial improve-ments were registered, particularly since the last reporting period in 2012. 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 con-sider 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 compre-hensiveness 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 2012 global progress report.5 Since then, for most of the Parties the three-year dead-line for implementation of Article 11 passed as did the five-year deadlines in relation to Articles 8 and 13. The sections concerning implementa-tion of Articles 8, 11 and 13 of this report further illustrate the level of implementation of the time-bound 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 innova-tive 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 sub-stantial reduction in consumption and associ-ated 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, out-door cafes (Australia, Canada and some others), sheltered walkways and hospital compounds (Singapore), outdoor markets (Fiji) and even some


6

streets (New Zealand). Reports also indicate that some Parties have extended smoke-free policies to other settings traditionally not covered by such reg-ulations, such as prisons (New Zealand) and pri-vate 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 prod-uct 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 addi-tives in tobacco products, in line with the guide-lines adopted by the COP in 2010. 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 picto-rial warnings (occupying, in general, more than 60% of principal display areas) on tobacco pack-ages (most recently Australia, European Union, Fiji, Nepal, Sri Lanka and Thailand). Another bold development in this area has been the adop-tion and implementation of a law requiring plain packaging of tobacco products. Australia was the

first country to do so in 2012, with some other countries considering a similar measure.

Tobacco advertising, promotion and sponsor-ship Several Parties in recent years have banned the display of tobacco products at points of sale – one of the last remaining means of adver-tising 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 exam-ple 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 2012, 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

Source: European Union, © European Union.


7

15 of the Convention, and when in force will sub-stantially strengthen the action in this important area of tobacco control.

National legislation Parties now tend to enact legislation in areas that were previously imple-mented 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 depend-ence, 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 comprehen-sive 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 governmen-tal 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 adop-tion by the Government of the United Kingdom of Great Britain and Northern Ireland, in 2014, 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 legisla-tion, 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

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 2013. European countries stated their ambition to work towards a tobacco-free Europe in the Ashgabat Declaration.7 This trend, first highlighted in the 2012 global progress report, demonstrates the growing determination of Parties to achieve tobacco-free societies through full implementa-tion of the WHO FCTC.

Some of the strong or innovative achieve-ments 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 assis-tance and exchanges of information under the Convention, the Secretariat has prepared a series of technical publications. These pub-lications are grouped into three series cover-ing, respectively, matters of global importance, matters of regional importance, and national best practices deriving from regional imple-mentation meetings. They can be found at: http://www.who.int/fctc/publications/techseries/.

Box 2.1. Enforcement of tobacco-control measures through mobile courts in Bangladesh

Since 2005, distr ic t and subdistr ic t of f icials 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.


8

Priorities, needs and gaps, challenges and barriers to implementation

In their reports, Parties provide information about their priorities and needs identified, chal-lenges 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 prior-ity 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 pre-venting interference by the tobacco industry and reinforcing their national coordinating mecha-nisms or focal points for tobacco control. Other priorities cited in relation to Article 5 were devel-opment 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 prior-ity articles were: Article 14 (Demand reduction measures concerning tobacco dependence and cessation), Article 8 (Protection from exposure to tobacco smoke), Article 11 (Packaging and label-ling 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 avail-able and the needs assessed for implementa-tion 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 laborato-ries 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 evalu-ation of cessation services. Hungary also stated that it requires adequate resources for prevention activities and research concerning tobacco cessa-tion, as well as for surveys as well as for the infra-structure required for testing of tobacco products. Thailand referred to budget constraints hinder-ing 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 ques-tions 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 coordi-nation. 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 guide-lines 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 tobacco-control measures to prevent, delay or weaken


9

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 inno-vative measures.

In recent years, increasing attention has been paid to the relationship between the WHO FCTC and international trade and investment agree-ments and the implications of this relationship for effective implementation of the Convention. This occurs against a background of legal chal-lenges to implementation of tobacco-control measures in WTO dispute settlement proceed-ings and under international investment agree-ments, as well as in domestic forums. In 2014, both Australia and Uruguay reported ongoing international legal disputes relating to imple-mentation of tobacco-control measures.

In addition to trade- and investment-related challenges, many governments are being chal-lenged by the tobacco industry in domestic courts in relation to WHO FCTC implemen-tation. Some of these challenges incorporate claims related to international trade law, high-lighting the relationship between international and domestic disputes. Domestic disputes are initiated in relation to measures implemented under various articles of the Convention. In 2014, Brazil and the Philippines reported legal chal-lenges 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 promo-tion (Article 13) was also initiated in Pakistan. Several Parties also reported that the tobacco industry had threatened legal challenges in rela-tion 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 indus-try 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. ■

References1 As at 30 April 2014.2 Due to the specific nature of data on tobacco taxation

and pricing and related policies, the status of imple-mentation 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 73–93 of the 2012 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 2013.

3. ImplementatIon of the ConventIon by provIsIon

11

3. Implementation of the Convention by provision

3.1 General obligations (Article 5)

This article requires Parties to establish essen-tial infrastructure for tobacco control, includ-ing a national coordinating mechanism, and to

develop and implement comprehensive multi-sectoral 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 implemen-tation 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 poli-cies, which have an overarching importance and impact on implementation of the Convention. The share of Parties reporting the development and implementation of comprehensive multisec-toral national strategies, plans and programmes has increased consistently from 49% in 2010 to 59% in 2012 and 68% in 2014.

Of the 88 Parties, more than a third reported having developed and implemented new programmes or strategies since the pre-vious reporting cycle. Twenty-five of them reported new, standalone national tobacco-control 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/strategies3 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 pro-tection 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 pro-gramme/strategy has decreased considerably in comparison with previous years. Sierra Leone and Uzbekistan reported that, although the programmes had been adopted, their coordi-nation 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.

■ Based on the reports received in the 2014 reporting cycle, the average of the imple-mentation rates for the Article 5 provisions1 is 65%, up from 60% in 2012.

■ Over two thirds of the Parties reported recent development, adoption and imple-mentation of national tobacco-control pro-grammes/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 cov-ered by action plans, indicating an increas-ing 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’ legisla-tion often allows such interference to take place.

■ Parties reported on creating synergies in the prevention and control of all risk fac-tors 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.

Key observations


12

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 indi-cated that they have established a tobacco-con-trol 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 mech-anism 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 estab-lished by law or by another executive or admin-istrative measure. Kenya, for example, indicated that membership of its Tobacco Control Board is to be extended to include donors and other stake-holders that provide funding for tobacco control activities.

An emerging trend within the Parties demon-strates the synergies that exist between prevention and control of the main risk factors for noncom-municable 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.


13

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 pro-grammes. 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 adminis-trative 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 legisla-tive, 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-con-trol 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 2012, while others (Bangladesh, Chile, Hungary, Mexico, Mongolia, Montenegro and Singapore) have reported amending parts of their tobacco-control leg-islation to strengthen and further align it with the requirements of the Convention. In total, 49 Parties5 adopted national legislation after ratify-ing the Convention; of those that already had legislation in place at the time of ratification, 86

reported that they strengthened their legislation after ratification (see Fig. 3.1). Overall, 135 (80%) of the Parties6 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 imple-mentation decrees are required to implement legislative and executive measures adopted by national parliaments. Parties’ experiences indi-cate that the time lag between the adoption of legislation and the development of such regula-tions 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 tobacco-control legislation is still missing; in addition, 17 Parties have not revised their pre-treaty tobacco-control 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 tobacco-control legislation: Parties have started includ-ing in such legislation several areas of the Convention that, in most countries, were tradi-tionally covered by national strategies or action plans (e.g. Article 5.3 – preventing tobacco industry interference; Article 12 – educa-tion and communication; Article 14 – tobacco

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 2013. The Committee is chaired by the Prime Minister and the deputy chair is the Minister of Labour, Health and Social Affairs. All relevant Government min-istries 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.


14

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 compre-hensiveness of such legislation and its degree of compliance with the Convention. Additional research will be needed in this area7.

Protection of public health policies from com-mercial 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 2012 report-ing 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 includ-ing references to Article 5.3 in their national tobacco-control, health or development plans. For example, Gabon dedicated a section in its leg-islation 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 guide-lines, 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 gov-ernments, 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 exam-ple, in Thailand, the guidance for civil servants on “How to contact tobacco entrepreneurs and related persons” entered into force in April 2013. Norway reported that in its National Tobacco Strategy 2013–2016 attention is given to assess-ing 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

Fig. 3.1. Strengthening of national legislation after ratifying the Convention

16 Parties (25%)still not adopted

national legislation

65 Parties (39%)did not have legislation

168 Partiessubmitted report

17 Parties (17%)have not revisedtheir legislation

103 Parties (61%)had legislation

103 Parties (61%)had legislation

135 Parties (80%)strengthened or adopted legislation

49 Parties (75%)adopted

legislation

Prior to ratification

After ratification86 Parties (83%)strengthened


86 Parties (83%)strengthened



15

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 commission-ing of an academic study on an effective strategy to implement Article 5.3, which also included recommendations on measures required nation-ally. Parties reported that they used the oppor-tunity of World No Tobacco Day 2012 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 nec-essary, and take place in the presence of repre-sentatives of civil society. Finally, some Parties

Box 3.2. United Kingdom of Great Britain and Northern Ireland: guidance for overseas posts

In March 2014, the Government published revised guid-ance 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 specif ic 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 support-ing receptions or high-prof ile 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 endors-ing projects that are funded directly or indirectly by the tobacco industry. Further details can be found at: https://www.gov.uk/government/publications/tobacco-industry-guidance-for-uk-overseas-posts

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.


16

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 prohib-iting advertising of tobacco products in print media targeting children, the tobacco indus-try 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 prod-ucts. Such loopholes in existing legislation need to be eliminated not only to ensure full compli-ance with the requirements of the Convention but also to prevent the tobacco industry from running activities that are described by them as “socially responsible.”


17

3.2 Reduction of demand for tobacco

Price and tax measures to reduce the demand for tobacco (Article 6)

Under this article Parties are expected to implement tax policies that contribute to the health objectives aimed at reducing tobacco consumption; the arti-cle also refers to prohibiting or restricting sales of tax- and duty-free tobacco products.

Of the 130 Parties providing an implementa-tion report, 129 provided some information for analysis of taxation and/or pricing of tobacco products.8 Most of the data used for such analy-sis refer to cigarette9 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 usu-ally 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 calcu-late 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 differ-ent 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 2014 and in the year of the previous report (2012 for most countries) is available. Only three coun-tries 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 com-bination of the two) have changed the tax rates they apply, while 33 have not. The changes are presented in Fig. 3.2.

■ Several positive trends that had been observed previously continued in the cur-rent reporting period. First, the proportion of countries levying excise taxes has further increased (to 92%, up from 67% in 2010 and 85% in 2012). Second, a combination of spe-cific 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 2012). However, there are still significant differences between Parties and regions in terms of levels of taxa-tion and prices of tobacco products.

■ More than two thirds of Parties increased tax rates since 2012.

■ 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 coun-tries a tax-driven reduction in tobacco con-sumption 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 2012 reporting cycle.

■ There is also an increasing number of coun-tries that prohibit or restrict sales to and imports by international travellers of tax- and 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.

Key observations


18

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 coun-tries 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 compo-nent in the combined tax increased between 2012 and 2014. A higher specific component reduces the relative price of higher- to lower-priced

brands, thus discouraging downward substitu-tion 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 ciga-rette prices. The average proportion among the reporting countries is 67%, which is higher than in 2012 (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 ciga-rette 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 infla-tion, the proportion of taxes became lower.

Prices Data on cigarette prices were reported on by 121 countries in the 2014 reporting period; for 102 countries, data on prices for 2014 and 2012 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

Table 3.1. Parties levying excise tax or import duty for cigarettes in 2014, by WHO region

WHO region Excise tax Import duty only

%Specific only

% Ad valorem only

% Both specific and ad valorem

% Total

African 7 30 11 49 3 13 2 8 23Americas 7 39 4 22 6 33 1 6 18South-East Asia 1 20 3 60 0 0 1 20 5European 9 19 0 38 79 1 2 48Eastern Mediterranean

2 16 3 25 5 42 2 17 12

Western Pacific 14 61 2 9 4 17 3 13 23Overall 40 31 23 18 56 43 10 8 129

Fig. 3.2. Percentage of Parties changing the tax rates they apply between the 2012 and 2014 reporting periods

Increased both specific

and ad valorem

Increased ad valorem tax

Increased specific tax

No changeChange in the specific and/or ad valorem component

of a system

29

247

9

31


19

13 countries and had declined in three countries (Bahamas, Bahrain and South Africa11).

Prices of topbacco products can have an impact on smokers’ behaviour if they reduce affordabil-ity 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 2012 and 2014 (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 pre-sents minimum and maximum cigarette prices in US dollars for 2014 by WHO region.12

There are large differences in prices within each region. The European Region has the larg-est 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 2012. This can be explained by changes in the cur-rency 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 usu-ally 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 2012 contrib-uted to a reduction in cigarette sales of 10% in 2013. 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 2012–2013, resulting in a reduction in sales of about 50% in 2013 com-pared with 2007–2009); and Ukraine (a ninefold increase in the weighted average of cigarette excise tax between 2008–2013 was accompanied by a drop in cigarette sales of 40% and by a three-fold 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 taxa-tion of tobacco products and the economics of tobacco

Tax- and duty-free tobacco products Nearly half (57) of the Parties reported that they pro-hibit or restrict duty-free sales to international travellers and 59% (77) of the Parties prohibit or restrict imports by international travellers of tax- and duty-free tobacco products, both reflecting notable increases as compared with 2012, when

Table 3.2. Minimum and maximum prices for a pack of 20 cigarettes in US dollars by WHO region in 2014

WHO region Minimum (country) Maximum (country) Ratio Number of countries

African 0.35 5.30 15.00 20Americas 1.00 7.80 7.80 17South-East Asia 0.35 2.40 6.90 5European 0.55 16.37 29.50 47Eastern Mediterranean 0.77 2.40 3.20 10Western Pacific 0.75 16.09 21.50 22


20

38 and 57 Parties, respectively, reported imple-menting 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 2014.

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 2012 provides for the distribu-tion of funds raised by tobacco excise, with 60% going towards diagnosis, treatment and preven-tion 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 pro-grammes and sports and recreational activities; in Jamaica, 5% of a special consumption tax and 20% of a consumption tax on tobacco are chan-nelled 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 2012, the Sin Tax Law increased tobacco and alcohol taxes and estab-lished 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 promo-tion programmes and expansion of the health infrastructure.


21

Protection from exposure to tobacco smoke (Article 8)

Article 8 addresses the adoption and implemen-tation of effective measures to provide protection from exposure to tobacco smoke in indoor work-places, 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 recom-mended 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 2014 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 interna-tional data collection tools, independent national health surveys, and work undertaken with local/international universities or through collabora-tion with national associations and societies. While many Parties provided high-quality infor-mation, 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 sys-tems or any household surveys that are repeat-edly conducted.

Overall implementation A total of 125 (96%) of the Parties reported that they implement meas-ures to protect their citizens from exposure to tobacco smoke by applying a ban (either com-plete 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 orders15 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 imple-mentation 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

■ Based on information received from the Parties in the 2014 reporting cycle, Article 8 has the highest average implementation rate (84%) by all substantive articles, up from 78% in 2012. If, however, only complete smoking bans are taken into account, the average implementation rate is lower (61%), though still higher than in 2012 (53%) owing to the fact that a higher number of Parties have introduced a complete ban.

■ Many Parties reported that they have intro-duced 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; how-ever, the increase in inclusion of bars and res-taurants in smoke-free areas by more than 10 percentage points compared with 2012 shows the increasing attention that Parties are paying to smoke-free policies.

■ Enforcement of smoke-free policies remains a challenge in many Parties; however, encour-agingly, 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 enforce-ment. Efforts to strengthen enforcement benefit from clear assignment of responsi-bilities to the relevant agencies, as well as strengthened cooperation between them.

Key observations


22

into account. Twelve other Parties reported that they have expanded the scope of their exist-ing 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 subna-tional 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 smok-ing 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 jurisdic-tions. 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 2015.

As recommended in the Article 8 guidelines, an education campaign leading to the implemen-tation of newly adopted legislation will increase the likelihood of smooth implementation and high levels of voluntary compliance. Fourteen

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 expo-sure 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 2012 and 2014 reporting cycles. The findings of this comparison are presented in Fig. 3.3.

Fig. 3.3. reveals that apart from aeroplanes and ground public transport, health-care facili-ties, educational facilities (universities excluded), government buildings and universities are the settings most frequently covered by a complete ban on tobacco smoking, while private work-places, pubs and bars and especially private vehi-cles are the least covered. At the same time it is encouraging to observe higher implementation rates of smoke-free policies in all settings, com-pared with the findings of 2012.

Mechanisms/infrastructure for enforcement Over three quarters (104) of the Parties reported that they have put in place a mechanism/

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 residen-tial premises or building (e.g. corridors, void decks and staircases); any covered or underground pedestrian walkway, whether permanent or temporary; any pedes-trian 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.


23

infrastructure for the enforcement of measures to protect their populations from exposure to tobacco smoke, a significant increase compared with 2012. Most Parties provided details, to vari-ous 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 organ-ization and operation of such systems made in the 2012 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 out-door 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 play-grounds, 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 regula-tions. These measures are scheduled to enter into force in July 2014. 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 guide-lines 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 viola-tions 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

Feel free! Every day we have more smoke-free places. Photo courtesy of Ministry of Health, Ecuador.


24

Fig. 3.3. Percentage of Parties applying various degrees of bans on tobacco smoking in 2014 and 2012, by setting

0 25 50 75 100

Private vehicles

Pubs and bars

Private workplaces

Nightclubs

Restaurants

Ferries

Trains

Shopping malls

Motor vehicles used for work

Universities

Cultural facilities

Government buildings

Educational facilities

Health-care facilities

Ground public transport

Aeroplanes

No answer/not applicableNonePartial Complete

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

10

8

87 4 3 6

84 5 4 7

82 9 2 7

75 12 5 8

81 15 1 3

77 18 5

80 16 4

2174 5

74 20 1 5

64 26 3 7

72 21 2 5

57 30 6 7

71 23 1 5

59 29 2 10

67 22 6 5

62 23 10 5

59 528 8

48 31 8 13

57 15 6 22

51 12 19 18

52 22 9 17

40 21 16 23

52 38 5 5

41 40 11 8

46 29 15 10

32 31 26 11

45 44 6 5

36 44 12 8

45 32 14 9

33 32 25 10

17 67 6

14 61 17

(%)


25

the enforcement of smoke-free measures, includ-ing by increasing fines, an “authentic interpreta-tion” issued by the Parliament concerning the Austrian National Tobacco Act entered into force in February 2014, stating that “it is reasonable for guests of hospitality venues to pass through smok-ing 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 smoke-free bylaws, the responsibility for implement-ing 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.


26

Regulation of the contents of tobacco products (Article 9) and regulation of the tobacco product disclosures (Article 10)

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 harm-ful effects of tobacco use. The COP adopted par-tial guidelines for implementation of Articles 9 and 10 in 2010, which were further amended in 2012, 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 indus-try against this measure. The revised Tobacco Products Directive of the European Union repre-sents a significant policy development, including, inter alia, for the implementation of Articles 9 and 10 through a ban on products with charac-terizing 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 informa-tion regarding their compliance with the previ-ous 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 implemen-tation 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 regula-tions. 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 emis-sions of tobacco products Fewer than half of the Parties reported that they require testing of con-tents and measurement of emissions of tobacco products (54 and 60 Parties, respectively).

■ 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 dis-closure of such information to the public.

■ Several Parties that have already developed relevant regulations reported on the short-age 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.

Key observations


27

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 contain-ing 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 men-tioned 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 f irst country to implement a nationwide cigarette fire safety standard in 2005. Since then, several countries have followed suit. Since 17 November 2011, only cigarettes with reduced igni-tion propensity have been legally sold in Bulgaria. All cigarettes on the market must conform to the standard EN 16 156:2010. 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 2014 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 2015.

Fig. 3.4. Percentage of Parties implementing provisions under Articles 9 and 10 in 2014 and 2012

0

25

50

75

100

EmissionsContentsEmissionsContents Disclosure of emissions

Disclosure of contents

Disclosure of emissions

Disclosure of contents

To the government To the public

No/no answer Yes

Testing Regulating

2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012

46

54

49

51

49

5155

45

54

4658

42

58

42

60

40

34

6638

62

38

62 47

53

46

54 53

47

51

4957

43

(%)


28

also the case in the previous reporting cycle. Fiji, Jamaica, Solomon Islands and Suriname indi-cated that they have relevant new legislation in place. Other Parties noted that new or updated laws are under development or considera-tion, 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 com-prehensive 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 pro-ject, Public Information on Tobacco Control (PITOC).19 Tobacco product disclosures are regulated by Government decision.


29

Packaging and labelling of tobacco products (Article 11)

Article 11 stipulates that each Party shall adopt and implement effective measures concern-ing 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 implementa-tion of this article to assist Parties in addressing these requirements of the treaty.

Health warnings Implementation rates of meas-ures under Article 11 concerning health warn-ings to which the three-year deadline applies are presented in Fig. 3.5, including the progress

■ 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 2014 reporting cycle, the average of the imple-mentation 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 2012) 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, occu-pying, on average, 60% or more of principal package areas.

■ One notable breakthrough was the adoption by Australia of the first ever legislation requir-ing 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 pic-torial 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 warn-ings and aims both at weakening legislation and delaying its application. As an impor-tant 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.

Key observations

Fig. 3.5. Percentage of Parties implementing the time-bound provisions under Article 11 in the past two reporting cycles

25 50 75 1000

50% or moreof principal dislay area

Pictures/pictogramsrequired

No less than 30%

Warnings rotated

Misleading descriptors banned

Approved by authority

Clear, visible and legible

Health warnings exist

No/no answer Yes

(%)

Requ

irem

ents

88

84

85

80

84

80

78

73

78

72

78

70

50

42

41

35

12

16

15

20

16

20

22

27

22

28

22

30

50

58

59

65

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012


30

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 warn-ings, e.g. their size, requirement for rotation, and prohibition of misleading messages, there is an increase of a few percentage points in implemen-tation rates; this is also reflected in the increas-ing 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 2012.

More than 70 Parties provided additional information on progress made in implement-ing Article 11, most of them reporting notable progress.

Use of pictorials Half of the reporting Parties indicated that they require pictorial health warn-ings on tobacco product packaging. Twenty-two of them reported that they have recently adopted legislation to introduce pictorial health warn-ings or to enforce the previously adopted legis-lation 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 legis-lation to implement Article 11. Introduction of pictorial health warnings remained particularly low in Africa. The Convention Secretariat facili-tated a South–South cooperation project to pro-mote the filling of this gap, which resulted in a library of images to be made available for use in the region by mid-2014 (see also Box 3.6).

Plain packaging Australia’s legislation already reported in the 2012 global progress report has now entered into force, and all tobacco prod-ucts manufactured in Australia for domestic consumption were required to be sold in plain packs, effective 1 October 2012, and the same requirement is applied to all tobacco products, effective 1 December 2012. The legislation pro-hibits tobacco industry logos, brand imagery, colours and promotional text other than brand and product names in a standard colour, posi-tion, 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 question-naire was reviewed with regard to this sub-ject, 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

Photo courtesy of Ministry of Health, Madagascar.


31

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 warn-ings 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 carry-ing 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 sec-tors of government responsible for trade and commerce, or interference from the tobacco industry in blocking or delaying the implementa-tion 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 meas-ures 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 consid-ered quitting because of them.

Regional cooperation Finally, some Parties also reported on regional efforts to facilitate imple-mentation 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 devel-oped 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.

T h e dat ab as e is maint a in e d by W H O an d is a v a i l a b l e a t h t t p : // w w w. w h o . i n t / t o b a c c o /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 grant-ing of licences to use pictorial health warnings to 22 Parties since 2010. 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 warn-ings 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 neighbour-ing 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.


32

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 tech-nical 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.


33

Education, communication, training and public awareness (Article 12)

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

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 edu-cational 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 employ-ees; officials of health ministries; parents; people living with disabilities, mental illnesses or living in disadvantaged areas; unemployed people; prisoners; law enforcement personnel; hospital-ity 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. 3.6. Percentage of Parties that reported targeting specific groups in educational and public awareness programmes

0 25 50 75 100

No Yes

Ethnic groups

Pregnant women

Men

Women

Adults or the general public

Children

6

33

27

31

69

94

100

77

73

69

31

(%)

■ Based on the reports received in the 2014 reporting cycle, the average of the imple-mentation 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 2012 global progress report.

■ The messages of communication pro-grammes still strongly focus on the health risks of tobacco use and benefits of cessa-tion, while economic and environmental consequences of tobacco use and especially tobacco production receive less coverage.

■ The trends concerning the targeting of dif-ferent segments of society with commu-nication programmes have also remained unchanged since 2012, 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 pro-grammes 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 devel-oped 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.

Key observations


34

disadvantaged groups. In Senegal, the first ever anti-tobacco media campaign was launched in April 2013. 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 imple-mentation of communication, education, train-ing 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 cam-paigns were not evaluated.

One of the areas that needs to be covered by research before the launching of communica-tion programmes is the analysis of key differ-ences between targeted population groups, in line with the implementation guidelines. Most

Parties consider age and gender in their pro-grammes (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 aware-ness programmes, including messages used20 (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 pre-sented in Fig. 3.8. In addition to the categories

Poster from the "Sponge" campaign in Senegal. Photo courtesy of Ministry of Health and Social Action.


35

set out in the reporting instrument, 13 Parties also reported targeting other, less frequently targeted groups, such as religious, social, com-munity and youth leaders; legal profession-als (lawyers and magistrates); police and local authorities; women’s organizations; universities;

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 pri-vate 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 men-tioned that coordination among different sectors of government and relevant agencies and organi-zations played an instrumental role in promoting educational and public awareness programmes. For example, the Ministry of Health in the

Fig. 3.7. Areas covered in Parties’ educational and public awareness programmes

No Yes

0 25 50 75 100

Environmental consequencesof tobacco production

Economic consequences of tobacco production

Environmental consequencesof tobacco use

Economic consequencesof tobacco use

Benefits ofcessation of use

Health risks of exposureto tobacco smoke

Health risks oftobacco use

100

1

4

18

35

59

59

99

96

82

65

41

41

(%)

Fig. 3.8. Percentage of Parties indicating specific targets of their training and sensitization programmes in 2014 and 2012

0

25

50

75

100

Social workersAdministratorsMedia professionalsCommunity workersDecision-makersEducatorsHealth workers

No/no answerYes

(%)

2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012

15

85

48484539

44444042

3733

24

16

525255

45

5561

56566058

6367

76

84


36

Marshall Islands works closely with other minis-tries and agencies and television and radio chan-nels 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 imple-mentation of education and public awareness pro-grammes, 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 fund-ing 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 pro-vision of mutual support for training or sensi-tization 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.

Sticker used in the anti-tobacco media campaign. Photo courtesy of Prevention Unit – Ministry of Health, Palau.


37

Tobacco advertising, promotion and sponsorship (Article 13)

Article 13 refers to the banning of tobacco adver-tising, promotion, and sponsorship. To be effec-tive, the ban should cover all types of advertising, promotion and sponsorship conducted by the tobacco industry. Effective monitoring, enforce-ment 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 advertis-ing, 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 comprehen-sive 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 spon-sorship 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 indi-cates that progress has been made in almost all media as far as the percentage of Parties’ requir-ing the respective measures are concerned.

Six Parties reported including advertising bans in their comprehensive tobacco control legisla-tion (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 regula-tions concerning tobacco advertising, Chile, Suriname, Togo and Ukraine reported that they

■ Based on the reports received in the 2014 reporting cycle, the average of the imple-mentation rates for Article 13 provisions is 63%,21 up from the 59% of 2012. Of the reporting Parties, 70% consider their adver-tising, promotion and sponsorship bans to be comprehensive, up from 66% in 2012. However, a significant percentage of the Parties are still to comply with this time-bound requirement of the Convention.

■ The findings indicate that Parties devote more attention to strengthening their laws and regulations concerning tobacco advertis-ing, promotion and sponsorship, with special regard to indirect tobacco advertising. One quarter of the Parties still only apply restric-tions 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, imple-mentation of bans on cross-border advertis-ing, 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 enforce-ment 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.

Key observations


38

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 per-centage points from 2012 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 smok-ing on the outer walls of tobacco stores, and South

Africa has improved its regulations to restrict dis-plays at points of sale (see also Box 3.7).

To eliminate the last forms of advertis-ing, promotion and sponsorship, Australia has required plain packaging of tobacco products since 1 December 2012; some other Parties are considering similar measures. More details are provided in the section on Article 11.

Two Parties reported that they have con-ducted research with regard to tobacco adver-tising, 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 sur-veillance are expected as a result of the observa-tions 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, includ-ing through distribution and use of promotional

Fig.3.9. Percentage of Parties reporting inclusion of selected provisions in their ban on tobacco advertising, promotion and sponsorship in 2014 and 2012

0

25

50

75

100

No/no answer

Global Internet

Display at points of sale

Corporate social responsibility

Cross-border originating

from territory

Brand stretching

Cross-border entering territory

Domestic Internet

Depiction in media

Product placement

Tobacco sponsorship

Yes

2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012

(%)

10 1218

2430

25

3427

33 3439

3438 37 37

46 48

68 71

10

90 90 8882

7670

75

6673

67 6661

6662 63 63

54 52

32 29


39

materials like signage, boards, ashtrays (Maldives) or at music events for young people (Portugal).

Cross-border advertising, promotion and spon-sorship As was also the case in the 2012 reporting period, among the problematic areas reported by Parties in the implementation of Article 13, the provisions relating to cross-border advertis-ing, promotion and sponsorship were frequently mentioned. Despite some improvement since 2012, this particular aspect of Article 13 gener-ally 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, promo-tion and sponsorship Parties that do not apply a comprehensive ban pursuant to the require-ments 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

tobacco advertising be accompanied by health warnings.

Box 3.7. Strengthening the ban on tobacco advertising, promotion and sponsorship in Palau

Significant progress has been made in Palau since February 2012, 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.

Photo courtesy of the Norwegian Directorate of Health.


40

Measures concerning tobacco dependence and cessation (Article 14)

Article 14 concerns the provision of support for reducing tobacco dependence and ces-sation, 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. 3.10. Most improvements concern the programmes using media campaigns, which 75% of Parties reported to be in place (com-pared with fewer than half of the Parties in 2012), 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 pro-grammes for uniformed services and Canada reported on new guidance on cessation at the workplace. Australia reported on a new pro-gramme to reach out to indigenous communi-ties. In 2012, Norway launched a national plan for systematic and evidence-based services for tobacco cessation. “Healthy living centres” were established in all regions, and cessation coun-sellors 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, indicat-ing the widespread recognition of the opportu-nities inherent in these settings. Around half of the Parties also reported implementing ces-sation programmes in educational institutions and workplaces (68 and 66 Parties, respectively) and one third (44) of the Parties include sport-ing 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 organiza-tions; prisons; cultural centres; and religious and workplace settings.

■ Based on the reports received in the 2014 reporting cycle, the average of the imple-mentation rates of indicators under this arti-cle is 51%, slightly up from 2012 (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 guide-lines, 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 inte-grating 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 addi-tion, many Parties still report limited avail-ability of pharmaceutical products used for the treatment of tobacco dependence.

■ The inclusion of tobacco dependence treat-ment 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.

Key observations


41

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 ser-vices in their national tobacco-control strategies, plans and programmes. Fifty-six Parties reported that they include these items in educational pro-grammes, plans and strategies.

Integration of cessation into health-care sys-tems Regarding the integration of diagnosis and treatment of tobacco dependence into health-care systems, almost three quarters (95) of the Parties reported doing so, and more than half of these Parties reported having established spe-cialized centres for cessation counselling and dependence treatment (see Fig. 3.11).

Fig. 3.10. Percentage of Parties reporting a specific programme to promote cessation of tobacco use in 2014 and 2012

0

25

50

75

100

Programmes for underage girls

Programmes for women

Telephone quitlines

Programmes for pregnant women

Media campaigns

Local events, e.g. WNTD

No/no answerYes

2014 2012 2014 2012 2014 2012 2014 2012 2014 2012 2014 2012

%

1215

25

55 5865

5864 68 70 70 73

88 85

75

45 4235

4236

32 30 3027

Fig. 3.11. Percentage of Parties reporting integration of cessation services into various levels of their health-care systems in 2014 and 2012

Rehabilitation centres

Cessation counselling treatment centres

Secondary and tertiary health care

Specialist health care

Primary health care

0 25 50 75 100

No/no answer Yes

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

66

77

77

23

23

65 35

34

60

58

40

42

60

52

40

48

33

25

67

75

(%)


42

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 par-ticipate in tobacco dependence treatment, for example centres providing psychiatric and neu-rological, drug treatment, and lung and chest care. Several Parties reported that private uni-versities, 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 ser-vices. 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 health-care system are fully reimbursed (a notable increase from 2012 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, includ-ing 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.

Advertisements from the "Health Benefits" campaign. © Commonwealth of Australia.


43

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 pre- and 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 pharma-ceutical products for the treatment of tobacco dependence More than half (77) of the Parties stated that they seek to ensure the accessibil-ity and affordability of treatment for tobacco dependence, including relevant pharmaceuti-cal products. Eighty-seven Parties reported the availability of nicotine replacement therapy (NRT); however, only 60 reported the availability

of varenicline and 66 of bupropion. This repre-sents an improvement since 2012 (74, 55 and 52 Parties, respectively). Other pharmaceutical products available for tobacco dependence treat-ment 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 avail-able 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 pre-scriptions were needed, 12 Parties reporting that over-the-counter sales were permitted; 10 Parties also reported that NRT was provided at hospi-tals, clinics, or other medical facilities. NRT was reported to be available for sale without prescrip-tion 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 health-care 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

Fig. 3.12. Percentage of Parties that reported the involvement of various health and other professionals in treatment and counselling services in 2014 and 2012

0

(%)

25 50 75 100

Practitioners oftraditional medicine

Communityworkers

Midwives

Social workers

Dentists

Pharmacists

Family doctors

Nurses

Physicians

No/no answer Yes

2014

2012 94

93

6

7

55

19

21

81

79

51

27

30

73

70

49

45

56

58

44

42

63

59

37

41

63

63

37

37

66

66

34

34

74

76

26

24

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012


44

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 pharma-cies 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 pri-vate 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 inno-vative 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 direc-tory/registry for tobacco cessation service pro-viders (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 health-care services and to provide support to NGOs that are active in tobacco cessation and treatment. Based on this mandate, the Ministry has introduced a compre-hensive set of measures. More than 150 smoking cessa-tion 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 guide-lines 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 cessa-tion 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.


45

3.3 Reduction of the supply of tobacco

Illicit trade in tobacco products (Article 15)

Article 15 concerns the commitment of Parties to eliminate all forms of illicit trade in tobacco prod-ucts. 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. 3.13 for imple-mentation 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, pro-vides 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

■ Based on the reports received in the 2014 reporting cycle, the average of implementa-tion rates for Article 15 provisions is 60%, up from the 54% seen in 2012, but it remains in the middle range of implementation of sub-stantive 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 com-pared with 2012 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 prod-ucts 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 trac-ing 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.

Key observations

Fig. 3.13. Percentage of Parties reporting on implementation of provisions under Article 15 in 2014 and 2012

0 25 50 75 100

Tracking and tracing

Carry the statement“sales only alowed...”

Collection of data on cross-border trade

Information exchange facilitated

Confiscation of proceeds

Marking to determinethe origin of product

Control of storage and distribution

Marking that the productis legally sold

Promoting cooperation in investigations

Destruction of proceeds

Marking is legible

Legislation against illicittrade enacted

No/no answer Yes

Licensing

7165

7064

7060

6862

6755

6666

6553

6462

6454

6245

5350

3836

2627

3529

3630

4030

3832

4533

3434

4735

3836

4636

5538

5047

6462

7374

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

(%)


46

decreased, three reported an increase. It should be noted that many Parties do not provide infor-mation on illicit trade. Burkina Faso and Senegal indicated that data exist, but that they are dif-ficult 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 deter-mining 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 lan-guages 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 ques-tion 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 monitor-ing 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 track-ing 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, includ-ing 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 stor-age 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, counter-feit and contraband cigarettes and other tobacco

products derived from illicit trade, using envi-ronmentally friendly methods where possible, or their disposal in accordance with national law.

Many Parties reported that they have intro-duced or strengthened enforcement measures, including increased penalties for tobacco smug-gling (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 intro-duced web-based customs software, which will enable customs to connect with other relevant systems, such as quarantine and immigrations.

Licensing Regarding the requirement for licens-ing or other actions to control or regulate pro-duction 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 licens-ing, 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 2012, the Parties to the WHO FCTC adopted the Protocol to Eliminate Illicit Trade in Tobacco Products22 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 2014. During that time, the Protocol was signed by 54 Parties to the WHO FCTC. As at June 2014, 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 establish-ing 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, techni-cal assistance, law enforcement cooperation, mutual legal assistance and extradition.


47

Promoting cooperation Eighty-seven Parties responded that they promote cooperation between national agencies and relevant regional and international intergovernmental organiza-tions with a view to eliminating illicit trade in tobacco products. Mali, Myanmar and Poland reported that they have improved multisec-toral cooperation on illicit trade within their jurisdictions.

In their implementation reports, many Parties referred to the negotiations, adoption and signa-ture of the Protocol to Eliminate in Illicit Trade in Tobacco Products. Several Parties are either already in the process of ratification or are work-ing towards ratification.


48

Sales to and by minors (Article 16)

This article requires Parties to adopt and imple-ment measures to prohibit sales of tobacco products to and by minors as well as other meas-ures 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 prod-ucts by minors, up from two thirds of the Parties in the 2012 reporting cycle. Implementation rates of other requirements under this article, in com-parison with implementation rates measured in 2012, are shown in Fig. 3.14.

Fifty-two Parties reported making progress in implementation of this article since the last reporting period, and 17 Parties reported adopt-ing new or upgrading existing legislation to strengthen measures under this article (see also Box 3.10).

Circumstances of tobacco sales One of the provi-sions 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 super-vise sales through such instruments (Malta) or

■ Based on the 2014 reports, the average of the implementation rates for the provisions under Article 16 is 73%, the second high-est among all substantive articles of the Convention, and further up from the 67% seen in 2012.

■ Most progress has been achieved through adopting new or strengthening existing leg-islation, 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.

Key observations

Fig. 3.14. Percentage of Parties reporting implementation of Article 16 provisions in the 2014 and 2012 reporting cycles

0 25 50 75 100

Sales from open storeshelves banned

Sales of tobacco fromvending machines prohibited

Sweet, snacks, toys in formof tobacco prohibited

Tobacco vending machinesnot accessible to minors

Sellers to requestproof of age

Sale in small packsprohibited

Placing prominentindicator at POS

Sales by minors prohibited

Penalties againstsellers provided for

Distribution of free samplesto the public prohibited

Distribution of free samplesto minors prohibited

Sales to minors prohibited

No/no answer Yes

14991

86

82

8482

8273

7666

6960

6867

6659

6552

6259

62

54

5549

87

18

13

1816

18

24

27

31

34

32

40

34

33

41

4835

4138

46

38

5145

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

20142012

(%)


49

allowing the machine to check the age of buyer through smart card reading systems. Finland reported forbidding sales of tobacco from auto-matic 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 vend-ing machines in their jurisdictions.

Another area of notable progress is the place-ment 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.

Penalties against sellers There has also been notable progress in providing for penalties against sellers and distributors to ensure com-pliance (see Fig. 3.14). Full and effective enforce-ment 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 enforce-ment 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.

Box 3.10. Reducing young people’s access to tobacco in Hungary

In September 2012 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 40 000 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.


50

Tobacco growing and support for economically viable alternatives (Article 17) and protection of the environment and the health of persons (Article 18)

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 pro-ducing 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 (400 000) and Brazil (716 000) 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 prod-uct (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 grow-ers, with 11 Parties enforcing replacement of tobacco farming with other agricultural pro-grammes, 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 agro-nomic 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

■ Based solely on the reports of Parties indi-cating 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 nota-ble increase in the implementation rates of these articles as compared with 2012, they still remained two of the least implemented articles of the Convention.

■ In the meantime, new evidence is emerg-ing as Parties pay greater attention to these areas, with several Parties providing exam-ples of how alternative livelihoods to tobacco growing have been promoted and the envi-ronmental consequences of tobacco grow-ing and production addressed. Promotion and sharing of good practices could be the focus of future work in these areas to improve implementation of these challeng-ing 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 work-ing group on Articles 17 and 18 (document FCTC/COP/6/12) contains policy options and recommendations on economically sustain-able alternatives to tobacco growing.

Key observations


51

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 protec-tion of the environment and 28 Parties indicated that they consider the health of persons in rela-tion 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 protec-tion of the environment, and 34 Parties indicated that they consider the health of persons in rela-tion 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 regard-ing 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 refor-estation and soil water management. China implements measures to improve energy savings and reduce emissions in the cigarette manufac-turing process. Standards for reduced ignition propensity cigarettes are enforced in Bulgaria, Republic of Korea and South Africa. Costa Rica

is currently working on legislation to classify cig-arette 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.

Box 3.11. 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 2005. 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 2012, 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 55 000 families. The programme invested more than US$ 12 million between 2005 and 2012 to provide technical assistance and rural extension training and research to support the diversification process.

In 2012, 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 10 000 households that were producing tobacco with investments of over US$ 5 million. In 2012, 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.


52

3.4 Other provisions (liability, research and reporting)

Liability (Article 19)

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 implementa-tion from the 2012 reporting period, in which one quarter of the Parties reported having imple-mented any measures to tackle liability (see also Box 3.12).

In 2014, only 18% of Parties reported that any person in their jurisdiction had launched a crimi-nal 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

■ Based on the 2014 reports, the average of the implementation rates for the Article 19 pro-visions is 14%, the second-lowest among all substantive articles of the Convention, but up from the 10% of 2012.

■ Implementation of Article 19 is lower in rela-tion to the implementation or use of liabil-ity 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 liabil-ity, 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.

Key observations

Box 3.12. Republic of Korea prepares litigation against the tobacco industry

In April 2014, the National Health Insurance Service (NHIS) of the Republic of Korea announced that it is pre-paring 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 2002. 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 associ-ated with smoking. The lawsuit is the first undertaken by a State organization against tobacco firms among the Parties in the Western Pacific Region.


53

Article 19. In 2014 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 rel-evant costs.

Criminal liability was most commonly identi-fied as being available as recourse for breaches of tobacco-control legislation. Almost half (48%) of the Parties reported having measures regarding crimi-nal liability in place in their tobacco control legisla-tion, 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 liabil-ity were available in relation to offences against a wide range of tobacco control laws, including laws relating to smuggling, advertising prohibi-tions, packaging and labelling measures, outdoor smoking bans and taxation measures.


54

Research, surveillance and exchange of information (Article 20)

In this article the Parties undertake to develop and promote national research and to coordi-nate 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 eco-nomic indicators related to tobacco consump-tion. As in 2012, 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 indi-cated under Article 20.1 as requiring promotion and encouragement.

Parties reported that they have conducted research on key issues related to strengthen-ing tobacco control and implementation of the Convention. Seven Parties have conducted research on how to implement national poli-cies, legislation and regulations more effectively. Three Parties have conducted public opinion sur-veys 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 pos-sible impact of options for further regulation of the contents of tobacco products.

■ 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 sig-nificant increase since 2012; there is also a notable increase in the number of Parties covering tobacco-related social, economic and health indicators in their national sur-veillance 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 identifica-tion of effective programmes for the treat-ment 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 under-taking such research.

Key observations

Fig. 3.15. Percentage of Parties reporting implementation of research activities, by topic, in 2014 and 2012

0 25 50 75 100

Alternativelivelihoods

Treatment of dependence

Tobacco useamong women

Exposure totobacco smoke

Social and economicindicators

Consequences oftobacco use

Determinants oftobacco use

No/no answer Yes

32

36

32

45

38

47

42

47

52

55

55

58

85

84

68

64

68

55

62

53

58

53

48

45

45

42

15

16

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

(%)


55

Other areas of research reported by the Parties include: health warnings; cessation of tobacco use; tobacco use in pregnancy; smok-ing-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 con-ducted 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 legisla-tion in Europe, published a qualitative study in March 2012 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 2012.

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 collabo-ration between stakeholders. In Sweden, the National Tobacco Control Commission financed several projects aimed at developing methods for tobacco prevention and supporting dissemina-tion of evidence-based methods.

National systems for epidemiological surveil-lance 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 determi-nants of tobacco consumption, and 59 Parties that they cover the consequences of tobacco con-sumption. There is a significant increase since the previous reporting period in the number of Parties that reported covering social, eco-nomic and health indicators related to tobacco consumption.

Many Parties provided additional informa-tion on their regular collection of tobacco-related data. Most of them are conducting surveys assess-ing 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 profession-als. Other Parties reported recently implement-ing 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 resolu-tion of the Government, the Russian Federation established a procedure for monitoring and eval-uating 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 2014) 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, tech-nical, socioeconomic, commercial, or legal infor-mation; 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 per-centage points compared with 2012.

Database on laws and regulations Around two thirds (89) of the Parties reported that they main-tain a database of national laws and regulations


56

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 regula-tions. In addition, the Supreme Court’s web page makes available all its rulings on pertinent juris-prudence, by subject matter, including rulings relevant to tobacco control.


57

Article 21 (Reporting and exchange of information)

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 fre-quency and format of such reports.

Status of reporting by the Parties Before 2012, 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 2012, Parties’ reports are expected biennially, in designated reporting periods, with deadlines of six months before the next regular session of the COP.

In 2012, 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 2012 global progress report. Additionally, 20 Parties reporting for the 2012 reporting cycle submitted their reports after the deadline, and they were counted as 2012 reports.25

In the 2014 reporting cycle, between 1 January and 30 April 2014, 130 Parties (73% of the 177 that were due to report) submitted an implementa-tion 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, tobacco-related 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 prod-ucts, tobacco growing, taxation and prices of tobacco products, tobacco-related morbid-ity, mortality and economic costs, need to be strengthened. Some Parties have indicated that such information is either not available or is dif-ficult 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 implementa-tion reports in the 2014 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 pro-vides 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 2014, when this document was finalized, the Secretariat had received at least one implementation report from 168 out of the 178 Parties27 (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 report-ing cycle.

For the first time in the 2014 reporting cycle, the Parties to the Convention have had the opportunity to report on their use of the imple-mentation guidelines adopted by the COP. The Convention Secretariat developed, with input from the Parties, an online questionnaire to facilitate voluntary submission of information

■ The transition to the revised, biennial report-ing cycle has been completed smoothly, with more than 70% of the Parties submitting their 2012 and 2014 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 pric-ing 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 implementa-tion reports needs to be strengthened to ensure that preparation of national reports becomes a joint and coordinated exercise.

Key observations


58

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 2014 reporting period. Information received therein was reflected in this report.

The status of reporting by the Parties, includ-ing the number of reports and submission dates, is provided in Annex 1.28

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 sub-stantial 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 con-cerned Parties in April 2013, requesting them to respond to a few questions concerning their rea-sons for not/delayed reporting. Of the 31 Parties contacted, two responded by sending their out-standing 2012 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 compara-ble 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 mecha-nisms to promote the reporting system of the Convention and to train officers responsible for reporting, for example by holding reporting ses-sions within regional meetings on implemen-tation of the Convention. The Secretariat has also established an Internet-based forum for

discussing reporting and exchange of informa-tion. In addition, at the beginning of the 2014 reporting cycle, web-based training sessions were held to further inform and train interested officials. About half of the Parties received assis-tance through web-based and face-to-face train-ing and invidualized advice through telephone or electronic means (e-mail or the information exchange platform). The assistance and clari-fications 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 under-standing 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 sev-eral 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 2014 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 COP29 and in cooperation with WHO, developed and made available to Parties, for their use in the 2014 reporting cycle and beyond, a WHO FCTC Indicator Compendium. Integrating WHO FCTC-specific indicators into Parties’ national data collection systems will cer-tainly 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 ses-sion of the COP, based on consideration of the Secretariat’s report, which contains recommen-dations on the establishment of a mechanism to facilitate such review.


59

International cooperation (Article 22)

Article 22 the Convention requires Parties to cooperate directly or through competent inter-national bodies to strengthen their capacity for implementing obligations arising from the Convention. In connection with that matter, Article 26 requires that Parties promote the uti-lization 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 spe-cific 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. 3.16 presents the areas of assistance and the percent-age 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 2012, reported receiving assistance to establish and strengthen national tobacco-control strat-egies, plans and programmes and for the devel-opment and acquisition of knowledge, skills, capacity and expertise related to tobacco con-trol, pursuant to Article 22.1(a) and (b), while the other areas such as training and sensitiza-tion of personnel did not attract the same level of attention. The least reported areas, with results comparable to those of 2012, 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 com-prehensive 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 coun-try Parties through traditional developments partners. Thailand and Uruguay, for example, reported providing assistance to other Parties, while Italy and Norway reported receiving assis-tance. Several developed country Parties also reported on assistance received from WHO and the Convention Secretariat. Several Parties reported on needs assessments and regional meet-ings 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

■ 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 part-ners 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.

Key observations


60

Ceremony at the opening of the Center for International Cooperation in Tobacco Control in Montevideo, Uruguay. Photo courtesy of Ministry of Health, Uruguay.

Fig. 3.16. Percentage of Parties reporting on assistance they provided or received, by areas of assistance, in 2014 and 2012

0255075100 0 25 50 75 100

Assistance on researchinto affordability

Methods for tobacco control,e.g. treatment of nicotine addiction

Equipment, supplies,logistics

Training and sensitizationof personnel

Assistance on transferof skills and technology

Expertise for tobaccocontrol programmes

No/no answer Yes

Assistance providedAssistance received

59

5842

39

26

25

25

18

17

13

12

6

49

49

55

64

72

67

77

77

75

89

86

92

51

51

45

36

28

33

23

23

25

11

14

8

41

4258

61

74

75

75

82

83

87

88

94

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

2014

2012

(%) (%)


61

Box 3.13. 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 2012, a joint needs assessment mission was conducted in Cook Islands, and this has proven to be an impor-tant 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 2012–2016, which was adopted in December 2012. 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 2012 and August 2015. The first such increase in 2012 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 2014 smoking cessa-tion 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 2014 with a view to strengthen-ing 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 3.14. 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 2011. 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 2014 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, expo-sure to second-hand smoke, and to change the social norms around tobacco. The project aims to influence attitudes and knowledge levels of the target popula-tion 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 addi-tion, in 2013 Australia provided funding to the WHO Regional Office for the Western Pacific for the develop-ment 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 mil-lion grant to the Convention Secretariat to be used to support low- and middle-income countries in their tobacco-control efforts through effective implemen-tation 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 integrat-ing 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.


62

Secretariat to support and enhance implemen-tation of the Convention internationally, with a particular focus on the needs of developing country Parties.Uruguay inaugurated, in May 2014, a new center for international cooperation in tobacco control.

With respect to assistance received or pro-vided 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 picto-rial health warnings; conducting surveys such as GYTS and GATS; conducting smoking cessation programmes, education, communication, train-ing 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 assess-ments 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 implementa-tion of WHO FCTC implementation into United Nations’ Development Assistance Frameworks.

It is also important to note that in three subre-gional settings the strengthening of implementa-tion 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 sur-veys, 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 organiza-tions (Article 26.4) Twenty-six Parties reported using this mechanism; 19 Parties also provided additional information. Specifically, Australia reported it has actively promoted implementa-tion 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 coun-try’s President spoke on the burden of noncom-municable 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 organiza-tions 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. ■

Box 3.15. Regional cooperation on implementation of specific measures under the Convention

On 12 December 2012, the Caribbean Community (C AR I COM)31 Co unci l fo r Tr ad e an d Eco n o mic 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 manu-facturers, 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 ciga-rette packages since 9 August 2012 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.


63

References1 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 imple-

mentation report.6 Representing 79% of the world’s population.7 Such research is foreseen as part of the impact assess-

ment 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 avail-able 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 2012 and 2014, and average cigarette prices calculated per pack of 20 cigarettes for such brands. These calcu-lated prices cannot be considered as WAP, and they are mainly used to make hypotheses regarding price trends.

11 In South Africa in 2012–2013 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 http://www.who.int/fctc/guidelines/adopted/en/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 http://www.cieh.org/policy/smokefree_workplaces.html

17 Further information can be found at http://ec.europa.eu/health/tobacco/docs/dir_201440_en.pdf.

18 Maldives also referred to tobacco industry interference in the process.

19 See http://www.rivm.nl/en/Topics/T/Tobacco/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 imple-mentation of Article 12.

21 The calculation of the average implementation rate of this article took into account responses to questions 3.2.7.1 and 3.2.7.2, 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 3.2.7.12 and 3.2.7.13.

22 For the text of the Protocol and more information see http://www.who.int/fctc/protocol/about/en/.

23 See http://www.who.int/fctc/protocol/ratification/en/ 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 2012 reporting cycle (covering 80% of the world’s population).

26 This includes four Parties that submitted their 2012 reports in 2013 (Mauritius, Poland, Slovakia and Venezuela (Bolivarian Republic of)) and that were requested to provide updates in the 2014 reporting cycle without sending a full report again.

27 Ethiopia, for which the Convention entered into force in 2014, 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: http://www.who.int/fctc/reporting/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 2010.

4. Prevalence of tobacco use and related health and economic consequences

65

4. prevalence of tobacco use and related health and economic consequences

4.1 Prevalence of tobacco use

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 support-ing 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 meth-odology across the two compared periods, and in which the latest data were collected in 2012 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 2012 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 2012, with decreases ranging from 1 percent-age point (Luxemburg, Singapore and Sweden) to 8.49 percentage points (Hungary) for total adult prevalence (current or daily smoking, which-ever was collected in the country). In 12 Parties2 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 smok-ing, 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 fol-lowed 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

■ 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 2014 compared with the 2012 reporting cycle (45 and 25 Parties, respec-tively); 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 tobacco-related 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 indi-cators 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 com-parisons, comparable estimates by WHO are presented at the end of this section.

Key observations


66

female smoking prevalence increased while male prevalence decreased.

Prevalence among young people

In a similar exercise for young people, 323 Parties were identified as having two comparable data sets. Total youth smoking prevalence decreased in 19 Parties by between 1.0 and 15.30 percent-age 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%) pro-vided data on use of smokeless tobacco products by adults in their 2014 reports, and 41 provided

these data broken down by gender, but very few countries have available comparable data allow-ing 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 jurisdic-tions, 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 2012 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 prev-alence among the 16–24 age group. In Poland, an increase in the prevalence of smokeless tobacco

“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 2013. Photo courtesy of the Brazilian National Cancer Institute (INCA).

4. Prevalence of tobacco use and related health and economic consequences

67

use (chewing tobacco, oral and nasal snuff) both in male and female populations was also reported for the period 2010–2013. On the other hand Panama saw a decrease from 2010–2013 regard-ing 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 2012/13.

Tobacco use in ethnic groups4

Twenty-eight of the 130 reporting Parties pre-sented data on tobacco use by ethnic groups. Data in this section were not sufficient to enable conclusions to be drawn on the basis of compari-sons 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 gen-eral population; and in five Parties the reported prevalence for the studied ethnic groups was below that of the general population. The differ-ences 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 collec-tion 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 con-sultation 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 smok-ing 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 assis-tance 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 smoke-less tobacco use.

Globally, the weighted average adult smoking prevalence rates estimated for the year 2012 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 smoke-less 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 there-fore 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 fig-ures by WHO region and country income group, can be found in Annex 7.

4.2 Tobacco-related mortality

Around half of the Parties (68) reported that they have information on tobacco-related mor-tality in their jurisdictions, up from 50 and 15


68

Parties reporting the same in the 2012 and 2010 reporting cycles, respectively. Of the 68 parties, 45 actually gave the number of deaths attribut-able 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 1.366 mil-lion tobacco-related deaths, the European Union (total of tobacco-related mortality cases in its 28 Member States) with 706 000 deaths, and the Russian Federation, reporting 278 000 tobacco-related deaths.

Seventeen Parties reported comparable data on mortality in both the 2014 and 2012 report-ing periods (providing the latest figures available to them), a significant improvement since 2012, 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 1 366 000 tobacco-related deaths in 2014, but only 1 200 000 in 2012.

The increasing number of Parties report-ing on tobacco-related mortality is encourag-ing. 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 calculat-ing 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 2014.

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 increas-ingly important and related research should be strengthened in all Parties to the Convention. The sharing of know-how and the most suit-able methodologies among the Parties, includ-ing 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 indi-cators used in the reporting instrument of the WHO FCTC, will contribute to making pro-gress in this important area of research.

References1 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 col-lected 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: http://www.who.int/fctc/reporting/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.

69

annex 1

Reports received from the Parties – status as at 30 May 2014

Parties

Reports submitted in the initial (2007–2011) reporting period 2012

report submitted

2014 report/ additional questions submitted

Entry into force

First (two-year) report submitted

Second (five-year) report

submitted

1 Afghanistan 11-Nov-10 NA NA 15-Apr-12 08-Apr-14

2 Albania 25-Jul-06 03-Aug-08 - 29-Apr-12 15-Apr-14

3 Algeria 28-Sep-06 - 03-Feb-11 30-Apr-12 30-Apr-14

4 Angola 19-Dec-07 - - - -

5 Antigua and Barbuda 03-Sep-06 03-Sep-08 - 30-Apr-12 -

6 Armenia 27-Feb-05 20-Feb-07 30-Jun-10 01-Nov-12 16-Apr-14

7 Australia 27-Feb-05 28-Feb-07 31-Oct-10 30-Apr-12 15-Apr-14

8 Austria 14-Dec-05 12-Dec-07 - 30-Apr-12 15-Apr-14

9 Azerbaijan 30-Jan-06 05-May–08 15-Mar-11 NA 09-Apr-14

10 Bahamas 01-Feb-10 NA NA 23-May–12 15-Apr-14

11 Bahrain 18-Jun-07 20-Jun-09 - 30-Apr-12 13 Apr 2014/13 Apr 2014

12 Bangladesh 27-Feb-05 27-Feb-07 02-Mar-10 13-May–12 15-Apr-14

13 Barbados 01-Feb-06 15-Jul-08 - 30-Apr-12 15-Apr-14

14 Belarus 07-Dec-05 14-Apr-10 07-Dec-10 30-Apr-12 15-Apr-14

15 Belgium 30-Jan-06 06-Nov-07 31-Jan-11 NA 15-Apr-14

16 Belize 15-Mar-06 09-Apr-08 - - 15-Apr-14

17 Benin 01-Feb-06 - 22-Feb-11 NA 20-Mar-14

18 Bhutan 27-Feb-05 27-Feb-07 18-Nov-10 30-Apr-12 18-Apr-14

19 Bolivia (Plurinational State of ) 14-Dec-05 - - 06-May–12 -

20 Bosnia and Herzegovina 08-Oct-09 - NA 27-Apr-12 15-Apr-14

21 Botswana 01-May–05 21-Dec-07 - 30-Apr-12 -

22 Brazil 01-Feb-06 16-Jun-08 09-Aug-11 NA 16-Apr-14

23 Brunei Darussalam 27-Feb-05 03-Jul-07 01-Mar-10 30-Mar-12 31 Mar 2014/5 Apr 2014

24 Bulgaria 05-Feb-06 01-Apr-09 22-Feb-11 NA 17-Apr-14

25 Burkina Faso 29-Oct-06 23-Feb-09 - 20-Apr-12 27-Mar-14

26 Burundi 20-Feb-06 27-Jan-09 - 22-Oct-12 -

27 Cambodia 13-Feb-06 23-Sep-08 11-Feb-11 NA -

continues ...

70


Parties


report submitted


Entry into force



submitted

28 Cameroon 04-May–06 08-Nov-08 - 03-Oct-12 15-Apr-14

29 Canada 27-Feb-05 23-Feb-07 10-Mar-10 28-Feb-12 10-Apr-14

30 Cabo Verde 02-Jan-06 - - - -

31 Central African Republic 05-Feb-06 14-Jan-10 - 01-Jun-12 -

32 Chad 30-Apr-06 08-Sep-09 - 30-Apr-12 -

33 Chile 11-Sep-05 14-Jul-08 - 28-May–12 25-Feb-14

34 China 09-Jan-06 14-Apr-08 06-Jul-11 NA 15-Apr-14

35 Colombia 09-Jul-08 13-Sep-10 NA 30-Apr-12 15 Apr 2014/30 Apr 2014

36 Comoros 24-Apr-06 12-May–09 22-Apr-11 31-Mar-12

37 Congo 07-May–07 21-May–08 - 27-Apr-12 15-Apr-14

38 Cook Islands 27-Feb-05 24-Feb-07 23-Mar-10 03-Feb-12 25-Apr-14

39 Costa Rica 19-Nov-08 - 29-Mar-11 NA 25 Mar 2014/12 Apr 2014

40 Côte d’Ivoire 11-Nov-10 NA NA 16-Aug-12 14-Apr-14

41 Croatia 12-Oct-08 11-Jan-11 NA NA 25-Apr-14

42 Cyprus 24-Jan-06 25-Jul-08 05-Aug-11 NA 15-Apr-14

43 Czech Republic 30-Aug-12 - - - 15-Apr-14

44 Democratic People’s Republic of Korea

26-Jul-05 - - 02-Apr-12 -

45 Democratic Republic of the Congo

26-Jan-06 08-Sep-09 - - -

46 Denmark 16-Mar-05 01-Apr-08 13-Jul-10 30-Apr-12 20-May–14

47 Djibouti 29-Oct-05 05-Aug-09 - 30-Apr-12 15-Apr-14

48 Dominica 22-Oct-06 - - - -

49 Ecuador 23-Oct-06 12-Nov-08 - 28-Apr-12 15-Apr-14

50 Egypt 26-May–05 22-Apr-09 16-Aug-10 22-May–12 -

51 Equatorial Guinea 16-Dec-05 - - - -

52 Estonia 25-Oct-05 02-May–07 - 27-Apr-12 28-Apr-14

53 Ethiopia* 23-Jun-14 - - - -

54 European Union 28-Sep-05 21-Dec-07 12-Nov-10 09-Nov-12 16-Apr-14

55 Fiji 27-Feb-05 02-May–07 - 04-Apr-12 15-Apr-14

56 Finland 24-Apr-05 04-Jul-07 23-Apr-10 19-Apr-12 01-Apr-14

57 France 27-Feb-05 14-Jun-07 08-Jul-10 31-May–12 30-Apr-14

58 Gabon 21-May–09 - NA 22-Apr-12 6 Apr 2014/27 Dec 2014

59 Gambia 17-Dec-07 21-Dec-09 NA 04-May–12 16-Apr-14

60 Georgia 15-May–06 23-May–08 - 10-Feb-12 15-Apr-14

61 Germany 16-Mar-05 25-Jun-07 24-Feb-10 25-Apr-12 06-Mar-14

62 Ghana 27-Feb-05 28-Feb-07 18-Apr-10 04-Jun-12 14 Apr 2014/30 Apr 2014

... continued

continues ...

ANNEX 1

71

Parties


report submitted


Entry into force



submitted

63 Greece 27-Apr-06 07-Oct-08 - 30-May–12 -

64 Grenada 12-Nov-07 - - - 15-Apr-14

65 Guatemala 14-Feb-06 09-Apr-08 - 22-Mar-12 -

66 Guinea 05-Feb-08 - - - -

67 Guinea-Bissau 05-Feb-09 - - - -

68 Guyana 14-Dec-05 12-Dec-07 12-Jan-11 NA -

69 Honduras 17-May–05 17-May–07 08-Apr-11 NA -

70 Hungary 27-Feb-05 19-Mar-07 19-Feb-10 27-Apr-12 18-Apr-14

71 Iceland 27-Feb-05 30-Oct-09 - 15-May–12 15-Apr-14

72 India 27-Feb-05 28-Feb-07 11-Jun-10 12-Nov-12 -

73 Islamic Republic of Iran (Is-lamic Republic of )

04-Feb-06 21-Apr-07 - 09-Oct-12 16-Apr-14

74 Iraq 15-Jun-08 13-Jun-10 - 01-May–12 14-Apr-14

75 Ireland 05-Feb-06 18-Jul-08 24-Mar-11 NA 15-Apr-14

76 Israel 22-Nov-05 15-Jul-08 - 23-May–12 -

77 Italy 30-Sep-08 04-Oct-10 NA 27-Apr-12 14-Apr-14

78 Jamaica 05-Oct-05 18-Jul-08 - - 15 Apr 2014/15 Apr 2014

79 Japan 27-Feb-05 27-Feb-07 26-Feb-10 27-Apr-12 31 Mar 2014/1 Apr 2014

80 Jordan 27-Feb-05 25-Feb-07 25-Feb-10 16-Feb-12 15-Apr-14

81 Kazakhstan 22-Apr-07 08-May–09 - 17-Apr-12 14-Apr-14

82 Kenya 27-Feb-05 04-Apr-07 10-Sep-10 - 15-Apr-14

83 Kiribati 14-Dec-05 - - - 15-Apr-14

84 Kuwait 10-Aug-06 05-Jun-08 30-Jun-11 NA -

85 Kyrgyzstan 23-Aug-06 25-Aug-08 - 02-Apr-12 16-Apr-14

86 Lao People’s Democratic Republic

05-Dec-06 02-Mar-10 - 28-Feb-12 19-Nov-13

87 Latvia 11-May–05 02-Jul-07 31-Mar-10 28-Feb-12 14 Apr 2014/15 Apr 2014

88 Lebanon 07-Mar-06 19-Aug-09 07-Mar-11 NA -

89 Lesotho 14-Apr-05 17-Nov-08 13-May–10 03-May–12 -

90 Liberia 14-Dec-09 - - - -

91 Libyan Arab Jamahirya 05-Sep-05 30-Jun-09 - 05-Apr-12 08-Apr-14

92 Lithuania 16-Mar-05 16-Jan-09 21-Apr-10 26-Apr-12 09-Apr-14

93 Luxembourg 28-Sep-05 25-Sep-07 12-Nov-10 29-Oct-12 14-Apr-14

94 Madagascar 27-Feb-05 28-Feb-07 19-Jan-12 09-Feb-12 07-Apr-14

95 Malaysia 15-Dec-05 17-Dec-07 17-Dec-10 13-Apr-12 28-Mar-14

96 Maldives 27-Feb-05 15-Feb-07 - - 16-Apr-14

97 Mali 17-Jan-06 17-Mar-09 - 13-Apr-12 01-Apr-14

98 Malta 27-Feb-05 18-May–07 20-Jan-11 NA 15-Apr-14

... continued

continues ...

72


Parties


report submitted


Entry into force



submitted

99 Marshall Islands 08-Mar-05 04-Apr-07 24-Mar-10 30-Nov-12 30-Apr-14

100 Mauritania 26-Jan-06 23-Dec-09 - 11-Oct-12 14-Apr-14

101 Mauritius 27-Feb-05 27-Feb-07 01-Mar-10 23-Aug-13 24-Mar-14

102 Mexico 27-Feb-05 27-Feb-07 23-Jun-10 08-May–12 03-Apr-14

103 Federated States of Micronesia (Federated States of )

16-Jun-05 18-Jun-07 29-Sep-10 26-Apr-12 08-Apr-14

104 Mongolia 21-Jan-07 27-Feb-07 18-Jan-11 08-Jun-12 14-Mar-14

105 Montenegro 27-Feb-05 27-Nov-08 28-Nov-11 NA 04-Apr-14

106 Myanmar 05-Feb-06 30-Jan-07 - - 30-Apr-14

107 Namibia 27-Feb-05 21-Oct-08 06-Oct-11 NA -

108 Nauru 05-Feb-07 24-May–07 - - -

109 Nepal 27-Apr-05 27-Feb-07 - 05-Apr-12 13-Apr-14

110 Netherlands 27-Feb-05 18-Sep-08 27-Apr-10 30-Mar-12 15-Apr-14

111 New Zealand 08-Jul-08 28-Feb-07 26-Feb-10 01-Jun-12 15-Apr-14

112 Nicaragua 23-Nov-05 - - - -

113 Niger 18-Jan-06 28-Jan-09 - 13-Apr-12 -

114 Nigeria 01-Sep-05 14-Nov-08 - - 29-Apr-14

115 Niue 27-Feb-05 28-Aug-08 11-Nov-10 - 14-Apr-14

116 Norway 07-Jun-05 27-Feb-07 22-Mar-10 24-Apr-12 15 Apr 2014/15 Apr 2014

117 Oman 27-Feb-05 27-Jun-07 19-Oct-10 30-Apr-12 04-Apr-14

118 Pakistan 27-Feb-05 16-Feb-09 30-Sep-10 10-Jul-12 15 Apr 2014/24 Apr 2014

119 Palau 27-Feb-05 26-Feb-07 12-Mar-10 01-May–12 10-Apr-14

120 Panama 23-Aug-08 21-Jun-07 26-Feb-10 16-Apr-12 7 Apr 2014/7 Apr 2014

121 Papua New Guinea 25-Dec-06 30-Jun-09 NA - 16-Apr-14

122 Paraguay 28-Feb-05 16-Feb-09 - 26-Apr-12 14-Jan-14

123 Peru 04-Sep-05 03-May–07 - 28-Mar-12 30-Apr-14

124 Philippines 14-Dec-06 04-Sep-08 03-Oct-11 NA 15-Apr-14

125 Poland 06-Feb-06 08-Jun-10 - 09-May–13 15-Apr-14

126 Portugal 27-Feb-05 27-Jun-08 29-Apr-11 NA 08-Apr-14

127 Qatar 14-Aug-05 27-Feb-07 27-Jul-10 19-Mar-12 -

128 Republic of Korea 04-May–09 14-Sep-07 28-Feb-12 06-Jul-12 29-Apr-14

129 Republic of the Republic of Moldova

27-Feb-05 - NA 08-May–12 14-Apr-14

130 Romania 27-Apr-06 18-Jun-08 - - 30-Apr-14

131 Russian Federation 01-Sep-08 - 28-Oct-10 05-Apr-12 15-Apr-14

132 Rwanda 17-Jan-06 01-Sep-09 - 25-Apr-12 -

133 Saint Kitts and Nevis 19-Sep-11 NA NA 25-May–12 -

134 Saint Lucia 05-Feb-06 - - 26-Sep-12 -

... continued

continues ...

ANNEX 1

73

Parties


report submitted


Entry into force



submitted

135 Saint Vincent and the Gren-adines

27-Jan-11 NA NA 01-Jun-12 -

136 Samoa 01-Feb-06 03-Oct-08 - - -

137 San Marino 27-Feb-05 - 03-May–10 25-Feb-11 16-Apr-14

138 Sao Tome and Principe 11-Jul-06 - 28-Jul-10 25-May–12 15-Apr-14

139 Saudi Arabia 07-Aug-05 28-Oct-08 - 25-Feb-13 15-Apr-14

140 Senegal 27-Apr-05 27-Apr-07 - 30-Apr-12 14-Apr-14

141 Serbia 09-May–06 15-May–08 09-May–11 NA 08-Apr-14

142 Seychelles 27-Feb-05 02-Mar-07 18-May–10 28-Mar-12 15-Apr-14

143 Sierra Leone 20-Aug-09 - NA 18-Jun-12 07-Apr-14

144 Singapore 27-Feb-05 11-Apr-07 22-Oct-10 11-May–12 22-Apr-14

145 Slovakia 27-Feb-05 26-Feb-07 05-Mar-10 19-Jun-13 15-Apr-14

146 Slovenia 13-Jun-05 04-Nov-08 29-Jun-10 26-Apr-12 01-Apr-14

147 Solomon Islands 27-Feb-05 - 22-Dec-11 NA 30-Apr-14

148 South Africa 18-Jul-05 18-Jul-08 14-Dec-10 04-May–12 31-Mar-14

149 Spain 11-Apr-05 13-Jun-07 26-Oct-10 02-Apr-12 17 Mar 2014/2 Apr 2014

150 Sri Lanka 27-Feb-05 27-Feb-07 16-Apr-11 NA -

151 Sudan 29-Jan-06 28-Jan-08 - 27-May–12 -

152 Suriname 16-Mar-09 - NA 19-Mar-12 15-Apr-14

153 Swaziland 13-Apr-06 11-Sep-09 - 12-Mar-12

154 Sweden 05-Oct-05 27-Feb-08 05-Nov-10 13-Apr-12 15-Apr-14

155 Syrian Arab Republic 27-Feb-05 25-Feb-07 12-Apr-10 - -

156 Tajikistan 19-Sep-13 - - - 30-Apr-14

157 Thailand 27-Feb-05 27-Feb-07 29-Mar-10 07-Nov-12 14-Apr-14

158 The former Yugoslav Republic of Macedonia

28-Sep-06 - - - 04-Apr-14

159 Timor-Leste 22-Mar-05 16-Feb-07 - - -

160 Togo 13-Feb-06 - 24-Feb-11 30-Apr-12 02-Apr-14

161 Tonga 07-Jul-05 30-Jun-09 15-Nov-11 NA 15 Apr 2014/21 Apr 2014

162 Trinidad and Tobago 27-Feb-05 10-Apr-07 08-Oct-10 04-May–12 -

163 Tunisia 05-Sep-10 NA NA 30-Apr-12 14-Apr-14

164 Turkey 31-Mar-05 19-Jun-07 31-Mar-10 27-Apr-12 9 Apr 2014/15 Apr 2014

165 Turkmenistan 11-Aug-11 NA NA - 26-Mar-14

166 Tuvalu 25-Dec-05 22-Feb-10 - 07-Jun-12 15-Apr-14

167 Uganda 18-Sep-07 17-Sep-09 - 31-Oct-12 15-Apr-14

168 Ukraine 04-Sep-06 29-Sep-08 06-Sep-11 NA 23 Mar 2014/15 Mar 2014

169 United Arab Emirates 05-Feb-06 27-Jan-09 - 20-Mar-12 -

... continued

continues ...

74


Parties


report submitted


Entry into force



submitted

170 United Kingdom of Great Brit-ain and Northern Ireland

16-Mar-05 27-Feb-07 04-Nov-10 30-Apr-12 15-Apr-14

171 United Republic of Tanzania 29-Jul-07 - - 07-Nov-12 15-Apr-14

172 Uruguay 27-Feb-05 26-Feb-07 28-May–10 20-Jul-12 14-Apr-14

173 Uzbekistan 13-Aug-12 - - - 28-Apr-14

174 Vanuatu 15-Dec-05 - - 27-Apr-12 -

175 Venezuela (Bolivarian Republic of )

25-Sep-06 31-Mar-09 16-Sep-13 16-Sep-13 -

176 Viet Nam 17-Mar-05 27-Jun-07 06-Sep-11 NA 15-Apr-14

177 Yemen 23-May–07 03-Nov-09 NA 19-Apr-12 14-Apr-14

178 Zambia 21-Aug-08 - NA - -

* Due to report for the first time during the next reporting cycle.

NA = Not applicable.

- = Report not submitted.

... continued

75

Article 5

■ development and implementation of com-prehensive, multisectoral, national tobacco-control strategies, plans and programmes*1

■ existence of a focal point for tobacco control*

■ existence of a tobacco-control unit ■ existence of a national coordinating mecha-

nism 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 work-places, public transport and indoor public places *

■ comprehensiveness of protection in govern-ment buildings*2

■ comprehensiveness of protection in health-care facilities*

■ comprehensiveness of protection in educa-tional 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 shop-

ping 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*

annex 2

List of indicators deriving from the reporting instrument used in assessing the current status of implementation

76


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 warn-

ings 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 pro-grammes implemented*

■ public agencies involved in programmes and strategies*

■ nongovernmental organizations involved in programmes and strategies

■ private organizations involved in pro-grammes and strategies

■ programmes are guided by research ■ training programmes addressed to health

workers implemented* ■ training programmes addressed to commu-

nity 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 decision-makers implemented

■ training programmes addressed to adminis-trators implemented

Article 13

■ comprehensive ban on all tobacco advertis-ing 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 shar-

ing required ■ ban covering product placement required ■ ban covering the depiction/use of tobacco in

entertainment media required ■ ban covering tobacco sponsorship of inter-

national events or activities required ■ ban covering corporate social responsibility

required ■ ban covering cross-border advertising, pro-

motion 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 cross-border advertising

■ penalties imposed for cross-border advertising

Article 14

■ evidence-based comprehensive and inte-grated guidelines developed*

■ media campaigns to promote tobacco cessa-tion 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 educa-

tional institutions designed

ANNEX 2

77

■ programmes to promote cessation in health-care facilities designed

■ programmes to promote cessation in work-places designed

■ programmes to promote cessation in sport-ing 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 pharmaceu-tical 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 distri-bution 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 acces-

sible 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 environ-ment implemented

■ measures in respect of tobacco cultiva-tion considering the health of persons implemented

■ measures in respect of tobacco manufactur-ing 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

78


Article 20

■ research on determinants of tobacco con-sumption promoted*

■ research on consequences of tobacco con-sumption 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 depend-ence 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 determi-nants of tobacco consumption established

■ national system for surveillance of conse-quences 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 enforce-ment of laws established

■ database of the pertinent jurisprudence established

Article 22

■ assistance received on transfer of skills and technology

■ assistance received on expertise for tobacco-control programmes

■ assistance received in training and sensitiza-tion of personnel

■ assistance received in equipment, supplies and logistics

■ assistance received in tobacco control meth-ods, e.g. treatment of nicotine addiction

■ assistance received in research on affordabil-ity 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.

79

anne

x 3

Curr

ent s

tatu

s of i

mpl

emen

tatio

n of

SU

BSTA

NTI

VE A

RTIC

LES

by th

e Pa

rtie

s, b

y in

com

e gr

oup

Part

ies w

ith lo

w-in

com

e ec

onom

ies1

Coun

try

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)

Afgh

anis

tan

40

80

00

00

00

1N

AN

A0

00

Bang

lade

sh4

214

00

811

117

17

10

113

4

Beni

n2

112

12

710

93

46

02

04

2

Burk

ina

Faso

62

172

410

1110

62

81

01

147

Gam

bia

61

10

07

119

1112

40

NA

09

5

Keny

a6

317

44

810

135

1311

04

17

5

Kyrg

yzst

an4

113

44

911

816

1211

13

116

5

Mad

agas

car

51

150

010

119

09

8N

A0

02

4

Mal

i4

15

14

711

111

410

10

03

0

Mya

nmar

43

120

04

811

93

9N

AN

A0

113

Nep

al5

314

24

1012

118

711

30

010

1

Sier

ra L

eone

30

10

01

20

00

00

00

04

Tajik

ista

n2

34

00

1011

312

94

NA

NA

00

3

Togo

42

160

010

1013

24

111

NA

013

3

Uga

nda

31

114

46

121

23

01

02

145

Uni

ted

Repu

blic

of T

anza

nia

10

70

21

00

60

30

00

24

1 Num

ber i

n pa

rent

hesi

s is

the

num

ber o

f ind

icat

ors

cons

ider

ed u

nder

that

art

icle

, and

this

is th

e m

axim

um n

umbe

r (or

sco

re) w

hich

a P

arty

can

be

giv

en fo

r com

plyi

ng w

ith th

e re

quire

emnt

s of

that

art

icle

.2 T

hose

art

icle

s m

arke

d w

ith a

n as

teris

k in

clud

e on

ly th

e nu

mbe

r of P

artie

s to

whi

ch th

e qu

estio

n in

the

repo

rtin

g in

stru

men

t was

app

licab

le.

NA

= N

ot a

pplic

able

80


Part

ies w

ith lo

wer

-mid

dle-

inco

me

econ

omie

s

Cou

ntry

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)

Arm

enia

53

74

27

90

119

100

NA

013

1

Bhut

an6

314

22

612

714

89

NA

40

166

Cam

eroo

n2

03

01

77

813

00

00

011

0

Cong

o3

116

22

36

56

08

00

05

2

Côte

d’Iv

oire

31

160

00

100

57

00

00

86

Djib

outi

31

110

29

911

212

80

NA

03

0

Geo

rgia

33

21

07

101

136

100

01

23

Gha

na5

117

02

1012

87

1310

04

014

3

Kirib

ati

32

82

49

127

1513

111

00

43

Lao

Peop

le’s

Dem

ocra

tic R

epub

lic5

111

00

77

71

39

00

04

5

Mau

ritan

ia2

14

00

00

00

50

NA

00

11

Fede

rate

d St

ates

of M

icro

nesi

a (F

eder

ated

Sta

tes o

f)5

15

00

012

715

010

00

05

4

Mon

golia

51

80

210

313

22

110

NA

28

5

Nig

eria

43

84

49

111

1012

101

20

111

Paki

stan

51

140

07

111

36

100

40

21

Papu

a N

ew G

uine

a2

110

00

84

101

15

01

03

4

Para

guay

11

130

11

70

120

00

00

60

Phili

ppin

es6

111

00

17

14

136

12

116

5

Repu

blic

of t

he R

epub

lic o

f Mol

dova

51

114

48

1012

1510

110

40

174

Sao

Tom

e an

d Pr

inci

pe3

113

00

08

013

04

00

00

1

Sene

gal

31

154

49

69

611

8N

A2

10

3

Solo

mon

Isla

nds

42

142

210

96

311

80

22

72

Ukr

aine

31

132

410

60

26

90

00

82

Uzb

ekis

tan

31

163

48

110

1210

80

40

125

Viet

Nam

63

122

210

97

56

80

20

115

Yem

en4

02

44

107

75

106

00

08

2

ANNEX 3

81

Cou

ntry

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)

Alba

nia

63

163

39

126

108

100

30

152

Alge

ria3

29

22

74

97

122

02

06

0

Aze

rbai

jan

11

42

25

50

510

80

00

20

Bela

rus

63

94

48

107

1910

100

00

125

Beliz

e2

012

00

38

010

137

NA

NA

00

0

Bosn

ia a

nd H

erze

govi

na6

310

44

99

817

1311

00

014

2

Braz

il5

117

42

97

812

117

12

119

3

Bulg

aria

53

164

48

110

208

91

40

185

Chin

a6

35

41

712

211

1210

14

015

5

Colo

mbi

a2

117

00

94

113

1110

11

08

5

Cost

a Ri

ca5

116

21

1012

817

1211

00

018

4

Ecua

dor

42

160

410

80

95

80

10

114

Fiji

43

32

210

67

58

80

20

85

Gab

on4

311

21

67

91

127

02

01

2

Gre

nada

20

80

01

51

13

0N

AN

A0

10

Hun

gary

23

133

49

54

1511

101

40

62

Isla

mic

Rep

ublic

of I

ran

(Isla

mic

Rep

ublic

of)

43

124

310

1211

1612

110

40

152

Iraq

51

101

28

1212

85

61

00

125

Jam

aica

41

161

210

110

1313

60

NA

016

6

Jord

an4

15

42

1012

1016

1210

02

017

5

Kaza

khst

an2

18

14

910

08

210

02

04

1

Liby

an A

rab

Jam

ahiry

a3

09

00

610

09

69

NA

NA

012

5

Mal

aysi

a3

112

20

912

514

1210

2N

A0

123

Par

ties

wit

h up

per-

mid

dle-

inco

me

econ

omie

s

cont

inue

s ...

82


Cou

ntry

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)

Mal

dive

s4

19

00

76

73

37

0N

A0

24

Mar

shal

l Isl

ands

30

50

00

110

46

5N

AN

A0

133

Mau

ritiu

s5

314

00

1012

611

1011

00

012

6

Mex

ico

61

104

49

110

190

110

02

132

Mon

tene

gro

50

162

29

68

1011

110

00

81

Pala

u3

27

00

010

09

811

1N

A0

40

Pana

ma

53

160

410

1012

1711

11N

AN

A1

166

Peru

31

160

010

50

69

110

20

61

Rom

ania

13

53

48

37

109

80

00

42

Serb

ia5

313

40

78

67

129

00

012

3

Seyc

helle

s4

315

04

1010

127

1310

NA

NA

04

4

Sout

h Af

rica

32

52

25

115

54

70

00

54

Surin

ame

63

152

09

128

1611

110

NA

019

7

Thai

land

63

162

210

1211

1712

100

40

177

The

form

er Y

ugos

lav

Repu

blic

of M

aced

onia

33

154

48

1010

810

90

20

61

Tong

a4

39

24

812

315

117

NA

NA

03

5

Tuni

sia

62

64

48

116

176

62

40

93

Turk

ey5

316

34

1012

1114

1311

14

017

0

Turk

men

ista

n5

317

23

1011

1018

511

0N

A0

23

Tuva

lu3

05

20

36

95

58

0N

A0

23

Vene

zuel

a (B

oliv

aria

n Re

publ

ic o

f)5

316

44

912

119

89

00

016

4

... co

ntin

ued

ANNEX 3

83

cont

inue

s ...

Cou

ntry

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)

Aust

ralia

53

151

410

1210

2011

90

20

161

Aust

ria2

27

44

710

1112

139

2N

A0

105

Baha

mas

13

60

00

64

119

4N

AN

A0

21

Bahr

ain

52

42

410

1212

2012

110

00

170

Barb

ados

13

140

01

100

150

10N

AN

A0

61

Belg

ium

32

154

49

98

128

90

00

120

Brun

ei D

arus

sala

m3

311

22

87

913

611

0N

A0

125

Cana

da6

316

32

912

014

129

04

219

0

Chile

41

150

310

88

51

80

10

164

Croa

tia3

112

44

89

98

511

00

08

1

Cypr

us4

013

24

86

1111

126

NA

NA

03

0

Czec

h Re

publ

ic3

37

44

75

112

109

NA

20

100

Esto

nia

43

54

48

62

119

9N

AN

A0

41

Finl

and

33

34

48

1211

2011

80

01

160

Fran

ce1

27

44

96

1011

011

00

017

0

Ger

man

y5

27

34

89

911

69

00

016

0

Icel

and

43

143

29

18

163

110

00

65

Irela

nd5

316

24

911

619

119

NA

NA

116

0

Italy

33

63

48

68

1713

72

21

182

Japa

n5

20

22

811

113

127

04

112

0

Latv

ia3

312

33

85

46

119

NA

20

110

Lith

uani

a3

19

44

97

015

1310

NA

NA

07

0

Luxe

mbo

urg

40

143

39

710

1410

10N

AN

A0

111

Mal

ta4

115

02

105

1314

119

1N

A0

130

Par

ties

wit

h hi

gh-i

ncom

e ec

onom

ies

84


... co

ntin

ued

Cou

ntry

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)

Net

herla

nds

53

153

47

60

169

8N

A0

114

2

New

Zea

land

53

152

410

128

1910

81

NA

114

0

Nor

way

43

161

49

69

139

91

NA

112

0

Om

an5

214

20

104

04

107

02

08

2

Pola

nd4

30

04

15

117

110

00

019

7

Port

ugal

52

62

28

79

1512

90

40

111

Repu

blic

of K

orea

52

101

27

100

192

90

11

147

Russ

ian

Fede

ratio

n3

117

42

83

78

49

NA

02

61

San

Mar

ino

40

100

00

83

40

21

NA

01

0

Saud

i Ara

bia

32

12

410

86

99

70

NA

16

3

Sing

apor

e5

213

22

912

820

611

0N

A0

120

Slov

akia

51

114

48

811

169

11N

AN

A0

130

Slov

enia

53

164

47

99

1411

9N

AN

A0

151

Spai

n6

316

24

912

1117

128

34

118

0

Swed

en4

31

44

73

812

98

00

013

0

Uni

ted

King

dom

of G

reat

Brit

ain

and

Nor

ther

n Ire

land

62

163

39

711

1610

8N

AN

A1

161

Uru

guay

43

161

49

71

115

100

00

120

ANNEX 3

85

Par

ties

not

cla

ssifi

ed b

y th

e W

orld

ban

k

Cou

ntry

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)

Cook

Isla

nds

41

54

410

109

179

11N

AN

A0

187

Euro

pean

Uni

on1

42

14

410

87

211

61

20

172

Niu

e2

20

00

05

24

00

NA

10

04

1 The

Eur

opea

n U

nion

doe

s no

t hav

e co

mpe

tenc

y in

all

area

s co

nsid

ered

in th

is c

alcu

latio

n.

87

annex 4

Article 17

Article 19

Article 22

Article 18

Article 9

Article 20

Article 14

Article 10

Article 15

Article 6

Article 13

Article 5

Article 12

Article 11

Article 16

Article 8

0255075100 0 25 50 75 100

2014 2012

78

67

66

69

60

59

46

54

51

45

47

33

34

10

10

84

73

70

70

65

63

62

60

58

51

51

40

48 45

37

14

13

(%) (%)

Progress in implementation between the 2012 and 2014 reporting periods

89

annex 5

Implementation rates of indicators used in the 2014 reporting instrument1

Article/indicator name2014 (%)

2012 (%)

Article 5. General obligations Yes No Yes No

comprehensive multisectoral national tobacco control strategy developed 68 32 60 40

focal point for tobacco control exists 87 13 82 18

tobacco control unit exists 65 35 61 39

national coordinating mechanism for tobacco control exists 75 25 74 26

interference by the tobacco industry 68 32 55 45

public access to a wide range of information on the tobacco industry 28 72 28 72

Article 6. Price and tax measures to reduce the demand for tobacco Yes No Yes No

existence of information on tobacco-related mortality 52 48 51 49

existence of information on the economic burden of tobacco use 35 65 32 68

only specific tax levied 22 78 18 82

only ad valorem tax levied 9 91 14 86

combination of specific and ad valorem taxes levied 61 39 53 47

tax policies to reduce tobacco consumption 82 18 64 36

tobacco sales to international travellers prohibited 44 56 30 70

tobacco imports by international travellers prohibited 59 41 45 55

Article 8. Protection from exposure to tobacco smoke Yes No Yes No

availability of data on exposure to tobacco smoke 78 22 81 19

tobacco smoking banned in all public places 96 4 95 5

national law providing for the ban 85 15 73 27

subnational law(s) providing for the ban 25 75 21 79

administrative and executive orders providing for the ban 50 50 40 60

voluntary agreements providing for the ban 22 78 21 79

mechanism/infrastructure for enforcement provided 80 20 69 31

1 130 reports were included in the analysis for the 2014 reporting cycle and 146 were included for the 2012 reporting cycle.

90


Art

icle

8. C

ompr

ehen

sive

ness

of m

easu

res

appl

ied

2014

(%

)20

12

(%)

Com

plet

e Pa

rtia

l N

one

No

answ

erCo

mpl

ete

Part

ial

Non

e N

o an

swer

com

preh

ensi

vene

ss o

f pro

tect

ion

in g

over

nmen

t bui

ldin

gs74

201

564

263

7

com

preh

ensi

vene

ss o

f pro

tect

ion

in h

ealth

-car

e fa

cilit

ies

8115

13

7718

05

com

preh

ensi

vene

ss o

f pro

tect

ion

in e

duca

tiona

l fac

ilitie

s, ex

cept

uni

vers

ities

8016

04

7421

05

com

preh

ensi

vene

ss o

f pro

tect

ion

in u

nive

rsiti

es71

231

559

292

10

com

preh

ensi

vene

ss o

f pro

tect

ion

in p

rivat

e w

orkp

lace

s45

446

536

4412

8

com

preh

ensi

vene

ss o

f pro

tect

ion

in a

erop

lane

s87

43

684

54

7

com

preh

ensi

vene

ss o

f pro

tect

ion

in tr

ains

5715

622

5112

1918

com

preh

ensi

vene

ss o

f pro

tect

ion

in fe

rrie

s52

229

1740

2116

23

com

preh

ensi

vene

ss o

f pro

tect

ion

in g

roun

d pu

blic

tran

spor

t82

92

775

125

8

com

preh

ensi

vene

ss o

f pro

tect

ion

in m

otor

veh

icle

s use

d fo

r wor

k67

226

562

2310

5

com

preh

ensi

vene

ss o

f pro

tect

ion

in p

rivat

e ve

hicl

es10

1767

68

1461

17

com

preh

ensi

vene

ss o

f pro

tect

ion

in c

ultu

ral f

acili

ties

7221

25

5730

67

com

preh

ensi

vene

ss o

f pro

tect

ion

in sh

oppi

ng m

alls

5928

58

4831

813

com

preh

ensi

vene

ss o

f pro

tect

ion

in p

ubs a

nd b

ars

4532

149

3332

2510

com

preh

ensi

vene

ss o

f pro

tect

ion

in n

ight

club

s46

2915

1032

3126

11

com

preh

ensi

vene

ss o

f pro

tect

ion

in re

stau

rant

s52

385

541

4011

8

ANNEX 5

91

2014 (%)

2012 (%)

Article 9. Regulation of the contents of tobacco products Yes No Yes No

testing and measuring the contents of tobacco products 42 58 40 60

testing and measuring the emissions of tobacco products 46 54 42 58

regulating the contents of tobacco products 54 46 51 49

regulating the emissions of tobacco products 51 49 45 55

Article 10. Regulation of tobacco product disclosures Yes No Yes No

requiring disclosure of information about the contents of tobacco products 66 34 62 38

requiring disclosure of information about the emissions of tobacco products 62 38 53 47

requiring public disclosure on the contents of tobacco products 54 46 47 53

requiring public disclosure on the emissions of tobacco products 49 51 43 57

Article 11. Packaging and labelling of tobacco products Yes No Yes No

packaging of tobacco products does not carry advertising or promotion 69 31 62 38

misleading descriptors banned 78 22 73 27

health warnings required 88 12 84 16

health warnings approved by the competent national authority 84 16 80 20

rotated health warnings 78 22 72 28

large, clear, visible and legible health warnings required 85 15 80 20

law mandates, as a minimum, a style, size and colour of font 77 23 62 38

health warnings occupying no less than 30% required 78 22 70 30

health warnings occupying 50% or more required 41 59 35 65

health warnings in the form of pictures or pictograms required 50 50 42 58

copyright to pictures owned by the Government 52 48 61 39

granting of license for the use of health warnings 59 41 56 44

information on constituents required on packages 51 49 NC NC

information on emissions required on packages 80 20 NC NC

warning required in the principal language(s) of the country 51 49 64 36

92


2014 (%)

2012 (%)

Article 12. Education, communication, training and public awareness Yes No Yes No

implemented educational and public awareness programmes 96 4 91 9

implemented educational programmes targeted to adults or the general public 94 6 94 6

implemented educational programmes targeted to children and youth 100 0 98 2

implemented educational programmes targeted to men 73 27 70 30

implemented educational programmes targeted to women 77 23 74 26

implemented educational programmes targeted to pregnant women 69 31 76 24

implemented educational programmes targeted to ethnic groups 31 69 28 72

age differences reflected in educational programmes 94 6 86 14

gender differences reflected in educational programmes 75 25 74 26

educational background differences reflected in educational programmes 63 37 57 43

cultural differences reflected in educational programmes 42 58 39 61

socioeconomic differences reflected in educational programmes 45 55 50 50

programmes covering the health risks of tobacco consumption 100 0 98 2

programmes covering the risks of exposure to tobacco smoke 99 1 97 3

programmes covering the benefits of cessation of tobacco use 96 4 97 3

programmes covering economic consequences of tobacco production 41 59 39 61

programmes covering economic consequences of tobacco consumption 82 18 80 20

programmes covering environmental consequences of tobacco production 41 59 38 62

programmes covering environmental consequences of tobacco consumption 65 35 70 30

public agencies involved in programmes and strategies 92 8 90 10

NGOs involved in programmes and strategies 88 12 91 9

private organizations involved in programmes and strategies 57 43 58 42

programmes guided by research 63 37 61 39

training programmes addressed to health workers 85 15 84 16

training programmes addressed to community workers 60 40 56 44

training programmes addressed to social workers 52 48 52 48

training programmes addressed to media professionals 56 44 61 39

training programmes addressed to educators 76 24 67 33

training programmes addressed to decision-makers 63 37 58 42

training programmes addressed to administrators 55 45 55 45

ANNEX 5

93

2014 (%)

2012 (%)

Article 13. Tobacco advertising, promotion and sponsorship Yes No Yes No

comprehensive ban on all tobacco advertising, promotion and sponsorship instituted 70 30 66 34

ban on display of tobacco products at points of sale 54 46 52 48

ban covering the domestic Internet 75 25 66 34

ban covering the global Internet 32 68 29 71

ban covering brand stretching and/or sharing 66 34 61 39

ban covering product placement 88 12 82 18

ban covering the depiction/use of tobacco in entertainment media 76 24 70 30

ban covering tobacco sponsorship 90 10 90 10

ban covering corporate social responsibility 63 37 63 37

ban covering cross-border advertising originating from the country 66 34 62 38

ban covering cross-border advertising entering the country 73 27 67 33

precluded by constitution from undertaking a comprehensive ban 15 85 10 90

all tobacco advertising, promotion and sponsorship restricted 42 58 42 58

cross-border advertising originating from the country restricted 21 79 17 83

advertising by false and misleading means prohibited 45 55 37 63

use of warnings to accompany all advertising required 34 66 37 63

use of direct or indirect incentives restricted 38 62 37 63

disclosure of advertising expenditures required 8 92 11 89

advertising restricted on radio 62 38 60 40

advertising restricted on television 61 39 61 39

advertising restricted in print media 57 43 54 46

advertising restricted on the domestic Internet 33 67 27 73

advertising restricted on the global Internet 12 88 7 93

sponsorship of international events and activities restricted 47 53 38 62

tobacco sponsorship of participants therein restricted 44 56 36 64

cooperation on the elimination of cross-border advertising 32 68 29 71

penalties imposed for cross-border advertising 35 65 30 70

94


2014 (%)

2012 (%)

Article 14. Demand reduction measures concerning tobacco dependence and cessation Yes No Yes No

evidence-based comprehensive and integrated guidelines developed 58 42 53 47

implemented media campaigns on the importance of quitting 75 25 45 55

implemented programmes specially designed for underage girls and young women 30 70 27 73

implemented programmes specially designed for women 32 68 30 70

implemented programmes specially designed for pregnant women 42 58 35 65

implemented telephone quitlines 42 58 36 64

implemented local events to promote cessation of tobacco use 88 12 85 15

designed programmes to promote cessation in educational institutions 52 48 56 44

designed programmes to promote cessation in health-care facilities 75 25 72 28

designed programmes to promote cessation in workplaces 51 49 47 53

designed programmes to promote cessation in sporting environments 34 66 32 68

included diagnosis and treatment in national tobacco-control programmes 73 27 62 38

included diagnosis and treatment in national health programmes 72 28 61 39

included diagnosis and treatment in national educational programmes 43 57 39 61

included diagnosis and treatment in the health-care system 73 27 64 36

primary health care providing programmes on diagnosis and treatment 77 23 77 23

secondary and tertiary health care providing programmes on diagnosis and treatment 58 42 60 40

specialist health-care systems providing programmes on diagnosis and treatment 66 34 65 35

specialized centres for cessation providing programmes on diagnosis and treatment 52 48 60 40

rehabilitation centres providing programmes on diagnosis and treatment 25 75 33 67

physicians offering counselling services 93 7 94 6

dentists offering counselling services 42 58 44 56

family doctors offering counselling services 70 30 73 27

practitioners of traditional medicine offering counselling services 24 76 26 74

nurses offering counselling services 79 21 81 19

midwives offering counselling services 37 63 37 63

pharmacists offering counselling services 55 45 51 49

community workers offering counselling services 34 66 34 66

social workers offering counselling services 41 59 37 63

tobacco dependence treatment incorporated into the curricula of medical schools 46 54 37 63

tobacco dependence treatment incorporated into the curricula of dentist schools 25 75 19 81

tobacco dependence treatment incorporated into the curricula of nursing schools 32 68 24 76

tobacco dependence treatment incorporated into the curricula of pharmacy schools 22 78 17 83

accessibility and affordability of pharmaceutical products facilitated 59 41 58 42

nicotine replacement therapy available 91 9 91 9

treatment with bupropion available 63 37 68 32

treatment with varenicline available 69 31 67 33

ANNEX 5

95

Article 14.2(b) and (c) services and treatment costs provided covered by public funding or reimburse-ment schemes

2014 (%)

2012 (%)

Fully Partially None Fully Partially None

programmes in primary health care covered by public funding

41 34 25 43 36 21

programmes in secondary and tertiary health care covered by public funding

28 30 42 24 35 41

programmes in specialist health-care systems covered by public funding

33 28 39 23 41 36

programmes in specialized centres for cessation covered by public funding

23 25 52 34 26 43

programmes in rehabilitation centres covered by public funding

14 12 74 15 15 70

nicotine replacement therapy costs covered by public funding

28 16 56 27 11 62

bupropion costs covered by public funding 17 15 68 17 13 70

varenicline costs covered by public funding 13 15 72 13 11 76

2014 (%)

2012 (%)

Article 15. Illicit trade in tobacco products Yes No Yes No

marking that assists in determining the origin of product required 64 36 62 38

marking that assists in identifying legally sold products required 66 34 66 34

statement on destination required on all packages of tobacco products 38 62 36 64

tracking regime to further secure the distribution system developed 26 74 27 73

legible marking required 70 30 64 36

monitoring of cross-border trade required 53 47 50 50

information exchange facilitated 62 38 45 55

legislation against illicit trade enacted 71 29 65 35

requiring that confiscated manufacturing equipment be destroyed 70 30 60 40

storage and distribution of tobacco products monitored 65 35 53 47

confiscation of proceeds derived from illicit trade enabled 64 36 54 46

cooperation to eliminate illicit trade promoted 67 33 55 45

licensing required 68 32 62 38

Article 16. Sales to and by minors Yes No Yes No

sales of tobacco products to minors prohibited 91 9 86 14

clear and prominent indicator required 69 31 60 40

required that sellers request evidence that potential purchasers have reached full legal age 66 34 59 41

ban of sale of tobacco in any directly accessible manner 55 45 49 51

manufacture and sale of any objects in the form of tobacco products prohibited 62 38 59 41

sale of tobacco products from vending machines prohibited 62 38 54 46

tobacco vending machines not accessible to minors 65 35 52 48

distribution of free tobacco products to the public prohibited 84 16 82 18

distribution of free tobacco products to minors prohibited 87 13 82 18

sale of cigarettes individually or in small packets prohibited 68 32 67 33

penalties against sellers stipulated 82 18 73 27

sale of tobacco products by minors prohibited 76 24 66 34

96


2014 (%)

2012 (%)

Article 17. Provision of support for economically viable alternative activities Yes No NA Yes No NA

viable alternatives for tobacco growers promoted 15 40 45 12 40 48

viable alternatives for tobacco workers promoted 5 52 43 3 52 45

viable alternatives for tobacco sellers promoted 3 67 30 1 71 28

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

19 35 46 14 35 51

measures implemented in respect of tobacco cultivation considering the health of persons

22 33 45 15 35 50

measures implemented in respect of tobacco manufacturing for the protection of the environment

25 35 40 19 36 45

measures implemented in respect of tobacco manufacturing considering the health of persons

26 34 40 20 35 45

Article 19. Liability Yes No NA Yes No

measures on criminal liability contained in the tobacco control legislation 45 42 13 NC NC

separate liability provisions on tobacco control outside the tobacco control legislation exist 28 55 17 NC NC

civil liability measures that are specific to tobacco control exist 26 55 19 NC NC

civil liability measures that could apply to tobacco control exist 35 44 21 NC NC

civil or criminal liability provisions that provide for compensation exist 18 61 21 NC NC

criminal and/or civil liability action launched by any person 18 68 14 16 84

actions taken against the tobacco industry on reimbursement of costs related to tobacco use 10 78 12 4 96

ANNEX 5

97

2014 (%)

2012 (%)

Article 20. Research, surveillance and exchange of information Yes No Yes No

research on determinants of tobacco consumption promoted 68 32 64 36

research on consequences of tobacco consumption promoted 68 32 55 45

research on social and economic indicators promoted 62 38 53 47

research on tobacco use among women promoted 48 52 45 55

research on exposure to tobacco smoke promoted 58 42 53 47

research on identification of tobacco dependence treatment promoted 45 55 42 58

research on alternative livelihoods promoted 15 85 16 84

training for those engaged in tobacco control provided 55 45 53 47

national system for surveillance of patterns of tobacco consumption established 68 32 59 41

national system for surveillance of determinants of tobacco consumption established 48 52 45 55

national system for surveillance of consequences of tobacco consumption established 45 55 40 60

national system for surveillance of social, economic and health indicators established 50 50 40 60

national system for surveillance of exposure to tobacco smoke established 57 43 49 51

scientific and technical information exchanged 62 38 60 40

information on tobacco industry practices exchanged 43 57 40 60

information on cultivation of tobacco exchanged 28 72 25 75

database of laws and regulations on tobacco control established 68 32 67 33

database of information about the enforcement of laws established 54 46 55 45

database of pertinent jurisprudence established 26 74 33 67

Articles 22 & 26 International cooperation and assistance Yes No Yes No

assistance provided on transfer of skills and technology 26 74 28 72

expertise for tobacco-control programmes provided 25 75 33 67

training and sensitization of personnel provided 17 83 25 75

equipment, supplies, logistics provided 18 82 23 77

methods for tobacco control, e.g. treatment of nicotine addiction provided 12 88 14 86

assistance on research on affordability provided 6 94 8 92

assistance received on transfer of skills and technology 58 42 51 49

expertise for tobacco-control programmes received 59 41 51 49

training and sensitization of personnel received 42 58 45 55

equipment, supplies, logistics received 39 61 36 64

methods for tobacco control, e.g. treatment of nicotine addiction received 25 75 23 77

assistance on research on affordability received 13 87 11 89

development institutions encouraged to provide financial assistance for developing country Parties 20 80 18 82

specific gaps identified 53 47 56 44

99

anne

x 6

Adul

t sm

okin

g pr

eval

ence

1 repo

rted

by

the

part

ies

cont

inue

s ...

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Afgh

anis

tan

2011

35.2

035

.20

35.2

0

35.2

0

Alba

nia

NA

Alge

ria20

1027

.00

27.0

027

.00

2.

502.

502.

50

15.0

015

.00

15.0

0

Arm

enia

2009

, 201

2

55.7

050

.90

-4.8

0

2.90

3.20

0.30

28

.30

25.4

0-2

.90

Aust

ralia

2007

, 201

0/11

, 201

1/12

18.

0016

.40

17.6

0 1

5.20

13.9

013

.60

16.6

015

.00

15.6

0N

C

Aust

ria20

0843

.50

43.5

043

.50

34

.70

34.7

034

.70

38

.90

38.9

038

.90

Aze

rbai

jan

2009

, 201

236

.30

36.3

035

.30

-1.0

00.

000.

000.

00 0

.00

17.1

017

.10

16.7

0-0

.40

Baha

mas

2012

26.9

0

6.40

16

.70

Bahr

ain

2007

33

.40

33.4

0

7.

007.

00

19

.90

19.9

0

Bang

lade

sh20

0944

.70

44.7

044

.70

1.

501.

501.

50

23.0

023

.00

23.0

0

Refe

renc

es1

Whe

neve

r rep

orte

d by

the

Part

ies,

cur

rent

sm

okin

g pr

eval

ence

wer

e in

clud

ed in

the

tabl

e. N

C=da

tase

ts n

ot c

ompa

rabl

e. N

A=

data

not

repo

rted

.2

The

list

con

tain

s Pa

rtie

s th

at h

ave

subm

itte

d a

repo

rt in

the

2014

repo

rtin

g cy

cle.

100


... co

ntin

ued

cont

inue

s ...

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Barb

ados

2000

, 200

719

.80

11.3

011

.30

1.80

1.40

1.40

8.

506.

106.

10

Bela

rus

2009

, 201

1, 2

013

51.1

050

.40

48.6

0-1

.80

9.80

10.2

09.

70-0

.50

27.0

027

.00

25.9

0-1

.10

Belg

ium

2008

28.6

028

.60

28.6

0

20.7

020

.70

20.7

0

24.5

024

.50

24.5

0

Beliz

e20

06, 2

009

52.0

0

17.7

0

43.9

0

1.40

11

.70

10

.20

N

C

Beni

n20

0816

.00

16.0

016

.00

1.

701.

701.

70

8.70

8.70

8.70

Bhut

an20

07, 2

011

8.40

4.20

4.90

1.00

7.00

2.80

Bosn

ia a

nd

Her

zego

vina

20

03/2

010,

201

2

45.8

546

.90

29

.85

34.5

0

39.3

540

.70

NC

Braz

il20

08

21.6

021

.60

13.1

013

.10

17.2

017

.20

Brun

ei D

arus

sala

m20

01, 2

010

31.8

131

.81

34.9

02.

942.

943.

9017

.47

17.4

718

.00

NC

Bulg

aria

2008

, 201

350

.30

50.3

041

.60

-8.7

028

.20

28.2

025

.40

-2.8

038

.80

38.8

036

.80

-2.0

0

Burk

ina

Faso

2007

, 201

323

.90

24

.50

7.

60

0.10

16

.30

11

.30

N

C

Cam

eroo

n ?,

201

128

.80

15.2

08.

100.

7017

.50

Cana

da

2008

, 201

0, 2

012

20.1

019

.70

18.4

4-1

.26

15.7

013

.80

13.9

00.

1017

.90

16.7

016

.14

-0.5

6

Chile

2003

, 201

048

.30

44.2

044

.20

36

.80

37.1

037

.10

42

.40

40.6

040

.60

Chin

a20

10

52.9

052

.90

2.40

2.40

28.1

028

.10

Colo

mbi

a20

0823

.81

23.8

123

.81

11

.13

11.1

311

.13

17

.06

17.0

617

.06

Cong

o 20

08, 2

012

12

.10

13.0

0

1.00

1.30

6.

60N

C

Cook

Isla

nds

2004

, 201

146

.60

46.6

024

.26

41

.10

41.1

016

.36

43

.90

43.9

020

.27

N

C

ANNEX 6

101

... co

ntin

ued

cont

inue

s ...

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Cost

a Ri

ca20

10

18.0

018

.00

9.00

9.00

13.4

013

.40

Cote

D’Iv

oire

2005

36

.30

36.3

0

9.

309.

30

22

.90

22.9

0

Croa

tia20

07, 2

011

33

.80

38.3

0

21.7

031

.70

27

.40

35.0

0N

C

Cypr

us

2008

43.9

043

.90

16.9

016

.90

30.1

030

.10

Czec

h Re

publ

ic20

12

36

.50

26

.30

31

.30

Djib

outi

2006

, 201

2

41.1

018

.00

9.20

2.00

25.4

0

N

C

Ecua

dor

2010

36

.30

36.3

0

8.

208.

20

18.4

022

.70

22.7

0

Esto

nia

2010

, 201

2

45.8

044

.60

-1.2

0

26.0

026

.30

0.30

34

.20

34.2

00.

00

Euro

pean

Uni

on20

10, 2

012

35.0

032

.00

32.0

0-3

.00

25.0

024

.00

24.0

0-1

.00

29.0

028

.00

28.0

0-1

.00

Fede

rate

d St

ates

of

Mic

rone

sia

2002

42.0

042

.00

42.0

021

.00

21.0

021

.00

31.6

031

.60

31.6

0

Fiji

2002

53.0

053

.00

53.0

0

18.0

018

.00

18.0

0

36.6

036

.60

36.6

0

Finl

and

2008

, 201

0, 2

013

30.6

029

.40

25.6

0-3

.80

23.3

021

.10

18.9

0-2

.20

26.5

024

.80

21.9

0-2

.90

Fran

ce

2005

, 201

033

.30

35.6

035

.60

26

.50

27.9

027

.90

29

.90

31.6

031

.60

Gab

on

NA

Gam

bia

2010

31

.30

31.3

0

1.

001.

00

15

.60

15.6

0

Geo

rgia

2011

55

.50

55.5

0

4.

804.

80

30

.30

30.3

0

102


... co

ntin

ued

cont

inue

s ...

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Ger

man

y20

06, 2

009,

201

236

.50

33.9

031

.50

-2.4

028

.90

26.1

023

.90

-2.2

032

.60

29.4

027

.60

-1.8

0

Gha

na

2008

7.50

7.50

7.50

0.

400.

400.

40

2.90

2.90

2.90

Gre

nada

N

A

Hun

gary

20

07, 2

009,

201

348

.00

36.7

625

.11

28.0

026

.72

16.2

3 3

8.00

31.4

320

.48

NC

Icel

and

2009

, 201

1, 2

013

15.

7019

.10

15.9

0-3

.20

15.

2018

.60

17.3

0-1

.30

15.

4018

.90

16.6

0-2

.30

NC

(with

20

09)

Iran

2009

, 201

1

22.0

620

.84

-1.2

2

1.26

0.90

-0.3

6

11.7

910

.91

-0.8

8

Iraq

2006

41

.50

41.5

0

6.

906.

90

21

.90

21.9

0

Irela

nd20

07, 2

013

31

.00

22.9

0

2

7.00

20.2

0

29

.00

21.5

0N

C

Italy

2009

, 201

1, 2

013

29.5

028

.40

26.4

0-2

.00

17.0

016

.60

15.7

0-0

.90

23.0

022

.30

20.9

0-1

.40

NC

(with

20

09)

Jam

aica

20

00, 2

007/

2008

30.6

022

.10

7.70

7.20

19.2

014

.50

NC

Japa

n20

08, 2

009,

201

136

.81

38.2

032

.40

-5.8

09.

1310

.90

9.70

-1.2

021

.78

23.4

020

.10

-3.3

0

Jord

an

2007

49.6

049

.60

49.6

0

5.70

5.70

5.70

29

.00

29.0

029

.00

Kaza

khst

an20

07, 2

012

37.0

0

41.5

0

12.1

0

11.0

0

29.8

0

26.5

0N

C

Keny

a20

08/2

009

19.6

0

19.6

0

1.00

1.

00

20.6

0

20.6

0

Kirib

ati

2004

/200

6

37

.70

22

.30

29

.20

Kyrg

yz R

epub

lic20

05-2

006,

201

241

.70

44

.00

1.

50

3.00

20

.20

N

C

Lao

PDR

2003

, 201

267

.70

67.7

041

.00

1

5.90

15.9

08.

10

40.

3040

.30

24.4

0

NC

Latv

ia20

08, 2

010,

201

245

.00

47.4

052

.00

4.60

15.6

020

.70

17.6

0-3

.10

27.9

033

.70

34.3

00.

60

ANNEX 6

103

... co

ntin

ued

cont

inue

s ...

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Liby

a 20

09

49.6

049

.60

0.70

0.70

25.1

025

.10

Lith

uani

a20

08, 2

010

40.5

043

.30

38.6

0-4

.70

18.4

020

.80

17.6

0-3

.20

27.7

029

.10

26.1

0-3

.00

Luxe

mbo

urg

2009

, 201

1, 2

013

24

.00

24.0

00.

00

20.0

019

.00

-1.0

0

22.0

021

.00

-1.0

0

Mad

agas

car

2013

28.5

0

0.80

Mal

aysi

a20

06, 2

011

46.4

043

.90

43.9

0

1.60

1.00

1.00

21

.50

23.1

023

.10

N

C

Mal

dive

s 20

1134

.70

3.40

18.8

0

Mal

i20

07, 2

013

34

.10

24.5

2-9

.58

3.

902.

72-1

.18

15

.80

10.8

4-4

.96

Mal

ta20

0831

.00

31.0

031

.00

21

.40

21.4

021

.40

25

.70

25.7

025

.70

Mar

shal

l Isl

ands

2010

, 201

2

32.3

026

.00

-6.3

0

6.80

2.70

-4.1

0

19.6

017

.40

-2.2

0

Mau

ritan

ia20

08

34.1

034

.10

5.70

5.70

18.9

018

.90

Mau

titiu

s20

09

40.4

040

.40

3.70

3.70

21.7

021

.70

Mex

ico

2009

, 201

124

.80

24.8

031

.40

7.80

7.80

12.6

015

.90

15.9

021

.70

NC

Mon

golia

2009

, 201

348

.00

48.0

049

.10

1.10

6.90

6.90

5.30

-1.6

027

.70

27.7

027

.10

-0.6

0

Mon

tene

gro

2008

, 201

236

.70

36.7

035

.00

-1.7

029

.00

29.0

027

.00

-2.0

032

.70

32.7

031

.00

-1.7

0

Mya

nmar

2009

44.7

7

7.80

21

.99

Nep

al20

08, 2

012/

2013

35

.50

27.0

0

15

.90

10.3

0

26

.20

18.5

0

NC

Net

herla

nds

2009

, 201

1, 2

013

29.5

026

.80

25.6

0-1

.20

25.9

022

.60

24.5

01.

9027

.70

24.7

025

.00

0.30

New

Zea

land

2008

, 200

9, 2

012/

1324

.50

21.9

018

.70

-3.2

021

.80

20.2

016

.40

-3.8

023

.10

21.0

017

.60

-3.4

0

104


... co

ntin

ued

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

Nig

eria

2012

7.30

0.

40

3.90

Niu

e20

06, 2

011/

2012

31.0

0

22.6

0

16.0

0

13.0

0

23.0

0

17.7

0

NC

Nor

way

2009

, 201

1, 2

013

32.0

028

.00

25.0

0-3

.00

28.0

028

.00

22.0

0-6

.00

30.0

028

.00

24.0

0-4

.00

Om

an20

04, 2

008

13.4

016

.60

16.6

0

0.50

0.70

0.70

7.

007.

007.

00

Paki

stan

2006

, 201

2/13

32.

0032

.00

27.7

0 4

.10

4.10

1.60

18.

0018

.00

14.6

0N

C

Pala

u20

11

.24

.00

8.

40

17.

00 1

7.00

16.6

0

NC

Pana

ma

2007

, 201

0, 2

013

17.7

014

.10

9.40

3.90

3.10

2.80

9.40

6.40

6.10

NC

Papu

a N

ew G

uine

a20

07

60

.30

27

.00

44

.00

Para

guay

2003

, 201

1

41.6

022

.80

13.3

06.

10

27

.30

14.5

0

NC

Peru

20

06, 2

010

48.4

019

.70

2

4.10

7.80

3

4.70

13.3

0

NC

Phili

ppin

es20

09

47.7

047

.70

9.00

9.00

28.3

028

.30

Pola

nd20

09/1

0, 2

013

36

.90

38.0

01.

10

24.4

019

.00

-5.4

0

30.3

029

.00

-1.3

0

Port

ugal

2005

30.9

030

.90

30.9

0

11.9

011

.90

11.9

0

20.9

020

.90

20.9

0

Repu

blic

of K

orea

20

08, 2

010,

201

247

.70

48.1

043

.30

-4.8

07.

306.

107.

401.

3027

.30

26.9

025

.00

-1.9

0

Repu

blic

of

Mol

dova

2005

, 201

2

51.1

048

.20

7.

108.

20

28.0

027

.20

NC

Repu

blic

of S

erbi

a20

0638

.10

38.1

038

.10

29

.90

29.9

029

.90

33

.60

33.6

033

.60

Rom

ania

2010

37.4

0

16.7

0

26.7

0

Russ

ian

Fede

ratio

n20

09, 2

013

60

.20

57.0

0-3

.20

21

.70

18.0

0-3

.70

39

.70

36.0

0-3

.70

cont

inue

s ...

ANNEX 6

105

Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

San

Mar

ino

2013

16.1

0

14.4

0

15.2

0

Sao

Tom

e an

d Pr

inci

pe20

099.

709.

709.

70

1.70

1.70

1.70

5.

505.

505.

50

Saud

i Ara

bia

2006

35.8

035

.80

35.8

05.

705.

705.

7023

.00

23.0

023

.00

Sene

gal

2003

19.3

01.

0010

.00

Seyc

helle

s20

04, 2

013

38.5

038

.50

34.1

0-4

.40

5.80

5.80

7.70

1.90

22.2

022

.20

20.9

0-1

.30

Sier

ra L

eone

20

09

43.1

043

.10

10.5

010

.50

25.8

025

.80

Sing

apor

e20

07, 2

010,

201

323

.70

24.7

023

.10

-1.6

03.

704.

203.

80-0

.40

13.6

014

.30

13.3

0-1

.00

Slov

akia

2006

49

.00

49.0

0

28

.00

28.0

0

38

.00

38.0

0

Slov

enia

2007

, 201

1/20

1228

.20

28.2

026

.80

-1.4

021

.70

21.7

021

.10

-0.6

024

.90

24.9

024

.00

-0.9

0

Solo

mon

Isla

nds

2006

54

.10

54.1

0

25

.00

25.0

0

39

.80

39.8

0

Sout

h Af

rica

2003

, 201

235

.10

35.1

010

.20

10.2

018

.20

Spai

n20

06, 2

009,

201

1/20

1235

.33

35.3

431

.37

-3.9

723

.88

24.5

922

.77

-1.8

229

.529

.87

26.9

6-2

.91

Surin

ame

2007

, 201

3

38.4

034

.00

-4.4

0

9.90

6.60

-3.3

0

20.0

0

NC

Swed

en20

04, 2

011,

201

333

.00

23.0

023

.00

0.00

22.0

021

.00

20.0

0-1

.00

2522

.00

21.0

0-1

.00

Tajik

ista

n 20

09/2

010

8.70

0.00

Thai

land

2009

, 201

1, 2

013

40.

4741

.70

39.0

0-2

.70

2.0

12.

102.

05-0

.05

20.

7021

.40

19.9

4-1

.46

... co

ntin

ued

cont

inue

s ...

106


Part

ies2

Year

Mal

eFe

mal

eCo

mbi

ned

Com

men

tBy

20

1020

1220

14Pe

rcen

tage

po

int

chan

ge

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

By

2010

2012

2014

Perc

enta

ge

poin

t ch

ange

The

Form

er

Yugo

slav

Rep

ublic

of

Mac

edon

ia

NA

Togo

2007

, 201

024

.40

12.4

012

.40

8.

101.

801.

80

32.5

06.

806.

80

Tong

a20

06, 2

011

45.8

645

.86

43.2

0-2

.66

11.6

411

.64

11.3

0-0

.34

28.7

728

.77

27.1

0-1

.67

Tuni

sia

2005

48

.40

48.4

0

8.

208.

20

24

.90

24.9

0

Turk

ey20

08, 2

010,

201

247

.90

40.7

041

.40

0.70

15.2

013

.80

13.1

0-0

.70

31.2

029

.00

27.1

0-1

.90

Turk

men

ista

n 20

1318

.80

1.10

8.10

Tuva

lu20

02, 2

008

68.7

068

.70

47.8

0

31.2

031

.20

15.5

0

37.9

037

.90

32.0

0

NC

Uga

nda

2006

, 201

123

.30

14.7

04.

202.

8

Ukr

aine

2008

, 201

2

25.6

021

.80

-3.8

0

Uni

ted

King

dom

of

Gre

at B

ritai

n an

d N

orth

ern

Irela

nd20

08, 2

010,

201

221

.56

23.2

822

.83

-0.4

520

.59

18.9

317

.41

-1.5

221

.04

21.0

519

.79

-1.2

6

Uni

ted

Repu

blic

of

Tanz

ania

1992

, 201

2

17.0

026

.00

5.

002.

90

14

.10

N

C

Uru

guay

2009

30.

7030

.70

30.7

0

19.

8019

.80

19.8

0

25.

0025

.00

25.0

0

Uzb

ekis

tan

2007

20.0

01.

1010

.50

Vene

zuel

a20

11

21.6

021

.60

12.7

012

.70

17.1

017

.10

Viet

Nam

2001

/200

2, 2

010

56.1

047

.40

47.4

0

1.80

1.40

1.40

26

.98

23.8

023

.80

N

C

Yem

en20

03

27.4

027

.40

10.3

010

.30

18.9

018

.90

... co

ntin

ued

107

annex 7

Estimated averages for tobacco use prevalence by WHO region and country income group

Country income groups

Male Female

Current smokers

Daily smokers

Current smokers

Daily smokers

Low-income 29 25 4 3

Middle-income 39 33 6 4

High-income 28 23 18 14

Global 36 30 8 6

Estimated averages for prevalence of smoking and smokeless tobacco use among adults by WHO region (%)

WHO region

Male Female

Current smokers

Dailysmokers

Current smokeless

tobacco users

Current smokers

Daily smokers

Current smokeless

tobacco users

African 22 19 4 7 6 1

Americas 26 17 1 16 11 0

South-East Asia 34 33 32 4 3 19

European 38 32 3 19 15 0

Eastern Mediterranean 38 27 5 4 3 1

Western Pacific 47 42 1 3 3 0

Global 36 31 12 8 6 7

Estimated averages for prevalence of smoking tobacco use among adults by country income group (%)

ISBN 978 92 4 150777 6

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