Smoking remains the single largest cause of preventable death and the biggest cause of cancer worldwide (WHO Report on the Global Tobacco Epidemic. 2008). It is also the cause of many preventable illnesses, including cardiovascular disease, stroke and chronic obstructive pulmonary disease.
The WHO Framework Convention on Tobacco Control (FCTC) is widely seen as a seminal event in tobacco control and in global health and has ushered in a wave of interventions all over the world. However, the level of success of tobacco control interventions varies significantly at the country level, which is reflected by the wide variability in smoking prevalence around the world.
The current research was undertaken to see if critical success factors could be identified from countries with high levels of success in reducing smoking prevalence compared with those with more modest results over a period of at least 10 years. If so, these could potentially be applied by other countries to help them accelerate their own smoking cessation agendas.
A full range of smoking prevention, reduction and cessation interventions were analyzed in depth across five high success countries (Japan, Norway, South Korea, Sweden, UK) and five low success countries (France, Germany, Italy, Russia, Switzerland).
The research and advice from experts suggested that tax increases are the single most impactful intervention as well as the most cost effective, and may be a good place for countries to start. Tax increases may be followed by a range of legislative interventions, which collectively de-normalize tobacco over time (e.g. advertising bans, public smoking bans, restrictions for minors, pack warnings and standardized packaging). It is vital that this legislation is accompanied by a support structure – including stop smoking services and a full range of medications and substitutions – for smokers to help them on the journey towards quitting. Finally, media, education and awareness campaigns, particularly aimed at minors, can help to reinforce the messages and continue to de-normalize smoking and prevent a new generation from starting.
