Doc. 9463

15 May 2002

Campaigning against passive and active smoking – daring to innovate and step up public health protection measures

 

Report

Social, Health and Family Affairs Committee

Rapporteur: Mr Francis Poty, Belgium, Socialist Group

Summary

The harmful effects of smoking, both active and passive, are undeniable. Recognition of the right to protection of health implies a tobacco-smoke free environment for Europe’s population. Yet more and more women and young people are smoking, victims of the tobacco industry’s attempts to recruit new consumers and to encourage their dependence on tobacco. The member states are invited to pass firmly anti-smoking legislation that is enforced and complied with, and to provide the requisite financial resources.

I.       Draft resolution

1.       The harmful effects of tobacco on the health of smokers, their families, friends and colleagues and, in particular, their unborn children are now well known and undeniable. The Assembly is, however, aware that smoking is far from being in decline; it is spreading among young people in particular, especially young women, and in many European countries which are Council of Europe member states tobacco consumption remains widespread, and smokers still enjoy a positive image.

2.       The Assembly welcomes the fact that the World Health Organisation (WHO) is drafting a Framework Convention on Tobacco Control to combat this scourge at world level.

3.       The Assembly recalls that the Council of Europe member states have made the protection of health a human right; recognition of this right implies that a tobacco smoke-free environment should be the norm for people living in Europe, and that non-smokers’ rights should take priority over freedom to smoke.

4.       The Assembly is concerned about the current practices and excesses of the tobacco industry, which is seeking to recruit new consumers and encourage them to become dependent on tobacco. It condemns the danger to young people, who are particularly vulnerable and exposed to such practices.

5.       The Assembly therefore invites all the member states to pass, without delay, public health legislation which is firmly anti-smoking and which:

i.       gives urgent priority to drastically reducing smoking and recognising non-smokers’ right to health protection;

ii.       makes smoke-free areas the absolute norm in enclosed places to which the public has access (public offices, workplaces, residential facilities and care centres, educational establishments, theatres and concert halls, sports venues, public transport, and so on). However by derogation clearly demarcated and separated areas could be set aside for smokers in public places and on company premises;

iii.       does not tolerate direct, indirect or disguised advertising in any form whatsoever of tobacco products or by-products;

iv.       encourages aggressive anti-smoking advertising that shows the harmful effects of tobacco smoke on the health of smokers and their families, friends and colleagues and promotes the rights and image of non-smokers;

v.       requires that tobacco products, particularly cigarette packets, bear a compulsory warning, written in strong terms, about the harmful effects of tobacco on the health of smokers and their families, friends and colleagues;

vi.       requires that all the ingredients of tobacco products are indicated and prohibits the use of chemical or other additives that increase dependency on tobacco;

vii.       prohibits any misleading term or expression that gives the impression that certain cigarettes are less dangerous.

6.       The Assembly also invites member states to introduce

i.       appropriate policies to prevent adolescents, a tobacco industry target group, from starting to smoke and developing dependence on tobacco;

ii.       policies aimed at encouraging people to give up smoking, especially young people and pregnant women, by ensuring easy access to the various methods and substitutes available to help people stop smoking.

7.       The Assembly recommends that member states adopt the “polluter pays” principle and levy a charge on all tobacco products, in addition to the relevant taxes, of an amount equivalent, if possible, to 0.75 of a euro, 0.25 euro of which would go to a public body set up to finance anti-smoking activities, and the rest to research into and treatment of, smoking-related diseases.

8.       Member states must make sure that the legal provisions introduced accordingly are effectively enforced and are complied with; to this end, the states must recognise, among other things, consumer associations’ right to take a case to court and to seek compensation for the non-observance of legal prohibitions and for violations of non-smokers’ rights. In the case these rights are not respected, member states could set up a mediation service to intervene as a first level of appeal, funded out of the tax on tobacco.

9.       The Assembly asks the member states to conduct an active policy in favour of farmers who switch their production from tobacco to other products.

10.       The Assembly also calls on member states to support the work of the World Health Organisation so that an efficient legal instrument for combating smoking worldwide is completed as soon as possible.

II.       Explanatory memorandum by Mr. Poty

1.       The motion presented by Mr Evin and others (Doc. 8101), which prompted this report, was initially aimed at combating alcohol and tobacco consumption. At its meeting in Paris on 29 May 2001, the Social, Health and Family Affairs Committee, in agreement with its rapporteur, Mr Evin, decided that it would be more efficient to divide the motion into two separate reports. I was appointed rapporteur on tobacco consumption.

State of play

2.       The World Health Organisation regards tobacco consumption as one of this century’s major public-health challenges. It is a sort of worldwide epidemic that must be combated at world level.

3.       WHO’s reports are worrying and damning. In 2000, there were about 1.4 billion smokers in the world; the figure will rise to 1.64 billion in 2025. Tobacco was considered responsible for 4 million deaths in 2000, and will probably cause 10 million deaths in 2025.

4.       It has been established that in the industrialised world, three million people die from the effects of tobacco consumption each year (six people every minute). Extrapolations show that about sixty million people lost their lives as a result of tobacco consumption in the period 1959-2000; forty million of them were in the 35 to 69 age group. 80% of new smokers in the EU countries are under 18.

5.       However, in western Europe the situation is beginning to stabilise and tobacco consumption among men is falling in some countries. This is not the case in central and eastern Europe where, with a few exceptions, tobacco consumption is on the increase. It appears that nowhere in Europe is tobacco consumption falling among women; in some countries it is reportedly even higher than among men.

6.       The dangers of tobacco consumption are well known. WHO has officially listed 25 diseases caused by smoking. The dangers of indirect or passive tobacco consumption – inhalation of tobacco smoke by people other than the smoker - are now well-documented and uncontested and can be observed during gestation of the child and right from birth. The risks to children of smoker mothers are well known and include increased risk of miscarriage, premature birth, sudden death and lung infections…

7.       Studies have shown that tobacco consumption not only by mothers but also by fathers may seriously affect their children’s health. A study by the University of Birmingham shows that the risk of cancer during childhood increases by 3% if the father is a light smoker. This figure rises to 31% for moderate smokers and 42% for heavy smokers. Studies also show a higher prevalence of pulmonary diseases if children are exposed to tobacco smoke after birth.

8.       Tobacco is indisputably a danger to children’s health and no-one would disagree with WHO that the rights of the child take precedence over those of the tobacco industry.

9.       Even adults who do not smoke, but are often in the company of smokers, run a 25% higher risk of lung cancer. Between 1,000 and 4,000 deaths are caused by passive smoking in Europe each year.

10.       The international community is determined to combat the scourge. WHO has launched a Tobacco-Free Initiative (TFI). A 3rd action plan for a tobacco-free Europe covers the period 1997-2001; it deals with market regulation, prices, advertising and so on, as well as schemes to educate and inform the public. Every year on 31 May we celebrate World No Tobacco Day. In November 2001, Dr Gro Harlem Brundtland, Director General of WHO, called on states to take action against tobacco advertising.

11.       The 191 members of WHO intend to draft a framework convention on tobacco control, which should be finalised by May 2003. WHO considers that adopting resolutions alone is insufficient and that stronger measures are needed to tackle the threats to public health posed by the sale, promotion and use of tobacco.

12.       The declared objectives of the future convention are to: protect children and teenagers against tobacco; prevent and treat tobacco addiction; encourage tobacco-free environments and the development of healthy, tobacco-free economies by ending smuggling; give women a greater role in the war on smoking; enable all member states to combat tobacco consumption more effectively and improve information exchange and knowledge at national and international level; and, lastly, protect vulnerable communities, including native populations.

13.       These objectives are ambitious and difficult, as achieving them entails taking on the tobacco industry, thereby endangering the jobs it represents. But a recent study by the World Bank concludes that the social and health costs of tobacco far outweigh the economic benefits of growing it.

14.       In the European Union, Directive 2001/37/EC of the European Parliament and of the Council of 5 June 2001 is aimed at harmonising law in the member states governing the manufacture, presentation and sale of tobacco products. However, these rules are not due to come into force until 2004 or even 2006!

Citizens’ right to health protection

15.       There is no right to health, but there is a right to protection of health. This is clearly stated in Article 11 of the Council of Europe’s European Social Charter (and of the Revised Charter).

The objectives of this report are fully in keeping with the constant battle to preserve health, being to:

–       protect non-smokers;

–       reduce tobacco consumption and, consequently, the number of smokers.

16.       This order of priorities is quite deliberate; clearly it is important to do everything possible, and make it a priority, to protect those who, against their will, are exposed to the harmful effects of tobacco.

17.       The aim is certainly not to declare war on smokers, but to limit the serious harm done by tobacco consumption in the interests of public health. A strategy therefore has to be developed to bring home that tobacco is a drug that harms everyone, smokers and non-smokers alike; smokers have a duty to respect non-smokers’ right to an environment unpolluted by tobacco smoke.

18.       This requires that:

–       smoking be forbidden in all indoor public places,

–       and that no smoke can reach the protected public area from any special areas set aside for smokers as exceptions to the general-interest requirement.

The norm: a smoke-free area

19.       The premise is therefore that normal living space, by its very nature, must be unpolluted by tobacco smoke. Wherever smoking is tolerated in public places, there must be full respect for non-smokers’ health, and this means that smokers must bow to the obligation to use special smoking areas. In theory, “non-smoking area” signs would no longer be necessary, as freedom to breathe non-polluted air in all public places would be the norm, not freedom to smoke. This is already the approach in the law of a number of countries outside Europe.

20.       In practice, to reduce tobacco consumption effectively the public places where smoking is totally prohibited must be clearly identified and are those indoor areas of establishments or buildings to which the public have access and where:

–       public services are provided, whether for payment or free of charge, including places where food products and/or drinks are available for consumption;

–       sick or elderly persons are admitted or cared for;

–       preventive or curative health care is provided;

–       children or young people of school age are admitted, accommodated or cared for;

–       instruction or training are given;

–       entertainment is provided;

–       exhibitions are held;

–       sports are practised;

–       as well as on public transport (by air, road and rail). 

21.       The prohibition must extend to large indoor common workplaces, and here above all respect for non-smokers must be the unbreakable rule. It is up to companies to inform their staff of the rules and enforce them. However, clearly demarcated, separate and suitably equipped areas could be set aside for smokers in public places or on company premises as an exception.

22.       Special efforts should be made to protect young people. There should be no exceptions to the ban on smoking in educational establishments – no allowances should be made. It is particularly difficult to get teachers to enforce this recommendation since they are often smokers themselves.

Combating smoking

23.       Measures taken to combat tobacco consumption are often inadequate and half-hearted.

24.       The first step in combating tobacco consumption must be to improve the information given on the packaging of tobacco products themselves; it must be sufficiently striking to get its message across. In Canada, for example, “Smoking can kill you” is printed on cigarette packets in large letters. This legal warning has proved to be more effective than the “Smoking damages your health” warning printed in tiny letters on packets in other countries.

 

25.       In Europe, cigarette manufacturers are, as a rule, only obliged to indicate the tar and nicotine content of their products, whereas it is estimated that there are some one hundred additives in tobacco. Not all of these additives have been identified but there is no doubt that some of them are designed to increase tobacco dependence.

26.       Prohibiting all direct and indirect advertising of tobacco products is a step in the right direction and should be generalised as soon as possible. The ban must cover both direct and indirect advertising. To attract the young people who will be tomorrow’s smokers, the tobacco industry promotes a form of disguised tobacco advertising by all the means at its disposal, including parties, sports events, and cigarette logos or brand-names on clothes.

27.       However, it is even more important that advertising critical of tobacco be developed quickly, in a move from a passive approach to positive, vigorous action to genuinely reduce tobacco consumption.

28.       If this is to be achieved, public authorities must make available substantial finance, raised from the sale of tobacco products on the “polluter pays” principle.

29.       What we need to do is to tell smokers and non-smokers the truth about the health risks of tobacco, downgrade smokers’ social standing, alert parents and teachers to their responsibilities, and find the right way of getting the message across to young people, particularly adolescents, so as to prevent them from smoking their first cigarette and becoming dependent on tobacco.

30.       We should also provide more information on the various methods of giving up smoking and easier access to substitutes designed to help people to do so. Alternative means of consuming tobacco should not be overlooked. Snuff and chewing tobacco are nothing new. Some countries now recommend these practices as alternatives which minimise tobacco-related risks and, at any rate, eliminate the dangers of passive smoking. Research workers are looking into new products which are less toxic than cigarettes, such as oral solutions of nicotine that can be dissolved in drinks. New products are coming on to the market, such as small compressed tobacco tablets that melt in the mouth called “cigalettes”.

Conclusions:

31.       The Rapporteur asks the Assembly to adopt the following recommendations to member governments:

i.       give priority to protecting the health of non-smokers by introducing appropriate national laws and measures and raising smokers’ awareness of non-smokers’ right to breathe tobacco-smoke-free air;

ii.       prohibit smoking as a general rule in all indoor public places and work areas. Where companies allow exceptions, the areas set aside for smokers must be markedly separate from areas accessible to all so that non-smokers are in no way subjected to passive smoking; smoking areas should not take up more than a third of the space available and should be gradually reduced;

iii.       prohibit:

 

a. all forms of advertising of tobacco products, by-products and other goods carrying tobacco brand-names and enforce this prohibition within a reasonable period;

b. all indirect forms of advertising through the use of images or words in connection with cultural productions or commercial products (for example films, television and radio programmes, comic strips, websites, etc.);

c. the use of chemical additives to increase tobacco addiction;

d. develop vigorous ongoing counter-publicity (prevention) aimed in particular at young people and women who are the current targets of the tobacco industry;

e. adopt the “polluter pays” principle, whereby:

Reporting committee: Social, Health and Family Affairs Committee

Reference to committee: Doc 8101 and Reference No. 2283 of 26 May 1998

Draft resolution adopted on 22 March 2002 with seventeen votes in favour, no votes against and one absention.

Members of the committee: Mrs Ragnarsdóttir (Chairman), Mr. Hegyi, Mrs Gatterer, Mr. Christodoulides (Vice-Chairmen), MM. Alís Font, Arnau, Mrs. Belohorská (alternate: Mr. Tkáč), Mr. Berzinš, Mrs. Biga-Friganović, Mr. Bilovol, Mrs. Björnemalm, Mrs. Bolognesi, MM. Brînzan, Brunhart, Cerrahoğlu, Cesário, Cox, Dees, Dhaille, Evin, Floros, Flynn, Mrs. Gamzatova, MM. Giertych, Glesener, Goldberg, Gönül, Gregory, Gusenbauer, Gustafsson, Haack, Herrera, Hřie, Hörster, Mrs. Jäger, Mrs. Jirousová, Baroness Knight, MM Kontogiannopoulos, Liiv, Lomakin-Rumiantsev, Mrs. Lotz, Mrs.. Luhtanen, MM. Makhachev, Małachowski, Manukyan, Mrs. Markovska, MM. Marmazov, Marty (alternate: Mr. Schmied), Mattei, Mrs. Milotinova, MM. Mladenov, Monfils (alternate: Timmermans), Ms. Nowiak, MM. Olekas, Ouzký, Padilla, Podobnik, Popa, Poroshenko, Poty, Provera, Rigoni, Rizzi, Seyidov, Mrs. Shakhtakhtinskaya, MM. Slutsky, Surján, Telek, Mrs. Tevdoradze, Mrs. Troncho, MM. Tudor, Vella, Mrs. Vermot-Mangold, MM. Vesselbo, Vis, Vos, Mrs. Zafferani, M. Zidu.

NB : The names of those members present at the meeting are printed in italics.

Secretaries to the committee: Mr. Newman, Ms Meunier and Ms Karanjac