COMMUNICATION FROM THE COMMISSION TO THE COUNCIL AND THE EUROPEAN PARLIAMENT on the present and proposed Community role in combating tobacco consumption
Date: 1996-12-18
Institutions: European Commission
Subjects: action programme, disease prevention, public health, smoking, tax system

COMMISSION  OF THE  EUROPEAN  COMMUNITIES 

Brussels,  18.12.1996 
COM(96) 609  final 

COMMUNICATION  FROM  THE  COMMISSION 
TO  THE  COUNCIL  AND  THE  EUROPEAN  PARLIAMENT 

on the present and proposed Community role 

in combating tobacco consumption 

Communication to the Council and the European Parliament 

on the present and proposed Community role 

in combating tobacco consumption 

I. 

INTRODUCTION 

1.  The  Community  and  its  Member  States  have  their  respective  and  complementary 
roles to play in promoting  an effective  anti-smoking  strategy.  Already,  several  of the 
most  effective  measures  aimed  at  reducing  the  damage  caused  by  smoking  are  of 
Community  origin.  These  are outlined  later in this Communication.  The  Community 
is  also  in  a  position  to  act  as  a  catalyst  for  measures  across  all  Member  States, 
strategies  is  swiftly 
ensuring  that  information  on  the  most  -  and  least  -  effective 
exchanged.  To  this  end,  a  series  of  national  anti-smoking  initiatives  are  also 
described. The purpose of the Communication is to contribute to  a review of existing 
and  possible future  anti-smoking  strategies both  at Community  and  at Member  State 
level, aimed at reducing the public health impact of smoking on European citizens. 

2.  The  Communication  then  sets  out  possible  options  for  further  action  at  the 
Community  level  and  by way of improved  cooperation  between  the  Member  States. 
The  Commission  will  subsequently  consider  the  necessity  for  proposing  further 
specific  measures and actions in the light of the response to this Communication. 

n. 

FACTUAL  BACKGROUND 

3.  The  damage  to  public health  caused  by tobacco  consumption  is considerable.  Half a 
million persons  die in the  Community  each year  from  its  effects.  The  death  rate will 
continue  to  rise  sharply  into  the  next  century  and  smoking  will  remain  the  biggest 
single  form  of  avoidable  death  in  the  Community  according  to  statistics  from  the 
World Health Organisation and the International  Centre for  Cancer Research.  Almost 
half of these  deaths  occur  in persons  aged  between  35  and  69 years  of  age  and  thus 
well  below  average  life  expectancy.  This  puts  tobacco  in the  first  rank  of  causes  of 
mortality.  Yet  the  resulting  human  and  economic  costs  can  be  effectively  reduced. 
There  is a very wide  range  of  options  available  to  reduce  the  incidence  of  smoking. 
These  include,  for  example,  health  education  measures,  a  taxation  policy  aimed  at 
discouraging  consumption,  improved  consumer  information  and  restrictions  on  the 
advertising and marketing of tobacco products. Progress to date in reducing  smoking 
incidence  is  nevertheless  disappointing.  Deaths  from  smoking  will  rise  substantially 
over  the  coming  decades  as  changes  in  the  population  structure  and  the  delayed 
impact of smoking on health come fully  into  effect. 

Over 40% of the Community  adult population continue to smoke 

4.  The  incidence  of  smoking  in  the  Community  has  been  in  decline  for  a  number  of 
decades  but  the  rate  of  fall  has  slowed  in  recent  years.  In  May  1994,  an  estimated 
42%  of  the  adult  population  smoked  compared  to  46%  in  1987.  Men  continue  to 
smoke  substantially  more  than  women  though  the  gap  has  been  closing  for  some 
time.  Greeks  are  the  heaviest  smokers  in  the  Community,  followed  by  the  Danes, 
Spaniards and Austrians. Conversely,  the lightest  smokers are the Finns,  Swedes  and 
Portuguese. Behind  these headline figures  are some important  data,  which  are  briefly 
outlined  below. 

4.1. 

Women are increasingly taking up smoking 

Far fewer  women than men smoke. However,  the gap is narrowing  as the rate 
of uptake  among younger women  rises.  One  statistic  bears  this  out.  The  rate 
of smoking  amongst  women  aged  over  55 years, at  14%, is only one third  of 
the corresponding figure  of 42% for women aged between  25 and  39 years of 
age.  The  corresponding  figures  for  men are  31%  and  51%  respectively.  This 
trend  is  even  more  apparent  in  Member  States  such  as  Spain  and  Portugal 
where  the  incidence  of  smoking  among  women  has  risen  from  negligible 
levels to 25% and  15% respectively in a generation. 

Changes  in lifestyles  and  successful  niche marketing  are  the  principal  factors 
behind  this  rise.  If  unchecked,  this  trend  could  lead  to  a  narrowing  of  the 
current  higher life expectancy  of women  over  men.  At  present  women  are up 
to  40%  less  likely  to  contract  cancer  than  men  but  this  gap  is  narrowing  as 
the  higher  incidence  of  female  smoking  begins  to  impact  on their  health  and 
especially  on  their  susceptibility  to  cancer.  Figures  for  the  incidence  of  lung 
cancer  among  women  already  reflect  this trend.  In  addition  it  will impact  on 
womens' susceptibility to heart disease, respiratory diseases and  infertility. 

4.2 

Many young people  continue to ignore the dangers of  smoking 

There  is  a  remarkable  rise  in  smoking  among  young  people  from  a  rate  of 
around  1%  at  age  11  to  between  20%  and  33% at  15  years  of  age.  Many 
young  people  are  clearly  ignoring  the  evidence  of  the  harmful  effects  of 
tobacco.  The older the person, the less likely they are to  commence  smoking. 
Marketing  activities therefore  concentrate on  young people in their  formative 
years. There is a pressing need from  a public health perspective to  discourage 
young people from  taking up the habit. 

4.3 

The better-off increasingly avoid smoking 

A  further  notable  trend  is the  higher  prevalence  of  smoking  in  lower*socio 
economic  groups  as better  educated,  better  paid  and  more  health  conscious 
individuals  increasingly  avoid  smoking.  This  has  very  important  socio 
economic  implications.  Persons  on  lower  incomes  spend  a  disproportionate 
amount  on tobacco  as,  due to  its  addictive  properties,  it  often  takes  priority 
over  other  household  expenditure.  Expenditure  on  other  items  important  to 
health,  such as food  and housing, suffers  accordingly. 

4.4 

Non-smokers are increasingly demanding protection from  smoking 

Many non-smokers object to being exposed  to the inconvenience  and  dangers 
of other people's smoking. For various reasons, non-smokers traditionally  are 
less well catered  for  than  smokers.  Smoking  is long  established  and  evidence 
of  the  damage  caused  by  passive  smoking  has  only  come  to  light  in  recent 
years.  There  is  a  period  of  adjustment  therefore  as  society  adapts  to  these 
changed  circumstances. Nonetheless, non-smokers have every right to  expect 
that  their  health  is  not  impaired  by  smokers.  This  is  especially  the  case  for 
persons with respiratory diseases, pregnant  women  and children,  all of whom 
are particularly vulnerable to secondary smoking. 

5.  All  the  above  trends  highlight  the  need  for  a  targeted  approach  towards  combating 
smoking. The generic message that smoking is bad for you remains valid but needs to 
be supplemented  by measures targeted  at sectors especially vulnerable to  smoking. 

m. 

W HY  A COMMUNITY  DIMENSION? 

6.  The  Treaty  provides  in  Article  3(0),  that  "the  activities  of  the  Community  shall 
include a contribution  to  the  attainment  of a high level  of health  protection".  Article 
129 of the Treaty  also provides that  Community  action  shall be directed  towards  the 
prevention  of  diseases,  in particular  the  major  health  scourges.  It  also  provides  that 
health protection requirements  shall form a constituent part of the Community's  other 
policies.  This  Article  also  states  that  Member  States  shall  co-ordinate  among 
themselves  their  policies  and  programmes  towards  ensuring  a  high  level  of  human 
health protection  and that the Commission may take  any useful  initiative  to  promote 
such  co-ordination.  The  scale  of the  problem  of the  damage  to  health  from  tobacco 
consumption  calls for the mobilisation of every effort  to reduce it. 

7.  The Community  is in a good  position to  promote  a better  and  more coherent  overall 
strategy to combat  smoking. All Member  States pursue measures to  combat  smoking 
but  these  strategies  differ  substantiaUy.  Clearly,  there  are lessons to  be  learned  from 
these  differences.  Why  do  fewer  people  smoke  in some Member  States  than  others? 
Why  are  there  divergent  trends  in  the  incidence  of  smoking  between  males  and 
females  and  amongst young people between Member  States?  Which  strategies  have 
been  most  successful  in reducing the incidence  of  smoking? What  is the  appropriate 
strategy  for  countering  tobacco  marketing  which  continues  to  attract  large  numbers 

of new consumers?  The answers to  many of these  questions  can be  effectively,  even 
if not exclusively,  addressed  at a Community level. 

IV. 

EXISTING COMMUNITY  PROVISIONS TO COMBAT SMOKING 

8,  The  Community  has  already  adopted  a  range  of  measures  which  help  to  counter 

tobacco  consumption.  Seven specific initiatives merit attention, namely: 

• 

• 

• 

• 

• 

• 

• 

the  Europe  against  Cancer  Programme  which  has  acted  as  a  major  focus  for 
measures  aimed  at  reducing  tobacco  consumption.  Surveys  of  the  public,  in 
particular  through  the  Eurobarometer  reports,  have  consistently  shown  a  very 
positive  appreciation  of the  Community's  actions  in relation  to  combating  cancer 
and in prevention  of smoking; 

the recent  formal  establishment  of the Advisory Committee for  Cancer  Prevention 
to enable it to  strengthen its advisory role to the Commission in its pursuit  of anti-
smoking  measures.  The  Commission's  public  health  strategy  can  benefit  greatly 
from  the invaluable expertise which is available from  the cancer experts as regards 
combating  smoking; 

the  Council  directive  on  television  without  frontiers  (89/552/EEC),  which 
harmonised  a ban on television advertising of tobacco products. 

the Council  directives  (89/622/EEC  and 92/41/EEC) on the  approximation  of the 
laws  relating  to  the  labelling  of tobacco  products.  These  have  alerted  consumers 
to  certain  of  the  dangers  of  smoking  through  the  display  of  health  warnings  and 
information  on tar and nicotine content; 

the Council directive (92/41/EEC) which banned the marketing of certain types of 
tobacco  for  oral  use.  This  measure  was  specifically  aimed  at  the  protection  of 
young  people  since  oral  tobaccos  have  served  as  a  precursor  for  other  tobacco 
products; 

the  Council  directive  (90/239/EEC) on the  approximation  of the laws  concerning 
the  maximum  tar  yield  of  cigarettes.  This  has  served  to  alert  consumers  to  tar 
content  which  is  a  major  risk  factor  for  cancer  and  provides  for  a  progressive 
reduction  in tar  content  to  a maximum  of  15 mg per  cigarette  from  31  December 
1992 and  12 mg from  31 December  1997. 

the  Council  Resolution  of  26.11.96  on  reduction  of  smoking  in  the  European 
Union,  which  outlines  the  various  strategies  adopted  in  the  Member  States  to 
reduce  the  prevalence  of  smoking  and  recognises  that,  by  cooperating  and 
illness  and  death 
coordinating  their  policies  and  programmes  to  prevent 
associated  with  smoking  and  addiction  to  smoking, 
the 
Commission,  the  Member  States  can  contribute  to  the  reduction  of  smoking-
induced  diseases across the Community. This Resolution calls on the  Commission 
to  take  particular  account,  in  Community  policies,  of  the  detrimental  effect  of 
smoking on the health and quality of life of citizens of the Community; 

in  liaison  with 

- 

to  carry  out  surveys  on  best  practices  conducted  in  the  Member  States  towards 
reducing the prevalence of smoking, and the evaluation of their impact; 

- 

- 

to examine, in the light of its assessment of measures taken by Member  States,  the 
possible  further  measures  which  might  be  taken  by  the  Community  to  support 
actions taken by Member States directed towards the reduction  of smoking;" 

to  support  the efforts  of Member  States to reduce smoking and  to  present  reports 
on  a  regular  basis  on  the  progress  achieved  by  the  Community  in  promoting 
coordination  by  Member  States  of  their  policies  and  programmes  and  on  the 
potential for further  initiatives. 

9.  Most  of  these  measures  were  introduced  under  the  Community's  programme  of 
actions aimed at the harmonisation  of the Single Market.  Others were  adopted  under 
the Treaty provisions governing public health. 

10.  Tobacco  is a very heavily taxed  product  in most  Member  States.  This is justified  on 
public  health  grounds  as  it  helps  discourage  consumption.  High  tobacco  prices  are 
particularly  effective  in discouraging young people from  smoking due to their  limited 
disposable  income.  They  also  serve  to  raise  very  substantial  revenues  which,  in 
several  Member  States,  help  finance  the  health  care  costs  arising  from  tobacco 
consumption.  However,  high  taxation  policy  for  tobacco  is  limited  in  its  effect  by 
several  factors:  in  particular,  it  does  not  affect  addiction  to  nicotine  of  individuals 
who  smoke.  Thus,  to  have  a  satisfactory  preventative  effect,  a high  taxation  policy 
needs to be accompanied  by flanking  measures,  such as smoking  cessation  assistance 
provided  to  consumers,  curbs  on  promotion  of  tobacco  products,  health  education 
and information  campaigns. 

The Community has taken initiatives under the  Single Market  programme  in  relation 
to  the  taxation  of  cigarettes  and  other  forms  of  manufactured  tobacco.  However, 
unlike the internal market measures outlined above, these were initiated under  Article 
99  of  the  Treaty  rather  than  Article  100a.  This  is  an  important  distinction  as  the 
Council acts on the basis of unanimity in relation to the former,  whereas  decisions in 
relation to the latter are on the basis of qualified majority. 

11.  At  present,  three  principal  forms  of  taxation  are  levied  on  tobacco  products  in  the 
Member  States  -  value  added  tax,  a  fixed  specific  excise  duty  and  a  variable  ad 
valorem  excise duty.  The relevant  Council  directives  provide  for  a limited  degree  of 
approximation  of these taxes. Consequently,  Member States continue to  enjoy  a very 
considerable  degree  of flexibility  in fixing  taxes  on tobacco.  This  accounts,  together 
in  ex-factory  prices  and  retailers'  margins,  for  the  very 
with  the  differences 
substantial variation in the retail prices of cigarettes between Member  States. 

12.  These  differences  in retail  prices  are very significant,  ranging  from  a low  of ECU  39 
per  1000  cigarettes  in  Greece  to  a  high  of  ECU  186  in  Denmark  and  with  a 
Community  average  of ECU  119. Indeed  no  other  common  everyday  product  varies 
so  substantially  in  price  throughout  the  Community.  Price  differences  are  especially 
pronounced  in the case of rolling tobacco. 

13.  It  must  be  recognised  that  the  comparatively  high  tax  levels  on  tobacco  products 
make  them  very  susceptible  to  fraud.  The  higher  the  tax  levels,  the  greater  the 
incentive to  smuggle. Present  estimates are that up to MECU 400 is lost  each year in 
Member  State and Community  receipts through  such activity. This needs to be borne 
in mind in the context  of any possible increases in tax levels. 

V. 

O P T I O NS  F OR  A D D I T I O N AL  F U T U RE  A C T I O NS  AT  T HE  C O M M U N I TY  L E V EL 

to  propose 

14.  Clearly,  there  are  limitations,  including  the  principle  of  subsidiarity,  (3n  the 
Commission's  possibilities 
tobacco 
consumption.  Nonetheless,  it  is  opportune  to  consider  a  new  Community  strategy 
aimed  at  encouraging  reduced  tobacco  consumption.  The  Commission  has  already, 
under  Article  129  of  the  Treaty,  secured  Council  and  Parliament  approval  for  a 
programme  of  action  on  cancer  prevention.  Measures  to  combat  smoking  will 
continue  to  be  a  priority  objective  of  this  programme,  given  that  one  third  of  all 
cancer deaths are  smoking-related. 

further  actions 

to  combat 

15.  In  addition,  the  following  policy  options  are  open  at  the  Community  level.  These 
options  can only be realised  with the active  support  of other  Community  institutions 
and of the Member States: 

15.1 

Data Collection and epidemiological studies 

•  Propose  a  system  to  monitor  tobacco  consumption  throughout 

the 
Community,  using  as  a  basis  the  programme  of  action  on  health 
monitoring  currently  before  the  Council  and  the  Parliament.  This  would 
facilitate  closer  monitoring  of  trends  in  consumption  and  thus  better 
targeting  of  prevention  activities.  Information  on  existing  trends  is  often 
both inadequate  and  out-of-date  and thus  a very  serious  impediment  to  an 
effective  strategy. 

15.2 

Children 

Develop  a code  of  practice  on the  right  to  a  smoke-free  environment  for 
children,  based  on  the  existing  European  Code  Against  Cancer.  Young 
children  are  especially  vulnerable  to  the  secondary  effects  of  smoking. 
They  are also very vulnerable to the advertising  and  marketing  of tobacco 
and need to be informed  of the harmful  health effects  of the habit. 

Promote  studies  and  pilot  projects 
in  the  framework  of  existing 
Community public health programmes  and under the Community Fund  for 
Research  and  Information  on  Tobacco  to  improve  understanding  of  why 
young  people  commence  smoking;  on  the  impact  of  health  education 
programmes  on  young  people  in  schools;  on  the  factors  which  motivate 
young  people  to  smoke  and  on  the  development  of  a  comprehensive 
smoking  prevention  approach  aimed  at  adolescents.  Such  measures  are 
considered  necessary  as  it  is clear  that  existing  measures  are  not  working 
sufficiently  well to curb smoking incidence among young people. 

15.3 

Classification 

Propose  that  nicotine  addiction  be  considered  as  a  dependency,  thus 
allowing  it  to  be  tackled  through  the  relevant  Community  public  health 
programmes. 

15.4 

Additives 

•  Evaluate  possible  toxicity  and  health  consequences  arising  from  additives 
to  tobacco  products.  Community  legislation  on  consumer  protection 
already  provides  for  extensive  information  on  additives  and  ingredients  in 
a  very  wide  range  of  products  where  they  have  health  consequences. 
Paradoxically,  however,  there  is no  such  provision  in  relation  to  tobacco 
and  this  oversight  could  usefully  be  reviewed,  if  certain  additives  prove 
harmful  to human health. 

15.5 

Carcinogenic agents 

Consider  the  case  for  a further  progressive  reduction  in the  maximum  tar 
content  of  12  mg  per  cigarette  permitted  under  Council  Directive 
(90/239/EEC).  Medical  science  is  virtually  unanimous  in  advocating  that 
further  reductions  should  be  introduced1.  Similarly,  a  maximum  level  of 
nicotine in cigarettes could also be considered. 

15.6 

Consumer information and protection 

Review  the  implementation  of the  existing  labelling  directive  with  a view 
to  the evaluation  of its efficacity  in informing  consumers  on the dangers  of 
smoking  and  whether  improvements  in  the  content  and  form  of  warnings 
could  be  introduced.  The  possibility  of  requiring  bigger  and  more  visible 
health  warnings  already  exists 
the 
in 
Commission could  examine this possibility with the Member States. 

labelling  directive  and 

the 

Consider  definition  of  the  description  "light"  or  "low"  tar  tobacco 
products,  as  such  descriptions  are  presently  undefined  and  may  mislead 
consumers by understating the dangers to health of such products. 

Promote  measures  to  increase  awareness  among  the  public  and  especially 
pregnant  women  of the  dangers  of smoking  - both  active  and  passive  -  to 
the unborn. 

Update, at regular intervals, the present Council Resolution  on smoking in 
public  places,  with  a  view  to  identifying  best  and  worst  practices  in  the 
Member  States.  This could  encourage  an improvement  in the  overall  level 
of  protection.  Discussion  could  also  be  initiated  in  the  framework  of  the 
Agreement  on  Social  Policy  in order  to  consider  this  issue  in  the  context 
of improving  the working  environment  and  improving workers' health  and 
safety. 

In  the  interests  of  public  health  protection,  encourage  Member  States  to 
exploit  the  flexibility  available to  them  to  increase  their  taxation  levels  on 
tobacco.  The  Commission  is required  to  submit  to  the  Council  every  two 

See  Recommendations  on  tobacco,  adopted  by  the  High  Level  Cancer  Experts  Committee,  Helsinki 
02.10.96 in annex. 

years  a report,  and where  appropriate  a proposal,  on the  operation  of  the 
existing  Council  directives  on  the  approximation  of  excise  duties  on 
tobacco  products.  The report  must  take  into  account  not  only the  proper 
functioning  of the internal market  and the  actual value  of excise taxes  but 
the  wider  objectives  of  the  Treaty. The  Commission  could  pay  particular 
attention  to  these  wider  objectives,  especially  the  health  dimension,  in 
future  reports. 

•  In the context  of its report  on the  common  organisation  of the market  for 
raw  tobacco,  the  Commission  is  indicating  certain  orientations  for 
substantial  reform.  Among  these  is  the  proposal  to  increase  from  1%  to 
2% the proportion  of the premium reserved  for the Tobacco  Research  and 
Information  Fund, the tasks of which are firstly  to  search for  varieties  and 
cultivation  methods which are less harmful  to  human health,  and  secondly 
to inform the public at large about the harmful  effects  of smoking. 

VI. 

OPTIONS  FOR IMPROVING  COOPERATION BETWEEN THE  MEMBER  STATES 

16.  Given  that  smoking  is the  biggest  single  avoidable  cause  of  death  in  the  developed 
countries,  all  Member  States  afford  a  high  priority  to  measures  aimed  at  reducing 
tobacco  consumption.  The  content  of 
future 
development  are  of  course  a  matter  for  the  Member  States.  Nonetheless,  the 
Commission  has  an  obligation  under  Article  129  of  the  Treaty  to  encourage 
cooperation  between  the  Member  States  in  this  area  and  to  lend  support  to  their 
action.  The  following  measures,  which  are  operated  to  varying  extents  in  the 
Member  States, appear to offer  the best prospects for  such cooperation: 

these  programmes  and 

their 

Measures  aimed  at  protecting  non-smokers,  especially  children, 
16.1 
pregnant  women  and  persons  suffering  from  respiratory  diseases,  from  the 
harmful  effects  of  passive  smoking.  Hospitals,  schools,  public  buildings, 
public  transport  and  commercial  airline  flights  are  increasingly  careful  to 
ensure that non-smokers are protected  from  the harmful  effects  of smoking. 

The  setting  of  specific  targets  for  a  reduction  in  smoking  in  the 
16.2 
population.  The  example  of  Ireland,  where  the  target  is  for  a  reduction  in 
smoking to 20% of the population by 2000, has acted  as a very positive  focus 
on anti-smoking measures and could usefully  be considered  by other  Member 
States. 

The  reinforcement  of  national  rules  aimed  at  limiting  the  sale  of 
16.3 
tobacco  products  to  adults  and  at  restricting  access  of  young  people  to 
cigarettes.  For  example,  some  Member  States  have  limited  sales  through 
automatic vending machines or self-service  counters to secure areas. 

16.4 
Increases  in  the  price  of  tobacco  products  in  real  terms  (i.e.  in 
excess  of the  rate  of inflation)  as a  further  means  of  deterring  consumption. 
The  decision  of the United  Kingdom  authorities  to  raise  prices  in  real  terms 
by  3%  annually  serves  as  an  example,  as  does  the  French  approach. 
Furthermore,  the  impact  of  such  increases  is  omitted  from  price  indexation 
measures  in Belgium  in order  to  ensure that  they  do  not  have  an  inflationary 
effect. 

The  encouragement  of  measures  to  provide  for  greater  protection 
16.5  . 
for  workers  who  are  exposed  to  above-normal  levels  of  environmental 
tobacco  smoke  (ETS).  Incentives  to  install  improved  ventilation  facilities, 
especially  in  entertainment  premises,  are  one  important  element  of  this 
strategy. 

16.6 
The  limitation  of  tobacco  sponsorship  and  merchandising  of 
tobacco  products  at  major  sporting,  musical  or  cultural  events  which  are 
likely to be televised  in order  to  avoid  indirect  publicity  for  tobacco  products 
on television. 

The  increased  funding  of  health  education  measures  targeted  at 
16.7 
smokers  and of voluntary  organisations  engaged  in protecting  the interests  of 
non-smokers and in smoking cessation activities. 

16.8 
The  provision  of  smoking  cessation  medications  (nicotine  chewing 
gums,  nicotine  "patches"  etc)  at  minimal  or  no  cost  to  smokers.  Such  a 
measure  would  represent  a  progressive  aid  to  smokers  to  quit  the  habit. 
Similarly, the provision of a toll free number to inform  and help consumers  on 
the dangers of smoking. 

VII. 

INTERNATIONAL  ROLE 

17.  Article  129,  paragraph  3,  of  the  Treaty  provides  for  closer  co-operation  with  third 
countries and the competent  international  organisations in the sphere of public health. 
Clearly,  co-operation  in  the  field  of  combating  tobacco  consumption  offers  such 
scope.  Smoking  has  been  endemic  in  the  Community  Member  States  for  centuries 
and the costs are now well known. 

18.  However,  many  other  countries,  especially  in  the  developing  world,  are  only  now 
beginning to  suffer  the full  impact  of tobacco  consumption.  Indeed  as  smoking  rates 
in  the  developed  world  remain  stagnant,  the  principal  growth  markets  for  cigarette 
manufacturers  are  in  developing  countries.  There  are  a  number  of  areas  where  the 
Community  could  cooperate  with  third  countries  to  reduce  the  impact  on  public 
health  of  tobacco  consumption.  A reduction  in  the  tar  content  of  tobacco  products 
manufactured  in  the  Community  and  exported  to  third  countries  is  one  such  area. 
9 

The  Community  could  also  assist  in  developing  anti-cancer  strategies,  involving 
measures to combat tobacco consumption, in the context of the existing public health 
or cooperation programmes. 

19.  In  addition,  the  Community  Member  States  could  boost  anti-tobacco  campaigns 
through  active  support  for  the  World  Health  Organisation's  proposed  tobacco 
Convention.  A code of practice  on the marketing  of tobacco  products  in developing 
countries,  especially  aimed  at  protecting  vulnerable  groups,  would  be  a  particularly 
progressive  step.  The  Community  could  also  consider  the World  Bank  approach  of 
refusing  aid  to  tobacco  related  projects  in  the  context  of  its  own  development  aid 
policies. 

v m.  FOLLOW-UP 

20.  The Commission will examine the reactions to this Communication and in the light of 

it's examination may bring forward  appropriate proposals for actions and measures. 

21.  The Commission  proposes to present  a report  each year on the progress  achieved  in 
relation to  public health protection from the harmful  effects  of tobacco  consumption. 
It  will  include  comparative  figures  on  price  developments  in  relation  to  tobacco 
products  and  figures  for  trends in the incidence of smoking. The report  will  serve  to 
inform  Member  States  and  the  public  of  the  Community's  progress  in  combating 
tobacco  consumption. 

22.  The  intention  is  that  the  above-mentioned  report  will  provide  a  highly  transparent 
mechanism for  the evaluation of the  smoking prevention  strategy  at both the level of 
the Community  and of the Member  States. In particular it will provide policy  makers 
with  the  options  available  to  reduce  tobacco  consumption  and  analyse  their 
effectiveness.  The first  such report will be presented to the Council in the second half 
of  1997. The  Council  and  Parliament  will have the possibility to  examine this  report 
and  to  suggest  further  additional  measures  which  could  contribute  towards  the 
reduction of smoking in the Community. 

10 

ANNEX 

High Level Cancer Experts  Committee 
Recommendations  on Tobacco 

Recommendation 

The High Level Cancer Experts Committee of the "Europe Against  Cancer"  Programme 
of  the  European  Commission  (hereafter  referred  to  as  the  Cancer  Experts  Committee), 
taking  into  account  the  advice  of  the  Helsinki  Tobacco  Consensus  Conference, 
unanimously  recommends  to  the  European  Union  that  measures  to  reduce  Tobacco 
Consumption  be  the  top  health  priority  for  the  European  Union  for  the  quinquennium 
1997-2001. 

Recommendation 

The Cancer Experts  Committee  considers that there  is no  rationale  for  the promotion  of 
a  known  carcinogen  by  any  means,  direct  or  indirect.  It  therefore  recommends  in  the 
strongest  possible  terms  that  the  measures,  relevant  to  this  issue,  already  agreed  to  by 
the European Parliament  be implemented  without  delay. There  is widespread  agreement 
among  health  education  authorities  that  tobacco  advertising  plays  a role  in  encouraging 
the uptake of smoking and should  be banned. 

Recommendation 

Historically,  the  composition  of  the  cigarette,  unlike  any  other  marketed  poison,  has  been 
basically unregulated.  In recent years some limits have been recommended  or mandated  for  tar 
and  nicotine  contents  of  cigarettes.  Manufacturers  are  nevertheless  allowed  to  introduce 
additives without  demonstrating  their freedom  from  toxicity  either before  or  after  combustion. 
Government  Departments  have  avoided  taking  responsibility  for  authorising  the  inclusion  of 
substances  to  a mixture  which  changes  upon  combustion  and  is  carcinogenic.  They  have  had 
no  qualms  about  controlling  manufacturers  of  diverse  agents  including  antibiotics  and  soft 
drinks by formal  regulation. 

Therefore,  the Cancer  Experts  Committee  recommends  that  cigarette  content  should  be 
the  subject  of  regulation  throughout  the  European  Union.  From  31st  December  1997 
onwards : 

(i) 

Only  tobacco,  tobacco  paper,  filter  materials  and  tobacco  extracts  should  be 
permitted  in  cigarettes  sold  or  manufactured  in  the  European  Union.  Any 
additives  to  be  included  should  be  demonstrated  free  of  toxicity  and  other 
harmful  effects  on  health,  in  burnt  and  unburnt  form.  Additives  to  cigarettes 
should  be  monitored  and  included  on  the  labelling  as  with  other  drugs  and 
foodstuffs  on  the  market.  The  tar  content  of  cigarettes  should  be  limited  to  a 

M 

maximum  of  12mg  as  currently  mandated  for  31st  December  1997.  The  nicotine 
content of cigarettes should be limited to lmg from 31st December  1997.  * 

(ii) 

The maximum  allowable  limits  of the tar (12mgs)  and  nicotine  (lmg)  contents  of 
cigarettes  sold  or  manufactured  in  the  European  Union  should  be  decreased  by 
10 per cent per annum until levels of 5mgs tar and 0.5mg  nicotine are met. 

(iii)  By  31st  December  1997,  labelling  requirements  similar  to  those  currently 
applicable  in  Australia  should  be  in  force.  In  particular,  the  health  warning 
should  be strengthened,  made more prominent  and the labelling  should  include a 
toll-free,  telephone  number  from  which  accurate  information  about  smoking,  its 
health  consequences  and  smoking  avoidance  can  be  obtained.  By  31st  December 
2000, generic packaging  of cigarettes and tobacco products should  be mandatory. 

Recommendation 

The  Cancer  Experts  Committee  notes  that smoking  begins  in  adolescence  or earlier  and 
that  reduced  availability  is  an  anti-smoking  influence.  On  this  basis  it  is  recommended 
that  steps  should  be  taken  aiming  to  reduce  the  availability  of  tobacco  products  to 
children  and  adolescents.  Self  service  displays  and  vending  machines  should  be 
withdrawn. 

Recommendation 

In  the  light  of  evidence  that  price  increases  are  a  deterrent  to  smoking,  have  a  greater 
effect  on children  and, further,  that regular price increases are necessary  to maintain  the 
effect,  the  Cancer  Experts  Committee  recommends  that  the  European  Union  pursues  a 
tax policy aimed  at the upward  harmonisation  of the retail price of tobacco  products 

Recommendation 

Regardless  of the right  of the smoker to  smoke, non-smokers  have the right  to  breathe  air that 
is as unpolluted  as possible.  Pollutants  such as asbestos  and benzene  are  limited  by law to  the 
lowest  practical  level  attainable.  The  lowest  level  attainable  of  tobacco  smoke  is zero.  While 
cancer  risk  is  not  perhaps  as  immediate  as that  of  triggered  asthma  attacks,  orthodox  Public 
Health  practice  requires  that  non-smokers  be protected  from  tobacco  smoke  in the  workplace 
and  public  places  in  the  broadest  sense.  The  common-sense  of  this  recommendation  is 
emphasised  by  various  legal  precedents  which  show  that  employers  in  some  countries  are 
vulnerable at law for breach of the elementary requirement to provide a safe workplace. 

To protect the rights of non-smokers  and prevent involuntary  exposure to  environmental 
tobacco  smoke,  the  Cancer  Experts  Committee  recommends  that  smoking  be  banned  in 
public  places  and  in the workplace.  Separate smoking  sections  may  be  introduced  in the 
workplace,  and  in places such  as restaurants  and  bars. Smoking  should  be prohibited  on 
air flights  within  the European  Union. 

/il 

Recommendation 

The Cancer Experts  Committee  considers there is a clear and  obvious need  for  comprehensive 
education programs to inform professionals,  the public and children of the dangers  of smoking, 
as well as to explain the rationale for the anti-smoking measures recommended  here.  Education 
programmes obviously need to be culture and language  specific. 

With this in mind the Cancer  Experts  Committee  recommend  the following  general  proposals, 
aware that  some have already been adopted  and implemented  :by the European  Commission in 
the context  of the on-going "Europe Against Cancer" Programme; 

• 

• 

• 

• 

• 

• 

• 

That each country  be encouraged  to form  a coalition  of groups  involved  in 
public  health  and  education  to  be  charged  with  organising  appropriate 
national  programmes  whose  principal  aim  is  to  initiate  action  to  reduce 
tobacco consumption  and its serious  effects. 

That  national  groups  be  encouraged 
collaborative  network aimed at sharing information  and  expertise. 

to  join 

in  a  Europe-wide 

That  the  European  Commission  continue  to  sponsor  regular,  at  least 
annual,  meetings of this collaborative  network. 

That  relevant  public  health/education/behavioural  research  be  a  function 
of the national  and European  groups. 

, 

That  surveillance  and  monitoring  of  education  programmes,  behavioural 
trends,  smoking  prevalence,  knowledge  and  relevant  attitudes  be  a 
priority and  be funded  as part of the comprehensive  programme. 

That  programmes  directed  specifically  at  health  professionals  be 
supported  and  further  developed  in  those  countries  where  smoking 
prevalence  is high in these groups. 

That  there  be  a  designated  centre  whose  objectives  should  include  the 
continual  evaluation  of  the  scientific  literature  of  the  association  between 
tobacco  usage  and  disease  and  the  patterns  of  tobacco-related  disease 
within  the  European  Union.  This  Centre  should  be  mandated  to  prepare 
an Annual Report for submission  to the European  Parliament. 

Recommendation 

The  Cancer  Experts  Committee  welcomes  the  phasing  out  of  the  sale  of  duty  free 
cigarettes  and  other tobacco  products. 

m 

ISSN 0254-1475 

COM(96) 609 final 

DOCUMENTS 

EN 

05 

Catalogue  number  :  CB-C0-96-661-EN-C 

ISBN 92-78-13199-7 

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