Opinion of the Committee of the Regions on the "Proposal for a Council Recommendation on the Prevention of smoking and on initiatives to improve tobacco control"
Date: 2002-11-20
Institutions: European Committee of the Regions
Subjects: consumer information, consumer protection, health legislation, impact study, public awareness campaign, public health, smoking, social problem

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— Design programmes for the prevention, follow-up and
controlled treatment of hepatitis C, which is very com-
mon among drug users, in order to halt the spread,
progression and future consequences of the disease, in
particular the probability of chronic illness and pro-
gression to cirrhosis and carcinomas.

— Promotion of measures to prevent or minimise the
physical, psychological and social problems encountered
by drug addicts unable to give up drug use, e.g. use of
opiate substitutes, easier access to substitutes, distribution
of syringes and condoms.

— Promotion of measures in line with the ‘therapy not

punishment’ approach.

— Promotion of regional studies and research.

Brussels, 20 November 2002.

The President

of the Committee of the Regions

Albert BORE

Opinion of the Committee of the Regions on the ‘Proposal for a Council Recommendation on
the Prevention of smoking and on initiatives to improve tobacco control’

(2003/C 73/03)

THE COMMITTEE OF THE REGIONS,

having regard to the proposal for a Council recommendation on the Prevention of smoking and on
initiatives to improve tobacco control (COM(2002) 303 final);

having regard to the decision of the European Commission of 3 January 2002 to consult the Committee
under the fourth paragraph of Article 152 of the Treaty establishing the European Community;

having regard to the decision of its Bureau of 6 February 2002 to instruct the Commission for Economic
and Social Policy to prepare the Committee’s work on this subject;

having regard to the Resolution of the Council and the Ministers for Health of the Member States meeting
within the Council of 18 July 1989 on banning smoking in places open to the public (1);

having regard to Council Directive 89/552/EEC of 3 October 1989 on the coordination of certain
provisions laid down by law, regulation or administrative action in Member States concerning the pursuit
of television broadcasting activities (‘Television without frontiers Directive’) (2);

having regard to the recommendations on tobacco control initiatives required at Community level,
adopted by the Commission’s High Level Cancer Experts Committee (COM(1996) 609 final — Annex);

having regard to the Council Resolution of 26 November 1996 on the reduction of smoking in the
European Community (3);

(1) OJ C 189, 26.7.1989.
(2) OJ L 298, 17.10.1989.
(3) OJ C 374, 11.12.1996.

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having regard to the December 1996 Communication from the Commission to the Council and the
European Parliament on the present and proposed Community role in combating tobacco consumption
(COM(1996) 609 final);

having regard to the World Bank report entitled Curbing the Epidemic: Governments and the Economics
of Tobacco Control, Washington DC 1999;

having regard to the Commission Report to the European Parliament, the Council, the Economic and
Social Committee and the Committee of the Regions on progress achieved in relation to public health
protection from the harmful effects of tobacco consumption (COM(1999) 407 final) on the follow-up to
the above-mentioned 1996 Communication;

having regard to the Council Conclusions of 18 November 1999 on combating tobacco consumption (1);

having regard to Directive 98/43/EC of the European Parliament and of the Council of 6 July 1998 on
the approximation of the laws, regulations and administrative provisions of the Member States relating
to the advertising and sponsorship of tobacco products (2) annulled by the European Court of Justice in
case C-376/98, judgment of 5 October 2000, Germany v Parliament and Council, Digest of Community
case-law 2000, p. I-8419;

having regard to the Proposal for a Directive of the European Parliament and of the Council on the
approximation of the laws, regulations and administrative provisions of the Member States relating to the
advertising and sponsorship of tobacco products, presented by the Commission pursuant to Articles 47(2),
55 and 95 of the EC Treaty on 14 May 2001 (COM(2001) 283 final) (3);

having regard to Directive 2001/37/EC of the European Parliament and of the Council of 5 June 2001 on
the manufacture, presentation and sale of tobacco products;

having regard to the World Health Organisation Framework Convention on Tobacco Control (FCTC)
under discussion, Internet address: http://www.who.int/gb/fctc/;

having regard to its draft opinion (CdR 226/2002 rev.) adopted on 25 September 2002 by the
Commission for Economic and Social Policy (rapporteur: Mr Alvaro Ancisi, town councillor for Ravenna,
I/EPP),

adopted the following opinion at its 47th plenary session on 20 and 21 November 2002 (meeting of
20 November).

1. Views and recommendations of the Committee of the

Regions

The Committee of the Regions

1.1.
notes that smoking is a prime cause of human disease
and death. Smoking is enormously costly for the Community
and is the cause of considerable suffering for individuals and
their families. Approximately one third of the EU population
smokes and the health impact is grave, with 500 000 smoking-
related deaths a year, involving cancer in particular. Smoking
also has a proven effect on the health of non-smokers,
particularly on vulnerable groups, such as children, pregnant
women and people with respiratory diseases. Much has been
done in the EU to combat and prevent smoking, but there is a
great deal still to be done to secure widespread and solid
results. For this reason, the EU must adopt new and more
effective measures in this area;

( 1) OJ C 86, 24.3.2000.
( 2) OJ L 213, 30.7.1998.
( 3) OJ C 270, 25.9.2001, p. 97.

1.2.
recognises that the proposal for a Council recommen-
dation responds to this need in an effective and appropriate
way. It is in line with the policies followed by the EU up to
now, while also taking up a number of recommendations
made on the subject by other Community institutions in
previous documents. The Committee also notes that the
proposal follows on from and is in keeping with its own
previous opinions on public health and on the manufacture,
presentation and sale of tobacco products;

believes that, as the fight against smoking has world-
1.3.
wide implications,
it is very important that the measures
recommended by the Council are fully in line with the
discussions on the establishment of a World Health Organis-
ation framework convention on tobacco control (FCTC), given
that the draft elements of the FCTC currently under discussion
include measures aimed at a total ban on all forms of direct
and indirect advertising, preventing the access of minors to
tobacco vending machines, banning the sale of cigarettes
individually or in packets of fewer than 20 and requiring
tobacco companies to disclose their advertising expenditure;

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1.4.
notes that the proposal for a recommendation is
addressed to the Member States, who are asked to take new
and more incisive measures against the use of tobacco in
general and smoking and the sale of cigarettes in particular.
Although a recommendation is not legally binding on Member
States, they are naturally expected to comply with its require-
ments, given that smoking and the use of tobacco products is
a major public health problem in all countries. This expectation
is reflected in part by the monitoring role assigned to the
Commission;

in legal

1.5.
takes the view that in that respect, the proposals
contained in the recommendation appear for the most part to
be balanced and constructive, such as those aimed at pro-
hibiting the sale of tobacco to children and adolescents.
However, the Committee believes that in certain Member
States it will be more difficult
terms to apply
the requirement for manufacturers and vendors of tobacco
products to disclose their marketing expenditure or to prevent
the most insidious forms of direct or indirect advertising from
reaching children and adolescents (as demonstrated by the
Court of Justice judgment of October 2000, which annulled
the Directive of the European Parliament and of the Council of
6 July 1998 on the advertising and sponsorship of tobacco
products because it did not guarantee the free movement of
products or eliminate distortions to competition). While the
Committee is fully behind the aims and objectives of these
measures, which are clearly set out in the explanatory memor-
andum, it would also point out that there is a degree of friction
between the demands of health protection and those of the
internal market. The measures are essential however and the
legal barriers must be removed;

1.6.
underlines the continued relevance of its opinion of
April 2000 on the new tobacco directive, which has now been
adopted, in which it pointed out the need to harmonise or
at least approximate Member States’
laws, regulations and
administrative provisions regarding the manufacture, presen-
tation and sale of tobacco products. This is important both for
achieving a high level of public health protection and for
helping to remove the obstacles to the improved functioning
of the internal market. In view of the legal uncertainty in
some matters in this area, the Committee welcomes the
recommendation as it has come just at the right time.

health, pointing up the aim of protecting non-smokers in
public places and the workplace. The Committee is pleased to
note that the Commission document takes up this proposal in
point 4 of the recommendations to the Member States;

states that the achievement of smoke-free public places
2.2.
and workplaces is a strategic move in the fight against
smoking. The Committee would stress that to pursue this
objective effectively, specific policies must be adopted that
require the development of a social consensus, legal certainty,
monitoring mechanisms and penalties, and efficient bureau-
cratic procedures;

2.3.
calls for consideration to be given to the provision of
treatment and support for people giving up smoking, such as
anti-smoking counselling from GPs, courses on giving up
smoking in approved anti-smoking centres, counselling from
nurses in hospitals and from local chemists;

recommends that health systems provide support for people
giving up smoking, including nicotine substitution treatment,
specifically targeted at vulnerable groups such as:

— teenagers, in particular smokers, by offering anti-smoking
advice each time they come into contact with the health
system;

— pregnant women, by ensuring that health education
programmes designed for this group include information
on the risks of smoking and guidelines for giving up;

— people suffering from smoking-related diseases, by ensur-
ing that both primary and specialised healthcare centres
also provide treatment for people giving up smoking;

also suggests promoting the use of new communication
technologies to give as many people as possible access to
techniques for giving up smoking;

2. Protection from tobacco smoke in public places and

the workplace

The Committee of the Regions

would stress that in the above-mentioned opinion, in
2.1.
addition to legislative harmonisation, it expressed the need to
give consideration to other forms of action to protect public

2.4.
would stress in particular that the workplace is the
prime setting for action to achieve healthy environments,
using social acceptance as the key to the success of additional
and complementary measures in training, offering support in
giving up, and environmental monitoring. The Committee
would therefore suggest that particular attention be given to
workplaces whose institutional image is particularly important,
for instance hospitals and health services (where health service
employees must be the first to set a professional example by
not smoking), schools and government offices, inasmuch as
they are supposed to set an example for the whole community.

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3. Total ban on smoking in schools

The Committee of the Regions

3.1.
would stress that in schools especially it is essential to
be consistent in the messages given and the behaviour shown.
It believes therefore that the no-smoking rule should be
extended throughout school premises, including toilets and
playgrounds, in order to prevent young people from smoking
publicly during breaks, often in the company of teachers (who
ought to refrain from smoking anywhere in school buildings,
even staff rooms), giving younger pupils the idea that rather
than being a bad habit, smoking is socially acceptable and to
be imitated. The Committee believes that an anti-smoking
policy is especially useful in nursery and primary schools, as it
is easier to count on effective parental involvement at this
developmental stage. The aim must be to prevent children
from becoming regular smokers in their adolescence as it is at
this stage in their development that they are most likely to
adopt anti-social behaviour patterns, and smoking is a pre-
ferred form of rebellion; later it is difficult to give up.

b)

c)

d)

e)

f)

g)

giving young people a role in spreading the word and
promoting health in the community, in accordance with
an open and informative model of local society;

raising family awareness, stressing the negative effect that
family habits can have in encouraging young people to
take up smoking;

using effective techniques to communicate the risks to
formal and informal groups of young people (without
moralising or scare-mongering, and using positive role
models to bolster the image of the non-smoker);

involving the local media in information campaigns
targeted according to gender and age group;

taking care to avoid any form of
tobacco-industry
sponsorship at public (musical or sporting) events that
are likely to attract young people;

take appropriate information and training initiatives
(involving sectoral associations) to raise tobacco vendors’
awareness of the correct way to deal with minors.

4.

Local intervention in the field of information and
education

5. The role of local and regional authorities

The Committee of the Regions

The Committee of the Regions

4.1.
would point out that, up to now, the content of the
recommendations made has tended to focus on bans and rules,
although these cannot be dissociated from training measures
able to achieve the basic social consensus without which no
imperative law can become customary. It is pleased to see
however that in point 5 of the recommendations to the
Member States there is an invitation to bolster health education
and programmes to discourage the use of tobacco products,
namely,
information and education measures to promote
health and healthy lifestyles, which can counterbalance the
social pressure that boosts tobacco consumption. In advance
of its comments on the importance of local-level action, the
Committee would point out that in this area of prevention, the
bulk of the effort should be aimed at the younger generations,
and that, in this respect, there is a vast spectrum of potentially
useful local initiatives, such as:

a)

carrying out effective teaching programmes in schools
with a view to dissuading children from taking up
smoking (developing awareness and the ability to over-
come the social pressure mounted by family models, peer
groups, advertising and social mores);

5.1.
having stressed the importance of local measures in
the field of training and education for the younger generations,
would underline the central role of local and regional auth-
orities in the fight against smoking.
In reality, measures
designed and adopted at central level have little chance of being
accepted socially or succeeding if that role is undervalued. More
specifically, the Committee would point out that local and
regional authorities can be effective in:

a)

b)

c)

d)

the supervision, control and monitoring of the regional
application of legislative guidelines adopted by the State;

the drafting of legislative proposals addressed to their
national governments and more generally to the Member
States, expressing demands and ideas for the future that
have been generated from the bottom up;

the drawing-up of regional and local guidelines on the
prevention, control and treatment of tobacco addiction,
following broad consultation with professional and social
representatives;

implementation of Member States’
the regional-level
strategies for preventing and combating tobacco addic-
tion;

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5.2.
notes that local and regional authorities clearly have an
important role to play in the establishment and development of
a regional network of services and resources directed towards
combating smoking, involving all the representatives of the
community’s economic, political and cultural fabric, including
the private and voluntary sectors. The Committee would also
stress that
local and regional authorities is
fundamental in managing the system as a whole, to ensure the
measures are:

the role of

a)

b)

c)

d)

coordinated to form an integrated and complementary
set of measures;

directed at clearly defined target groups, with the creation
of health promotion-friendly environments;

conducted gradually so that through the process of
securing a social consensus a non-smoking culture is
formed and citizens are empowered to play an active role
in health promotion;

an integral and coherent part of a multi-sectoral health
promotion strategy across the board, underpinning politi-
cal and government action;

5.3.
points out that the importance of the role of local and
regional authorities, both in making the Community guidelines
operational and in assessing their impact at regional level,
demands the development of stable cooperation mechanisms
and the forging of new alliances with governmental and non-
governmental organisations in order to compare experiences
and share ideas for the future;

5.4.
highlights the need to spread the practice of setting up
national tobacco advisory councils in the Member States, to
gather contributions from scientific institutions, government
agencies and NGOs;

5.5.
refers, in this context, to the example of cooperation
between Member State NGOs given by the European Network

Brussels, 20 November 2002.

for Smoking Prevention (ENSP), whose role should be further
developed in the area of technical and scientific consultation.

6. A European centre for the study of smoking preven-

tion and control

The Committee of the Regions

6.1.
believes that it would be extremely useful for the EU to
have a centre for the study of the prevention and control of
smoking, tasked with:

— conducting a Europe-wide epidemiological study of the
phenomenon (from addiction and related illnesses to
social and health costs);

— collecting and documenting experiences of good practice

in the anti-smoking field, carried out by Member States;

— preparing and disseminating tried and tested method-
ologies, programmes and practical tools in line with the
Community guidelines;

— the provision of ongoing training for operators;

— monitoring and assessing smoking prevention and con-

trol measures conducted by the Member States;

6.2.
takes the view that this study centre should have close
operational links with other European agencies and working
groups dealing with drug addiction in general and alcoholism
in particular. Above all, a stronger joint initiative is needed at
Community level in the area of ‘legal substances’ as a whole
(tobacco and alcohol), as opposed to illegal substances, in the
light of the many similarities in their social and cultural
features and in the types of prevention scheme that can be
used.

The President

of the Committee of the Regions

Albert BORE