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2018

GLOBAL PROGRESS REPORT

on Implementation of the WHO

Framework Convention

on Tobacco Control

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2018

GLOBAL PROGRESS REPORT

on Implementation of the WHO

Framework Convention

on Tobacco Control

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WHO Library Cataloguing-in-Publication Data

2018 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 978-92-4-151461-3

Acknowledgements

This report was prepared by the Convention Secretariat,

WHO Framework Convention on Tobacco Control. Dr Tibor

Szilagyi from the Reporting and Knowledge Management

team of the Convention Secretariat led the overall work on

data analysis and preparation of the report. Hanna Ollila,

from the WHO FCTC Secretariat’s Knowledge Hub on

Surveillance, conducted the data analysis and drafted the

text for the report as per guidance from the Convention

Secretariat. The following colleagues from the Secretariat’s

Reporting and Knowledge Management teams contributed

to the drafting of the report: Leticia Martínez López,

Dominique Nguyen, Rob Tripp and Kayla Zhang. Special

thanks for contributions by the other teams of the

Convention Secretariat. Important contributions were

made by Alison Louise Commar of the WHO Department

for Prevention of Noncommunicable Diseases to the section

on the prevalence of tobacco use and Corne van Walbeek,

Chipo Rusere and Samantha Filby, on behalf of the WHO

FCTC Secretariat’s Knowledge Hub on Taxation and Illicit

Trade, to the section on taxation. Special recognition

goes to Shyam Upadhyaya, Chief Statistician of the

United Nations Industrial Development Organization and

an Observer to the Conference of the Parties, for data on

global tobacco manufacturing trends. The report benefited

from the guidance and inputs provided by Dr Vera Luiza da

Costa e Silva, Head of the Convention Secretariat. Their

assistance and contributions are warmly acknowledged.

Any mediation relating to disputes arising under the licence

shall be conducted in accordance with the mediation rules

of the World Intellectual Property Organization.

Suggested citation.

2018 Global progress report on

implementation of the WHO Framework Convention on

Tobacco Control. Geneva: World Health Organization;

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TABLE OF CONTENTS

FOREWORD

EXECUTIVE SUMMARY

1. INTRODUCTION

2. OVERALL PROGRESS IN IMPLEMENTATION OF THE CONVENTION

3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS

General obligations (Article 5)

Reduction of demand for tobacco

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

Protection from exposure to tobacco smoke (Article 8)

Regulation of the contents of tobacco products (Article 9)

and Regulation of the tobacco product disclosures (Article 10)

Packaging and labelling of tobacco products (Article 11)

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

Tobacco advertising, promotion and sponsorship (Article 13)

Measures concerning tobacco dependence and cessation (Article 14)

Reduction of the supply of tobacco

Illicit trade in tobacco products (Article 15)

Sales to and by minors (Article 16)

Other provisions

Tobacco growing and support for economically viable alternatives (Article 17)

and protection of the environment and the health of persons (Article 18)

Liability (Article 19)

Research, surveillance and exchange of information (Article 20)

Reporting and exchange of information (Article 21)

International cooperation (Article 22)

4. NEW AND EMERGING TOBACCO PRODUCTS

5. PREVALENCE OF TOBACCO USE

6. PRIORITIES, NEEDS, GAPS AND CHALLENGES

7. CONCLUSIONS

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FOREWORD

The 2018 Global Progress Report on

Implementation of the WHO Framework

Convention on Tobacco Control (WHO FCTC) is

reflective of the level of activity and commitment

of the Parties to the Convention as they move

forward with implementation of the Convention.

The WHO FCTC is the first international treaty

negotiated under the auspices of WHO. It

was adopted by the World Health Assembly

on 21 May 2003 and entered into force on 27

February 2005. It has since become one of the

most rapidly and widely embraced treaties in

United Nations history.

The advances that have taken place in the

implementation of the Convention, which are

reflected in this report, demonstrate the impact

of the Convention – in the reduction in tobacco

use among adults and young people in many

Parties.

This report marks the first time since the

Convention came into force that all Parties

have formally submitted at least one report on

the implementation of the treaty within their

respective jurisdictions. As we are hopeful

to have the Conference of the Parties (COP)

adopt the Convention’s first

Medium-term

Strategic Framework,

this global analysis of

WHO FCTC implementation status will provide

the baseline dataset for measuring the impact

of the Strategic Framework in the future.

The concerted effort of the Parties, the

Convention Secretariat and other stakeholders

have led to significant advances in

implementation of various measures required

under the Convention. The 2018 reporting

cycle also detected mounting support for the

Protocol to Eliminate Illicit Trade in Tobacco

Products, which successfully gathered the 40

ratifications needed for its entry into force just

after the closure of the reporting period.

The active engagement of the WHO FCTC

Secretariat’s knowledge hubs is making a

significant contribution towards strengthening

the implementation of the Convention and

in the development of policy and legislative

enhancements among the WHO FCTC Parties.

New tools have been developed in the areas

of smokeless tobacco and water-pipe tobacco

use by some hubs, and other new tools are

coming from the others. Technical assistance

generated through South–South and triangular

cooperation projects and through other

partners of the Convention Secretariat also

helps in building country capacity to improve

the implementation of the Convention.

Reporting, while an obligatory function under

the WHO FCTC, presents an opportunity

for Parties to recount their stories on how

tobacco control can remarkably improve

the health of their populations. This process

helps highlighting the Parties’ own domestic

successes, but also helps to paint a picture

of the treaty’s global impact. Sharing this

valuable information on worthwhile practices

can help all Parties improve the health of their

own populations, strengthen their relations with

one another and withstand the influence of the

global tobacco industry.

Despite the broad acceptance of the WHO

FCTC reporting instrument introduced in

2016, challenges remain as the reporting

process is complex and could be perceived

as burdensome. The Convention Secretariat

is continuously looking for the most effective

ways to improve the reporting process and

make it more user-friendly.

The Convention Secretariat is happy to

inform the Parties that for the first time in the

preparation of the Global Progress Report a

knowledge hub was involved in the analytical

work. Specifically, the WHO FCTC Secretariat’s

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Knowledge Hub on Taxation has taken over

the duty of analysing taxation and price data

reported by the Parties. Our positive experience

with the hub will help us extend the scope of

such collaboration to other hubs. Additionally,

it is also for the first time that a United Nations

agency partner, which also happens to be a

COP observer, the United Nations Industrial

Development Organization, contributed to

the Global Progess Report by summarizing

the information they collect on tobacco

manufacturing. As always, our main partner,

the World Health Organization, contributed to

the analysis of the prevalence data. All these

contributions are warmly acknowledged.

The Convention Secretariat, when releasing

this 2018 Global Progress Report, remains

enthusiastic on the advances that we are

making collectively in addressing the global

tobacco epidemic. We remain committed to

working with and supporting the Parties to the

Convention in their efforts.

The Convention Secretariat

(Courtesy of the Secretariat of the WHO FCTC. Photo: A.Tardy)

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EXECUTIVE SUMMARY

The 2018 reporting cycle for the WHO

Framework Convention on Tobacco Control

(WHO FCTC) was conducted in accordance

with decision FCTC/COP4(16), using an

Internet-based reporting instrument. Data

collection for the 2018 reporting cycle was

carried out from 1 January to 31 March 2018.

Of all 181 Parties to the Convention, 142 (78%)

formally submitted their 2018 implementation

reports, while most of the remaining Parties

updated some of their information in the reporting

database. For the first time since the Convention

entered into force, all Parties have formally

submitted at least one implementation report.

Reporting on their implementation of the

WHO FCTC is not only an obligation for the

Parties, it also is an opportunity for them to

share information on their progress towards

implementation, as well as challenges, needs

and barriers. In addition, the reporting process

contributes to the dissemination of experiences

and best practices among the Parties to the

WHO FCTC.

While the status of implementation has

consistently improved since the Convention’s

entry into force in 2005, progress towards

implementation of the various articles remains

uneven, with implementation rates ranging from

13% to 88%. Time-bound measures under the

Convention (Articles 8, 11 and 13) continue to

be the most implemented, with the Article 13

measures lagging somewhat behind the other

two time-bound articles.

As was the case in previous reporting cycles,

Article 8 (Protection from exposure to tobacco

smoke), Article 11 (Packaging and labelling

of tobacco products), Article 12 (Education,

communication, training and public awareness)

and Article 16 (Sales to and by minors) have been

implemented most successfully. Meanwhile,

Article 18 (Protection of the environment and

the health of persons), Article 19 (Liability) and

Article 17 (Provision of support of economically

viable alternative activities) seem to be the

least successfully implemented, with little or

no progress in comparison to 2016. Some

implementation details are highlighted below.

In 2018, an increasing number of Parties

reported having put in place or developed

comprehensive

multisectoral

national

strategies and tobacco control action plans,

with nearly two thirds reporting measures taken

to prevent tobacco industry interference with

tobacco control policies. Tobacco industry

monitoring, in line with the recommendations

of the Guidelines for implementation of Article

5.3 of the Convention, seems to receive more

attention from the Parties, not least because of

the emphasis put by the Convention Secretariat

on the project establishing sentinel tobacco

industry observatories in various regions.

Important advances were observed in

implementation of measures relating to the

reduction of demand for tobacco. More

than 90% of the Parties indicated having

implemented tax and/or price policies, and

the same percentage declared having banned

smoking in all public places. A considerable

number of Parties also shared their experience

in extending or planning to extend smoking

bans to outdoor environments, as well as on

the inclusion of novel products in their existing

smoke-free legislation.

Health warnings are now required in almost

90% of Parties, with a growing number of

Parties implementing or planning to implement

plain or standardized packaging. Education,

communication, training and public awareness

campaigns have been carried out widely at the

national and regional levels, often in conjunction

with World No Tobacco Day. However, further

efforts should be carried out by Parties to

specifically address gender-specific risks

when developing tobacco control strategies.

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Furthermore, it is important to address the

needs of indigenous peoples in order to reduce

the high prevalence of tobacco use in such

communities.

While most of the Parties have reported the

existence of a comprehensive ban in their

countries on all tobacco advertising, promotion

and sponsorship, cross-border advertising

remains less regulated and difficult to enforce.

Tobacco-dependence diagnosis, treatment

and counselling services are included in national

tobacco control programmes in more than

two thirds of the Parties, which is significant

progress compared to one half in 2016.

A key milestone for 2018 was the entry into

force of the Protocol to Eliminate Illicit Trade

in Tobacco Products, which was ratified by 46

Parties at the time of the writing of this report.

Meanwhile, over two thirds of the Parties

have also reported enacting or strengthening

legislation aimed at tackling illicit trade on the

national level.

Even though 85% of the Parties have prohibited

sales of tobacco products to minors and a

growing number of the Parties have increased

the minimum age to purchase tobacco

products, there is still room for improvement,

especially in banning self-service shelves and

vending machines.

National

tobacco

surveillance

systems

established by more than 70% of the Parties,

advances in research, and the observation

of patterns of tobacco consumption have

contributed to the improved monitoring of

progress towards both the implementation

of the WHO FCTC, which is a target in the

Sustainable Development Goals, and global

targets for noncommunicable diseases.

Despite the significant progress and sustained

effort in implementation of the Convention, the

lack of human and financial resources remains

the challenge cited most often by the Parties.

Additionally, technical assistance is still very

much needed in the fields of taxation, policy

development, research and national cessation

programmes.

Finally,

tobacco

industry

interference, combined with the emergence of

new and novel tobacco products, continues

to be considered the most serious barrier to

progress.

The WHO FCTC Secretariat’s knowledge

hubs, South–South and triangular cooperation

among the Parties, the dissemination of reports

documenting best practices in countries,

and the development of toolkits by the

Convention Secretariat and its partners offer

the Parties tailored support in areas in which

implementation rates are lower and present

greater challenges.

Overall, the progress described in this report

indicates that the Convention is indeed having

an impact through the momentum it creates,

the intensification of international collaboration

and creation of a network of supporting

partners within and outside the UN system, all

these taking place under the clear guidance of

the Conference of the Parties (COP).

For the first time in the history of the Convention,

the eighth session of the COP will consider a

draft Medium-term Strategic Framework for

scaling up implementation of the Convention.

The data and findings from this reporting cycle

present a solid body of information on which

the new framework could be based, as they

provide insight into the most successful and

most challenging areas of work. That insight will

help the COP and the Parties to the Convention

prioritize their actions at the national, regional

and international levels.

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INTRODUCTION

The

2018 Global Progress Report on

Implementation of the WHO Framework

Convention on Tobacco Control

is the eighth

global tobacco report since 2007. It has

been prepared in accordance with decision

FCTC/COP1(14) taken by the Conference

of the Parties (COP) at its first session,

which established reporting arrangements

under the WHO Framework Convention on

Tobacco Control (WHO FCTC), and decision

FCTC/COP4(16) taken at its fourth session,

harmonizing the reporting cycle under the

Convention with the regular sessions of the

COP. Furthermore, in the latter decision the COP

requested the Convention Secretariat to submit

global progress reports on implementation 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.

The scope of this Global Progress Report is

threefold. First, it provides an overview of the

status of implementation of the Convention on

the basis of the information submitted by the

Parties in the 2018 reporting cycle. Second,

it presents self-assessments by the Paries of

measures and innovative practices they put

in place while implementing the Convention.

Finally, the report summarizes progress,

opportunities and challenges related to the

implementation of individual articles of the

Convention and formulates conclusions for

consideration by the COP when determining

possible ways forward.

In the 2018 reporting cycle, two questionnaires

were available for Parties’ use: 1) the core

questionnaire, adopted by the COP in 2010 and

subsequently amended for the 2014 and 2016

reporting cycles; and 2) a set of “additional

questions on the use of implementation

guidelines adopted by the Conference of the

Parties”, available for Parties’ use since 2014

and updated for the 2016 reporting cycle. Both

questionnaires are in the public domain and

can be viewed on the WHO FCTC website

. In

2016, the reporting was conducted for the first

time with an online questionnaire, and in 2018

the online questionnaire was populated for the

first time for each Party with the data from their

latest available implementation report.

Of all 181 Parties to the Convention, 142 (78%)

formally submitted their 2018 implementation

reports via the online platform

. Several Parties

also updated some of their data. The number of

Parties submitting their implementation report

increased since 2016, when 133 (74% of the

180 Parties in 2016) submitted their report in

the given time frame. Since the publication of

the 2016 Global Progress Report, an additional

18 Parties have submitted their 2016 report on

the online platform. In this 2018 Global Progress

Report, the full 2016 dataset (151 Parties) is

used for the comparative analysis.

The results in this report were also compared to

the total number of WHO FCTC Parties for the

first time. Since 2007, implementation analyses

in the previous reports have been conducted

http://www.who.int/fctc/reporting/reporting_instrument/

The 2018 reporting period ended on 31 March 2018, but upon request from the Parties the data extraction date was extended. For the

analysis presented here, data including all submissions and updates in the reporting system by 17 April was utilized. The following Parties have

formally submitted reports by this time: Afghanistan, Algeria, Angola, Australia, Austria, Azerbaijan, Bahrain, Bangladesh, Barbados, Belarus,

Belgium, Benin, Bhutan, Bolivia (Plurinational State of), Bosnia and Herzegovina, Botswana, Brazil, Brunei Darussalam, Bulgaria, Burkina Faso,

Cabo Verde, Cambodia, Cameroon, Canada, Chad, Chile, China, Colombia, Comoros, Cook Islands, Costa Rica, Côte d’Ivoire, Croatia, Czech

Republic, Democratic People’s Republic of Korea, Democratic Republic of the Congo, Denmark, Djibouti, Ecuador, Egypt, El Salvador, Equatorial

Guinea, Estonia, European Union, Finland, France, Gabon, Gambia, Georgia, Germany, Ghana, Grenada, Guatemala, Guinea-Bissau, Guyana,

Honduras, Iceland, Iran (Islamic Republic of), Iraq, Ireland, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kuwait, Lao People’s

Democratic Republic, Latvia, Lebanon, Liberia, Libya, Lithuania, Luxembourg, Madagascar, Malaysia, Maldives, Mali, Malta, Marshall Islands,

Mauritania, Mauritius, Mexico, Micronesia (Federated States of), Mongolia, Montenegro, Mozambique, Myanmar, Nepal, Netherlands, New

Zealand, Nicaragua, Nigeria, Norway, Oman, Pakistan, Palau, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Qatar,

Republic of Korea, Republic of Moldova, Saint Lucia, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Senegal, Serbia, Seychelles,

Sierra Leone, Singapore, Slovenia, Solomon Islands, South Africa, Spain, Sudan, Suriname, Sweden, Syrian Arab Republic, Thailand, The Former

Yugoslav Republic of Macedonia, Togo, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Ukraine, United Arab Emirates, United Kingdom,

United Republic of Tanzania, Uruguay, Viet Nam, Yemen, Zambia and Zimbabwe.

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GLOBAL PROGRESS REPORT 2018

among the responding Parties of the respective

reporting cycle. As the number of Parties to the

WHO FCTC has stabilized, the new analysis

method provides better comparability between

reporting cycles and indicates the needs and

gaps in the implementation better among all

Parties. In addition, three Parties

submitted

information on their use of the implementation

guidelines adopted by the COP by completing

the additional questions, and this information is

also utilized in the report.

The regularly updated status of submission

of reports can be viewed on the WHO FCTC

website

. The report follows as closely as possible

the structure of the Convention and that of the

reporting instrument.

In the reporting instrument, Parties have the

opportunity to provide more detailed information

of the progress in the implementation of the

Convention through open-ended questions. This

qualitative information was utilized for identifying

examples of novel approaches or themes where

several Parties tended to progress. In addition,

examples of progress by individual Parties were

searched from the updates and short news pieces

collected in the WHO FCTC Implementation

Database

of the environment and the health of persons)

is considered only among the tobacco-growing

Parties.

This report also provides examples of how the

Parties have progressed in their implementation

of the Convention. These include examples of

recent activities, legislative processes and other

actions. The examples are based on reporting the

Parties’ answers to the open-ended questions

concerning progress in the implementation of

different articles in the core questionnaire, Parties’

responses to the additional questions, or on the

news and updates received from Parties in the

period between the last two reporting cycles

published in the WHO FCTC Implementation

Database or on social media.

However, some limitations need to be noted. The

Parties’ implementation reports are not subject to

systematic confirmation against laws, regulations

and programmatic documents (such as national

strategies or action plans), and do not always

include enforcement and compliance aspects

unless Parties provide this information in the

open-ended questions (except in the Article 8

section of the core questionnaire, where Parties

are required to provide information on their

enforcement activities). This may lead to some

discrepancies between the information reflected

in the implementation reports in different reporting

cycles and the experience on the ground.

Global progress reports provide a snapshot of the

status of implementation in the latest reporting

period among those Parties that provided

their information by the deadline. This may not

fully reflect the situation among all Parties. For

this reason, the Convention Secretariat has

established the WHO FCTC Implementation

Database, which presents the information among

all Parties to the Convention across all reporting

cycles, with changes applied on a regular basis

as additional reports are being received from the

Parties, outside the designated reporting cycles.

METHODOLOGICAL NOTES

In this Global Progress Report, implementation of

the Convention is analysed on two levels: 1) as a

percentage of the Parties implementing individual

key measures; and 2) and as an average of

implementation rates across substantive articles.

The calculation of the average implementation

rates is provided in the footnotes to Chapter 2,

entitled “Overall progress in implementation of the

Convention”. The complete list of key indicators

is available on the WHO FCTC website.

should be noted that implementation of Article

17 (Provision of support for economically viable

alternative activities) and Article 18 (Protection

Japan, Panama and Turkey.

http://www.who.int/fctc/reporting/en/

http://untobaccocontrol.org/impldb/updates/

http://www.who.int/fctc/reporting/party_reports/who-fctc-annex-1-indicators-current-status-implementation.pdf

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OVERALL PROGRESS IN IMPLEMENTATION

OF THE CONVENTION

CURRENT STATUS OF IMPLEMENTATION

The status of implementation on the Convention

was assessed on the basis of information

contained in the Parties’ 2018 implementation

reports. A total of 152 key indicators were taken

into account across 16 substantive articles

the Convention.

Figure 1 presents the average implementation

rate

of each substantive article as reported by

the Parties in 2018. The figure shows that the

implementation rates across the articles are

very uneven, ranging from 13% to 88%.

The articles having the highest implementation

rates, with an average implementation rate of

65% or more, across all Parties analysed are,

in descending order:

• Article 8 (Protection from exposure to tobacco

smoke);

• Article 11 (Packaging and labelling of tobacco

products);

• Article 12 (Education, communication, training

and public awareness);

• Article 16 (Sales to and by minors);

• Article 5 (General obligations); and

• Article 6 (Price and tax measures to reduce

the demand for tobacco).

They are followed by a group of articles for

which the implementation rates are in the

middle range between 42% and 61%, namely,

and again in descending order:

• Article 13 (Tobacco advertising, promotion

and sponsorship);

• Article 15 (Illicit trade in tobacco products);

• Article 10 (Regulation of tobacco product

disclosures);

• Article 14 (Demand reduction measures

concerning tobacco dependence and

cessation);

• Article 20 (Research, surveillance

exchange of information);

and

• Article 9 (Regulation of the contents of

tobacco products); and

• Article 22 (Cooperation in the scientific,

technical and legal fields and provision of

related expertise).

The articles with the lowest implementation

rates are:

• Article 18 (Protection of the environment

and the health of persons);

• Article 19 (Liability); and

• Article 17 (Provision of support for

economically viable alternative activities)

When assessing the development in the overall

implementation rates of the substantive articles

among all Parties in the 2016 and 2018 reporting

cycles,

notable improvement was observed

for most articles (Fig. 1). The largest increase

in the average implementation rate, over 10

percentage points, was observed for Article 11

(Packaging and labelling of tobacco products),

Article 12 (Education, communication, training

and public awareness), Article 15 (Illicit trade in

tobacco products) and Article 16 (Sales to and

by minors).

TIME-BOUND MEASURES

There are several indicators under Article 11

(concerning the size, rotation, content and

legibility of health warnings, banning of misleading

descriptors, etc.) and Article 13 (concerning

adoption of a comprehensive ban and coverage

The status of the implementation was assessed as of 17 April 2018.

Due to the specific nature of quantitative data on tobacco taxation and pricing, the status of implementation of Article 6 is described in more

detail in the section on that article.

Implementation rates of each indicator were calculated as the percentage of all the Parties (181 in 2018) that have provided an affirmative answer

with respect to implementation of the provision concerned.

Average implementation rates for Articles 17 and 18 are calculated only among tobacco-growing Parties.

The 2016 implementation rates were recalculated among all Parties (180 in 2016) to: 1) allow comparability with the 2018 calculation; and 2) include

all 151 reports submitted in the 2016 reporting cycle, not only those 133 that were submitted by the end of the designated reporting cycle of 2016.

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GLOBAL PROGRESS REPORT 2018

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, although there is no timeline

imposed in the Convention itself, the guidelines

for implementation of Article 8 recommend that

comprehensive smoke-free policies be put in

place within five years of entry into force of the

Convention for that Party.

Two out of the three articles mentioned in the

paragraph above (Articles 8 and 11) currently

have the highest implementation rates, thus

sustaining their places at the top of all articles

since 2014 (Fig. 1). Specifically:

• nine out of 10 reporting Parties have now

implemented measures to protect their

citizens from exposure to tobacco smoke,

which makes Article 8 the most-implemented

of all WHO FCTC articles.

• implementation of Article 11 as a whole

improved considerably since the previous

reporting cycle, showing a notable increase

of 13 percentage points in its average

implementation rate. The greatest increase

was observed in the proportion of Parties

requiring pictorial warnings, and the need for

health warnings to cover 50% or more of the

main display area of the package.

• over two-thirds of all Parties have reported

instituting a comprehensive ban on all

tobacco

advertising,

promotion

and

sponsorship, but despite notable increase

in implementation, Article 13 continues to

show the lowest implementation rate of the

three time-bound measures. Parties also

progressed in broadening the scope of their

tobacco advertising legislation to cover new

and emerging tobacco and nicotine products.

As shown in Fig. 2, there are still many Parties

that have not yet implemented the time-bound

requirements of Articles 8, 11 and 13. It is

therefore important for Parties that have not yet

implemented them do so as early as possible.

Fig. 1

Average implementation rates (%) by Parties of substantive articles (n=180 in 2016; n=181 in 2018)

Article 8

Article 11

Article 12

Article 16

Article 5

Article 6

Article 13

Article 15

Article 10

Article 14

Article 20

Article 9

Article 18*

Article 19

Article 17*

2018

2016

*The average implementation rates for Articles 17 and 18 are calculated only among Parties which report tobacco growing in their jurisdiction in

the reporting instrument (n=33 in 2016; n=27 in 2018).

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2. OVERALL PROGRESS IN IMPLEMENTATION OF THE CONVENTION

Fig. 2

Number of Parties, which have not currently implemented time-bound measures under

Articles 8, 11 and 13 of the Convention.

Government buildings

Health-care facilities

Educational facilities

ARTICLE 8 TIME-BOUND MEASURES

Universities

Private workplaces

Airplanes

Trains

Ground public transport

Ferries

Motor vehicles used as places of work

Private vehicles

Cultural facilities

Shopping malls

Pubs and bars

116

Nightclubs

Restaurants

ARTICLE 11 TIME-BOUND MEASURES

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

warnings 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 are in the form of pictures

or pictograms required

ARTICLE 13

TIME-BOUND

MEASURES

comprehensive ban on all tobacco advertis-

ing, promotion and sponsorship required

Ban covering cross-border advertising,

promotion and sponsorship originating

from the country’s territory required

103

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GLOBAL PROGRESS REPORT 2018

IMPLEMENTATION OF THE CONVENTION

BY PROVISIONS

KEY

OBSERVATIONS

General obligations

[Article 5]

▪

Parties

have significantly progressed in establishing focal points, national

coordinating mechanisms and units for tobacco control, advancing both the national

and global infrastructure for tobacco control.

▪

The implementation of Article 5.3 seems also to have increased, as over two thirds of

all Parties have now adopted or implemented measures to prevent tobacco industry

interference.

Infrastructure for tobacco control (Article

5.2(a)).

The infrastructure for tobacco control

appears to have been strengthened significantly

in 2016–2018 (Fig. 3). The majority, 84% (152),

of all Parties now have reported designating a

national focal point for tobacco control, and 64%

(115) have established a tobacco control unit.

Most focal points are based in either a health

ministry or public health agency, which is under

the direction of a health ministry. In some cases,

the health and social ministry are combined.

A national coordinating mechanism for tobacco

control was put in place by 74% (134) of all

Parties. Seven Parties (Afghanistan, Cameroon,

Georgia, Madagascar, Nigeria, Saint Lucia and

Zambia) reported that they have established

new national coordinating mechanisms.

In Guyana, in addition to passage of the tobacco

control bill in 2017, a National Tobacco Control

Council was created in order to advise and work

with the Minister of Public Health. Established

by law or by other measures (executive and

administrative), these mechanisms often

involve governmental departments, agencies

and other key stakeholders, as appropriate.

Comprehensive, multisectoral tobacco

control strategies, plans and programmes

(Article 5.1).

In 2018, some 67% (122) of

all Parties had such strategies, plans and

programmes in place. They are more prevalent

today as compared to the situation in 2016 (61%).

Several Parties reported having developed and

implemented new programmes or strategies

since the previous reporting cycle. More than

20 Parties reported having developed new

national tobacco control action plans, while

some Parties integrated tobacco control in their

health and development programmes.

For example, China adopted the

Healthy China

2030 Plan Outline,

which prioritizes a number

of areas of WHO FCTC implementation. In

Qatar, the

National Health Strategy 2018–2022

includes tobacco control. In India, the

National

Health Policy 2017

identifies coordinated action

on addressing tobacco, alcohol and substance

abuse as one of the seven priority areas for

improving health. Some Parties that are taking

part in the FCTC 2030 project have considered

developing action plans in line with this project.

http://untobaccocontrol.org/impldb/guyana-new-tobacco-control-bill-passed/

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS

GEORGIA

Comprehensively addressing

Article 5 of the Convention

On 30 May 2017, the Parliament of Georgia adopted amendments to the Law of Georgia

On Tobacco Control (2010), in accordance with Article 5.2(b) of the Convention. The new

law introduces a series of advanced measures, including, among others, plain packaging of

tobacco products and a complete ban of tobacco advertising, promotion and sponsorship,

and also makes all public places smoke free and bans tobacco-vending machines. The law

also introduced measures to ensure full implementation of Article 5 of the Convention, as

summarized below.

Article 5.1 – According to the amendments to the law, the Government of Georgia is now

required to implement a long-term state strategy and an annual state tobacco control

programme. Georgia is now one of the FCTC 2030 Parties, receiving support for the

implementation of a various range of programmes. This includes a revision of the national

action plan approved by Government decree in 2013 to put it in line with the new legislation.

Article 5.2(a) – The Health Promotion and Prevention Council was created soon after the

adoption of the amendments of the tobacco control legislation. The leading force behind the

Council is the Committee on Health-care and Social Matters of the Parliament of Georgia, and

consists of tobacco control agencies, including enforcement agencies, and other stakeholders

of this field. The Council assists with the implementation of tobacco control legislation,

coordinates the work of different sectors and is also involved in proposing revisions of the law.

Article 5.3 – As a new principle in tobacco control, introduced in the new version of the law,

the development and implementation of state policy on tobacco control shall be protected

from interference by the tobacco industry, and any interactions shall be conducted in

accordance with state publicity and transparency principles.

(Photo courtesy of Nino Maglakelidze, WHO FCTC focal point, Georgia)

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Fig. 3

Percentage of reporting Parties with tobacco control infrastructure in 2016–2018

(n=180 in 2016; n=181 in 2018)

Focal point for tobacco

control exist

National coordinating mechanism

for tobacco control exist

Comprehensive multisectoral

national tobacco control

strategy developed

Tobacco control unit exist

2018

2016

Adopting and implementing effective

legislative,

executive,

administrative

and/or other measures. (Article 5.2(b))

The reports of the Parties show that most

progress in implementation of the Convention

seem to be achieved through the adoption

and implementation of new legislation or the

strengthening of already existing tobacco

control legislation.

New tobacco control acts or amendments

of their previous tobacco acts were reported

by 17 Parties, 11 of which are members of

the European Union (EU). Four other Parties

(Dominica, Grenada, Malaysia and South

Africa) reported that they are considering, or

in the process of developing, new legislation

or amendments to their existing laws. Three

Parties (Gabon, Niger and Seychelles) reported

that they developed regulations to implement

already adopted legislation.

Overall, 158 (87%) of the Parties have strengthened

their existing or adopted new tobacco control

legislation after ratifying the Convention.

In many jurisdictions, regulations or implement

tion decrees are required to implement legislative

and executive measures adopted by national

parliaments. The experiences of the Parties

indicate that the time lag between the adoption

of legislation and the development of such

regulations or decrees varies substantially and

that the process may be delayed by internal

factors (for example, the lack of technical/

financial capacity), changing priorities and volatile

circumstances or challenges by the tobacco

industry.

Protection of public health policies from

commercial and other vested interests of

the tobacco industry (Article 5.3).

Global

tobacco production continues to fall despite

the sustained effort of the tobacco industry to

interfere with policy development.

Overall, 71% (128) of all Parties had adopted or

implemented at least one measure to prevent

tobacco industry interference. This is a notable

increase as compared to 2016 (Fig. 4). Providing

public access to information on the activities of

the tobacco industry became more common.

However, it remains an underutilized measure,

implemented only by 37% (67) of all Parties.

Several Parties have succeeded in their recent

efforts to strengthen implementation of Article

5.3. For example, Georgia’s new legislative

changes only allow for strictly necessary

interactions with the tobacco industry and

call for transparency of such interactions;

furthermore, it provides the grounds for criminal

and civil liability actions against the industry.

In 2017, France adopted a government decree

to ensure transparency of tobacco industry

activities, with special regard to its expenditures,

including spending on lobbying. Lithuania

amended its tobacco legislation in 2016 by

stating that in the process of setting and

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS

implementing national tobacco control policies,

the Government should be required to protect

these policies from the commercial and other

interests of the tobacco industry. The newly

adopted tobacco legislation in 2017 by Benin

limits the interactions between representatives

of the tobacco industry and public officials.

Finally, despite fierce attacks from the tobacco

industry, which were dismissed by the

Constitutional Court, the Ugandan Tobacco

Control Act became fully operational on 19 May

2017. Among other public health provisions of

the legislation, including the protection of current

and future generation from the devastating

health, economic and environmental effects of

tobacco, the act also highlighted the duty of the

Government to protect tobacco control policies

from the tobacco industry interference and to

ensure transparency of any interactions with

it (Part VIII of Uganda’s Tobacco Control Act,

2015).

Other Parties reported having conducted

national workshops, engaging in the

development of codes of conduct or

developing information materials to promote

implementation of Article 5.3. Three Parties

(Brazil, South Africa and Sri Lanka) established

tobacco industry observatories to monitor

the activities of the tobacco industry within

their countries and beyond. The WHO FCTC

Secretariat’s Knowledge Hub for Article 5.3,

hosted by the University of Thammasat in

Bangkok, Thailand, was officially launched on

1 November 2017.

Furthermore, the needs assessment exercise,

which is a review of a Party’s implementation

status jointly conducted by the Party and

the Convention Secretariat and its partners,

also covers Article 5.3. The resulting report

addressing all areas of the Convention contains

recommendations on how to further address

the gaps in implementing article 5.3. Such

gaps, if identified as urgent priority by the Party,

are addressed in the post-needs assessment

phase in the form of assistance projects.

Fig. 4

Implementation (%) of Article 5.3 reported by Parties in 2016–2018 (n=180 in 2016; n=181 in 2018)

Adopted or implemented measures

to prevent tobacco industry interference

Public access to a wide range

of information on the tobacco industry

2018

2016

http://www.who.int/fctc/publications/fctc-article-5-3-best-practices.pdf

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GLOBAL PROGRESS REPORT 2018

New knowledge hub set

to curb tobacco industry

interference

In November 2017, the Convention Secretariat of the WHO FCTC launched a new Knowledge

Hub to track and gather data on – and inform the public about – tobacco industry interference

in public policy-making. Located in Bangkok at the Thammasat University’s School of Global

Studies, the Global Center for Good Governance in Tobacco Control (GGTC) has a specific

mission related to Article 5.3 of the Convention.

The Knowledge Hub was created to counter tobacco industry interference and aims to

assist WHO FCTC Parties in developing strategies to counter interference through various

channels, including training and direct assistance. This Knowledge Hub is also expected to

coordinate tobacco industry monitoring efforts of the Parties, including the establishment

and operation of formal tobacco industry monitoring centres (observatories).

The primary objective of the WHO FCTC is to reduce tobacco use worldwide, an important

public health goal. Since the adoption and entry into force of the WHO FCTC, governments

increasingly recognize that policy-making involves a range of legal issues. Thus, the WHO

FCTC should be applied as a policy in good governance when developing public health

goals. Instruments such as codes of conduct for government officials, transparency

measures and policies to protect against conflict of interest facilitate the workings of all

governmental institutions. It is imperative that governments act now to implement good

governance policies enshrined in the WHO FCTC and its guidelines.

The Thai Knowledge Hub joins a worldwide network of six other institutions from Australia,

Finland, India, Lebanon, South Africa and Uruguay, mostly based in renowned universities and

all working with the Convention Secretariat to assist Parties in specific areas of the Convention.

(Photo courtesy of WHO FCTC Secretariat’s Knowledge Hub on Article 5.3, Thailand)

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS

UNIDO

Recent trends of global

tobacco production

In general, global tobacco production has been falling,

especially since 2016, and the total output of tobacco

manufacturing globally fell consistently throughout

2017. The global output of tobacco manufacturing in

industrialized economies dropped by 7.6% in the first

quarter of 2018 compared to the same period of the

previous year. In the first quarter of 2018, global output

of tobacco manufacturing dropped by 0.1%. In 2017, an

overall negative growth was observed in production of

tobacco also in emerging industrial economies. It is still to

be seen how the future trend progresses.

Output growth of tobacco manufacturing (in percent compared to the same quarter

of the previous year)

6.0

4.0

2.0

0.0

-2.0

-4.0

-6.0

-8.0

-10.0

- 2017

Q1 - 2018

Industrialized

economies

Emerging

industrial

economies

World

Source: United Nations Industrial Development Orgnaization Quarterly report

To summarize, the production of tobacco is falling worldwide, according to an analysis

of production data. It would also be relevant to analyse export–import data to estimate

consumption by country. As the production data suggest, a small number of economies has

significant share in the global tobacco market.

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GLOBAL PROGRESS REPORT 2018

REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Price and tax measures to reduce

the demand for tobacco

[Article 6]

▪

The proportion of Parties that levy some form of excise tax increased from 93% in 2016

to 96% in 2018. There have been substantial improvements in the structure of the excise

system in a number of reporting Parties. Between 2016 and 2018 there has been a

move towards mixed systems, away from purely ad valorem systems. The proportion of

Parties that levy only a specific tax remained unchanged.

the future, which makes the future tax level and prices more predictable. The aim is to

make cigarettes increasingly unaffordable.

public health or the number of Parties that prohibit or restrict imports of tax- and duty-

free tobacco products by international travellers.

▪

Several countries have announced large increases in the excise tax up to four years into

▪

No change was observed in the proportion of Parties that earmarks tobacco taxes for

▪

The reporting of data related to tobacco taxation and pricing, as required by the

Convention (in Article 6.3), remains a challenge for Parties, especially in the case of

tobacco products other than cigarettes. Data on cigarette prices were also not adequately

reported on by the Parties, with only 24 out of 142 reporting Parties providing 2018

prices in the 2018 reporting cycle.

Taxation of tobacco products.

133 Parties

provided sufficient information on tobacco

taxes and prices to be included in the analysis.

Most Parties only provided data on cigarettes.

The global median total tax burden – that is, the

sum of excise tax, value-added tax (VAT) and/or

other sales taxes, and other duties and levies –

on the most popular price category of tobacco

product was 63%, compared to 58% in 2016.

The African Region has the lowest median tax

burden at 34%, and the European Region has

the highest median tax burden at 78%.

129 out of 133 Parties in 2018 (96%) levied

excise taxes in some form (Table 1). There

has been a marked change in the type of

excise tax levied since 2016. The proportion

of Parties applying ad valorem excise alone

decreased from 21% in 2016 to 14% in 2018

while those applying a mixed excise tax system

(a combination of both specific and ad valorem

Regular and rapid increases in tobacco taxation

are an essential part of a comprehensive

tobacco control strategy, which can contribute

to the achievement some of the Sustainable

Development Goals (SDGs). Raising the price of

cigarettes and other tobacco products can be

an effective measure in deterring people from

starting to smoke and encouraging smokers to

quit, particularly among lower socioeconomic

groups. There is a sizable amount of literature

that indicates that household expenditure on

tobacco products crowds out expenditures

on other basic necessities, such as education

and food that often is consumed by children.

Particularly among the poor, increasing tobacco

tax can help to redirect income towards the

consumption of other products, promoting

good health and well-being. It can also help

reduce poverty by redirecting income away

from tobacco consumption and to other goods

and services.

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

taxes) have increased from 43% in 2016 to

56% in 2018. The proportion of Parties that

levy only a specific tax has increased marginally

from 29% to 30%.

A combination of specific and ad valorem rates

remains the most favoured excise regime in

the European Region with a large proportion

of Parties in that Region reporting its use.

Countries that belong to the EU are obliged to

implement such a mixed system under the EU

Directive 2011/64/EU. Compared to the 2016

report, Parties in the Region of the Americas

have reported a stronger preference for a mixed

excise tax regime as well (from 29% to 65%).

In the African Region, there has been a move

away from an ad valorem regime to a mixed

tax system. While in 2016, 31% of Parties in

the African Region preferred a mixed regime, in

2018 that number stands at 46%. Parties in the

Western Pacific Region continue to favour the

use of specific tax only.

With regards to the reported progress in

taxation policy, several member states of the

Cooperation Council for the Arab States of

the Gulf (Bahrain, Kuwait, Oman, Qatar, Saudi

Arabia and the United Arab Emirates) recently

imposed, for the first time, excise taxes on

tobacco products. This is applied in the form of

a selectivity tax of 100% on the net-of-tax price

and a 5% VAT), based on the sum of the net-of-

tax price and the excise tax.

Price of tobacco products.

Table 2 presents

maximum and minimum cigarette prices in US

dollars by WHO region, as well as the ratio

of maximum to minimum prices within each

region.

TABLE 1

Cigarette excise regimes in 2018, by WHO region

TYPE OF EXCISE TAX

WHO Region

Specific

only

valorem

only

Both

Specific

and Ad

valorem

Total

Excise

Import

duty

only

Total

No.

Reporting

Without

tax

answer

African

Eastern

Mediterranean

European

Americas

South-East

Asia

Western

Pacific

Overall

31%

22%

60%

23%

26%

13%

17%

46%

32%

89%

65%

17%

16%

17%

71%

10%

19%

30%

14%

56%

129

133

Data on cigarette prices presented in this table originate from the reports of the Parties submitted in 2018.

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GLOBAL PROGRESS REPORT 2018

TABLE 2

Minimum and maximum prices for a pack of 20 cigarettes in US dollars by WHO

region in 2016 and 2018

2016

Total

reporting

Ratio

Parties

in 2016

Minimum

(country)

2018

Maximum

(country)

Total

reporting

Ratio

Parties

in 2018

WHO Region

Minimum

(country)

Maximum

(country)

African

Americas

South-East

Asia

European

Eastern

Mediterranean

Western

Pacific

Total

0.49

0.97

1.52

0.44

0.58

8.39

7.47

2.93

15.43

3.27

17.1

7.7

1.9

35.1

5.6

0.07

1.14

1.22

0.87

0.42

7.35

8.12

4.55

14.79

6.04

74.0

7.4

3.8

16.4

15.0

2.62

15.18

5.8

132

0.90

16.54

18.3

142

Illicit trade in tobacco products poses a threat

to government revenue through tax evasion.

Large price differences among countries in the

same region increase incentives for illicit trade

activities and potentially undermine government

efforts to collect tax revenues from the sale of

tobacco products. The European Region and

the Region of the Americans display an increase

of minimum prices and a reduction of the ratio

of maximum to minimum prices between the

two reporting periods. For the other four WHO

regions, the reported minimum prices are lower

than in 2016 and the ratio of maximum to

minimum price has increased.

Changes in taxation across reporting

cycles.

Regular and rapid increases in

tobacco taxation are an essential part of a

comprehensive tobacco control strategy.

An innovative initiative is Australia’s policy

to announce in advance large increases in

the excise tax, over and above inflationary

adjustments, for the coming four years. Since

2013, Australia has consistently increased the

excise tax on cigarettes by 12.5% each year

and intends to continue with this strategy until

at least 2020, resulting in some of the highest

cigarette prices in the world.

Fifteen countries reported that they have not

implemented tobacco tax policy changes

between the last two reporting periods, and

47 Parties did not provide any information on

this issue (Table 3). The Eastern Mediterranean

Region and the Region of the Americas reported

the highest proportion of reporting Parties with

no tax policy changes between 2016 and 2018,

while the African and South-East Asian regions

reported the largest proportion of Parties with

no information on the change in tax policy.

Earmarking tobacco taxes for funding

tobacco control.

Thirty-four countries reported

earmarking a proportion of their tobacco taxation

income for funding national plans, tobacco

control strategies or other activities, such as

sport. Between 2016 and 2018 the number/

proportion of countries that earmark some of

tobacco tax revenues has remained largely the

same. The majority of countries earmark tobacco

taxes specifically for funding tobacco control

activities, while a minority direct the resources to

health promotion and health financing.

Costa Rica, for example, allocates tobacco taxes

widely, towards the diagnosis, treatment and

prevention of diseases associated with smoking

(60%), Ministry of Health (20%), cessation and

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

TABLE 3

Regional distribution of “no change” and “no information provided”

options on tax policy

Percentage

over reporting

countries in

the region (%)

6.3%

21.1%

2.6%

21.7%

0.0%

13.6%

10.6%

Percentage

over reporting

countries in

the region (%)

53.1%

31.6%

15.4%

34.8%

57.1%

27.3%

33.1%

Percentage of

countries with

no change and

no information

59.4%

52.6%

17.9%

56.5%

57.1%

40.9%

43.7%

Number of

reporting

countries

WHO Region

Changes

Information

African

Eastern

Mediterranean

European

Americas

South-East Asia

Western Pacific

Total

142

prevention education programmes (10%),

and sports and recreation (10%). Bangladesh

approved the

Health Development Surcharge

Management Policy

in 2017, in which revenue

collected from a surcharge on tobacco products

is allocated among various tobacco control and

health-promotion activities.

Tax and duty-free tobacco products.

Ninety-

one out of 142 (64%) Parties that submitted

implementation reports in 2018 indicated that

they prohibited or restricted imports of tax- and

duty-free tobacco products by international

travellers, reflecting a consistent trend

compared with 2016, when more than 65% of

Parties reported such a policy.

The WHO FCTC Secretariat’s Knowledge

Hub on Taxation is now fully operational at the

University of Cape Town. The hub provides

assistance to the Parties in designing their tax

systems through training programmes and

tailored assistance at country level.

The WHO FCTC Secretariat’s Knowledge Hub on Taxation at the University of

Cape Town (South Africa) hosted a workshop on the economics of tobacco

control at the University of Cape Town, from 29 January to 1 February 2018.

The workshop had 12 participants from Burkina Faso, Chad, Gabon, Kenya,

Madagascar and Mauritania. This workshop aimed to provide policy makers

with the essential tools to illustrate the benefits of tobacco taxation using taxa-

tion modelling. (Photo courtesy of WHO FCTC Secretariat’s Knowledge Hub

on taxation, South Africa)

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JAMAICA

Why a simple tobacco tax system

is important: the example of Jamaica

WHO FCTC Article 6 Guidelines encourage Parties to adopt simple tax structures. Uniform

specific taxes, regularly adjusted to account for inflation and increases in per capita income, are

generally recommended as the most appropriate, as they have desirable properties from both

a public health and an administrative perspective (Article 6 Guidelines, 2014 and WHO, 2010).

Jamaica provides an interesting example of a country that migrated from a highly complex,

multi-layered tax system to a simple uniform tax. It also highlights the importance of adjusting

the specific tax on a regular basis to avoid inflation eroding the real value of the tax.

Until 2008, the tobacco excise tax in Jamaica consisted of two components: (1) a specific

tax; and (2) an ad valorem tax that came into effect if the price exceeded a specific threshold

value. For many, and the media included, it was reported to be very complicated to determine

the net effect of any tax change. The tobacco industry used this confusion to increase the

retail price by more than the increase in the excise tax, allowing itself to increase its profits at

the expense of smokers and government treasuries.

In 2005, the dominant tobacco company in Jamaica terminated all domestic production and

imported all its cigarettes. Excise tax revenues and especially the levy (23% of the sum of

the base price) imposed to fund the National Health Fund fell precipitously.

Nominal tax versus real tax on cigarettes in Jamaica (2004-2018)

18 000

16 000

J$ per 1 000 cigarettes

14 000

12 000

10 000

8 000

6 000

4 000

2 000

mai.04

mai.05

mai.06

mai.07

mai.08

mai.09

mai.10

mai.11

mai.12

mai.13

mai.14

mai.15

mai.16

mai.17

mai.18

nov.05

nov.06

nov.07

nov.15

nov.16

nov.17

nov.04

nov.08

nov.09

nov.10

nov.11

nov.12

nov.13

nov.14

Total tax amount per 1000 sticks (real,base Nov 2014)

Total tax amount per 1000 sticks (nominal)

Van Walbeek, C. A review of excise taxes on cigarettes in Jamaica; 2015 (https://www.moh.gov.jm/wp-content/uploads/2016/07/ Jamaica-

report-2015.-Van-Walbeek.pdf, accessed 14 August 2018)

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

The Government responded by abolishing the complex tax structure and implemented a

uniform system. It then raised the excise tax, increasing the retail price and tax revenue,

and decreasing consumption. However, for five years subsequently, the nominal excise

tax remained unchanged, and the real value of the excise tax dropped by 32% eroded by

inflation.

In that time, the tobacco industry increased the retail price of cigarettes to its own

benefit. Since 2015, the Government has been consistently increasing excise taxes.

The Jamaican experience illustrates many important lessons for the designers of tax systems,

including the need to keep the tax system simple. The tobacco industry will exploit a complex

tax system for its own benefit A uniform specific tax system is good from an administrative and

public health perspective, with regular adjustments to palliate the effects of inflation.

In 2017, Jamaica was recognized “for steady increases to tobacco taxes over several years to

protect the health of all Jamaicans” at the 5th Latin American and Caribbean Conference on

Tobacco or Health.

Sheryl Dennis-Wright from the Ministry of Health Jamaica was presented with an award by Bea-

triz Champagne from InterAmerican Heart Foundation. (Photo courtesy of Sheryl Dennis-Wright,

WHO FCTC focal point, Jamaica)

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REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Protection from exposure

to tobacco smoke

[Article 8]

▪

Nine out of 10 reporting Parties now have implemented measures to protect their

citizens from exposure to tobacco smoke, which makes Article 8, the most-implemented

of all WHO FCTC articles.

▪

The trend of extending smoking bans from closed public places to outdoor areas continued,

and several Parties also broadened the scope of their smoke-free legislation to cover new

and emerging tobacco products. Several Parties have succeeded in advancing legislation

to ban smoking in private cars when minors are present. Many Parties highlighted progress

on smoke-free legislation or policies at regional or local level.

Measures to protect from environmental

tobacco smoke.

In 2018, overall 91% (165) of

all Parties had implemented measures to protect

their citizens from exposure to tobacco smoke

by applying a ban – either complete or partial

– on tobacco smoking in indoor workplaces,

public transport, indoor public places and, as

appropriate, other public places. There was

a significant increase as compared to 2016,

when 79% of all Parties had banned smoking in

public places. Most Parties (149) have national

legislation providing for the ban, but 44 Parties

reported operating with subnational legislation.

Thirty-six Parties still have voluntary agreements

providing for the ban.

As Fig. 5 shows, among the 165 Parties

that have smoking bans, over 80% of these

Parties enforce a complete ban in aeroplanes,

educational facilities, public transport, health

and cultural facilities, motorized vehicles for

work, and government buildings. Partial bans

tend to be common in private workplaces,

restaurants, pubs and bars, and nightclubs.

A positive trend was observed in banning

smoking in private cars in the presence of

children, enforced now as either a complete

or partial ban by 40% of Parties that have

smoking bans. Bans on smoking in cars when

minors are present were recently enacted by

Finland, France, Luxembourg, Malta, Qatar and

Slovenia. The Republic of Korea also enacted a

ban on smoking in multi-family housing.

Several Parties highlighted in their progress

notes success in extending their smoking bans

to outdoor areas, such as parks (Luxembourg,

Malaysia and Singapore), outdoor dining areas

(Australia and Sweden), tourist attraction and

pilgrimage sites (Viet Nam), childcare facilities

or playgrounds (Luxembourg, Republic of

Korea and Sweden) and balconies in housing

cooperatives (Finland).

Barbados,

Croatia,

Finland,

Georgia,

Luxembourg, Norway, Poland, Portugal and

Slovenia reported amending their smoking bans

to cover new and emerging tobacco products.

For instance, in 2017 Luxembourg prohibited

smoking and vaping in sports arenas where

children below the age of 16 are performing

sports, and the amendments also ban smoking

and vaping in vehicles when children below the

age of 12 are present. Vaping in play areas for

children was also banned.

Benin, Guyana, Georgia and the Czech

Republic succeeded in passing long-awaited

comprehensive smoke-free bills. For instance,

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

the legislation passed in 2017 in Benin now

prohibits smoking in enclosed public places,

in some open areas, and within a range of

500 metres from any school, health institution,

sports facilities, and cultural and administrative

infrastructure.

Regional or local progress was highlighted

by Bosnia and Herzegovina, Canada, China,

Malaysia, Pakistan and the Philippines. For

example, new provincial legislation in Quebec

(Canada) requires colleges, universities and

hospitals to adopt a policy regarding smoking

on their grounds.

Mechanisms/infrastructure for enforcement.

A majority, 86% (142) of the 165 Parties that

have enacted smoking bans had put in place a

mechanism/infrastructure for the enforcement of

smoke-free measures, which includes specific

guidelines (Solomon Islands and Zambia) and

strong collaboration with other governmental

agencies (Jamaica and Pakistan). However, a few

Parties have highlighted the need for meaningful

penalties and a sufficient level of inspections to

ensure compliance and limit violations of the law.

Smoke-free sign in Islamabad, Pakistan. (Photo from Dr Tibor Szilagyi’s

personal collection)

Fig. 5

Percentage of settings covered by Parties smoke-free bans in 2016–2018 (n=142 in 2016;

n=165 in 2018)*

Aeroplanes

Ground public transport

Educational facilities

Health-care facilities

Motor vehicles used for work

Government buildings

Cultural facilities

Universities

Shopping malls

Trains

Ferries

Private workplaces

Restaurants

Pubs and bars

Nightclubs

Private vehicles

Partial ban

Complete ban

2018

2016

Note: the remaining percentage includes Parties with no ban or no data

Calculated among Parties that have a smoking ban

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GLOBAL PROGRESS REPORT 2018

MALAYSIA

All public parks go smoke-free

The guidelines for implementing WHO FCTC Article

8 reiterates the requirement for Parties to put in place

protective measures not only in all “indoor” public places, but also

in “other” outdoor or quasi-outdoor public places where they feel it is most

“appropriate” to protect citizens from the hazards of second-hand smoke.

On 1 February 2017, and in line with the definition of “other” public places, the

Government of Malaysia officially designated all public parks as non-smoking

zones. This new regulation was put under the Control of Tobacco Regulations

(CTPR 2004) of the Food Act of 1983.

Under the new regulation, smoking is banned in public parks, any open area for

leisure and recreational purposes, such as pedestrian paths, playing fields, game courts and

playgrounds.

The Government of Malaysia is fully committed to implementation of Article 8. In Malaysia, it

is estimated that seven out of every 10 adults (8.6 million adults) who visit reastaurants are

exposed to cigarette smoke in public places, while four out of every 10 adults, or 4.9 million,

are exposed to it at home.

With 22.8% of the Malaysian population estimated to be smokers, this law aims to help

reduce morbidity and mortality attributable to tobacco use in Malaysia and contribute to the

strengthening of the implementation of the WHO FCTC.

(Photo courtesy of Dr Norliana Ismail, WHO FCTC focal point, Malaysia)

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REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Regulation of the contents

of tobacco products

[Article 9]

and regulation of tobacco

product disclosures

[Article 10]

▪

Notable progress took place in Parties requiring the testing and measuring of the contents

▪

Over two thirds of all Parties now require the disclosure of the information of the contents

of tobacco products to government authorities. It remains less common to require the

disclosure related to the emissions of these products, especially to the public.

Regulating contents and emissions of

tobacco products.

For the 2018 reporting

cycle, notable progress has been made by

the Parties in implementation of requirements

under Article 9 (Fig. 6). Over half (55%) of all

Parties now regulate the contents of tobacco

products, and almost half (47%) the emissions

of tobacco products.

Progress has been noted by several European

Parties that have transposed the 2014 EU

Tobacco Products Directive into their national

legislation (see text box). As a specific example,

Austria, an EU Member State, amended its

Tobacco Act in May 2016 to cover novel tobacco

products including electronic nicotine delivery

systems (ENDS) and to ban tobacco products

with characterizing flavours. In 2017, Canada

amended its legislation to prohibit menthol in

cigarettes, blunt wraps and most cigars.

Additionally, Brazil banned all flavours in

tobacco products in 2012 but was challenged

by the National Confederation of Industries on

and emissions of tobacco products, but almost half of all Parties still lack such legislation

or other regulatory measures.

Fig. 6

Implementation rates (%) by Parties of provisions under Articles 9 and 10 in 2016–2018

(n=180 in 2016; n=181 in 2018)

Testing and

measuring

Contents of tobacco products

Emissions of tobacco products

Contents of tobacco products

Regulating

Emissions of tobacco products

Requiring disclosure

of information to

the government

Requiring disclosure

of information to

the public

Contents of tobacco products

Emissions of tobacco products

Contents of tobacco products

Emissions of tobacco products

2018

2016

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GLOBAL PROGRESS REPORT 2018

the constitutional grounds. The Supreme Court

has recently judged the case unconstitutional

and has granted the mandate of Anvisa, the

Brazilian health regulatory agency, to regulate

tobacco products and the tobacco industry.

Testing and measuring of the contents

and emissions of tobacco products.

Of all Parties, almost half test and measure

the contents (46%) and emissions (45%) of

tobacco products (Fig. 6).

While many Parties still relied on the

manufacturers and importers to report on the

ingredients and emissions of tobacco products,

a number of Parties carrying out tests within

specific governmental divisions (Japan, the

Republic of Korea, Trinidad and Tobago, and

Turkmenistan). Others mentioned using the

services of independent laboratories (Bulgaria,

Kingdom of Bahrain and Luxembourg) or were

in the process of setting one up (Honduras and

the Islamic Republic of Iran).

Disclosure to government authorities and

the public.

In 2018, 67% of all Parties required

manufacturers or importers of tobacco products

to disclose information on the contents of the

products, and 58% of the Parties required the

release of emissions findings to government

authorities. Around half of the Parties require

such disclosures to be made available to the

public. As compared to 2016, there was a clear

positive trend in requiring the disclosure of the

information (Fig. 6).

Of note, Italy developed a website to disclose

available information to the public. In Canada,

the numerical values of toxic emissions on

tobacco packs have been replaced by four text-

based statements that provide clear, concise

and easy to understand information about the

toxic substances found in tobacco smoke.

Inauguration of the testing laboratory at the National Institute for Cancer Prevention and Research, Noida, India. (Photo courtesy of

the WHO FCTC Secretariat’s Knowledge Hub on smokeness tobacco)

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

EUROPEAN

UNION

A shared vision and direction

Article 9 provides a framework for Parties

to test, measure and regulate the content

of tobacco products. While progress

has been made, only slightly over half of

the Parties reported that they regulate

the contents and emissions of tobacco

products.

Following the introduction of the Tobacco Products Directive in 2014, EU Member State

Parties have since 2016 accelerated their implementation of the requirements under the

directive. The directive provides rules and a framework to govern the manufacturing,

presentation and sale of tobacco and related products. It also requires the tobacco industry

to report on the ingredients used in the production of tobacco products, including information

on tobacco ingredients, additives, emissions and toxicological data. Working in partnership

with EU Member States and industry stakeholders, the EU developed a Common Entry Gate

(EU-CEG), designed to reduce the burdens for regulators and companies to report and to

make it easier to compare data.

While they are in the process of implementing measures regulating contents and emissions

of tobacco products within their domestic jurisdictions, many EU Member States are now

participating in an effort called Joint Action on Tobacco Control (2017–2020), which focuses

on supporting Member States in this endeavour.

While the directive has given support to EU Member States for the implementation of measures

within their jurisdictions, a comprehensive website and supporting materials developed by the

EU Commission provide a reference for other WHO FCTC parties to consider similar legislation.

This may include implementation of measures such as the EU common reporting format as a

means of providing comparability of data in the reporting on the content of tobacco products.

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GLOBAL PROGRESS REPORT 2018

BRAZIL

Brazilian Supreme Court upholds

the regulatory power to regulate

the tobacco in favour of public health

Following a five-year wait, the Supreme Court has ruled that a

regulatory agency has the power to ban additives in tobacco

products, including flavours in cigarettes.

In 2012, Anvisa, the Brazilian health regulatory agency, amended

the Collegiate Board Resolution prohibiting the use of additives

that confers aroma and flavour to cigarettes. In 2012, the National Confederation of Industry

(CNI) filed a lawsuit questioning Anvisa’s competence to amend the resolution and questioned

the law that creates the agency.

The injunction requested by CNI was granted, and the Anvisa Resolution was suspended

in 2013. The judgement was challenged and the case reopened in November 2017. The

Minister of Federal Attorney General´s Office argued that the discussion involved only the

insertion of additives in the manufacture of cigarettes, not the prohibition of their sale. She

presented numbers on the damage to public health from smoking and argued about the need

of prohibiting the addition of flavours to the product due to its potential appeal to the young

population, encouraging children and adolescents to initiate cigarette consumption.

She further argued that Anvisa acted within the regulatory limits assigned by the legislature,

fulfilling its duty, in view of the recognized need to ban these additives, and in the spirit of agile

response typical of regulatory agencies.

The Direct Action of Unconstitutionality (ADI) judgement concluded in February 2018. The

Court favoured the constitutionality declaration of the law that creates Anvisa. The regulatory

power of the agency was maintained, which is a great victory for Public Health.

However, regarding the specific aspect of the additives, there was a tie: The Supreme Court

considered that the application of the resolution would have no binding effect throughout the

national jurisdiction, which means that the rule prohibiting the use of additives in cigarettes may

be challenged in lower court environments.

This ruling provides support for WHO FCTC Parties in passing measures supporting FCTC,

including bans on tobacco flavours and additives.

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REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Packaging and labelling

of tobacco products

[Article 11]

▪

As compared to 2016, the greatest increase in the average implementation of the Articles

was observed for Article 11.

▪

There has been a domino effect as more Parties to the Convention adopt plain packaging

legislation. Following Australia’s lead, France, Ireland, Hungary, Norway, Slovenia and the

United Kingdom of Great Britain and Northern Ireland have passed legislation on plain

packaging.

▪

Many Parties have increased the size of their pictorial warnings. Meanwhile as an

important development concerning a regional block, EU Member States have started

implementing the 2014 EU Directive and increased the size of their combined text and

pictorial warnings to cover 65% of the package surface.

▪

Pictorial health warnings and plain packaging continue to be under constant scrutiny and

legal action by the tobacco industry at the national and international levels.

Health warnings.

Implementation rates for

measures under Article 11 to which the three-

year deadline applies are presented in Fig. 7.

The reports show that 88% of all Parties now

require health warnings. In the 2018 reporting

cycle, the implementation of Article 11 as a

whole improved considerably. The greatest

increase was observed in the proportion of

Parties requiring pictorial warnings, and the

need for health warnings to cover 50% or more

of the main display area of the package.

Use of pictorial warnings.

In 2018, 64% of

all Parties required health warnings in the form

of pictures or pictograms on tobacco product

packaging.

EU Member States began implementing the

2014 EU Directive and increased the size of

their combined text and pictorial warnings to

cover 65% of the package surface. Georgia has

increased the required size of health warnings

to 60% of the entire surface. In addition, India

has increased pictorial health warnings to 85%

of the principal display areas.

Plain packaging.

Australia adopted the law

requiring plain (standardized) packaging of

tobacco products in 2012.

In the wake of Australia’s action, there was

a domino effect with Parties adopting plain

packaging standards. Following Australia’s

lead, France, Ireland, Hungary, New Zealand,

Norway, Slovenia and the United Kingdom of

Great Britain and Northern Ireland have passed

legislation on plain packaging, and some of

them have already begun implementation.

Other Parties (Belgium, Georgia, Lithuania,

Mauritius, the Russian Federation, South

Africa, Sri Lanka and Uruguay) have expressed

their interest to implement similar measures.

Ecuador reported organizing a high-level

forum, Towards Plain Packaging, with panellists

from the National Assembly, the Pan American

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GLOBAL PROGRESS REPORT 2018

Health Organization and the Ministry of Public

Health in 2016.

Plain packaging is a measure that is often

challenged at international foums. In 2018 after

years of litigation, a World Trade Organization

(WTO) panel rejected a complaint brought by

four countries (Cuba, Indonesia, Honduras

and Dominican Republic) and confirmed that

Australia’s plain packaging policy for tobacco

products was in line with global trade rules.

Implementation challenges.

The tobacco

industry has aggressively and vehemently

fought against the implementation of package

warnings and plain packaging because

tobacco packaging is a crucial aspect of its

marketing strategy to target consumers,

especially children and young people. With

the use of litigation, its objective is to avoid,

dilute or delay effective measures on tobacco

product packaging, with the pretext that the

packaging violates the industry’s intellectual

property rights or would facilitate an increase

illicit trade. Numerous lawsuits to discourage

countries from enacting or implementing life-

saving tobacco control laws were launched

and decisively rejected in Australia, Norway

and the United Kingdom of Great Britain and

Northern Ireland.

Fig. 7

Percentage of Parties implementing the time-bound provisions under Article 11 in 2016–2018

(n=180 in 2016; n=181 in 2018)

Health warnings required

Large, clear, visible and legible

health warnings

Warning required in the principal

language(s) of the country

Warnings approved by

the competent national authority

Misleading descriptors banned

No less than 30% of principal

area for warnings

Rotated health warnings

Pictorial warnings

≥ 50% of principal area

for warnings

2018

2016

http://untobaccocontrol.org/kh/legal-challenges/initial-overview-wto-panel-decision-australia-plain-packaging/

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

WORLD

The domino effect

in effective

pictorial messages

Health warning messages are an effective

and cost-efficient means of communicating

the health risk of smoking. Compared to

2016, the greatest increase in the average

implementation of the FCTC was observed

for pictorial warnings, with close to 90% of all

Parties now requiring health warnings.

The efficiency and effectiveness of health

warnings has led to a domino effect in

developing measures as Parties moved forward

to apply legalisation based on the successes

and outcomes of other Parties. This was most

evident in the portion of Parties now requiring

pictorial warnings to cover 50% or more of

the principal display area of the package, and

as Member States of the EU move towards

implementing the 2014 EU Directive requiring

an increase combined text and pictorial

messages to 65% of the principal display area.

Plain packaging in Hungary (Photo courtesy of Tibor Demjen, WHO

FCTC focal point, Hungary)

The move towards plain packaging has emerged as the next leading milestone for Article

11, with a fast-growing number of Parties to the Convention developing legislation following

Australia’s lead in 2012. France, Ireland, Hungary, New Zealand, Norway, Slovenia and

the United Kingdom of Great Britain and Northern Ireland have passed legislation on plain

packaging, and some of them have already commenced implementation. Other Parties

(Belgium, Georgia, Lithuania, Mauritius, the Russian Federation, South Africa, Sri Lanka and

Uruguay) have expressed their interest to implement similar measures. In addition, Ecuador

organized a high-level forum, Towards Plain Packaging, with panellists from the National

Assembly, the Pan American Health Organization and the Ministry of Public Health in 2016.

This domino effect is a result of the collaborative and cooperative approaches among

Parties in the sharing of information, best practices, and milestones in the development

of national policies and legislation. This collaborative approach is not just reflected in the

implementation on measures of pictorial warnings and health messages but also serves to

further the effective and efficient implementation of the Convention.

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GLOBAL PROGRESS REPORT 2018

REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Education, communications,

training and public awareness

[Article 12]

▪

Ninety per cent of all Parties reported having implemented educational and public

awareness programmes. However, there is still a need to better reflect the socioeconomic,

educational and cultural differences of the target population and the needs of ethnic

groups in the implemented programmes.

not only health workers and educators, but also other key stakeholders such as decision-

makers and media professionals.

▪

Parties have broadened the reach of their training and awareness activities by targeting

▪

Involvement of public agencies, nongovernmental organizations (NGOs) and private

organizations in the development of programmes and strategies, as well as using evidence-

based research to guide the development of programmes, has clearly strengthened.

Implementation of educational and public

awareness programmes.

Ninety per cent (162)

of all Parties reported that they had implemented

educational and public awareness programmes.

The proportion was significantly larger than

in 2016 (76%). Several Parties succeeded in

continuing their previously established campaigns

or activities.

For instance, Norway highlighted that as

part of its five-year-strategy of mass media

tobacco campaigns, including extra funding

of approximately 19 million Norwegian krones

annually (US$ 2.3 million), five campaigns have

been carried out in 2016–2018. A wide range

of topics such as health risks, addiction, snus

(smokeless tobacco) use, smoking cessation and

standardized tobacco packaging were covered.

In Qatar, the Ministry of Public Health was

implementing a media campaign in four phases,

focusing on health risks, tobacco control

legislation, smoking prevention and smoking

cessation. The United Kingdom of Great

Britain and Northern Ireland continued to run

“Stoptober”, a 28-day mass participation event

to help smokers in the country quit via a public

challenge to stop smoking for the duration of the

month of October. Social media plays an integral

part in this campaign, which was developed

using

behavioural

economic

principles.

Participants were supported to quit, receiving a

free Stoptober pack with information about the

health and financial benefits of quitting smoking.

Altogether 80% of all parties implemented local

events to promote cessation of tobacco use, and

World No Tobacco Day (WNTD) was the single

most often highlighted event by the Parties. Many

Parties systematically build national activities

around the date and/or the theme of WNTD.

This highlights the importance of continuing the

WHO WNTD campaigns in collaboration with

the Convention Secretariat and other partners

as appropriate, as a means of promoting

implementation of the Convention by the Parties.

New campaign initiatives were reported for

instance by Bulgaria (student competition), Chad

(oral cancer), France (Mois Sans Tabac), Italy

(women’s health) and the Kingdom of Tonga (first

national quit smoking campaign).

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

TONGA

Hard-hitting two-phase

campaign to curb smoking

and noncommunicable diseases

On 1 June 2016, to celebrate World No Tobacco Day, the

Tongan Ministry of Health launched a hard-hitting mass media and

social media campaign highlighting the dangers of smoking around

children. The Tuku Ifi Leva (Quit Smoking Now) messages was intended

to motivate smokers to stop with the support and advice from a trained

specialist through a newly established toll-free national Quitline.

In October 2017, the second-part of this campaign was launched. With strong graphic

visuals showing tumours and damaged organs, the objective was to increase awareness

among tobacco users on the deadly risks of tobacco use, including cancers and heart

disease.

The Tonga Police, alongside the Ministry of Health’s Tobacco Control Unit, has been using

this campaign as an opportunity to deliver an enforcement blitz to reinforce the new tobacco

legislation requiring most public places to be smoke-free.

Currently 46% of men and 13% of women are smokers, which makes Tongan prevalence

among the highest in the world.

This campaign was implemented by the Tongan Ministry of Health as part of the

Tonga

National Strategy for Prevention and Control Non-communicable Diseases 2015–2020.

The implementation of a sustained mass media campaign was recommended as part of

the needs assessment exercise conducted jointly by the Convention Secretariat and the

Government of Tonga.

(Photo courtesy of Dr Reynold ‘Ofanoa, WHO FCTC focal point, Tonga)

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GLOBAL PROGRESS REPORT 2018

Georgia, Nigeria and Vanuatu launched

campaigns to support newly adopted smoke-

free legislation. For instance, the Tobacco-

Free Nigeria Advocacy Programme campaign,

supported by the Campaign for Tobacco Free

Kids, an Observer to the COP, aims to educate

the population about the National Tobacco

Control Act that was signed into law in 2015.

It focuses on reaching young Nigerians through

social media and the #ClearTheAir hashtag. It

also called on support from influential leaders

such as Nigerian music superstars Timi Dakolo

and Oluwatosin Oluwole Ajibade, known as

Mr Eazi, and Miss Saadatu Hamu Aliyu of the

World Economic Forum’s Abuja Global Shapers

Hub. This public awareness campaign and

stronger partnership with the civil society was

recommended as part of the needs assessment

exercise conducted jointly by the Convention

Secretariar and the Government of Nigeria.

Azerbaijan, with the support of the International

Union Against Tuberculosis and Lung Disease

and the Bloomberg Philanthropies, carried out

a project to advocate for stronger tobacco

control legislation.

Target groups and messages of educational

and public awareness programmes.

Almost all Parties that have implemented these

programmes targeted at children or young

people, and adults or the general public. Several

Parties reported progress in programmes and

activities, especially in the school context.

For example, in Costa Rica, the Ministry

of Health has initiated a project where two

mobile exhibitions equipped with interactive

electronic devices and information about the

risks related to tobacco visit schools, including

those in rural areas.

Around three quarters of all Parties that had

implemented these programmes reported

having run specific campaigns targeted at

women, men and pregnant women. This

remained on similar levels as in 2016.

Thirty percent of Parties also reported targeting

their educational and public awareness

programmes to ethnic groups. Australia

continues to lead in this area with its Tackling

Indigenous Smoking (TIS) programme. The

programme aims to contribute to closing the

gap in indigenous health outcomes by reducing

tobacco smoking as the most significant risk

factor for chronic disease among Aboriginal

and Torres Strait Islander people.

Most of the Parties implementing educational

and public awareness programmes consider

age and gender differences (91% and 78%,

respectively) among targeted population groups

in their programmes. Fewer Parties reflected

socioeconomic differences (51%), educational

background (62%) and cultural differences

(42%). The proportions considering the different

background aspects in the targeted population

groups remained similar in 2016 and 2018.

Almost all that reported implementing

communications programmes covered the

health risks of tobacco use, risks of exposure

to tobacco smoke and benefits of cessation

in their messages (Fig. 8). The largest increase

was observed in covering the economic

consequences of tobacco consumption,

reported by 79% of Parties. The economic

and environmental consequences of tobacco

production remain least covered, but the

proportions increased in 2018 as compared to

2016.

Targeted

training

sensitization

programmes on tobacco control.

A majority

of the reporting Parties had implemented

targeted training or sensitization programmes

to at least one specific group. Targeted training

or programmes were most often addressed

to health workers and educators, followed by

decision-makers and community workers (Fig.

9). A notable increase was observed in all target

groups, indicating broader reach of the training or

sensitization activities in tobacco control.

Parties also mentioned several other groups

that they had targeted in their programmes.

These included religious, social and community

leaders; police and local authorities; youth

workers; trainees and their supervisors; military

personnel; tobacco retailers; employees in

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

Fig. 8

Percentage of Parties that covered various areas in their educational and public awareness

programmes (n=137 in 2016; n=162 in 2018)*

Health risks of tobacco

consumption

Risks of exposure

to tobacco smoke

Benefits of cessation

of tobacco use

Economic consequences

of tobacco consumption

Environmental consequences

of tobacco consumption

Economic consequences

of tobacco production

Environmental consequences

of tobacco production

100

2018

2016

private organizations and non-health public

sector; parents and foster-parents; and students.

Examples from progress reported by the Parties

include training to local administrators and police

officers in Malta following the smoking ban in

cars when minors are present. Chad reported

training young peer educators in smoking

prevention. China reported that annual training

sessions on tobacco control are organized in

various cities to raise the awareness of local

health authorities and establish an information

exchange platform.

Awareness and participation of agencies

and organizations and use of research to

guide the development of programmes.

Eighty-eight per cent (160) of all Parties involved

public agencies and 83% (151) involved NGOs

in the development and implementation of

intersectoral programmes and strategies for

tobacco control.

Fig. 9

Percentage of Parties with training and sensitization programmes on tobacco control targeting

specific groups (n=180 in 2016; n=181 in 2018)

Health workers

Educators

Decision-makers

Community workers

Media professionals

Administrators

Social workers

2018

2016

Calculated among Parties that have implemented educationnal and public awareness programmes

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GLOBAL PROGRESS REPORT 2018

In addition, 69% (124) of all Parties used research

to guide the development, management and

implementation of communications, education,

training and public awareness programmes,

as well as the required pretesting, monitoring

and evaluation, as suggested in the Article 12

Guidelines. As compared to 2016, the proportion

increased significantly. Very few Parties

gave details as to how they use research in

programme development and implementation;

however, Australia provided comprehensive

information on its TIS programme.

In addition to the groups included in the

questionnaire, Parties reported the involvement

of many other stakeholders in the development

and implementation of strategies and

programmes. These included academic and

higher education institutions; community and

scientific groups; professional colleges; police

and military; the media; and international

organizations, including WHO.

In Finland, Action on Smoking and Health (ASH)

carried out and coordinated the activities of the

Tobacco-free Finland 2030 network consisting

of NGOs, public agencies, hospitals and

research institutes. The network supports the

objective of the Finnish Tobacco Act to have

a tobacco- and nicotine-free Finland by 2030.

It organized seminars and events, prepared

statements, and initiated and emphasized the

positive health and social gains from tobacco-

and nicotine-free environment.

Several Parties also continued to highlight

advances in strategic planning for educational

and public awareness programmes in their

progress notes. A number of Parties, such as

Malta, Mongolia and Solomon Islands, reported

that they either established a comprehensive

national tobacco control communications

strategy or action plan or were in the process

of developing one. Belgium mentioned that

in Brussels, a health promotion framework

for 2018–2022 was adopted by the French-

speaking Government in 2017 and one of the

priorities addresses healthy lifestyles, including

the promotion of healthy food, physical activity,

and the reduction of alcohol and tobacco

consumption.

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

AUSTRALIA

Tackling indigenous smoking

The National Tobacco

Campaign contributes

to reducing the adult daily

smoking rate in Australia.

The recent iteration of the

campaign – Don’t Make Smokes Your Story – was

launched in 2016 and is intended to empower Aboriginal

and Torres Strait Islander smokers aged 18–40 years to quit smoking.

The campaign uses the theme of family to focus on encouraging quit

attempts through a positive and empowering message that speaks

(Photo courtesy of Department

directly to Aboriginal and Torres Strait Islander people. The campaign

of Health, Australia)

works with communities to develop culturally relevant smoking

cessation resources and support community events to challenge the social norms around

the acceptance of smoking. The TIS programme for 2018–2019 to 2021–2022 comprises :

• 37 organizations that have been provided funding through Regional Tobacco Control

Grants (RTCG) to raise awareness and to design and implement smoking prevention and

cessation activities tailored to local needs;

• a National Best Practice Unit (NBPU) to support best practices in RTCG activities;

• indigenous Quitline enhancement grants, which aim to improve the capacity of Quitline services

to provide accessible and appropriate services to Aboriginal and Torres Strait Islander people;

• the Quitskills training programme, which provides training in brief intervention and motivational

interviewing that aims to increase the number of suitably trained and qualified professionals

working with Aboriginal and Torres Strait Islander smokers and their communities, including

enhancements for young people, pregnant women and new mothers;

• a National Coordinator to deliver high-level advice to the Australian Government for the

shaping of policies, as well as providing leadership and support to grantees;

• enhanced activities targeting priority groups for promising approaches for priority groups

and particularly pregnant women and smokers in remote areas;

• a national evaluation to be continued in 2018 by an external evaluator, looking at the

programme’s appropriateness, effectiveness, impact and efficiency; and

• an assessment of the impacts and outcomes of the RTCG component that forms

approximately 80% of the funding for the TIS programme. Approximately 39% of Aboriginal

and Torres Strait Islander people over the age of 15 are daily smokers, 2.8 times the

smoking rate for other Australians. It is estimated that smoking accounts for one in five

Aboriginal and Torres Strait Islander deaths.

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GLOBAL PROGRESS REPORT 2018

REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Tobacco advertising,

promotion and sponsorship

[Article 13]

▪

Parties progressed in broadening the scope of their tobacco advertising, promotion and

sponsorship legislation to cover new and emerging tobacco and nicotine products.

▪

Almost a third of all Parties still have not instituted a comprehensive ban on all tobacco

▪

Only about a third of all Parties have reported regulating cross-border advertising.

Comprehensive

ban

tobacco

advertising, promotion and sponsorship

(TAPS).

Of all Parties, 72% (131) reported having

a comprehensive ban on all TAPS. However,

Parties’ definitions of a comprehensive ban on

TAPS vary and do not always cover all of the

specific measures called for by the guidelines

for implementation of Article 13. As Fig. 10

shows, in 2018 the most commonly covered

areas in the Parties comprehensive TAPS bans

were tobacco sponsorship (87%), product

placement (85%) and depiction of tobacco in

entertainment media (73%).

New TAPS legislation was reported by

Azerbaijan, China, Georgia, Lithuania, Oman,

Qatar, Slovenia, Thailand and Turkmenistan. In

the 2018 reporting period, inclusion of different

provisions strengthened overall, but notable

progress was observed in the proportion of

Parties that included the depiction of tobacco

in entertainment media in their comprehensive

bans (Fig. 10). This is an especially positive trend

as many Parties previously shared the difficulties

of its regulation in their implementation reports,

and this measure is also in line with decision

FCTC/COP7(5) of the seventh session of the

Conference of the Parties.

In their progress notes, the Australian Capital

Territory, the Czech Republic, Lithuania,

Luxembourg, the Netherlands and Portugal

reported amending their existing TAPS

legislation to include electronic cigarettes. In

addition, Portugal stated in addition to electronic

cigarettes, the scope of their TAPS ban has

been broadened since January 2018 to the

advertising of cigarette paper, water pipes and

devices for using heated tobacco products.

Lithuania’s new advertising ban covers also

herbal products intended for smoking.

Several Parties highlighted their recent ad-

vances in banning tobacco sponsorship. Chi-

na banned Internet advertising and the use of

charitable donations to promote tobacco prod-

ucts. Slovenia’s comprehensive new legislation

bans, among other things, contributions and

donations from the tobacco industry to any

other entity. Luxembourg prohibited the spon-

sorship of electronic cigarettes in addition to

sponsorship of tobacco. Lithuania banned any

kind of public or private sponsorship of radio

programmes with respect to tobacco, electron-

ic cigarettes and their refills, as well as herbal

products intended for smoking.

advertising, promotion and sponsorship, despite it being one of the time-bound

measures of the Convention.

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

Fig. 10

Percentage of Parties reporting inclusion of selected provisions in their comprehensive ban

on tobacco advertising, promotion and sponsorship (n=109 in 2016; n=131 in 2018)*

Tobacco sponsorship

Product placement

Depiction/use of tobacco

in entertainment media

Corporate social responsability

Cross-border advertising

entering the country

Domestic internet

Brand stretching and/or sharing

Cross-border advertising originating

from the country

Display at points of sales

Global internet

2018

2016

Cross-border

advertising,

promotion

and sponsorship.

Banning cross-border

advertising – originating from one country and

viewed in another – is the second time-bound

measure under Article 13, in addition to the

general TAPS ban. However, only 60% of the

Parties’ comprehensive TAPS ban was shown

in 2018 to cover cross-border advertising,

promotion and sponsorship originating in

country. Only a limited number of Parties have

put in place measures to tackle the issue of

cross-border advertising such as penalties

(36%) or cooperation in its elimination (30%).

Recent progress was highlighted by Lithuania,

where the 2016 amended legislation

encompasses a ban of any type of public or

private sponsorship of events, activities or

individual persons, which directly or indirectly

promotes the use of electronic cigarettes,

refillable cartridges of electronic cigarettes and/

or herbal products intended for smoking, when

it is associated with several countries that are

members of the European Economic Area

(EEA), takes place in several EEA countries or

has cross-border effects.

Restrictions

the

absence

comprehensive TAPS ban.

Overall 27% (49) of

all Parties reported that they did not implement a

comprehensive ban for TAPS. Of these Parties,

five (10%) indicated that they were precluded

by their constitution or constitutional principles

from undertaking a comprehensive TAPS ban.

Of the Parties that only applied restrictions

instead of a comprehensive ban, only a third

(31%) required restrictions for all TAPS. Only

one in 10 of the Parties without comprehensive

TAPS ban required disclosure of tobacco

advertising expenditures. Most common

restrictions for TAPS were restrictions on radio

(61%), television (59%) and print media (47%).

The least restricted area was cross-border

advertising originating from the country (14%),

global Internet (18%), tobacco sponsorship in

international events and activities (33%) and

participants therein (27%).

Calculated among Parties that have a ban on tobacco advertising, promotion and sponsorship

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GLOBAL PROGRESS REPORT 2018

THAILAND

bans further tobacco product advertising,

promotion and sponsorship

Thailand has been strengthening its tobacco control policies

in the past 30 years and Article 13 of the WHO FCTC is no

exemption to this. A ban on tobacco advertisement was first

implemented in 1989. The latest updates to the legislation on

tobacco advertising, promotion and sponsorship entered into

force on 4 July 2017 under the Tobacco Products Control Act

2017 (BE 2560).

Article 35 stipulates that business operators and related persons shall not be allowed to

sponsor or support individuals, groups or public and private agencies in any way. This

includes promoting the image of tobacco products, manufacturers or importers of tobacco

products, advertising of tobacco products, their manufacturers or importers and promoting

tobacco consumption, in any way that interferes with tobacco products control policies.

An exemption is still given for donations and humanitarian assistance in case of severe

disasters. However, this kind of activities or news cannot be promoted to the public.

Furthermore, article 36 of the law bans retailers to display or to permit a display of tobacco

products at points of sale. Display of names and prices of tobacco products along with display

of tobacco product retail places must comply with the rules, procedures and conditions, but

the regulations towards this end have not yet been published.

Tobacco use is still one of the most

serious public health problems in

Thailand, given that it constitutes the

single most important risk factor for

preventable deaths in the country, with

over 51,000 deaths caused by smoking

each year. Through the adoption of this

law, that was elaborated on the basis

of the Guidelines for implementation of

Article 13 of the WHO FCTC, Thailand

continues to be a leader in global

tobacco control, while fulfilling its

obligations under the Convention.

Before

After

Display at point of sale before and after the 2017 amendment of the Tobacco

Products Control Act (Photo courtesy of Ministry of Public Health, Thailand)

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REDUCTION OF DEMAND FOR TOBACCO

KEY

OBSERVATIONS

Measures concerning tobacco

dependence and cessation

[Article 14]

▪

As a positive development, Parties have included diagnosis, treatment and counselling

services in their national tobacco, health and educational programmes, plans and strategies

more actively than before.

events, such as the World No Tobacco Day, media campaigns and programmes in health-

care facilities being the most popular initiatives.

▪

Parties have strengthened their programmes promoting tobacco cessation, with local

▪

Slightly over half of all Parties declared having integrated tobacco dependence and

cessation in the curricula of various of medical students and it was even less common in

nursing, dentistry and pharmaceutics. Better inclusion of the methodology in the curricula

would reduce the need for later extensive and more costly training of health workers.

Inclusion of diagnosis, treatment and

counselling services for tobacco cessation

in national programmes, plans and

strategies.

Just above two thirds (123) of

all Parties included tobacco dependence

diagnosis, treatment and counselling services

in their national tobacco control strategies,

plans and programmes. A total of 69%

(125) had included the same in their health

programmes (Fig. 11). Over one third, 40% (72),

had included it in educational programmes,

plans and strategies. Inclusion of smoking

cessation in various national programmes,

plans and strategies became more common in

2016–2018. One recent example of progress

in this area was provided by Malta, where a

group of selected health professionals visited

the Health Services Executive (HSE) in Dublin,

Ireland, in 2016 to observe and learn in order to

strengthen national tobacco cessation services

in Malta. After the visit, the delegation continued

to work together for the preparation of a draft

Tobacco Action Plan, which is expected to form

part of the national Tobacco Control Strategy.

Fig. 11

Percentage of Parties reporting the inclusion of diagnosis and treatment for smoking cessation

in their national strategies, plans and programmes in 2016–2018

Health strategies,

plans and programmes

Tobacco control strategies,

plans and programmes

Educational strategies,

plans and programmes

2018

2016

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GLOBAL PROGRESS REPORT 2018

Programmes

promote

tobacco

cessation in the general population.

The

majority (80%) of all Parties have utilized the

opportunities raised by local events, such as

the World No Tobacco Day, to promote tobacco

cessation (Fig. 12). A similar percentage of

Parties designed programmes to promote

cessation in health-care facilities. Over two

thirds (71%) have run media campaigns to

promote smoking cessation.

WHO

World No Tobacco Day:

an awareness raising opportunity

for WHO FCTC Parties

Every year, on 31 May, WHO

and partners celebrate World No

Tobacco Day (WNTD), highlighting

the health and other risks

associated with tobacco use and

the policy interventions needed to

effectively control it.

Posters from previous WNTD celebration. (Source: http://www.who.int/tobacco/wntd/en/)

The World Health Organization

and its Member States initiated the World No Tobacco Day in 1987 to draw global attention

to the growing tobacco epidemic and the disease and health problems caused by tobacco

use. Since then, different topics have been showcased in the yearly celebrations, from the

vicious circle of tobacco and poverty to gender and marketing to women, tobacco free

workplaces, smoking cessation, tobacco taxation, tobacco industry interference and illicit

trade in tobacco products, among many others. On the occasion of the WNTD, individuals,

institutions and governments showing exemplary leadership in tobacco control are presented

awards in recognition of their activities.

Reports of the Parties to the Convention indicate that the celebration of World No Tobacco

Day provides them with opportunities to highlight implementation of the WHO FCTC at national

level, to advocate for evidence-based policies required under the Convention, to generate

awareness and political will to strengthen implementation of effective tobacco control measures.

The Convention Secretariat is proud to support this WHO initiative and contribute to the yearly

actions. Among others, the Secretariat works with WHO colleagues to select the themes for

the yearly initiative, provide comments during the development of campaign and information

materials prepared for distribution within the countries.

Sustaining this initiative over time is important in order to provide support and opportunity for

countries to communicate and raise public awareness of the consequences of tobacco use,

to emphasize its health, economic, social, environmental and other impacts, and eventually

highlight the implementation of the WHO FCTC.

More details are available on: http://www.who.int/tobacco/wntd/previous/en/

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

For instance, a national mass media campaign

on tobacco was conducted in 2016 for the

first time in Tonga, themed

Tuku Ifi Leva

(Quit

Smoking Now), and the second phase was also

conducted in October 2017. The campaign is

planned to continue as an annual event for five

consecutive years to coincide with the timeline

of the current national noncommunicable

disease (NCD) strategy.

In Pakistan, the Ministry of National Health

Services, in collaboration with Vital Strategies,

launched the second national anti-tobacco

mass media campaign in 2017. The “Sponge”

video graphically shows the amount of tar found,

after only one year, in the lungs of an average

pack-a-day smoker. The cessation campaign

appeared on 14 TV channels across the country

over the duration of four weeks, as well as on the

radio, community signage and billboards.

As compared to 2016, Parties strengthened

their activities in promoting cessation in 2018

(Fig. 12). Programmes to promote cessation

among women and in sporting environments

remain the least utilized measures.

Group activity as part of the El Salvador cessation program of the «Addiction

Prevention and Treatment Centers». (Photo courtesy of Fondo Solidario para la

Salud - FOSALUD, El Salvador)

National guidelines, integration of cessation

into health-care systems and involvement

of various health professionals.

Overall,

60% (109) of all Parties had national cessation

guidelines based on scientific evidence and best

practices. Several Parties continued to update

their guidelines in the reporting period. For

example, Mexico highlighted having developed a

competency standard for providing brief advice

for smoking cessation. Globally, 69% (124) of

the Parties integrated diagnosis and treatment

into their health-care systems, most commonly

into primary health (Fig. 13).

Fig. 12

Percentage of Parties reporting programmes, events and quitlines to promote cessation of

tobacco use (n=180 in 2016; n=181 in 2018)

Local events

Programmes in health-care facilities

Media campaigns on the

importance of quitting

Programmes in educational institutions

Programmes in workplaces

Telephone quitlines

Programmes for pregnant women

Programmes for girls and young women

Programmes in sporting environments

Programmes for women

2018

2016

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GLOBAL PROGRESS REPORT 2018

No major changes were observed in terms of the

different structures providing for diagnosis and

treatment. Several Parties also mentioned that

other structures within their existing health-care

systems provided the services, for example,

occupational health services and centres

providing psychiatric care. Physicians, nurses

and family doctors are the most involved health

professionals (Fig. 14), but the overall involvement

of health professionals remained on similar level

as compared to 2016.

Curricula for health professionals.

Slightly

over half of the Parties (55%) reported that they

included tobacco dependence treatment in

the curricula of medical schools. Incorporating

it to the curricula in the training of other health

professionals was less common, but improved for

all the studied professions in the 2018 reporting

period (Fig. 15). Despite the small proportions of

Parties integrating it to the curricula of students,

a vast majority (86%) of Parties provided training

and awareness activities to health workers in line

with Article 12.

For example, Brunei Darussalam highlighted training

nurses and smoking cessation counsellors in every

government health centre since 2017. Mali trained

more than 120 health workers in health counselling,

education and smoking cessation. Bosnia and

Herzegovina, as well as Ecuador, systematically

trained medical doctors, nurses and health-care

technicians. In Myanmar, since May 2017, primary

health-care staff in 90 townships were trained in

brief advice as part of the implementation of the

WHO Package of Essential Non-Communicable

Disease Interventions for Primary Health Care in

Low-Resource Settings,

know by the acronym

PEN. A manual and guidelines were developed for

this purpose by the Ministry of Health and Sports.

Public funding or reimbursement schemes

for treatment costs.

Out of the Parties that

included diagnosis and treatment in their health-

care systems, 83% covered fully or partially

the costs of services and treatment in primary

health care by public funding or reimbursement

schemes. The percentage of Parties covering

such services is provided in Fig. 16.

Accessibility

and

affordability

pharmaceutical products for the treatment

of tobacco dependence.

More than half,

60% (109), of all Parties reported facilitating the

accessibility and affordability of pharmaceutical

products for the treatment of tobacco

dependence. Over nine out of 10 (94%) of these

Parties had nicotine replacement therapy (NRT)

legally available in their jurisdiction, and a majority

also had bupropion (69%) and varenicline (68%)

available. Of the Parties that had NRT legally

available, half (50%) confirmed covering the

costs of NRT fully or partially by public funding

or reimbursement schemes. Of those that had

bupropion or varenicline legally available, the

costs were fully or partially covered in 53% and

47%, respectively, of the Parties. The proportions

remained similar to the 2016 level.

Fig. 13

Percentage of Parties with programmes on diagnosis and treatment of tobacco dependence

within health-care systems, by settings (n=102 in 2016; n=124 in 2018)*

Primary health care

Secondary and tertiary health care

Specialized centres for cessation

Specialist health-care systems

Rehabilitation centres

2018

2016

Calculated among Parties with programmes on diagnostics and treatment of tobbaco dependence

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

REDUCTION OF DEMAND FOR TOBACCO

Fig. 14

Percentage of Parties with an involvement of health and other professionals in treatment and

counselling programmes (n=102 in 2016; n=124 in 2018)*

Physicians

Nurses

Family doctors

Dentists

Social workers

Pharmacists

Midwives

Community workers

Practitioners of traditional medicine

2018

2016

Fig. 15

Percentage of Parties reporting the inclusion of tobacco dependence treatment in the curricula

of different health professionals (n=180 in 2016; n=181 in 2018)

Medicine

Nursing

Dentistry

Pharmaceutics

2018

2016

Fig. 16

Percentage of Parties where service and treatment costs are covered by public funding or

reimbursement schemes (n=102 in 2016; n=124 in 2018)*

Programmes in primary health care

Programmes in secondary

and tertiary health care

Programmes in specialized

centers for cessation

Programmes in specialist

health-care systems

Programmes in rehabilitation centers

Fully covered

2018

2016

Partially covered

Calculated among Parties with programmes on diagnostics and treatment of tobbaco dependence

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GLOBAL PROGRESS REPORT 2018

MEASURES RELATING TO THE REDUCTION

OF THE SUPPLY OF TOBACCO

Illicit trade in tobacco products

[Article 15]

KEY

OBSERVATIONS

▪

Compared to the last reporting cycle, more Parties have confirmed having legislation in

place to address measures to control illicit trade in tobacco products.

as compared to the previous reporting cycle.

▪

The implementation of most of the measures under this article considerably improved

▪

The ratification/accession to the Protocol to Eliminate Illicit Trade in Tobacco Products

(the Protocol) has been advanced by many Parties, and came into force on 25

September 2018.

implementing a practical tracking and tracing

regime to secure the distribution system and

assist in the investigation of illicit trade (Fig. 17).

The tobacco industry and those that promote

its interests are increasingly advocating for

tracking and tracing systems in line with their

agendas. Related to this, Lithuania initiated a

motion signed by the Minister of Health, the

Chairperson of the Committee for Health, the

Chairperson of the National Health Board,

and the President of the National Alcohol

and Tobacco Control Coalition to reject, at

European Union level, the tracking and tracing

system proposed by the tobacco industry

called Codentify.

Confiscation and destruction.

Over two

thirds of all Parties, 69% (125), reported allowing

the confiscation of proceeds derived from

illicit trade in tobacco products, and similar

percentage, 67% (121), monitored, documented

and controlled the storage and distribution

of tobacco products held or moving under

suspension of taxes and duties. In addition, 70%

(127) required the destruction

of confiscated equipment, counterfeit and

contraband cigarettes, and other tobacco

products derived from illicit trade, using

environmentally friendly methods where possible,

or their disposal in accordance with national law.

Enacting or strengthening legislation against

illicit trade.

The average implementation of the

provisions under Article 15 increased significantly

from 50% in 2016 to 61% in 2018. Around two

thirds of all Parties 72% (130) reported having

adopted or strengthened legislation against illicit

trade in tobacco products (Fig. 17).

Marking of packaging.

Among all the Parties,

it was most common to require markings to

determine whether a tobacco product was

legitimately and legally sold on the domestic

market (66%) and to assist in determining the

origin of the product (63%). Overall 63% of

the reporting Parties also require the marking

to be legible and/or presented in the principal

language or languages of the country. However,

only 38% require that unit packs of tobacco

products for retail and wholesale use carry the

statement “Sales only allowed in…” or have

any other effective marking indicating the final

market destination (Fig. 17).

Tracking and tracing.

Over half, 52% (95), of

all Parties required monitoring and collection

of data on cross-border trade in tobacco

products, including illicit trade. On the other

hand, 18% reported having data on the

percentage of smuggled tobacco products

within their jurisdiction. One third, 35% (64),

of all Parties had reported developing or

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

MEASURES RELATING TO THE REDUCTION OF THE SUPPLY OF TOBACCO

Licensing.

Around two thirds, 69% (124), of

the Parties require licensing or other actions to

control or regulate production and distribution

in order to prevent illicit trade.

Since 1 January 2018 in Norway, wholesalers

and retailers of tobacco products and tobacco

surrogates, for example e-cigarettes and

herbal tobacco, are required to register their

products in a national tobacco sales registry.

In the Islamic Republic of Iran, almost 33 000

tobacco retailers received a license to sell

tobacco products since 2016.

Promoting cooperation.

Overall 65% (117)

of all Parties promote cooperation between

national agencies and relevant regional and

international intergovernmental organizations

(IGOs) with a view to eliminating illicit trade in

tobacco products.

To promote the entry into force of the Protocol,

the Convention Secretariat organized and

participated in several multisectoral, subregional

workshops between 2016 and 2018. These

workshops brought together officials from

various government sectors involved in the

ratification and implementation of the Protocol,

including health, foreign affairs, customs,

justice, law enforcers including the police

finance and trade, along with members of civil

society and IGO representatives. Members

of the Panel of Experts on the Protocol were

invited as facilitators. At least 55 Parties to the

WHO FCTC have attended these workshops.

Fig. 17

Percentage of all Parties reporting on implementation of illicit trade control provisions (n=180

in 2016; n=181 in 2018)

Legislation against illicit trade enacted

Requiring that confiscated manufacturing

equipment be destroyed

Licensing required

Confiscation of proceeds derived

from illicit trade enabled

Storage and distribution of tobacco

products monitored

Marking that assists in identifying legally

sold products required

Cooperation to eliminate illicit trade promoted

Legible marking required

Marking that assists in determining

the origin of product required

Information exchange facilitated

Monitoring of cross-border trade required

Statement on destination required

on all packages of tobacco products

Tracking and tracing

2018

2016

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GLOBAL PROGRESS REPORT 2018

#ItOughtToBeLaw

Achievements during the 2018 reporting period have led

to another important milestone in the history of tobacco

control, as more than 46 Parties to the WHO FCTC

have also become Parties to the Protocol to Eliminate

Illicit Trade in Tobacco Products. The requirements set in

Article 45 of the Protocol have been met and the Protocol

will enter into force on 25 September 2018. Together with

the WHO FCTC, the two treaties aim to tackle all aspects

of the tobacco pandemic both globally and nationally.

The Protocol contains three categories of measures

aimed at eliminating illicit trade in tobacco products:

preventing illicit trade; promoting law enforcement; and

providing the legal basis for international cooperation.

Parties are commended for their governments’ efforts

in ensuring the new Protocol entered into force. A clear message has been sent that the

illicit tobacco market will be targeted under the framework of international cooperation

by cost-effective measures that will protect particularly children and socioeconomically-

disadvantaged populations from being exposed to low-cost and easily available tobacco

products.

Key provisions of the Protocol focus on securing the supply chain of tobacco products

through, among other things, licensing and record-keeping requirements, the establishment

of national and regional tracking and tracing regimes, and a Global Information Sharing

Focal Point to enhance cooperation among the Parties. Other measures are aimed at

improving cooperation between law enforcement authorities by ensuring mutual legal and

administrative assistance.

In addition to the entry into force of the Protocol, the Parties have continued to reinforce

measures within their respective jurisdictions. Two thirds of all Parties have reported in 2018

having acted on WHO FCTC Article 15 by strengthening legislation against illicit trade in tobacco

products. While the implementation of all measures under this article improved compared to

the situation in 2016, further development and new measures are still needed, in particular

cross-Party collaboration, which is comprehensively encompassed in the new treaty.

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MEASURES RELATING TO THE REDUCTION

OF THE SUPPLY OF TOBACCO

KEY

OBSERVATIONS

Sales to and by minors

[Article 16]

▪

Parties have strengthened the implementation of all provisions under the article.

▪

A growing number of the Parties are in the process of increasing their minimum age

for tobacco purchase.

▪

There is still room for improvement especially in prohibiting the sale of tobacco products

in any manner in which they are directly accessible, such as open store shelves, and

from vending machines.

Sales to and by minors.

The vast majority of

Parties, 85% (154), reported having prohibited

sales of tobacco products to minors (Fig. 18).

A smaller proportion (70%) also prohibited

tobacco sales by minors. The legal age for

tobacco purchases ranged from 15 to 24 years,

with the average being 18 years.

The lowest ages reported were in Comoros

(15). In Austria, Belgium, the Democratic

People’s Republic of Korea, Djibouti, Mali and

The Former Yugoslav Republic of Macedonia

the legal age to buy tobacco is 16, while it is

17 in Timor-Leste. The highest minimum ages

were found in Japan, Thailand and Uzbekistan

(20); Honduras, Mongolia and Palau (21);

and Sri Lanka (24). Austria and Luxembourg

mentioned in their progress notes that the

minimum legal age for the purchase of tobacco

products was raised from 16 to 18. In Brazil,

the National Congress was processing a bill

that would raise the minimum legal age to 21.

Eight out of 10 Parties prohibited the distribution

of free samples to minors (83%) and to the

public in general (77%).

Several Parties amended their legislation to

cover new products in the ban of sales to

minors. This includes electronic cigarettes in

the Czech Republic, Poland and Slovenia and

heated tobacco products in the Republic of

Korea, which also banned the sale of any items

mimicking tobacco products under the Juvenile

Protection Act.

Requirements for tobacco retailers.

A total of 66% (120) of all Parties required

that all sellers of tobacco products place a

clear and prominent indicator inside their

point of sale about the prohibition of tobacco

sales to minors. A similar proportion, 66%,

requested that sellers of tobacco products ask

the purchaser to provide evidence of having

reached full legal age. Over half, 60%, of all

Parties prohibited tobacco sales from vending

machines, and 55% prohibited sales in any

manner by which they are directly accessible,

such as open store shelves. As an example of

recent progress, Brazil prohibited the display of

tobacco products in the proximity of sweets.

Prohibition of tobacco products with

specific appeal to minors.

A majority,

67% (122), of all Parties prohibited the sale

of cigarettes individually or in small packs. In

addition, 59% prohibited the manufacture

and sale of sweets, snacks, toys or any other

objects in the form of tobacco products.

Enforcement and sanctions.

Overall 77%

(139) of all Parties provided penalties against

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GLOBAL PROGRESS REPORT 2018

sellers and distributors in order to ensure

compliance. Some Parties also took measures

to improve the compliance with the legislation.

For instance, the Ministry of National Health

Services in Pakistan issued a notification to

all chief ministries in September 2016, noting

that violations of tobacco control laws were

observed across the country and all provincial

governments should ensure strict compliance

with existing legislation. The chief ministers

were advised to make provisions for tobacco

products not to be sold within 50 metres of

educational institutions and to establish the

prohibition of the of tobacco products to people

under 18, among other actions. Police officers

were encouraged and authorized to take action

against all violators. Additionally, chief ministers

were asked to issue necessary directives to

relevant authorities to maximize compliance.

Fig. 18

Percentage of Parties reporting implementation of Article 16 provisions (n=180 in 2016; n=181 in 2018)

Sales of tobacco products

to minors prohibited

Distribution of free tobacco

products to minors prohibited

Penalties against sellers provided

Distribution of free tobacco products

to the public prohibited

Sale of tobacco products

by minors prohibited

Sale of cigarettes individually or

in small packets prohibited

Required that sellers request for evidence

of having reached full legal age

Clear and prominent indicator required

Sale of tobacco products from

vending machines prohibited

Manufacture and sale of any objects in

the form of tobacco products prohibited

Ban of sale of tobacco in

any directly accessible manner

2018

2016

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OTHER PROVISIONS

KEY

OBSERVATIONS

Tobacco growing and support

for economically viable alternatives

[Article 17]

and protection of

the environment and the health

of persons

[Article 18]

▪

While there are examples of new diversification projects, the implementation rates of these

two articles have not seen significant change during the 2016–2018 reporting period.

▪

Among tobacco growing Parties, the share of tobacco leaf production in national

gross domestic product (GDP) is typically below or around 1%.

▪

An increasing number of Parties provided innovative examples of their projects

protecting the environment and the health of people in relation to tobacco growing or

manufacturing.

Tobacco growing.

Of all Parties, 50% (90) have

reported tobacco growing in their jurisdictions.

In this group, 84% (54) provided some

information on the number of people working

in tobacco growing, which varies widely, from

a few hundred in, for example, Azerbaijan,

Jamaica, Panama and the Republic of Moldova

and to several hundreds of thousands in Brazil

and Turkey and to 1.5 million in China.

In addition, 69% (44) of the Parties growing

tobacco provided information on the share

of the value of tobacco leaf production in the

national GDP. The share was typically below or

around 1%.

Economically viable alternative activities.

Among the 90 tobacco-growing Parties, 27%

(24) promoted viable alternatives for tobacco

growers (Fig. 19).

Several Parties provided information on their

activities. Sri Lanka announced it would

gradually phase out tobacco growing by 2020

and provide alternative options to tobacco

growers. Alternative crops to tobacco included

potatoes (Sierra Leone and Tunisia); saffron

(Afghanistan); corn, bean, mandarin oranges

and avocados (Colombia); pineapples, sugar

cane and coffee (Costa Rica); cocoa beans and

coffee (Ecuador); and kenaf (Malaysia). Several

Parties began promoting programmes that

would replace tobacco growing with livestock

(fish, dairy products and small livestock)

production.

On the other hand, some Parties still incentivize

tobacco growing as part of more general

agricultural support programmes that do not

make a distinction between supported crops.

In a very innovative project, France is helping

tobacconists (tobacco sellers) gradually diversify

their business model by selling other goods

and offering additional services. A Transition

Fund was created to support this project and a

budget was earmarked of 20 million Euros per

year until 2021.

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GLOBAL PROGRESS REPORT 2018

FRANCE

An agreement to support

tobacconists to diversify their activity

WHO FCTC Article 17 requires Parties to “promote,

as appropriate, economically viable alternatives for

tobacco workers, growers and, as the case may be,

individual sellers”. While a number of Parties have

implemented or promoted policies to help tobacco farmers diversify and shift from

growing tobacco to other crops, there is little documented evidence on projects assisting

tobacco sellers to shift away from selling tobacco.

The French Government has now developed and promotes a policy to provide alternatives

to tobacco sellers. Through this policy tobacco sellers (the so-called “tobacconists”) will

be able to diversify their activity and become, in the long run, managers of a new local

“convenience store”.

In February 2018, an agreement was signed between the Public Action and Accounts

Minister Gérald Darmanin and representatives of the national network of tobacconists to

seal this commitment.

Tobacconists in France currently enjoy dual status as they on the one hand are independent

retailers and on the other hand represent the state monopoly for tobacco retailing, under the

supervision of the Directorate General for Customs and Indirect Taxation.

According to the text of the 2018–2021 agreement, the objectives of this initiative are to

provide tobacconists with the means to evolve in the long term from tobacco retailing to a

new type of convenience shop, responding to a variety of needs from the local communities.

Among many initiatives listed in the agreement, a “transition fund” was set up to provide

resources to the project and help tobacconists diversifying from tobacco sales. The fund is

expected to ensure a prosperous future for the 25 000 such businesses in the country. Other

financial compensation is also available to businesses most vulnerable to the impact of the

various tobacco control measures put in place.

This agreement demonstrates the Government’s commitment to implement WHO FCTC in

many areas, including Article 17, by promoting alternative activities and supporting tobacco

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

OTHER PROVISIONS

Protection of the environment and the

health of people.

Protective measures in

tobacco cultivation and manufacturing are

utilized by around one third of tobacco-growing

Parties, and there was no notable progress in

this area in 2016–2018 (Fig. 19).

Several Parties reported recent progress in the

implementation of Article 18. China has reported

on energy-saving and emission-reduction

initiatives in the cigarette-production process.

Ecuador, Panama and European Union Member

States have comprehensively addressed the

protection of the environment and the health of

people working in the tobacco sector. Honduras

has reported new multisectoral engagement on

environmental protection, while Pakistan has

organized training programmes for tobacco

farmers regarding safe use of pesticides. In

the Philippines, a particular focus has been

placed on reforestation projects. In the Russian

Federation, the Ministry of Health proposed a

new ecological tax on cigarettes.

In India, the Ministry of Health and Family

Welfare provided support to a public interest

litigation case. This case was filed by the NGO

“Doctors for You” at the National Green Tribunal

aimed at declaring cigarettes and bidi butts as

toxic waste, as well as addressing deforestation

caused by tobacco curing and the adverse

health impact of tobacco growing.

Fig. 19

Percentage of tobacco-growing Parties reporting implementation of protective measures in tobac-

co cultivation and manufacturing, and promoting viable alternatives (n=73 in 2016; n=90 in 2018)

Measures

implemented

considering

The health of persons in tobacco

manufacturing

For the protection of the environment

in tobacco manufacturing

The health of persons

in tobacco cultivation

The protection of the environment

in tobacco cultivation

For tobacco sellers

Viable

alternatives

promoted

For tobacco workers

For tobacco growers

2018

2016

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GLOBAL PROGRESS REPORT 2018

PALAU

The Palau Pledge:

raising awareness on environmental

issues among visitors entering the country

Palau is the first nation on earth to change its immigration laws for the cause of environmental

protection. Upon entry, visitors need to sign a passport pledge to act in an ecologically

responsible way on the island, for the sake of Palau’s children and future generations of

Palauans. Palauans have also taken the pledge, from the president, the first pledgee, to

traditional chiefs and residents.

Every tourist/ visitors/anyone

who takes the pledge needs

to follow sustainable tourism

checklist or risk a fine. One item

on the checklist are related to

tobacco use: «Do not smoke in

restricted areas.» Additionally,

pledgers are warned as follows:

• Do not throw cigarette butts

in the ocean or on the beach.

• Throw your butts away in

appropriate receptacles.

• Do not pollute others with

your second-hand smoke.

(Source: https://palaupledge.com)

This pledge is an excellent example of implementation of Article 18 of the Convention, as Palau

agreed to have due regard to the protection of the environment in relation to tobacco use.

More details are available on: https://palaupledge.com/.

By the time of writing this report, almost 110 000 pledges were taken.

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OTHER PROVISIONS

KEY

OBSERVATIONS

Liability

[Article 19]

▪

There is progress in Parties implementing measures that improve their compliance with

Article 19 of the Convention, for example by including measures on liability in their tobacco

control legislation, and half of the Parties have instituted these protective measures in their

respective legislation.

Civil Liability Toolkit by the WHO FCTC Secretariat.

Of all the Parties, 51% reported that criminal

liability is contained in their tobacco control

legislation. Between 2016 and 2018, Parties

strengthened their measures in all studied

provisions under Article 19 (Fig. 20).

Several Parties (Czech Republic, Ecuador,

Grenada, Poland and Turkey) indicated

progress in the development or amendment of

▪

The implementation of Article 19 is expected to strengthen after the launch of the

legislation. The Brazilian Government continued

to gather information about liability actions, in

the field of legal doctrine and jurisprudence,

based on national and international law.

As implementation of Article 19 still poses

challenges to the Parties, the Convention

Secretariat has launched the

Article 19 Civil

Liability Toolkit

to assist Parties in this area.

Fig. 20

Percentage of Parties with provisions for liability (n=180 in 2016; n=181 in 2018)

Measures on criminal liability contained

in the tobacco control legislation

Civil liability measures that could

apply to tobacco control exist

Civil liability measures that are specific

to tobacco control exist

Separate liability provisions on tobacco

control outside of the tobacco control

Civil or criminal liability provisions that

provide for compensation exist

Criminal and/or civil liability action

launched by any person

Actions taken against the tobacco industry on

reimbursement of costs related to tobacco

2018

2016

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GLOBAL PROGRESS REPORT 2018

8th International Legal Training Course on law and noncommunicable disease prevention: The Mc-

Cabe Centre for Law and Cancer recently completed its 8th International Legal Training Course

on law and noncommunicable disease prevention. 14 participants from 12 WHO FCTC parties

– Botswana, Laos, Marshall Islands, Mongolia, Myanmar, Nepal, Philippines, Solomon Islands, Sri

Lanka, Uganda, Vietnam, and Zambia – attended the course, held at Cancer Council Victoria in

Melbourne, Australia from 30 April to 18 May 2018. (Photo courtesy of WHO FCTC Secretariat’s

Knowledge Hub on legal challenges, Australia)

The WHO FCTC Article 19 Civil

Liability Toolkit

Under Article 19 of the WHO FCTC, Parties agree to consider taking legislative action or

promoting their existing laws to deal with criminal and civil liability. They should also provide

each other with assistance in legal proceedings relating to liability, as appropriate and mutually

agreed. Implementation of Article 19 provides an opportunity for the Parties to collaborate in

their efforts to hold the tobacco industry liable for its misconduct. The importance of liability

as part of comprehensive tobacco control is also recognized in WHO FCTC Article 4.5.

In accordance to COP7 Decision FCTC/COP7(11), the Convention Secretariat supported the

development of an interactive and innovative web-based

Article 19 Civil Liability Toolkit

that

aims to strengthen global civil liability systems where there is a perceived power imbalance

between claimants and corporate defendants.

The Toolkit is intended to provide governments with advice about best practices and

innovative reforms that would facilitate health-care cost recovery, public-interest litigation

and greater access to justice for individual victims, including through collective redress.

It presents governments with the

opportunity to avail themselves

of effective means to hold

the tobacco industry legally

accountable for its conduct.

The Toolkit, launched at the World

Conference on Tobacco or Health

in Cape Town, South Africa, in

March 2017, is available on the

WHO FCTC information platform

at http://untobaccocontrol.org/

impldb/tobacco-control-toolkit/.

Welcome to the WHO FCTC Article

19 Civil Liability Toolkit

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OTHER PROVISIONS

KEY

OBSERVATIONS

Research, surveillance and

exchange of information

[Article 20]

▪

Parties strengthened their national surveillance systems for key indicators of the

tobacco epidemic.

▪

Around one half of all Parties had relatively recent data, from the last five years,

for both adult and youth smoking. However, only one third of all Parties had similar

recent data on smokeless tobacco use.

trade remained poor, despite improvement as compared to 2016.

National systems for epidemiological

surveillance.

In 2018, a majority of Parties

(71%) established a national system for

surveillance of patterns of tobacco consumption

(Fig. 21). In addition, 57% of Parties had

surveillance system for exposure of tobacco

smoke; 51% for determinants of tobacco

consumption; 50% on social, economic and

health indicators; and 44% for consequences

of tobacco consumption. The percentages

for all the mentioned increased as compared

to 2016.

▪

Availability of data on the economic burden of tobacco use and share of the illicit

Research topics.

The Parties most commonly

developed and/or promoted research that

addressed the determinants of tobacco use

(67%), consequences of tobacco use (66%),

and social and economic indicators related

to tobacco consumption (63%). Only half of

the reporting Parties developed or promoted

research on tobacco use among women,

particularly pregnant women, and treatment of

tobacco dependence. Addressing alternative

livelihoods in research remained still very rare

(Fig. 22). In 2018, the Parties covered different

topics in their research activities more broadly

as compared to 2016.

Fig. 21

Percentage of Parties that have established national surveillance systems for different topics

(n=180 in 2016; n=181 in 2018)

Patterns of tobacco consumption

Exposure to tobacco smoke

Determinants of tobacco consumption

Social, economic and health indicators

Consequences of tobacco consumption

2018

2016

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GLOBAL PROGRESS REPORT 2018

Fig. 22

Percentage of Parties developing and/or promoting research on different topics (n=180 in

2016; n=181 in 2018)

Determinants of tobacco consumption

Consequences of tobacco consumption

Social and economic indicators

Exposure to tobacco smoke

Identification of tobacco dependence treatment

Tobacco use among women

Alternative livelihoods

2018

2016

Several Parties reported progress in

conducting new tobacco surveys and research

activities. Trinidad and Tobago introduced a

new framework for a surveillance system for

tobacco and other related products. Myanmar

conducted a trend analysis workshop, which

compared the findings from

Global Youth

Tobacco Survey

(GYTS) 2001, 2007, 2011 and

2016. Chile carried out a study on the living,

working and financial conditions of the farmers

whose main source of income derives from the

cultivation of tobacco. Bahrain reported that

research on the economic impact of tobacco

use in the states of the Cooperation Council for

the Arab States of the Gulf would be conducted

in 2018. The United Kingdom of Great Britain

and Northern Ireland mentioned that the

Tobacco Control Plan

for England committed

Public Health England to update its evidence

report on e-cigarettes and other novel nicotine

delivery systems annually until 2022.

Availability of data on tobacco use.

Of all

Parties, 89% (161) had data available in the

reporting platform on the prevalence of tobacco

smoking among adults. Of these Parties, only

44 had available new data on adult smoking

collected in the 2016–2018 reporting cycle. In

this group, 33 Parties indicated that the new

data was fully comparable to an earlier dataset,

and seven Parties had partially comparable

data due to some changes, for example the

survey age group.

In addition, 55% (100) of all Parties had data

available in the reporting platform on the use

of smokeless tobacco among adults. Nearly

a quarter of those had new data on this topic

from the reporting period, with 16 indicating

that the new data was comparable to an earlier

dataset, and five had partially comparable data.

In terms of the data collected on adult smoking

as well as smokeless tobacco use among the

adult population, there was a large variation in

the survey methods utilized by the Parties, with

emphasis on national monitoring systems rather

than cross-national surveys with standardized

methodology, such as the WHO STEPwise

Approach to Surveillance (STEPS) or the

Global

Adult Tobacco Survey

(GATS).

With regard to how current the data were that

the Parties were using to monitor tobacco use

prevalence, around half (53%) of all Parties have

adult smoking data collected in last five years,

mostly from 2014–2017, whereas one third

(33%) had data for adult smokeless tobacco

use collected in the last five years. Only 11%

of all Parties do not have any data on adult

smoking, the respective proportion being 45%

for smokeless tobacco (Fig. 23).

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

OTHER PROVISIONS

Fig. 23

Availability of prevalence data on adult smoking and smokeless tobacco use, among all Parties

in 2018 (n=181)

Adult smoking

11%

45%

10%

20%

24%

Adult smokeless tobacco use

13%

2016-2017

2014-2015

2012-2013

2010-2011

2008-2009

2007 or older

No data reported

15%

29%

4% 3% 6%

Overall 95% (172) of all Parties have data

available on prevalence of tobacco smoking

among youth in the reporting platform. Twenty-

three per cent (42) of the Parties provided new

data on youth tobacco smoking from the 2016–

2018 reporting period, and 38 of these were

identified as having this data fully comparable

to an earlier dataset, and additional two partially

comparable.

In addition, 58% (105) had data available in

the reporting platform of the use of smokeless

tobacco among youth. In this group, 19 Parties

had new data from this reporting period, but

only 10 had the new data fully comparable to

an earlier dataset, and one partially. Most of the

youth data were collected with standardized

methodology enabling some cross-national

comparisons, mostly as part of the GYTS.

Health Behaviour in School-aged Children

(HBSC) study or the European School Survey

Project on Alcohol and Other Drugs (ESPAD)

were also utilized by several Parties.

Again when considering how current the data

are that the Parties have for monitoring youth

tobacco use, over half (55%) of all Parties have

recent smoking data, from 2014–2017, whereas

the respective proportion for youth smokeless

tobacco use is less than third (28%). Only 5% of

all Parties have not provided any data on youth

smoking, but the respective proportion is 42%

for smokeless tobacco (Fig. 24).

In addition, only 20% (37) of all Parties indicated

that they had data of tobacco use in ethnic

groups. As the preambule of WHO FCTC

already acknowledges Parties’ deep concerns

about tobacco use among indigenous peoples,

Parties are encouraged to focus more attention

on collecting tobacco use data for ethnic groups

including indigenous populations in order to be

able to develop tailored programmes.

Availability of data on exposure to tobacco

smoke.

A majority, 83% (151) of all Parties now

have data on exposure to tobacco smoke in their

populations. The proportion increased from 2016,

when it was 71%. The reported data originated

typically from surveys implemented in 2014, but

the range covered data collection from 2003 to

2018. Forty-five Parties reported exposure data

that had been collected in the past three years.

Availability of data on tobacco-related

mortality and economic burden.

Almost

one half of all Parties (45%) have information on

tobacco-related mortality in their jurisdictions.

The percentage increased from the 39% in 2016.

Available data ranged from year 2000 to 2018, but

it was typically collected in 2014. Only 29 Parties

had mortality data collected after 2015. Seventy-

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GLOBAL PROGRESS REPORT 2018

Fig. 24

Latest available prevalence data available on youth smoking and smokeless tobacco use,

among all Parties in 2018 (n=181)

Youth smoking

42%

10%

13%

32%

8% 4%

23%

18%

Youth smokeless tobacco use

10%

2016-2017

2014-2015

2012-2013

2010-2011

2008-2009

2007 or older

No data reported

three Parties provided information on the number

annual of deaths attributable to tobacco use in the

population. The median figure was 11 400, but

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 1.59 million tobacco-related

deaths, India, with 900 000 deaths, the European

Union (total of tobacco-related mortality cases

in its 28 Member States) with 706 000 deaths,

and the Russian Federation, reporting 310 000

tobacco-related deaths.

For the economic burden of tobacco, one

third of Parties (34%) indicated that they had

information available on this topic, as compared

to 28% in 2016. A total of 60 Parties provided

further details of the data they have. A number

of Parties had data from both direct and indirect

costs. The data was typically collected in 2013,

but the data collection years ranged from 2003

to 2017. Despite the recent trend of conducting

new studies in this area, most data that Parties

referred to was relatively old, as only 13 Parties

had data collected after 2015.

Share of illicit tobacco products on the

national tobacco market.

Only 18% (23) of the

reporting Parties responded having information

on the percentage of illicit tobacco products

on the national tobacco market, with minor

improvement since 2016 (13%). Only 29 Parties

provided data related to the national market share

of illicit tobacco products. In most cases, the data

was provided by customs authorities and other

government ministries or agencies.

Exchange of information and training and

support for research.

A total of 62% (113) of

all Parties had regional and global exchange of

publicly available national scientific, technical,

socioeconomic, commercial and legal information.

Information exchange was less common

regarding the practices of the tobacco industry,

as reported by 39% of the Parties. Exchange of

information relating to the cultivation of tobacco

was reported by 23% of the Parties. Almost two

thirds (61%) provided training for those engaged

in tobacco control activities, such as research,

implementation and evaluation.

Database on laws and regulations.

Sixty-six

per cent (120) of all Parties maintained a database

of national laws and regulations on tobacco control.

Half (50%) reported that the database contained

information on the enforcement of those laws and

regulations. One quarter (25%) had established a

database of pertinent jurisprudence.

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OTHER PROVISIONS

KEY

OBSERVATIONS

Reporting and exchange

of information

[Article 21]

▪

All Parties have reported at least once, and the Parties that have submitted all their

required reports over the years, have already submitted a total of six datasets (reports).

▪

At the time this report was prepared for the 2018 reporting cycle, 142 Parties (78%)

“formally” submitted their latest reports on the reporting platform.

Most of the

remaining Parties updated some information without formally submitting their

report, but their data were used in the preparation of this analysis.

The reporting platform, the content of the

reporting instrument and the process of

reporting has not changed since the 2016

reporting cycle. However, for the first time,

Parties were not required to prepare their report

from scratch: they were provided with the

text of their latest implementation report. This

enabled the reporting Parties to review data

and information in the report, and only change,

adjust or update those items that are no longer

valid. This allowed them to report on the new

developments that have occurred since the

submission of their previous implementation

report. As usual, submitted reports are made

available in the public domain in the WHO FCTC

Implementation Database,

where reports can

be viewed and searched by the indicators that

reflect the provisions of the Convention.

2017,

the

Convention

Secretariat

commissioned, completed and disseminated

among the Parties, a report summarizing best

practices in preparing and submitting WHO

FCTC implementation reports.

The report

demonstrated that the Parties are able to turn

the reporting process to their advantage and

also benefit from the many outcomes of the

reporting process. These outcomes can all

eventually promote national implementation of

the Convention (Fig. 25).

Using this report and its observations, the

Convention Secretariat convened a meeting

for those Parties that have never submitted

an implementation report. Angola, its Health

Ministry and the WHO country office, kindly

hosted that meeting in June 2017. The meeting

provided hands-on assistance to Parties that

have faced difficulties in reporting, and allowed

them to access and work on their reports during

the meeting. As a result of the work carried

out at the meeting or shortly afterwards, all

participating Parties have submitted their WHO

FCTC implementation reports – this also means

that all Parties to the Convention have now

submitted at least one implementation report.

The 2018 reporting period ended on 31 March 2018; but upon request from the Parties the data extraction date was extended. For the analysis

presented in this report, data including all submissions and updates in the reporting system by 17 April 2018 was utilized.

A regularly updated

table presenting the status of reporting by the Parties, including the number of core reports and additional questions, and their submission dates,

is available on the WHO FCTC website.

http://untobaccocontrol.org/impldb/

http://www.who.int/fctc/reporting/reporting-good-practices-who-fctc.pdf

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GLOBAL PROGRESS REPORT 2018

Fig. 25

Outcomes of WHO FCTC reporting

Inter-Party

learning

Sensitized

stakeholders

Intra-Party

learning

Increased

resources

Improved

data

Accelerated

WHO FCTC

implementation

Informed

policy-

making

Source: Good practices in Data collection, Preparation and Submission of FCTC Implementation Reports. WHO FCTC Secretariat. Geneva, 2017

The Secretariat also analyses the feedback

from the Parties on the use of and further

development of the reporting instrument. In

most cases, Parties feedback was positive:

they found it simple to complete and submit,

found the questions to be direct and easy to

understand, and appreciated the thoroughness

of the survey.

Parties also provided suggestions on further

improvements of the reporting instrument.

Some Parties enquired whether they could

expand more on yes-or-no questions. Some

Parties were concerned of the connectivity

issues they had; those that have very limited

access to the

Internet, or have no Internet access, found it

difficult to fill out the questionnaire online. The

Parties also proposed that the questionnaire be

made available in a Word document format, and

some Parties would prefer the questionnaire to

be shortened.

The Convention Secretariat has already

addressed some of these concerns as

they emerged during the reporting cycle.

For example, Parties could expand on their

achievements by using the space available to

respond to open-ended questions related to the

progress made in specific areas. For countries

in which a regular Internet connection was a

challenge, the Secretariat advised to explore

whether the WHO country office could provide

access to a working Internet connection. The

Convention Secretariat also provided, upon

request by the Parties, the Word version of the

reporting instrument. It is to be noted that a

PDF version of the questionnaire is permanently

available on the website of the Convention

Secretariat.

Upon request by some Parties,

the Secretariat has begun collecting and

publishing on its website versions of the

reporting instrument in languages other than

the six official United Nations languages –

Arabic, Chinese, English, French, Russian and

Spanish). It should be noted, however, that

such documents are published for information

only: they cannot be used for report completion

as the implementation reports should be

submitted in one of the official United Nations

languages.

The evolution of the reporting instrument

is ongoing: Parties may take decisions at

the COP that might have an impact on the

questions included in the reporting instrument.

The possible adoption of the Medium-term

Strategic Framework and the entry into force

of the Protocol to Eliminate Illicit Trade in

Tobacco Products will certainly result in some

adjustments in the reporting instrument.

http://www.who.int/fctc/reporting/reporting_instrument/

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

OTHER PROVISIONS

Workshop in Angola to ensure

100% reporting rate

On 20 June 2017, the Convention Secretariat organized a

meeting with six Parties within the African Region that had never

reported on their domestic implementation of the WHO FCTC.

The meeting engaged country officials responsible for WHO

FCTC reporting and worked with them in entering data into the current reporting template to

facilitate their successful completion and submission of their official reports.

Parties recognized that their reporting data were not just within the purview of the Ministry

of Health, but rather required a whole-of-government approach. It became evident that

the reporting process provided a useful tool for Parties to “tell their story” on the domestic

implementation of the Convention and served as a useful resource to share within their

leadership circles.

The exercise also provided insight to the Convention Secretariat on the complexities and

challenges that exist for Parties with restricted or limited Internet access and the challenges

in applying the reporting instrument in Parties with emerging national programmes. The

experience in working with Parties helped shape the direction and development of an

e-learning tool that will provide ongoing support for Parties.

The outcome of the session was positive – three of the six Parties submitted their reports

during the meeting with the remaining three submitting shortly thereafter. All Parties to

the WHO FCTC have now officially submitted their reports on the implementation of the

Convention within their respective jurisdictions.

(Photo courtesy of Dr Tibor Szilagyi’s personal collection)

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GLOBAL PROGRESS REPORT 2018

OTHER PROVISIONS

KEY

OBSERVATIONS

International cooperation

[Article 22]

▪

Parties reported receiving assistance to establish or strengthen capacity in national

tobacco control programmes.

▪

Parties increasingly collaborated with each other, received assistance from other

Parties and disseminated their experiences with neighbouring Parties.

Areas of assistance.

About one third of all

Parties provided assistance to other Parties

on expertise for tobacco control programmes,

transfer of skills and technology, training and

awareness of personnel (Fig. 26).

Over one half of the Parties have reported

receiving assistance, especially in relation to

the transfer of skills and technology (65%) and

expertise for tobacco control programmes

(64%). Providing and receiving assistance were

more common in 2018 than in 2016.

Brazil and the Philippines have formed

collaborative relationships with other Parties

in providing and exchanging assistance. Brazil

supported the Philippines in areas of alternative

livelihoods and good governance, while the

Philippines provided technical assistance to

Malaysia, Mongolia, Maldives and Nepal on

tobacco taxation. Both projects have been

implemented in the frame of South–South

and triangular cooperation, facilitated by the

Convention Secretariat.

Noticeable trends in assistance were observed

in the areas of litigation, taxation, legislation and

programme development, technical support in

developing policies relating to the Protocol, the

implementation of Article 5.3, and workshops

on strengthening the implementation of the

WHO FCTC.

Implementation

assistance

through

membership in regional and international

organizations.

Overall 22% (39) of all Parties

encouraged the provision of financial assistance

for low- and middle-income countries and for

Parties with economies in transition to assist

them in meeting their obligations under the

Convention.

The Government of the United Kingdom of

Great Britain and Northern Ireland invested £15

million to support 15 Parties in strengthening

their implementation of the WHO FCTC

provisions within the frame of the FCTC 2030

project under their development assistance

contribution, setting an important example in

the implementation of the SDG 2030 agenda.

Australia and Norway also supported the

Convention Secretariat by carrying out impact

assessment missions and a number of additional

activities as mandated by the Conference of

the Parties. Canada provided a grant to the

Convention Secretariat to support the work

related to the development of the Medium-term

Strategic Framework and a staff member to

support the Secretariat’s work in areas related

to reporting and knowledge management.

Netherlands has provided a secondment to

the Convention Secretariat increasing the

capacity of a small staff to react to requests

from Parties to the treaty. It is important to

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

OTHER PROVISIONS

notice that Parties with earmarked taxes are

also able to commit and support international

tobacco control. One sound example is the

invaluable contributions from Panama, that

not only provided extrabudgetary funds to the

Convention Secretariat to implement several

activities, but also hosted a number of regional

meetings to strengthen the implementation of

the treaty.

All WHO FCTC Secretarit’s knowledge hubs are

now operational and backed by their respective

government to support the implementation of

the WHO FCTC in their respective areas of work

and have now started conducting capacity-

building activities and technical assistance in

their respective work areas.

Fig. 26

Percentage of Parties reporting on provided or received assistance, by areas of assistance

(n=180 in 2016; n=181 in 2018)

Transfer of skills and technology

Expertise for tobacco control programmes

Assistance

provided

Training and sensitisation of personnel

Equipment, supplies, logistics provided

Methods for tobacco control, e.g.

treatment of nicotine addiction

Research on affordability

Transfer of skills and technology

Expertise for tobacco control programmes

Assistance

received

Training and sensitisation of personnel

Equipment, supplies, logistics

Methods for tobacco control, e.g.

treatment of nicotine addiction

Research on affordability

2018

2016

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GLOBAL PROGRESS REPORT 2018

FCTC 2030 Project

Consistent with decisions by the COP to the

WHO FCTC, the Convention Secretariat initiated

a new project to assist the Parties to strengthen implementation of the Convention.

The project, which will run until March 2021, enables the Convention Secretariat to provide

intensive support to 15 Parties and therefore accelerate implementation of the treaty at the

country level.

The direct support is focused on the achievement of the general obligations and the time-

bound measures of the Convention, strengthening tobacco taxation, implementing other

articles of the WHO FCTC according to national priorities and promoting the implementation

of the Convention as part of the 2030 Agenda for Sustainable Development.

The following 15 Parties to the WHO FCTC were selected through an open and transparent

process to receive direct support under the FCTC 2030 project: Cabo Verde, Cambodia,

Chad, Colombia, Egypt, El Salvador, Georgia, Jordan, Madagascar, Myanmar, Nepal,

Samoa, Sierra Leone, Sri Lanka and Zambia.

Through the FCTC 2030 project, in addition to the direct support for the 15 selected Parties,

the Convention Secretariat is providing general support and materials for all low- and middle-

income countries to promote implementation of the treaty. This support includes workshops,

toolkits, South–South and triangular cooperation, as well as other forms of assistance to

national governments.

Launch of the FCTC 2030 Project in Cambodia. (Photo courtesy of FCTC 2030 Project)

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3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS /

OTHER PROVISIONS

WHO FCTC Secretariat’s

knowledge hubs established

to assist Parties to the Convention

WHO FCTC Article 22 requires the Parties to cooperate directly or through competent

international bodies to strengthen their capacity to fulfil the obligations arising from the

Convention by promoting the transfer of technical, scientific and legal expertise and technology

in order to establish and strengthen national tobacco control strategies, plans and programmes.

As part of its overall knowledge management activities and as a response to various decisions

of the COP, the Convention Secretariat has established seven knowledge hubs that have the

responsibility to analyse, synthesize, and disseminate information and scientific evidence on

specific areas of the Convention.

Working with a global scope, the knowledge hubs aim to provide all Parties with tailored

assistance related to their technical expertise, which include: legal challenges; surveillance;

smokeless tobacco; water pipes; taxation; international cooperation; and Article 5.3 of the

Convention.

Parties wishing to learn more about any of the knowledge hubs or interested in receiving

specific assistance can do so by visiting the website of each knowledge hub at http://

untobaccocontrol.org/kh/.

Third meeting of the WHO FCTC Knowledge Hubs, University of Cape Town, South Africa, 10 March 2018. Representatives

of the WHO FCTC Knowledge Hubs met in March 2018, on the sidelines of the WCTOH, to discuss matters related to

implementation of Articles 5.3 (tobacco industry interference) and Article 20 (research, surveillance and exchange of

information) of the Convention. Participants reviewed on how these articles cut across the work of the different hubs and

how to facilitate implementation of these articles by the FCTC Parties. The meeting was kindly hosted by the WHO FCTC

Secretariat’s Knowledge Hub on Taxation, at the School of Economics at the University of Cape Town. (Photo courtesy of the

WHO FCTC Secretariat’s Knowledge Hub on taxation, South Africa)

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GLOBAL PROGRESS REPORT 2018

NEW AND EMERGING

TOBACCO PRODUCTS

Smokeless tobacco, water pipe

tobacco and ENDS/ENNDS

KEY

OBSERVATIONS

▪

The majority of the Parties had either smokeless tobacco, water pipe tobacco or electronic

nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS)

available in their national markets.

significantly as compared to 2016, but nearly half of the Parties have adopted these policies

and regulations following decisions of the COP.

Smokeless tobacco and water pipes were

traditionally used in several Parties to the

Convention, but recently there has been an

expansion of the availability of such products

in many parts of the world. Additionally, the use

of ENDS, such as e-cigarettes, and other novel

tobacco products has become increasingly

popular in many countries, as multinational

tobacco companies and other manufacturers

enter this new market.

With the aim to strengthen data collection

regarding these products, questions on new

and emerging tobacco products were included

in the 2016 reporting cycle; they are now

referred to in both the core questionnaire and

the additional questions (optional module) of

the reporting instrument.

The questions were

repeated in the 2018 reporting cycle.

As seen in Fig. 27, over one half of all Parties

declared having new and emerging products

available in their markets. The most common

was water-pipe tobacco (69%), followed by

smokeless tobacco (65%).

ENDS sales worldwide are increasing. ENDS

reached US$ 8.61 billion in 2016 and is

expected to garner US$ 26.84 billion by 2023.

The rapid growth of the e-cigarette industry

is visible also in Parties reports, as 56% had

ENDS/ENNDS in their national markets. In

general, around half of all Parties had policies

or regulations for these products in place. This

was less common for ENDS/ENNDS.

▪

Enacting and enforcing protective policies and regulations to these products increased

Shisha bar in Crete, Greece. (Photo courtesy of Dr Vera Luiza da Costa e Silva’s

personal collection)

These changes undertaken upon the mandate received from the COP which, at its sixth session, requested the Convention Secretariat to

include such reference to these products. In case of ENDS/ENNDS: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6(9)-en.pdf; in case of

water-pipe tobacco products: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6(10)-en.pdf (smokeless tobacco products were referred to

already in the reporting instrument, the new focus is on specific policies targeted at such products).

http://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf

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4. NEW AND EMERGING TOBACCO PRODUCTS

Advertisement for e-cigarette shop in Dublin, Ireland. (Photo courtesy of Dr Vera

Luiza da Costa e Silva’s personal collection)

Examples of smokeless tobacco products. (Photo courtesy of the WHO FCTC

Secretariat)

Fig. 27

Percentage of Parties reporting new and emerging tobacco products in national markets, and

implementation of product-specific policies and regulations (n=180 in 2016; n=181 in 2018)

Smokeless tobacco available

on national market

Adopted and implemented policy or

regulation specific to smokeless tobacco

Waterpipe tobacco availabe

on national market

Adopted and implemented policy or

regulation specific to waterpipe tobacco

ENDS/ENNDS available on national market

Adopted and implemented policy or

regulation specific to ENDS/ENNDS

2018

2016

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GLOBAL PROGRESS REPORT 2018

PREVALENCE

OF TOBACCO USE

Global trends of tobacco use

KEY

OBSERVATIONS

▪

Over half of the Parties, which reported in 2018 and held recent and comparable data, are

experiencing decrease in youth smoking. An increase was nevertheless reported by 13%

of the Parties, while for 24% the situation remained stable. In adult smoking, almost half

were not observing significant changes in their most recent data, while 39% experienced a

decreasing trend.

tobacco control activities in order to achieve the voluntary global NCD target to reduce

tobacco use by 30% between 2010 and 2025. Of note, 36 Parties are not projected to reduce

smoking rates if effective policies are not urgently put in place.

to the Convention need to strengthen their surveillance and monitoring systems, and more

generally, scale up their implementation of Article 20 of the Convention and exchange

collected data.

Recent developments in tobacco use as

reported by the Parties.

Among the Parties

that had provided comparable prevalence

data in the 2018 reporting cycle, a small

majority (58%) experienced a decrease in their

youth smoking prevalence. An increase was,

nevertheless, reported by 13% of the Parties,

while for 24% the situation remained stable.

For 5% the trend information could not be

validated.

Adult smoking prevalence decreased during the

reporting cycle for a third (39%) of the Parties

with recent comparable data, and nearly half

(45%) did not observe significant changes in the

prevalence, hence being in a stable situation.

However, one in 10 (9%) saw an increase, and

for 6% the trend could not be validated.

For the use of smokeless tobacco, few

conclusions can be drawn due to the limited

availability of recent comparable data among

Parties.

Comparable estimates for prevalence of

smoking and smokeless tobacco use.

Global and regional trends in tobacco smoking

were calculated by the WHO Department of

Prevention of Noncommunicable Diseases

using data reported in 2018 and earlier COP

reports, together with other national surveys

available in the public domain. The statistical

model

used to calculate these estimates

overcomes issues of comparability due to

different age ranges, years and tobacco

indicators covered by surveys.

WHO-modelled estimates made it possible to

compare smoking rates in 2017 with rates in 2005,

even though many Parties have not conducted

national surveys in those particular years.

Among all Parties globally in 2005, an estimated

24% of people aged 15 or older were current

smokers (39% of males and 8% of females). By

2017, smoking prevalence dropped to 19% (33%

of males and 5% of females). Smoked tobacco

includes cigarettes and/or any other smoked

▪

Trends to 2017 and projections to year 2025 show that most Parties need to accelerate

▪

To enable more accurate trend analyses, as well as estimates and projections, the Parties

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5. PREVALENCE OF TOBACCO USE

tobacco product (for example, pipes, cigars,

cigarillos, bidis, kreteks and water-pipe tobacco),

according to the varieties surveyed by each Party.

Current smoking means smoking either daily or

occasionally at the time of the survey.

All World Bank income groups of Parties are

trending downwards with average current

smoking rates (Fig. 28). In 2005, high-income

Parties had collectively the highest average

smoking rate at 29%, but by virtue of steeply

declining rates in many high-income countries,

by 2017, the upper middle-income countries

are now estimated to have the highest average

rate at 24%. Low income Parties have on

average the lowest smoking rates, but among

these Parties there is a mix of levels and trends,

and over a third are without sufficient national

surveys to monitor the trend.

While data regarding smokeless tobacco use

is increasing over time, there are still many

Parties not asking about smokeless tobacco

use in national surveys. Consequently, there

are insufficient data to measure changes over

time at the global level. Using the most recent

data about current smokeless tobacco use

reported in surveys completed by Parties since

2007, the average prevalence among Parties

globally was 6.2% (8.1% of males and 4.4% of

females). In total, 98 Parties have collected data

on smokeless tobacco use since 2007, therefore

these averages are only indicative.

Regarding tobacco use among young people, the

majority of Parties are beginning to consistently

monitor youth aged 13–15 years over time. It

should soon be possible to calculate trend

estimates of tobacco use among youth globally.

Using the most recent data about current

cigarette smoking reported in surveys completed

by Parties in 2007–2017, the average prevalence

among 163 Parties with surveys was 8.9%

for boys and 4.0% for girls. On average, boys

smoked at a rate more than double that of girls,

however, in 20 Parties, girls smoked at a higher

rate than boys. The same surveys reveal that

around 4.3% of boys and 2.4% of girls in Parties

consume smokeless tobacco.

Towards meeting tobacco use reduction targets

The WHO

Global Action Plan for the Prevention

and Control of Noncommunicable Diseases

2013–2020

(resolution WHA66.10) includes

a voluntary target to reduce the prevalence of

tobacco use among persons aged 15 and older

by 30% in relative terms between 2010 and

2025. Meeting this target will contribute greatly

to the overarching target of a 25% reduction in

premature mortality from NCDs. Looking beyond

2025, the SDG agenda also includes specific

actions to reduce deaths from NCDs, one of

which is to strengthen the implementation of the

WHO FCTC in all countries, as appropriate.

WHO estimates show that 23 Parties, or 13% of

Parties, are likely to achieve the target by 2025

(Fig. 29). An additional 76 Parties, or 42% of

Parties, are decreasing and need only accelerate

the decreases they are already achieving. Of

note, 36 Parties are expected to experience no

decrease in smoking prevalence unless effective

policies are urgently put into place. Trends are

unknown in 45 Parties where no survey or

only one nationally representative survey since

1990 has been reported. Most Parties need to

accelerate tobacco control activities in order to

achieve the NCD target.

These trend estimates reflect the effects of

tobacco control actions already implemented

by the Parties prior to conducting their most

recent survey. Where no survey has been

conducted since a policy was implemented,

the effects of the new policy will not be seen

until the next survey has been conducted.

These projections, therefore, reflect only what

has been captured in surveys to date and will

be subject to recalculation as new policies are

implemented and new surveys are released.

WHO uses the data from surveys reported by Parties in their 2018 implementation reports to augment the WHO tobacco use prevalence data set,

in order to calculate comparable trend estimates of smoking. The method for the estimation is described in the article “Global trends and projections

for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control”; Bilano,

Ver et al.; The Lancet , Volume 385 , Issue 9972 , 966 – 976; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60264-1/abstract

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GLOBAL PROGRESS REPORT 2018

Fig. 28

Estimated trend in current smoking prevalence, ages 15+, by World Bank income groups

35%

30%

25%

20%

15%

10%

2005

2017

Source: WHO estimates

High income

Upper middle income

FCTC Parties average

Lower middle income

Low income

Fig. 29

Projections for WHO FCTC Parties on achieving the 30% relative reduction target in 2025, by

World Bank income group

Number and proportion of FCTC Parties who might meet 30% relative reduction in tobacco smoking between 2010 and 2025

100%

Unknown

Increase

No change

Decrease

Achieve 30%

reduction

Source: WHO estimates

Note: in this figure, the numbers

inside the columns represent

the number of Parties in the

respective category.

High income

Upper middle income Lower middle income Low income

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PRIORITIES, NEEDS,

GAPS AND CHALLENGES

Constraints and barriers.

More than 40

challenges encountered by Parties were

enumerated. Similar to the previous reporting

cycles, Parties of all income levels noted that

interference by the tobacco industry and its allies

was the most common challenge to overcome.

Some Parties specifically mentioned that the

target of the tobacco industry interference

is the non-health sectors. The second most

frequently mentioned challenge was the lack of

capacity and the need for appropriately skilled/

trained personnel.

Other constraints mentioned by more than

10 Parties each include: lack or insufficient

coordination among sectors; lack of effective

law enforcement; absence, weakness or delay

in passing/implementing national legislation/

regulation; insufficient or unsustainable financial

resources or competing priorities in resource

allocation; and a lack of awareness of the WHO

FCTC or the harmful effects of tobacco. Political

instability and lack of political commitment, as

well as insufficient support or involvement from

the civil society, were also mentioned by several

Parties.

An increasing number of Parties indicated

that the arrival of new and emerging tobacco

products on their respective market was a

growing challenge for both regulators and

enforcers of tobacco regulations. Around two

thirds of Parties have smokeless tobacco

products, water pipes, and/or ENDS/ENNDS

available in their national markets. Around half

of the Parties adopted and implemented some

kind of policies or regulations specific to those

products.

Priorities.

Most reporting Parties gave details

on their priorities, with obligations under Article

5 of the Convention (General obligations) being

the most frequently mentioned. These priorities

include developing legislation, regulations,

national strategies and action plans, as well

as establishing or strengthening the national

tobacco control infrastructure (coordinating

mechanism, capacity, etc.)

Programmes to support tobacco cessation

(Article 14) and education, communication

and public awareness (Article 12) were also

highlighted. More than one fifth of the Parties

considered enforcement of various WHO

FCTC measures as an imperative, and 23

Parties indicated that they addressed ratifying/

acceding the Protocol as a prime concern. A

new issue was raised, with a dozen Parties

now considering novel and emerging tobacco

products as a serious issue that needs to be

tackled, and 11 Parties also see adopting plain

packaging as a prime concern.

Needs and gaps.

Of all the Parties, 60% (108)

identified specific gaps in the implementation,

and 101 also commented on needs and gaps.

Of those, almost two thirds – even several high-

income countries – indicated that the financial

resources available for national tobacco control

do not match their needs. Around one third

reported the same for human resources, or a

combination of the two shortcomings. Some

Parties indicated specific needs for technical

assistance, including tobacco taxation, drafting

of legislation, conducting various research

projects and scaling up of their cessation

programmes. Some Parties also noted issues

such as a lack of political will, insufficient

intersectoral cooperation and mobilization of

non-health sectors for tobacco control.

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GLOBAL PROGRESS REPORT 2018

CONCLUSIONS

1. Overall, implementation of the Convention

has improved since the issuance of

the

2016 Global Progress Report on

Implementation of the WHO Framework

Convention on Tobacco Control

for the

majority of the Articles and indicators.

Smoke-free

environments;

tobacco

packaging and labelling; and education,

communications and public awareness

programmes are the leading three areas

best implemented. This notable progress

makes us cautiously optimistic and

hopeful in terms of future strengthening of

implementation of the Convention globally,

with a view to close implementation gaps

through initiatives guided by the COP and

also referred to in the draft Medium-Term

Strategic Framework that will be presented

to the Eighth session of the Conference of

the Parties (COP8).

2. Strengthened implementation has already

started showing its impact, with a number

of Parties observing a decrease in tobacco

use among both adults and young people.

However, we need to be cautious when

interpreting such decrease, as in parallel

there seems to be an increasing body of

evidence showing an increasing trend in

the use of ENDS/ENNDS and other novel

nicotine products. Future monitoring of the

tobacco epidemic, including WHO FCTC

reporting, should be quickly enabled to

allow for the measuring of this trend.

3. A large number of Parties still have no

policies in place to protect public health

policies from the commercial and other

vested interests of the tobacco industry in

line with Article 5.3 of the Convention, thus

there should be a clear focus on this area in

the future. Efforts to monitor the activities of

tobacco companies should be strengthened

in each Party and new programmes to raise

awareness on the efforts of the tobacco

industry to interfere with policy-making

should be intensified. Parties should benefit

from the establishment of the WHO FCTC

Secretariat’s Knowledge Hub for Article 5.3

and should seek assistance from the hub

to promote their programmes, including

the establishment of Obesrvatories of

the Strategies of the Tobacco Industry, if

necessary.

4. Many Parties reported a range of strong

initiatives to reduce the demand of tobacco

products through implementation of the

time-bound provisions of the Convention.

A domino effect has been observed among

Parties introducing increasingly larger

pictorial warnings and plain packaging.

A growing number of Parties amended

their smoke-free legislation to extend their

smoking bans to outdoor public places

or to include novel tobacco products in

their bans. Several Parties strengthened

their advertising bans, including extending

them to novel tobacco products.

Implementing

time-bound

provisions

should be considered strong priorities by

the Parties in which there are still gaps in

implementing these policies. Specifically,

in the area of tobacco advertising, it is

important to strengthen policies with cross-

border effects by benefiting from the work

of the COP-mandated expert group on this

matter.

5. There were also developments in the

area of tobacco taxation. More Parties

are now using excise taxes and more are

moving towards mixed tax systems. Large

excise tax increases and better planning

of future increases in tobacco taxation

will certainly make the health impact

and tobacco-related revenue estimation

more computable. Many Parties reported

that reducing the affordability of tobacco

products was a priority. The scaling

up of the operation of the WHO FCTC

Secretariat’s Knowledge Hub on Taxation

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7. CONCLUSIONS

allows for better provision of assistance to

Parties and building national capacity for

more predictable policy actions that are in

line with the requirements of Article 6 and

its Guidelines.

6. Progress

has

been

observed

implementation of supply-side reduction

measures. An increasing proportion of

Parties reported new measures to control

the illicit trade of tobacco products.

Many Parties have ratified the Protocol to

Eliminate Illicit Trade in Tobacco Products,

making possible its entry into force on 25

September 2018. The entry into force of

the Protocol could provide new impetus

to collaborative efforts to counter the illicit

trade of tobacco products both nationally

and internationally.

7. Among the wide range of implementation

measures to reduce the supply of tobacco,

the minimum age to purchase tobacco

products continues to be raised by an

increasing number of Parties to at least

18 years. There are also new examples

documented on switching to alternatives

to tobacco growing and protecting

the environment in relation to tobacco

production and use. Further scaling

up of implementation of Article 17 will

also help address the health, social and

environmental consequences of tobacco

growing, including but not limited to halting

child labour in relation to tobacco growing.

8. Advances in research and surveillance

under Article 20 are contributing to an

improved monitoring system of progress

in implementation of SDG Target 3.a

(Strengthen implementation of the World

Health Organization Framework Convention

on Tobacco Control in all countries, as

appropriate) and of WHO’s global NCD

targets. The Convention Secretariat, as co-

custodian of SDG Target 3.a, will work with

WHO to promote appropriate monitoring

and voluntary reporting of measures taken

for the implementation of the Convention at

United Nations level.

9. Despite the progress, in many Parties,

the lack of human and financial resources

remains frequently cited as a barrier

to strong implementation, alongside

insufficient political commitment. There is

need to achieve full policy coherence at the

national level to ensure that implementation

of the relevant policies under the WHO

FCTC are embedded in the sectoral

policies developed and implemented by

various government ministries. This is

even more important with new evidence

of the increased vulnerability of non-

health sectors vis-a-vis interference by

the tobacco industry. Integration should

be carried out with other health and

development programmes at national level,

including in the collaborative efforts with

the United Nations System, for example

United Nations Development Assistance

Frameworks.

10. Several recent initiatives supported or

carried out by the Convention Secretariat

– such as strengthening joint needs

assessment and post-needs assessment

activities, promoting the establishment

of tobacco industry monitoring centres

(observatories), the new WHO FCTC

Knowledge Hub focusing on Article 5.3,

the ambitious FCTC 2030 Project and

the development of the creative Article 19

Civil Liability Toolkit – are important means

to support Parties in the areas where

implementation rates are lower. Information

exchange and collaboration between

Parties in implementation of the Convention

continues to be of crucial importance and

South-South and triangular cooperation

initiatives have been strengthened with the

support of the Convention Secretariat. Even

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GLOBAL PROGRESS REPORT 2018

though an increasing number of Parties

have started to put in place measures

to include new and emerging tobacco

products, including ENDS/ENNDS, in their

existing legislation (smoke-free laws, bans

on advertising, promotion and sponsorship,

regulations on contents and emissions,

and requirements for packaging and

labelling), comprehensive and concerted

actions are needed with the participation

of all concerned stakeholders to address

the proliferation of such products in line

with decisions of the Conference of the

Parties, including through the development

of specific policies to control their use,

specially among young people.

11. The implementation of the Convention

is at crossroads. There are international

developments that could provide impetus

to WHO FCTC implementation, including

the opportunities for integration with other

horizontal programmes, such as those

on NCDs, tuberculosis and HIV/AIDS.

International cooperation, a basic feature

that could have a strong role in assisting

Parties with their work on WHO FCTC

implementation, is to be strengthened.

WHO FCTC implementation needs to be

the business of all sectors – not only the

health sector – and policy coherence must

be ensured in matters related to tobacco

in all sectoral policies. The new Medium-

Term Strategic Framework, expected to

be adopted by COP8, should generate

additional action and should provide more

coordination for technical assistance

programmes and frameworks. New and

innovative approaches in financing tobacco

control should provide the resource-base

of intensified action.

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The Secretariat of the WHO Framework Convention on Tobacco Control

World Health Organization

Avenue Appia 20, 1211 Geneva 27, Switzerland

Tel. +41 22 791 50 43

Fax +41 22 791 58 30

Mail: [email protected]

Web: www.who.int/fctc

ISBN 978-92-4-151461-3