EQUIPP (Europe Quitting: Progress & Pathway) report..

March 22, 2011 -

The following organisations have endorsed the EQUIPP (Europe Quitting: Progress & Pathway)
report. (Bridgehead International, EQUIPP: Europe Quitting: Progress and Pathways, London, 2011)

The European Network for Smoking and Tobacco Prevention (ENSP),The German Society for Pneumology (DGP,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin) together with the
Bundesverband der Pneumologen (BdP) (German Association of Pulomonologists, The European Respiratory Society.

EQUIPP (Europe Quitting: Progress & Pathway Report


Tobacco use continues to be the single largest cause of death
and disease in the European Union (EU).2 Tobacco kills as many
as 650,000 Europeans every year – more than the population of
Malta or Luxembourg.3 Smoking causes more health problems
than, for example, alcohol, illicit drugs, blood pressure, obesity
or cholesterol.4 The economic cost of smoking was estimated
at €98-€103 billion in 2000 or around 1% of the gross domestic
product of the EU.5
Smoking accounts for 12–20 years of life lost and up to 21% of
deaths according to the World Health Organization (WHO)/Europe
tobacco control database,6 and is a major cause of death from
cancer, cardiovascular disease and pulmonary disease.7 Tobacco
smoking kills half of all lifetime users, with half of these dying in
middle age (between 35 and 69 years old).8
In Europe, the estimated daily smoking prevalence is around
28.6%9 but even a small reduction in this figure could lead to a
reduction in the number of smokers dying prematurely.10 Smoking
prevalence rates are generally stabilising or decreasing, however
smoking rates for females are slightly increasing in some Eastern
EU Member States.11 Youth smoking is also still a significant
problem in some European countries,12 and the rate of smoking
amongst European school children (aged 13-15) is 18%, which
is about twice the global average for that age.13 Children are
starting smoking at a younger age and in some Member States,
the average age for initiation has been reported as low as 11
years old.14

Thus, tobacco use continues to be a major public health problem
within Europe.

The economic burden of smoking on society is tremendous, with
the annual global cost of tobacco use estimated by the WHO at
US$500 billion.15 This figure includes direct healthcare expenditure,
lost earnings and reduced productivity, and other costs. Quitting,
or reducing smoking, has both economic and health benefits for
the smoker16 and there are also health benefits to the households
of smokers when second-hand smoke is removed.17 Similarly, the
introduction of smoke-free legislation is associated with health
benefits to co-workers.18

Twenty years ago, smoking was regarded purely as a habit but
now the WHO has provided an International Classification of
Disease code (ICD-10 code19) for tobacco dependence.

Likewise, nicotine dependence is listed by the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR 305.1020).
The WHO estimates that 75%-85% of smokers would like to
quit and that around one-third have made at least three serious
attempts. However, less than half of smokers succeed in stopping
permanently before the age of 60.21 Although a smoker can quit
without help, long-term abstinence is higher when the attempt is
aided medically.22

Smoking cessation services such as brief interventions,
behavioural therapy, self-help materials, provision of
pharmacotherapy or a combination of tactics can be a
cost-effective way to help smokers quit.23 Smoking cessation
services led by General Practitioners (GPs) are cost-effective24 and
good value for money. However, other healthcare professionals
(HCPs) such as secondary care physicians, pharmacists, dentists
and oral health professionals, nurses, and respiratory therapists
can all provide valuable smoking cessation interventions. For
example, smoking cessation interventions for in-patients have
been shown to reduce rehospitalisation and total mortality.25,26
Framework Convention on Tobaco Control
The Framework Convention on Tobacco Control (FCTC) is the first
international public health treaty and it has contributed to a change
in public perceptions about the need for regulations, and given new
impetus to efforts to control the harm caused by tobacco.27 The
FCTC requires that signatories enact comprehensive legislation to,
amongst other things, restrict exposure to second-hand smoke,
raise tobacco taxes, reduce smuggling, restrict tobacco advertising
and increase the health warnings on tobacco packaging.28 The
FCTC came into force in February 2005, and as of October 2010 it
had been ratified by 172 countries.29
It is important to remember that smoking is a disease of
dependency that can be successfully treated, and this should be
in the forefront of debate on smoking cessation. Article 14 of the
FCTC represents a clear commitment of parties to the FCTC to
tackle tobacco dependence. Guidelines on how countries should
implement Article 14, produced by a working group of national
experts, have recently been adopted by parties to the FCTC.30
This report assesses the preparedness of 20 European countries
(including Switzerland and the Czech Republic which have yet to
ratify the FCTC)31 to enact the required legislation and implement
policies compliant with the FCTC.
Report methodology
Experts in each of the 20 countries studied were interviewed
from June to October 2010 and, where possible, factual
information was verified and appropriate references supplied.
The country-specific reports and country-specific recommendations
were drawn from the views of the interviewees and their
recommendations were endorsed by the Editorial Partners.
Key recommendations (incomplete)
This report makes a number of recommendations to reduce
smoking prevalence and the demand for tobacco products.
These recommendations are based on country-specific
recommendations provided by the interviewees combined with
the Editorial Partners’ own experience and views. The following
recommendations are presented in the order of the themes
within this report (rather than editorial preference) and have been
endorsed by the Editorial Partners.

Increase tobacco prices
Increasing tobacco prices (through increased taxation), is supportive
of the FCTC and has been proven to lead to a decrease in tobacco
consumption.32,33 Increasing tobacco prices increases government
revenue,34 whilst encouraging smokers to quit and seek help,35,36
and thereby decreasing the demand for tobacco.37

Country-specific recommendations
In addition to the above key recommendations, this report
provides recommendations relevant to each country such as
tightening the existing smoke-free legislation, providing the
healthcare professionals with guidelines in their local language and
improving education for the general public so that they can better
understand smoking as a disease and the resources available to
help them quit (e.g. quitlines).

Countries covered in this report are:
Austria Italy
Belgium Luxembourg
Czech Republic Netherlands
Denmark Norway
Finland Poland
France Portugal
Germany Spain
Greece Sweden
Hungary Switzerland
Ireland United Kingdom
These countries were chosen, based on the quality and depth
of the data available from desk research, and to provide a broad
overview of smoking cessation services across Europe.



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