GPs Play a Key Role in Tobacco Control — in Just 1 Minute – Medscape

Tobacco Use in Europe: Challenges and Progress Towards Sustainable Development Goals

Despite over two decades of tobacco control efforts, Europe continues to have the highest tobacco use rates among all World Health Organization (WHO) regions, posing significant public health challenges. Tobacco is responsible for approximately 700,000 deaths annually within the European Union (EU), exerting substantial pressure on healthcare systems. This report highlights the ongoing efforts, challenges, and opportunities in tobacco control across Europe, with a focus on aligning these efforts with the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 12 (Responsible Consumption and Production).

Progress and Targets in Tobacco Control

In 2000, tobacco use among individuals aged 15 years and older in the WHO European Region was 34.9%. By 2024, this figure declined to 24.1%, reflecting progress but still insufficient to meet the global target of a 30% reduction by 2025. Only seven EU countries are currently on track to achieve this goal.

Europe has set an ambitious objective to establish a “tobacco-free generation” by 2040, defined as fewer than 5% tobacco users in the population. Achieving this vision requires enhanced engagement at the primary healthcare level, where healthcare providers play a critical role in tobacco cessation interventions.

Ambitious Policies and Emerging Challenges

Policy Frameworks and Implementation

1. Since 2003, the WHO Framework Convention on Tobacco Control has guided countries in implementing measures such as:
   • Increased taxation on tobacco products
   • Advertising bans
   • Cessation support services
   • Packaging regulations
   • Protection against tobacco industry interference
2. Implementation across Europe remains uneven, complicated by:
   • Emergence of new nicotine products (e-cigarettes, heated tobacco)
   • Regulatory challenges concerning these novel products
   • Persistent tobacco industry interference
3. The EU’s Tobacco-Free Generation Initiative, under Europe’s Beating Cancer Plan, aims to translate the 2040 vision into actionable policies, including:
   • Revision of the Tobacco Products Directive with stricter rules
   • Flavor bans
   • Updated taxation policies
   • Tighter controls on illicit trade
   • Consideration of generational sales bans

These policies contribute directly to SDG 3 by aiming to reduce premature mortality from non-communicable diseases and promote health.

Primary Care and Healthcare Providers: Frontline in Tobacco Cessation

Challenges Faced by Healthcare Providers

• Time Constraints: Limited consultation time restricts opportunities for cessation counseling.
• Training Gaps: Many healthcare professionals lack adequate training in tobacco cessation strategies.
• Provider Smoking Behavior: High smoking rates among healthcare workers undermine cessation advice credibility.
• System Limitations: Inadequate referral pathways and lack of reimbursement for cessation services.
• Complexity of New Products: Confusion regarding e-cigarettes and heated tobacco complicates patient discussions.

Expert Insights

1. Naomi van Westen-Lagerweij, PhD (Netherlands Expertise Centre for Tobacco Control):
   • Emphasizes the importance of brief advice and referral to professional support during primary care visits.
   • Notes that even one-minute interventions can significantly increase patient engagement with cessation services.
2. Maria Sofia Cattaruzza, MD, PhD (Sapienza University, Italy):
   • Highlights insufficient integration of smoking cessation in medical education.
   • Reports that fewer than 40% of doctors routinely inquire about smoking status and less than 50% provide cessation advice.
   • Calls for more training and system support for general practitioners (GPs).
3. Zsuzsa Cselkó, MD (National Korányi Institute of Pulmonology, Hungary):
   • Attributes slow decline in tobacco use partly to tobacco industry marketing of “harm reduction” products.
   • Stresses the need for sustained funding for counseling and nicotine withdrawal treatments.
4. Anto Domić, MD, PhD (Bosnia and Herzegovina):
   • Notes high tobacco use prevalence among health workers themselves, affecting cessation efforts.
   • Points to poor enforcement of smoke-free legislation and low prioritization of cessation funding.

System-Level Gaps and Recommendations

To align tobacco control efforts with the SDGs, particularly SDG 3 and SDG 17 (Partnerships for the Goals), the following system-level actions are critical:

• Embedding smoking cessation support into routine healthcare practice.
• Establishing clear referral pathways to specialized cessation services.
• Ensuring sustainable funding and insurance reimbursement for cessation treatments.
• Providing comprehensive training and resources for healthcare professionals.
• Implementing team-based care models involving nurses, psychologists, counselors, and pharmacists.
• Strengthening enforcement of tobacco control legislation and regulation of novel nicotine products.

Conclusion: Towards a Tobacco-Free Generation and Sustainable Development

Europe’s vision of a tobacco-free generation by 2040 is ambitious but achievable through combined efforts in policy enforcement and healthcare system strengthening. Primary care providers are pivotal in delivering cessation support, and their capacity must be enhanced through training, resources, and systemic support. Parallel progress in regulatory frameworks addressing emerging nicotine products is essential.

Achieving these goals will contribute significantly to the Sustainable Development Goals by reducing premature mortality, promoting healthy lives, and fostering sustainable health systems. Continued commitment from governments, healthcare systems, and communities is necessary to realize a healthier, tobacco-free Europe.

Note: The experts quoted in this report declared no relevant financial conflicts of interest.

1. Sustainable Development Goals (SDGs) Addressed or Connected to the Issues Highlighted in the Article

1. SDG 3: Good Health and Well-being
   • The article focuses on tobacco use and its impact on health, including mortality and strain on health systems.
   • It discusses tobacco control policies, cessation support, and healthcare provider roles in reducing tobacco use.
2. SDG 10: Reduced Inequalities
   • The article mentions disparities in tobacco use and cessation support across different European countries and populations.
   • It highlights challenges faced by healthcare workers and patients in various regions, including funding and enforcement issues.
3. SDG 17: Partnerships for the Goals
   • The article refers to international frameworks such as the WHO Framework Convention on Tobacco Control and EU initiatives.
   • It emphasizes collaboration among healthcare providers, governments, and organizations for tobacco control.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

1. SDG 3: Good Health and Well-being
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment.
   • Target 3.a: Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries.
   • Target 3.5: Strengthen the prevention and treatment of substance abuse, including tobacco use.
2. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • This relates to equitable access to cessation support and healthcare services for tobacco users.
3. SDG 17: Partnerships for the Goals
   • Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships.
   • Reflected in the cooperation between WHO, EU, national governments, and healthcare providers.

3. Indicators Mentioned or Implied in the Article to Measure Progress Towards the Identified Targets

1. Prevalence of Tobacco Use
   • The article provides data on tobacco use prevalence among people aged 15 years or older in the WHO European Region (e.g., 34.9% in 2000, 24.1% in 2024).
   • This relates to SDG Indicator 3.a.1: Age-standardized prevalence of current tobacco use among persons aged 15 years and older.
2. Mortality Due to Tobacco Use
   • The article cites an estimated 700,000 deaths annually in the EU attributable to tobacco.
   • This can be linked to measuring premature mortality from non-communicable diseases (SDG Indicator 3.4.1).
3. Coverage of Tobacco Cessation Interventions
   • Implied indicators include the proportion of healthcare providers routinely asking about smoking and providing cessation advice (e.g., less than 40% ask, less than 50% advise).
   • This relates to monitoring health system capacity and service coverage for tobacco cessation.
4. Implementation of Tobacco Control Policies
   • Indicators could include the extent of enforcement of tobacco control laws, taxation levels, bans on advertising, and regulations on novel nicotine products.
   • Though not explicitly quantified, the article discusses uneven implementation and policy revisions.

4. Table: SDGs, Targets and Indicators

Source: medscape.com