Experts Position to advance Tobacco Control policies in Italy


European Parliament, Brussels, 4 December 2018

 

According to the World Health Organization, tobacco consumption is worldwide the leading cause of avoidable deaths from cancer, respiratory, and cardiovascular diseases. Tobacco market in Italy from 2000 up to now, recorded a 27% reduction in consumption of manufactured tobacco cigarettes, and a 10% increase of Roll-Your-Own (RYO) cigarettes. Moreover, 2%-3% of Italians use electronic cigarettes, and there is an increase in consumption of new heated tobacco products (HTPs).

While tobacco smoking prevalence has almost halved in men (from 42% in 1986 to 25% in 2017), in women it has slightly decreased in the same period (from 25% to 21%), and in adolescents aged 15-16-year-old, current smokers have stalled around 20%- 25% since 1995. Furthermore, there is an increase from 8% in 2014 to 18% in 2018 in current electronic cigarette users among adolescents aged 13-15 years old.

Even though annual smoking attributable mortality rates decreased from 165 deaths per 100,000 in 1990 to 146 deaths per 100,000 in 2016, the smoking burden is still heavy: even today more than 70,000 Italians each year die because of smoking.

In Italy, few tobacco control measures have been implemented after the 2005 smoking ban. Italy was among the first Countries worldwide banning smoking in enclosed public places, reaching the eighth position in the ranking of European Countriesbased on the level of development of tobacco control policies, the so-called “Tobacco Control Scale”. Then, Italy fell to the 16th position in the Tobacco Control Scale, and recently, in 2016, Italy moved up to the 13th position, thanks to the introduction of the Directive 2014/40/EU. In Italy today tobacco fiscal policies, anti-smoking mass media campaigns and smoking cessation supports have not yet fully developed.

 

Obstacles that traditionally make difficult to implement other tobacco control measures are of different kinds:

  1. a) Levels of tax policy are defined by the Ministry of Economy and Finance, which administers them through the Agency of Monopolies. Taxation is modulated according to the market performance and not to the health needs. Managers of the Ministry of Economy and Finance are wrongly convinced that an increase in tobacco taxation would result in a reduction in tax revenues and would encourage smuggling. The voice of the Ministry of Health on tobacco taxation is scarcely listened, also because of interests of tobacco growers represented by the powerful Ministry of Agriculture.
  2. b) Tobacco companies are carrying out an intense activity of lobbying and public relations at the governmental level, funding foundations linked to political parties, funding economic institutions and groups of influencer in order to carry out studies whose factious results are presented to policy makers of Italian and European Parliaments.
  3. c) Philip Morris International has specifically chosen Italy, a Country with serious youth employment crisis, for the production of IQOS, its new generation tobacco product, employing about 600 young workers, in order to obtain tax benefits. Furthermore, tobacco companies try to seduce health professionals funding conferences of scientific societies.
  4. d) A voice too weak and fragmented is opposed to the lobbyists and their allies: The Ministry of Health (Prevention Department), the Istituto Superiore di Sanità (the National Institute of Health), few medical opinion leaders, researchers, a small number of smoking cessation specialists, and few health protection associations.
  5. e) Health professionals still believe that smoking is an informed choice, even if more than 50% of smokers start before the age of 18, mainly because they are influenced by peer groups. Even though health professionals know that smoking is one of the leading causes of death and disability, they are not yet ready for advocacy initiatives.
  6. f) Tobacco control research is still too far from health promotion practice. Research groups, including Italian, publish a considerable amount of studies in authoritative scientific journals, but the results in Italy are not effectively communicated in the public debate on tobacco control policies.

 

What we ask politicians and institutions is:

  1. Increasing taxes on cigarettes by at least 1 euro per package; balancing tax levels of hand-rolled cigarettes, of other tobacco products, and of new generation tobacco products (heated tobacco products) to those of conventional cigarettes.
  2. Extending the current smoking ban to outdoor areas in hospitals and health services, universities; implementing smoke-free beaches, stadiums, outdoor concerts, train stations, bus stops.
  3. Extending the current smoking ban in all enclosed public places and workplaces and banning advertisements of electronic cigarettes and heated tobacco products.
  4. Providing National Guidelines to certificate Smoking Cessation Centers (SCCs), identifying specific resources to support SCCs, facilitating SCC access, and training SCC health professionals; implementing training courses on smoking cessation treatments in university curricula for all health professionals; reimbursing evidence-based smoking cessation treatments, starting with patients already suffering from smoking-related chronic diseases.
  5. Using the revenues deriving from the increase in taxation (about 2 billion for each euro of package price increase), in order to increase resources in the National Prevention Plan for smoking prevention interventions, particularly among young people and women; sustaining SCCs, Quit Line and anti-tobacco mass media campaigns. Finally, allocating some revenues to carry out tobacco control research independent from the tobacco and electronic cigarette industries.

 

You can read the full document in Italian, here.

 

The document was summarized by Italian Tobacco Endgame, SITAB and Istituto Mario Negri based on the following Call to Actions with hundreds of signatories:

  1. 1. Appello per l’aumento della tassazione dei prodotti del tabacco “La tassa che allunga la vita” promosso dal gruppo tobacco endgame: http: //www.tobaccoendgame.it/
  2. Position paper sui nuovi prodotti del tabacco promosso della Società Italiana di Tabaccologia: http://www.tabaccologia.it/filedirectory/PDF/documento_e_sottoscrizioni_consensus_paper_5.pdf
  1. Position paper su indipendenza delle società scientifiche italiane: difendiamo la libertà del dibattito scientifico dall’influenza dell’industria del tabacco, promosso dall’Istituto di ricerche farmacologiche Mario Negri, Milano: http://www.tabaccologia.it/PDF/Indipendenza_da_industria_del_tabacco_1Ott_v2.pdf
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