WHO Representative to the EU, Ms. Oxana Domenti, delivers a speech at the ENSP Webinar


On 24th February, at 16:00 CET, ENSP hosted a webinar with key stakeholders in the field to discuss the framework set by Europe’s Beating Cancer Plan, where the European public health community is joining forces towards a common cause: smoking cessation.

Watch again the speech delivered by the WHO Representative to the European Union, Ms. Oxana Domenti.

Read again the speech

“Dr Francisco Rodriguez Lozano,

Commissioner Kyriakides, 

Frineds and Colleagues, ladies and gentlemen,

It is an honor to speak here today and always a pleasure to join the event organized by ENSP-one of the most active regional civil society advocate for the world without tobacco.   I see it as a great opportunity to come together with a shared commitment of tackling one of the key risk factors for cancer.

Tobacco use represents an important public health issue worldwide, but particularly in the WHO European Region, where it has the highest levels of use with over 29% of the population reportedly using tobacco. Worryingly, as we look to future generation, we see that tobacco use remains popular in the youth as 13.8% of boys and 11.5% of girl between 13–15th are reported to use tobacco in our region.

Tobacco is the single most preventable cause of illness and death in the world, with the latest research suggesting that smoking-related deaths globally has risen to 7.2 million lives annually, killing more people than AIDS, malaria and tuberculosis combined.

All forms of tobacco are harmful, and there is no safe level of exposure. Its use affects almost all organs of the human body and lifelong tobacco smokers lose at least 10 years of life on average.

The overall proportion of cancer deaths attributed to tobacco in our Region is 27% for men and 10% for women.  In men, nine out of 10 lung cancers are related to tobacco use.

Along with a significant burden on health, tobacco use also imposes enormous economic costs to society, both directly from healthcare needs and indirectly from loss of productivity. The total economic cost of smoking is around 1.4 trillion USD per year (equivalent to 1.8% of the world’s annual gross domestic product).

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Inequalities are key determinant in both the use of tobacco and cancer. 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. Inequalities are evident with poor access to health services which often dramatically contributes to poor health outcomes. We also see that an individual diagnosed with cancer is at a greater risk of dying in eastern Europe than western Europe. 

These inequalities in access to health services between and within countries run deep both within our region, and globally, but the COVID pandemic has affected both the resource rich and poor countries, exacerbating the situation with shortages of cancer drugs, significant drops in cancer diagnosis and reduced prevention and tobacco cessation activities.

This means the poor die at higher rates. 

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Tobacco kills up to half of its users and the COVID 19 pandemic has made a bad situation worse, with the economic crisis making it harder for many to adopt healthier behaviours or gain access to prevention or care services. Adding to this, early in the pandemic, WHO found that NCDs services were disrupted in almost 75% of countries globally. In the European region over 30% had partially or completed disrupted services.

But even in the midst of the worst health crisis in living memory, there is a ray of light. The COVID-19 pandemic has led to millions of tobacco users wanting to quit. However, quitting tobacco is challenging, especially with the added social and economic stresses brought about by the pandemic.

Worldwide, around 780 million people say they want to quit, but only 30% of them have access to the tools that can help them to overcome both physical and mental addictions to tobacco.

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WHO has been a leading force within tobacco control and supporting access to health services and have guidance tools and plans for political, strategic and individual use. WHO and partners have also developed a set of new materials on continuity of care for NCDs during the COVID-19 pandemic as well as tools and resources people need to make a successful attempt at quitting.

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The WHO Framework Convention on Tobacco is the first international health-related treaty to have been adopted globally. It outlines a number of evidence-based strategies to combat this global challenge, which will save lives, reduce the burden of illness and inequalities, and accelerate economic development. In order to meet targets, all countries need to accelerate tobacco control by fully implementing FCTC.

To support scale-up of specific provisions of the FCTC at country level, WHO introduced the MPOWER measures, which are the most cost effective and impactful of the FCTC measures.

Let me briefly take you through these key MPOWER measures that all countries should be applying:

  • Monitor      …tobacco use and prevention policies
  • Protect       …people from tobacco smoke
  • Offer          …help to quit tobacco use as without cessation support only 4% of attempts to quit tobacco will succeed.
  • Warn          …about the dangers of tobacco
  • Enforce       …bans on advertising, promotion and sponsorship
  • Raise          …taxes on tobacco for example as an increase of tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low- and middle-income countries. Despite this, introducing high tobacco taxes is a measure that is least implemented among the set of available tobacco control measures.

Globally, WHO has recently launched a year-long global campaign for World No Tobacco Day 2021 – “Commit to Quit”. This campaign aims to support 100 million people worldwide in their attempt to give up tobacco through various initiatives and digital solutions. It will help create healthier environments that are conducive to quitting tobacco by:

  • advocating for strong tobacco cessation policies
  • promoting increased access to cessation services
  • raising awareness of tobacco industry tactics
  • empowering tobacco users to make successful attempts to quit through “quit & win” initiatives.

Cessation policies are still among the least implemented of all WHO FCTC demand reduction measures. Governments should recognize this unmet need and act on it as part of a comprehensive tobacco control strategy. Population-level, cost-effective tobacco cessation interventions must be a priority for countries.

At the same time, innovation should be encouraged and mobile technologies should be fully harnessed to improve access to large and hard-to-reach populations.

WHO has set up the new Access Initiative for Quitting Tobacco, which gives people, among other things, free access to digital counselling. WHO has partnered with tech companies like Facebook, WhatsApp and Soul Machines to raise awareness and support tobacco users to quit with the help of chatbots and digital health workers. For instance, Florence, a digital counsellor, based on artificial intelligence, helps people develop a personalized plan to quit tobacco and guides them to available mobile apps and toll-free quit lines in their countries. Meanwhile, the Quit Challenge on WhatsApp provides signed-up tobacco users with free messages on how to quit, directly to their mobile phones.

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Within our WHO European region, 51 of our 53 Member States are Parties to the WHO FCTC. Within this region we have witnessed some of the greatest gains in the fight against tobacco in recent years. For instance:

  • Large graphic health warnings on tobacco products are now in place in 32 (60%) countries.
  • Tobacco use is regularly monitored in 39 (74%) countries.
  • Tobacco taxes are at 75% or more of the retail price of a packet of cigarette in 25 (47%) countries of the Region.

The progress made shows that it is possible for countries to turn the tide. But the WHO European Region is expected be the only WHO region in the world to fall short of the SDG targets with only 6 countries estimated to meet the target of 30% reduction in tobacco use by 2025

Adding to this sad situation, a new WHO European Region report published this month, “Through a gender lens: women and tobacco”, reveals that, although tobacco use among women is decreasing overall, the rate is going down at a much slower pace than in men, and in some countries it is increasing

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To deal with this situation, there is a lot we can do

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The WHO European Programme of Work provides the vision for health in the region for the next five years. This Programme has prioritized cancer presenting it as a central focus on ensuring people can live healthy lives, including reducing the risk factors that cause cancer. Addressing these is critical.

We must redouble efforts for tobacco control, reduce alcohol consumption and promote healthy diets and physical activity. The applied research underway at our NCD office in Moscow is closely aligned with this. It has become a centre of excellence on risk factor prevention, innovation and applied research in the field of NCDs, including tobacco control, and cancer globally.

This month saw the launching of the Pan European Cancer Initiative, uniting all towards better cancer control and prevention and to enable policy makers to make the right decisions to address cancer effectively. This initiative has five areas: prevention (ultimately a political choice), early detection, access to all to diagnosis and treatment, palliative care and a focus on data.

Our vision is bold but realistic. We strive to have a Region where cancer is no longer a life-threatening disease and where dying from cancer is no longer accepted as the norm.

Preventing and stopping tobacco use is a key component within this initiative.

Through this initiative we wish to strengthen collaboration and partnerships, reinforce political leaderships, engage youth and civil society, and to fast track the WHO signature solutions. These are cost effective, evidence-based policies and measures accompanied by technical guidance and tools, aligned with WHO expertise and resources to achieve real impact at country level.

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WHO welcomes the commitment of the European Union to the health agenda and we whole heartedly support the EUs initiatives on Cancer: Europe’s Beating Cancer Plan and Mission on Cancer.

This month, WHO Regional Director for Europe, Hans Kluge has appointed Aron Anderson, a Swedish adventurer with first-hand experience of cancer, as a Cancer Ambassador for WHO/Europe  with a remit  to raise awareness and mobilize and unite forces against cancer, including the tobacco control agenda.

The EU and WHO have a long history of collaboration and the synergies between the EU priorities relating to NCDs and cancer and the WHO European Programme of work, clearly show we are all on the same page. We very much look forward to our continued partnership and cooperation around the EU initiatives and let us the  be “united against cancer”

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Let’s strive to help Europe achieve the target of 30% reduction in tobacco use by 2025 and to ensure access for health services for all. This will take political will, it will take personal will, and it will take united efforts working together hand in hand. But today, we have an opportunity to step up the fight……. We know what to do and have the tools to do it.  Thank you.”

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