SPANISH TOBACCO CONTROL GROUPS PRESENT IN BRUSSELS THEIR PLAN FOR HEALTH AND FOR THE PROGRESS OF THE REGULATION OF TOBACCO IN SPAIN
DECLARATION OF MADRID 2018 FOR HEALTH AND THE ADVANCEMENT OF TOBACCO REGULATION IN SPAIN
Several Spanish associations, sheltered by the European Network for the Prevention of Smoking, presented today in the European Parliament the so-called "Declaration of Madrid", which proposes measures to limit the active and passive consumption of cigarettes in Spain, where tobacco causes 50,000 deaths per year .
"We are here because the main public health problem for Spain and for Europe is tobacco," said the president of the Spanish Medical Association (WTO), Serafin Romero, in a presentation organized in the premises of the European Parliament and sponsored by the Member of UPyD Maite Pagazaurtundua.
The aforementioned statement, presented in Madrid last July and whose authors want it to apply in Spain and serve as a model in other European Union countries, highlights the successes achieved in the fight against tobacco, with a fall in the rate of smokers of 32% before the anti-smoking law of 2010 to 22.1% of the news, according to data of the same.
But it warns of the danger of stalling efforts to eradicate nicotine addiction and its associated risks, especially in the most disadvantaged households.
"They are ahead of us," commented the president of the European Network for the Prevention of Smoking, Francisco Rodriguez-Lozano.
He pointed out that the Spanish law of 2010 was a pioneer but that currently there are EU countries such as France, the United Kingdom, Belgium, Slovenia or Romania that have approved more ambitious measures, such as forcing the packs of cigarettes to be "neutral" and not show the brand.
And among the complementary initiatives proposed by this "road map" to contain smoking, the attention to new products such as electronic cigarettes or vaporizers stands out, an upward phenomenon that they want to avoid being "normalized".
Young people "do not have smoke-filled discos in their retina", but those devices that sell tobacco to replace the fall of sales of traditional cigarettes are "flooding the classroom" in the United States, warned the president of the National Committee for the Prevention of Smoking, Regina Dalmau.
"We have to regulate it before it is a new problem," added the cardiologist in a debate that included representatives of civil society, medical associations, the Ministry of Health, the Spanish Representation to the EU, MEPs and Spanish national deputies.
In this sense, they ask that the taxation of all products containing nicotine be equated to the increase, while pointing out that a significant increase in the price of cigarettes favors the reduction of their consumption.
The professor of Pharmacology at the University of Cantabria Javier Ayesta explained that the rise should be "a minimum 20%" for its effect to be noticed, and cited as an example France, where there are a million fewer smokers since the pack was It sells with standard package and at a price of 8 euros whereas in Spain it does not reach 5 euros.
Other measures promoted by the Madrid Declaration include requiring compliance with current legislation regarding closed or semi-enclosed public spaces, prohibiting smoking in any type of vehicle, promoting smoke-free homes, facilitating and financing access to professionals and treatments. health and extend the regulations on tobacco and advertising to new products.
"It is the first public health problem in Spain due to mortality," said Araceli Arce, general deputy director of Health Promotion of the Ministry of Health.
In spite of progress having been made, tobacco consumption is still a problem in Spain and one which requires appropriate measures to be taken
Tobacco consumption is responsible every year in Spain for the death of more than 50,000 people, people who for the most part began to smoke long before reaching the age of majority. As the first cause of preventable death in our country, it represents an obstacle to the right to health and life of Spaniards, a right recognized in numerous human rights treaties ratified by the Spanish Government, among others the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of iscrimination Against Women and the International Covenant on Economic, Social and Cultural Rights, which in Article 12 states that countries must respect and protect “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.
The coming into force in 2005 and 2010 of two Spanish laws on smoking-related health measures contributed to a progressive denormalization of its consumption and resulted in a notable improvement in the health of the Spanish population.
The two primary effects of these laws were the decrease in the general exposure of the population to environmental tobacco smoke and the disappearance of direct and indirect advertising of tobacco products. This contributed decisively to an increase in the perception of risk associated with tobacco consumption in the general population. In the last decade, the percentage of
smokers has decreased significantly which is due to the fact that many smokers multiplied their cessation attempts and that a lower percentage of adolescents has taken up smoking.
The achievements of these two laws are evident but this should not make us lose sight of the original limitations of these regulations nor the aspects pending implementation. Today we can observe that:
- there continue to be spaces where part of the population is exposed to environmental tobacco smoke;
- one in four people still smoke, a figure significantly lower than in 2004, but one
excessively high for a risk factor that causes the premature death of half of its
regular consumers;.
- tobacco consumption is highly prevalent in people belonging to the most
disadvantaged social levels, something that is seen both in the adult population as
well as in the infant-juvenile population, and which is especially striking in the
case of pregnant women
- the Spanish public health system – exemplary in so many aspects – does not
always offer people suffering from this addictive disorder the effective diagnostic
and therapeutic possibilities available In a somewhat paradoxical manner, the evident improvements attained in recent
years have contributed to a situation where some regulators have the perception that almost everything has already been done regarding tobacco and that now it is time to focus on other public health problems. Nevertheless, without meaning to underes-
timate any other health problem, whose clinical and community approach can be improved, scientific evidence unequivocally shows that:
- tobacco consumption is still the main public health problem in our country, due to
the morbidity and mortality it generates as well as the reduction it causes in
quality of life and life expectancy;
- there are effective tobacco control measures that have been carried out in other
countries which have not yet been applied in Spain or that have been carried out
in a partial or deficient manner.
The signatory organizations of this document – scientific, health and social, all of them advocating for tobacco control in Spain – are concerned about not being able to offer our population the evidence-based strategies that have been shown to reduce tobacco harm as well as not being able to provide them with adequate tools to face up to the direct and indirect pressures coming from transnational tobacco industries to take up and keep up tobacco consumption. We are concerned about failing in particular those people who belong to the most disadvantaged segments of the population, in which a relative lack of various social, psycho-affective or economic resources means that they have more problems in dealing adequately with this disorder and that their prevalence of consumption is much higher than the rest of the population. This higher prevalence is a factor that contributes - and will continue contributing - to increasing social inequalities in health.
For all these reasons we consider it urgent that a series of measures be taken in our country and that we return to acquiring the social leadership we achieved in Europe in this field in the first years of this century. According to the scientific evidence available, these are the main measures that the public authorities should adopt in Spain:
1) related to article 6 of the World Health Organization Framework Convention on
Tobacco Control 2003 (FCTC):
- harmonise upwards taxation of all tobacco products;
- also harmonise taxation of products related to nicotine delivery and novel
tobacco products;
- increase the fiscal pressure on all tobacco products, bringing them into line
with most developed countries, in order to reduce their accessibility to the most
vulnerable populations, above all minors;
2) related to Article 8 of the FCTC:
- demand compliance with current legislation on consumption in enclosed or
semi-open public places (such as terraces, patios or transit areas in shopping
centers);
- apply the current regulation on smoke-free spaces to all related products
(electronic cigarettes and herbal products for smoking). All this with the double
objective of, on the one hand, avoiding the passive toxicity that these products
can cause, and on the other hand, achieving denormalization of their con-
sumption in public places;
- prohibit smoking in any type of vehicle to avoid smoke exposure for all
passengers, especially minors, for reasons of health and road safety;
- Extend the current legislation in accordance with the normative recommen-
dations and guidelines of the World Health Organization on the protection of
environmental tobacco smoke by means of: 1) the elimination of ambiguities
(definition and delimitation of outdoor spaces, exceptions in enclosed spaces,
etc.); 2) the expansion of smoke-free environments in some open air spaces
(sports and entertainment facilities, platforms and stops for means of transport,
beaches and other natural spaces, communal swimming pools); and 3) the
explicit involvement of the different security forces involved in the control of
enforcement of the Law;
- promote smoke-free homes and raise awareness among the general
population regarding passive smoking, as the home is currently the main place
of exposure to environmental tobacco smoke, responsible for morbidity and
mortality in adults and children
3) related to Article 11 of the FCTC:
- introduce plain packaging, as several countries have done, in order to reduce
the attractiveness of the product to minors and increase the perception of risk;
4) related to Article 12 of the FCTC:
- Carry out targeted campaigns on diverse segments of the population that
allow them to acquire an adequate perception of risk regarding tobacco con-
sumption. In this regard, campaigns such as the ‘Every cigarette is doing you
damage’ one are recommended, an initiative that has proven its effectiveness
in multiple countries of varying characteristics;
5) related to article 14 of the FCTC:
- facilitate access of the smoking population to health professionals trained in
the approach to tackling tobacco consumption and in the treatment of smoking;
- finance those clinical, behavioral and pharmacological interventions which
have demonstrated effectiveness and safety in smoking treatment;
6) related to other FCTC articles:
- reinforce and harmonise the regulation on advertising, promotion and spon-
sorship of tobacco products to related products, in addition including devices
used for their consumption (such as pipes, water pipes, HNBs, etc.) (Article 13
FCTC);
- eliminate advertising of tobacco and related products at points of sale (Article
13 FCTC);
- reinforce the ban on sales to minors, also addressing issues related to toba-
cco or nicotine delivery products distributed on the internet (Article 16 FCTC).
This set of measures is not intended to be exhaustive.
Scientific evidence from various countries (who have already applied such measures)
shows that their application will contribute decisively to ensuring that those who do
not want to start consumption do not do so and that those who want to quit have
more chances of quitting.
Most of these measures can be applied with hardly any cost, and some of them imply
a highly cost-effective investment when compared with other health measures that
our health system has adopted and considers irrevocable.
We ask the public authorities to prioritize the right to health and act. Smoking
remains the main public health problem in our country, a problem that is avoidable
and directly affects a quarter of the adult population. There is an urgent need for
public authorities to establish an action plan or roadmap with the aim of reducing
tobacco consumption in Spain.
To do so they can count on all our social as well as professional support.
Madrid 16th June 2018
