TOBACCO CONTROL: UP IN SMOKE IN EUROPE?

Experts from the United States, Canada and Europe have warned recently that the Dutch government is flying in the face of the evidence for reducing the burden of disease caused by tobacco consumption [1]. In June 2011, Edith Schippers, the Dutch Minister of Health, announced the end of the reimbursement of quit-smoking aids and withdrawal of funding from the National Centre On Tobacco Control (STIVORO). This abdication of public health responsibility comes as no surprise: the Netherlands was the first European country to overturn the smoking ban imposed on bars and cafés in 2010 and has not yet implemented pictorial health warnings on tobacco product packaging. The Netherlands appears to be in breach of Article 5.3 of the Framework Convention on Tobacco Control (FCTC), which requires protecting public health policies from the tobacco industry's influence.

Sadly, the Netherlands government is not alone in what can only be regarded as a pro-tobacco industry stance. On 31 May 2011, the World No-Tobacco Day, Xavier Bertrand, the French Minister of Health, announced that France would continue its moratorium on tobacco taxes and would ban varenicline from the very limited €50 coverage for smoking cessation under the mandatory French Health Insurance scheme. In 2009, his predecessor Roselyne Bachelot cut funding to the only non-governmental organization (NGO) that fights smoking during pregnancy [2]. Since the election of president Nicolas Sarkozy in 2007, the government has accepted several demands from the tobacco industry to limit increases in cigarette prices to 6%, a level that is inadequate to decrease sales [3]. Accordingly, cigarette sales in France have remained unchanged from 2004 (54.9 billion) to 2010 (55.0 billion). Sales for the tobacco industry (Philip Morris, British American Tobacco and Imperial Tobacco) showed a 3% rise from 2008 to 2009, despite the world economic crisis.

Overall, France has failed properly to implement the FCTC treaty despite its ratification in October 2004: the prevalence of daily smoking among 17-year-olds increased from 28.9% in 2008 to 31.5% in 2011 [4].

The Bellagio statement provides a graphic picture of the burden of disease, predicting one premature death per tonne of tobacco. Thanks to tobacco control provided via the Evin law (1991) and the Cancer Plan (2003), cigarettes sales in France decreased from 97.1 billion in 1991 to 54.9 billion in 2004. It is estimated that this will have prevented 36 000 premature deaths over 13 years. Since 2004, reversals in tobacco control in France have cost thousands of lives per year.

Many rich countries are firmly in the grip of the tobacco industry's influence, and even use the FCTC as a smoke-screen. The World Health Organization (WHO) provides no monitoring body to which FCTC violations can be reported. The WHO is poised on a slippery slope. We call on the WHO to raise the bar and issue blame when governments breach the treaty and sacrifice their citizens' health under pressure from vested interests. Since 1999 the United Nations has, under Security Council resolution 1265, intervened in many countries to protect civilians from the effects of armed conflict. Such activities are part of their wider responsibility to protect, a responsibility shared by the WHO.

Declarations of interest

Dr Braillon, a senior tenured consultant, was sacked in 2010 from Professor Dubois' unit by the French Department of Health against the advice of the National Statutory Committee. Professor Dubois was sued for libel by the French Tobacconists Union [Abuse of libel laws and a sacking: The gagging of public health experts in France. Tobacco control blog 8 November 2010 (Archived by Website http://www.webcitation.org/65B4o1Wey on 3 February 2012)]. Professor Dubois is honorary president of Alliance Contre le Tabac and chairs the Addiction Committee of the National Academy of Medicine. He has received consulting fees from Pfizer.