The aim of public health is preventing deseases and prolonging life of community. In order to fulfill this aim it is necesary to work on developement and improvement of general health throughout diferent sistems in diferent aerias of life. When we think about what could influence the health of community, first that comes to our mind could be education abouth health, which should be to date, control of community infections, organisation of medical services and so on. In order to find a way to maximize quality of public health first we need to recognise what are the bigest threats to general health. Here starts the story of this paper in which I will write about causes of deths in Europe which in large number of cases arise because of tobacco and/or acohol.
First of all, in this paper I will try to provide all the neccesary and importaint data about influence on healt of consuming tobacco and alcohol. Further more, I will write about development of legal grounds and measures for minimising deaths cosed by mensioned reasons throughout time.
And finaly I will try to answer the question which I asked myself in the title of this paper: ''What can EU do to minimise deads cosed by tobacco, alcohol and food?'' and try to make a critical point of view of todays regulations of tobacco and alcohol. Further, i'll try to provide some recomendations and ideas in which direction EU should go in order to make Europe healthier.
There are lot of adverse effects of cigaretts. It is not that they are just causing death, but also they are causing deseases with long lasting and hard concequences. All of this deseases, such as lung cancer, effect bouth life of the patient but also life of his close ones. Further, cigarettes are also effecting second hand smoker which are close to active smoker.
Reasarch made by European Union shows that there are 700,000 deaths in EU during one year cosed by cigarett smoking. More then one in four Europeans smoke, which puts Europeans at the top of the charts in the world. The bigest problem on which EU wants to orient, are not people who are already addicted, but rader young smokers who just started smoking. Their aim is suported by reasarch in which it is proven that nine out of ten people start smoking before they turn 18.
The regulation of tobacco products on the EU market
European Union started to deal with public health of it's member states in 1990s, but it started to face the problem with tobacco in early 1980s with the 'European against Cancer' programme'. Further developement continued in 1990s but unfortunately with no binding resolutions. Even though they were not binding, that was a move forward to helthier life because till then some states did not have any tobacco control. One of the first important Directives was Directive 98/43/EC on tobacco Advertising and Sponsorship which extended already existing ban on advertiseing tobacco on TV. Revision was adopted in Directive 2001/37 EC which was the first EU Tobacco Products Directive which regulated aspects such as manufacture, sale and presentation of tobacco products. While EU tried to minimize outcomes of tobacco usage, it was still the most heavily subsidized crop per hectare in Europe. The EU was spending nearly €1,000 million annually on these subsidies but then decided to size down these subsidies by 2010. Today, EU aid is completely separated from tobacco production.
In 2009, under the pressure of the public health community, the European Commission decided to review Directive 2001/37 EC. Unfortunately the revision was subject of lobbying by big tobacco companies such as Phillip Morris. Because of that The Directive did not provide protection of health of citizens as it should have. The ban on special flavors was present in the first draft but not in the final text. Even though flavors were still banned, menthol, one of the most commonly used flavorings, had a 4-year derogation in implementation. Although a slim cigarette ban and a ban on 10-cigarette packs were introduced in the first draft, only the ban on 10-cigarette packs remained in the final draft. That was the power of tobacco companies against which EU should have fought and still needs to. The final deadline for incorporating this Directive into national law was in 2016. Till 2016. 12 (42.9%) countries have fully transposed the Directive, while three countries have performed a partial or unofficial transposition.
Further, one of the steps to free-smoke Europe was European Commission's ‘'Ex-smokers are unstoppable'' initiative. One of the initiatives was got The Euro Effie Award, as one of the highest achievements for proven effectiveness. The last initiative was from 2014 to 2016 and was provided by an app called Icoach. One in three of the 480,000 registered users stopped smoking after three months.
Eliminate Illicit Trade in Tobacco Products
In order to really take this problem serious European Union needs to cooperate internationally. Because of that the 7th Conference of the Parties (COP7) to the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2016 was organized. By the act of signing the WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products in 2013, the EU committed to ratify and implement it. The Illicit Trade Protocol was the first international legally binding instrument aiming specifically at tackling the problem of illicit tobacco trade. One of the most important part of it is establishing a global tracking and tracing regime, consisting of national and regional systems, without unnecessary interaction with the tobacco industry. In the EU, the Tobacco Products Directive will implement this aspect of the Protocol by introducing an EU-wide tracing system for all tobacco products which should be introduced in 2019 for cigarettes and Roll-Your-Own tobacco products, and by 2024 for all other tobacco products.
Taxes on tobacco products
One of the measures to minimize tobacco consumption is putting high taxes on tobacco products. Directive which is now in force prescribes that those Cigarettes manufactured in the Union and those imported from third countries will be subject according to value calculated on the maximum retail selling price, including customs duties, and also to a specific excise duty calculated per unit of the product. The rate must be the same for all cigarettes. The range of retail selling prices reflects fairly the difference in the manufacturers' delivery prices. The percentage of the specific component of excise duty in the amount of the total tax burden on cigarettes shall be established by reference to the weighted average retail selling price which shall be calculated by reference to the total value of all cigarettes released for consumption, based on the retail selling price including all taxes, divided by the total quantity of cigarettes released for consumption.
Key changes for tobacco packages sold in the EU
Since new Directive came into the force, EU became more strict about tobacco regulation. The newest Directive aim is to affect buyers not to buy cigarets. It is oriented on turning away young people from smoking. Cigarette packages were designed before in a way to make appealing look to future smokers. The typical example we could see in perfume style packages of cigarettes which especially supposed to attract young girls.
This Directive demands from tobacco manufacturers not to write the number of milligrams of nicotine, tar, and other ingredients on the package. The logic behind that decision is to show consumers that there are no cigarettes which could cause more damage then the other, but rather that they all do the harm. EU in order to prevent smoking came to conclusion that not writing the amount of this ingredients should prevent consumers from taking cigarettes with lower amount of harmful ingredients. Further, Directive provides the need for Member states to implement the obligation to write text about effect of cigarettes and a picture which provides informations to a buyer what are the concequences of smoking. In that part Directive is dedicated to visual context of pacage of cigarets. It proscribes the need for picture and texts about devastating concequences of cigaret consummation. Also, it is important that now, text and the picture should cover 65 % percent of the package. Further, there should be a number of a contact which can help inform consumers about available help programs for people who want to quit smoking.
This Directive also baned some flavours which are mostly appealing to young smokers, such se chocolate, cofee, strawbery flavours. For products with a market share higher than 3% for example menthol, the ban will apply as of 2020.
Advertising restrictions for tobacco products
Tobacco advertising and sponsorship on television was prohibited for the first time in Directive in 1989. This directive was replaced by new one, which baned all forms of commercials for cigarettes and other tobacco products.
Directive on sponsorship of tobacco products proscribed an EU wide ban on advertising in the press and other printed publications, except publications intended exclusively for professionals in the tobacco trade and publications which are printed and published in third countries, where those publications are not principally intended for the Community market. The ban coveres print media, radio, internet and sponsorship of events involving Member States, but also events that have cross-border efect. The perfect example for such a event could be Formula One races. Till then Formula One race could not be imagined without the Marllboro signs and should have influenced suporters of Formula One races, asserting that there is nothing bad in smoking cigarets. Due to new Directive this no smoking environment should had changed peoples perspective on smoking.
Further, the Council Recomendation on preventing smoking, recommended Member States to prohibit the use of tobacco brand names on non-tobacco products or services such as the use of promotional items and tobacco samples, the use and communication of sales promotion, or an opportunity to participate in a promotional contest or game, the use of billboards, posters and other indoor or outdoor advertising techniques, the use of advertising in cinemas and any other forms of advertising, sponsorship or practices directly or indirectly addressed to promote tobacco products.
Through years Directives were changing and reducing of reclamations of cigarets became more and more strict. Living example are movies in which main caracters were smoking, and in that way promoting cigarets. Today this would be unimaginable.
The question is, are this measures effective enough? According to one research made in Croatia they could be if people would even have at least a bit of willingness to stop smoking. In Croatia there are 1,1 million smokers in compare to 4,5 million people. One of the new measures introduced in the newest Directive, as already mentioned, is possibility of calling an official number that is printed on the tobacco box. The research had shown that the number for psychological help was dialed just 1409 during one year. There are two possible ways of help- already recorded secretary which gives advices how to easier quit smoking and help provided by directly dialing the operator. The research journalist who dialed the number stated that the operator gives good advices for preventing smoking, but still there is notably small number of those who decided to search for help. That result shows us that this measures maybe are not effective enough and that EU should be more aggressive in providing some other measure which could reach more significant result. But, on the other hand results shown by EU are different, emphasizing that success is visible in 2% of population of European Union citizens which make 2.4 million fewer smokers in the EU.
Other critiques are referring to taxes on tobacco. Of course that smokers are against high taxes but, also are some associations, such as Croatian employers' association. They pointed out that due to high taxes the black market will arise and cigarettes with low value will be on the market. That means that cigarettes will not be a subject to any quality control or contribute to filling the national budget.
Alcohol causes 7% of health problems and deaths in the EU. Today it is third priority public health isuse after tobacco and high blood presure. It couses lots of various deseases such as cancer, cardiovascular and liver diseases. Same as tobacco, it can ruin not just life and health of the person who drinks, but also it can make influence on life of his cloose ones. Europe is the region with the highest alcohol consumption per person in the world consequently a high level of alcohol-related harm. Every year more than 55,000 people aged 15-29 die across Europe due to alcohol-related causes.
In the beginning alcohol in EU was a metter for agriculture, today, it represents one of the bigest threats to public helth. EU is equaly competent to protect health when it comes to acohol as from tobacco.
Timeline of EU Alcohol Strategy
The main duty to regulate alchol policy is given to EU Member states, but EU tries to suport them in reduction of alcohol related harm.
In 2001, the European Council adopted the Council Recommendation on youth alcohol consumption and a set of Conclusions. After the evaluation, the conclusion was made, and that was the time to come up with a extensive strategy. When the European Commission put forward such a strategy, that took several years to develope. The reason for procrastination was simmilar to situation that hapened with tobacco. Firstly, big resistance was given by drinking industry and secondly because the European Commission commissioned several preparing studies related to alcohol use and alcohol problems in Europe. The result was the report and impact assessments on health and on economic aspect.
Finally in 2006 the European Commission agreed upon the Alcohol Strategy which was designed for the period 2006-2012 and contained soft law. It summed up priorities which were relevant in all member states including protection of young people, children and the unborn child, reducing injuries and death related to alcohol traffic accidents, preventing adults alcohol-related harm, raiseing awareness on the impact of alcohol consumption and developing and supporting a common evidence base. The most concrete impact was made on the Alcohol and Health Forum which started in 2007. It was set up to give the drinks industry the chance to come up with specific prevention and information projects. After some time the European Parliament requested the European Commission to submit new proposal on labelling and start drafting a second European Alcohol Strategy but it was concluded that Commission will not make separate new alcohol strategy document. In 2015 the European Commission was asked to formulate a new EU Alcohol Strategy before the end of 2016. This special EU-strategy document must focus on measures to reduce alcohol-related harm with a cross-border dimension and it should take into account the work carried out by CNAPA and the WHO. After the adoption of the Council Conclusions in 2015, the debate on European alcohol policy stopped completely.
Today, EU does not have specific obligatory regulation regarding alcohol consumption but rather alcohol falls in the definition of food. Accordingly, some alcohol regulations can be find in Regulation about food. One other Regulation proscribes that all suppliers will have to ensure that their products carry a nutritional declaration, a list of ingredients and alcoholic strength by volume in alcohol beverages.
After 2012. when Alcohol Strategy was no longer in force, European Parliament made resolution on new alcohol strategy. It made a recommendation that priority objectives from the first Alcohol strategy should remain the same. One of the main ideas of new strategy is to support the World Health Organization's European action plan for 2012-2020 which was agreed between EU Members States. Member States should prepare, implement, review national action plan or strategy on alcohol. Member States should increase the number of people who receive alcohol consumption advice. Member States should increase the number of educational and other institutions that implement health-promoting action in order to point out harmful outcomes of consuming alcohol. Also, one of the aims which needs to be achieved is reduction of the number of drink-driving fatalities. Further, Member States should limit or reduce the availability of alcohol. Some of the actions should be oriented on sizing down the promotion of alcoholic beverages especially targeting young people. With regard to pricing policies, Member States should adopt it in order to influence the buyers in economical means. In order to increase the level of safety Member States should reduce the public health impact of “illicit alcohol” which covers homemade alcohol, illegally-produced or contraband alcohol and surrogate alcohol not intended for consumption and informally produced alcohol. Member States should publish regular reports on alcohol that include various information and statistics on drinking.
Even though there was an effort given by European Parliament that was put forward, EU still does not have Alcohol strategy since 2012.
Ewa-May Karlsson, the member of the Committee of the Reagons, critisised curent situation emphasizing that damages of not having official European regulations are huge. Efect of not having European Alcohol Strategy is that Member states often allow the drink industries to monitor and regulate themselves. The problem is that because there is no Alcohol Strategy it results in increasement of bad concequences provided by alcohol which in reality means that the financial costs of alcohol-related harm are colossal – up to €155.8 billion a year. She also highlighted the problem that it is still too easy to make alcohol aveable to children and young people, inter alia because some sport and cultural events are still having some alcohol companies as their sponsors. Under the Convention on the Rights of the Child, we have an obligation to protect children and young people from the harmful effects of alcohol.
Furteher on, there was a research that was prepared for the European Commission to examine whether there is an impacts of affordability of alcoholic beverages or of cross-border tax-driven price differentials that could efect consumption of alcohol. The real value of the Member States alcohol taxation has decreased since the 1990s in most EU countries and due to that alcoholic beverages have become more affordable. There is a positive relationship between alcohol affordability and alcohol consumption in Europe. In this research it is proven that alcohol affordability was driven by increase in income, while on the other hand, prices did not effect so much on affordability. What also makes a problem is that while incomes went up considerably across the EU, the relative price of alcoholic beverages has remained relatively stable, or fallen at a lower rate than the income increases. Another problem is that often, people from some countries which have high prices of alcohol, due to taxation, go to cheaper countries (Finland and Estonia). That would not happen if the taxations are the same in all Member States. The cross-border purchases not only reduce the tax revenues that can be collected by national tax authorities; there is also evidence that increased cross-border purchasing has led to an increase in consumption in the receiving countries, especially Finland and Sweden. This suggests consumers did not simply change the location of their alcohol purchases, but also increased their total alcohol consumption. However in some of the case studies consumption seems to have dropped once consumers adjusted to the availability of cheap alcohol in neighborhood countries, what could be seen in Sweeden and Finland.
It was shown that taxation of alcohol, for example, is used primarily with fiscal rather than public health objectives across most of the EU. As the analysis showed, the real value of alcohol taxation has decreased since the mid-1990s. Legislation setting minimum prices for alcohol, which could potentially reduce alcohol-related harms, is also uncommon in the region. This is most likely because minimum prices have tended to be seen as distorting the market by the European courts. Increases in taxation at the national level could be an effective strategy to reduce alcohol-related harms, but their viability in the current European context is compromised by downward pressure on taxes caused by the single market, and by the strength of the opposition to tax increases.
But except from prices there are other elements whish could influence the price and affordability of alcohol. Some other policies have showed to be effective in reducing harmful and hazardous alcohol consumption, such as reducing alcohol outlet density, increasing minimum legal drinking ages, and enforcing drink-driving counter-measures. An effective alcohol strategy is a policy mix that includes evidence-based interventions in all these fields.
Today taxes on alcohol are relatively low in many EU countries and, with few exceptions such as those in Scandinavian countries, represent primarily fiscal and not public health functions. This is reflected in the stability of alcoholic beverage taxes vis-à-vis inflation rates. The stability of alcohol taxation is partly due to the fact that public agencies may be reluctant to raise alcohol taxes because this would affect not only binge and dependent drinkers, but also moderate or light drinkers who do not generate public costs through alcohol-related harms. Another contentious issue is the extent to which certain alcohol pricing policies, such as higher taxation, could lead to increased smuggling and illegal production of alcoholic beverages. A central question for policy-makers, then, is how to strike the balance between reducing alcohol harms and minimising the costs and negative outcomes of alcohol policies. While the evidence strongly rejects the hypothesis that heavy drinkers are too addicted to reduce their consumption of alcohol, the effect of price on consumption does appear to be smaller for heavy drinkers than for more moderate drinkers.
There are various projects sponsored by European Union which are conected in any sens to alcohol problem. ALICE-RAP that was active from 2012-2016 and founded by European Commission investigated the impact of alcohol marketing on brain activity of heavy drinkers and of patients treated for alcoholism. Further, AMPHORA aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. This knowledge will be disseminated to those engaged in policy-making for development and implementation of more effective public health measures. It is co-financed by the Seventh Framework Program (FP7) of research of the European Commission.
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