Tobacco control in Europe: a deadly lack of progress.

igarettes are uniquely dangerous, killing half of all those who regularly use them and damaging the health of those who breathe in users’ smoke, particularly children. Just under a third of European adults currently smoke, and smoking has become increasingly associated with poverty, contributing significantly to widening health inequalities across the EU. In 2004, the ASPECT report, a comprehensive review of tobacco use and tobacco control policies in the EU, found that tobacco use caused well over half a million deaths in Europe annually and on top of that constituted a huge economic burden, estimated conservatively at E98-130 billion a year. 1 This review also identified that whilst some European countries were observing declines in tobacco use and mortality, in other countries tobacco use was still increasing, particularly among women. The ASPECT report identified 43 recommendations to combat the epidemic, covering tobacco control policy, interventions and research. Yet to date, few of these recommendations have been implemented, and as a result, future prospects for curbing the smoking epidemic across Europe are currently very bleak. On the optimistic side, in 2003, the world’s first public health treaty, the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) came into force in recognition of the smoking pandemic and the power of the major transnational tobacco companies to push their deadly products. 2 The FCTC sets out supply and demand strategies to reduce tobacco use and has since been ratified by all EU countries (except the Czech Republic) and the European Union. The FCTC represents a unique and historic opportunity to fight the pandemic and collectively reduce the public health burden caused by tobacco and should therefore herald the way to faster progress in reducing smoking. However, the FCTC will only fulfil its potential if it is implemented in the most effective way and there is strong evidence that this is currently not the case. The Tobacco Control Scale (TCS) was developed by Joossens and Raw 3 to monitor the implementation of tobacco control