Spain: Civil Rights and Public Health Organizations Press Government for a Tobacco Endgame by 2030

Laurent Huber, Ubaldo Cuadrado García de Arboleya, Raquel Fernández Megina and Leonardo Visconti

More than twenty civil rights associations and public health organizations in Spain have backed a Declaration asking the Spanish Government for a Tobacco Endgame by 2030. The goal is ambitious: to decrease smoking prevalence in Spain to under 5% by 2030. The Declaration brings the term “endgame” to the general public, with the intention of framing the conversation in a way that has never been done in Spain. It also aims to break a policy stalemate that has benefited the tobacco industry and led to the preventable deaths of more than 60,000 Spaniards per year. The Declaration includes a range of measures to protect the right to health of Spanish citizens, in line with the government’s obligations under the WHO Framework Convention on Tobacco Control (FCTC).

Protection from secondhand smoke

The Declaration calls on the government to ensure more places are smoke-free, including both indoor and outdoor areas of all bars and restaurants. The Declaration also demands that all university campuses become smoke free. The fact that the 2005 Tobacco Control Law forbade smoking in all university premises is not very well known. Unfortunately, this “ahead-of-its-time” measure took a step back in 2010, leaving outdoor spaces in adult education centers unprotected and creating an environment that fosters smoking among young adults. Furthermore, the Declaration calls on protections in private homes. Currently, someone assaulted by secondhand cigarette smoke in their home has no legal protection. This would be a groundbreaking measure necessary to protect some of the most vulnerable Spaniards, especially during COVID lockdowns.

Pricing and taxation

The Declaration demands that the Spanish government maximize tax and price measures to reduce smoking prevalence. The cost of a package of cigarettes is under 5 euros in Spain, making tobacco products cheaper than many European countries and easily accessible to youth. As a result, the current age of smoking initiation and addiction in Spain is 13.9 years old. The Declaration calls for price increases and tax measures on tobacco products in order to not only decrease smoking initiation and prevalence among current smokers, but also as a tool to help Spain during its COVID-19 economic recovery period. This measure has been identified by the WHO as a “best buy”, and is indispensable to curbing smoking. The UK, Finland, Australia and Spain’s neighbor, France, have been successful in using this tool. Now it is the time for the Spanish government to also fully realise its potential. Increasing prices would also ensure the tobacco prevention policies of our neighboring countries are not undermined by visitors to Spain purchasing cheap tobacco products – unifying us all in our joint effort to save lives.

Plain packaging

The Spanish Endgame community also calls on the government to follow its neighbors in 9 Europe countries, and 18 around the world, to implement plain packaging on tobacco products. Despite the urging of many health professionals, no Spanish government official has yet considered this measure. Spanish citizens should enjoy the same health protections as other Europeans.

Phase out commercial tobacco product sales
Steps to progressively phase out the commercial sale of tobacco products are also called for, starting with a sharp reduction in sales points. Currently, cigarettes are highly available, from thousands of vending machines placed in bars, restaurants, press kiosks, and many other locations. These should be removed as soon as possible and the ‘estancos’, (regulated tobacco stores), should be the only authorized selling points for tobacco and related products, using stronger ID policies to prevent purchases by under-age youth. Looking ahead, the Declaration goes even further: it calls on a progressive phase out of the sale of tobacco products, by not allowing tobacco retailers to sell tobacco products to people born after 2007. In other words, those who turn 18 on or after 2025 would be Spain’s first tobacco free generation.

Tobacco industry fund for smoking cessation and alternative livelihoods

The creation of a fund to redress the harms caused by tobacco is the final point in the Declaration. Based on the “polluter pays principle”, the tobacco industry would be subject to new levies, similar to those enacted by France in 2016. These appear to be highly cost-effective at driving down smoking prevalence. Given the negative impact of tobacco on both health and the economy, resources are needed for smoking cessation treatments as well as supporting alternative livelihoods for those who currently generate income through tobacco.

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The Declaration was formally submitted to the Health Ministry on 29 December 2020. If adopted by the government, it will not only reverse a decade of increasing smoking prevalence, but also put Spain at the forefront of global tobacco control. Currently, tobacco use prevalence is nearly 33%. Smoking prevalence reached a low point around 2010, when smoke-free laws were introduced for all closed public spaces, including bars and restaurants. Unfortunately, since its implementation the law has been under attack with the hospitality sector starting a campaign of civil disobedience, ignoring the law and setting up enclosed outdoor terraces where smoking is allowed. The current situation, in which the hospitality sector feigns compliance while effectively disobeying the law, clearly benefits the tobacco industry, and must end.

In addition, taxes on tobacco products remain low and prices are inexpensive compared to other European countries. The tobacco industry has been successful in lobbying to maintain this situation. It has interfered in the protection of the right to health of Spanish citizens by not only blocking the implementation of health measures but also by fully advertising their new tobacco-related products. Despite Spain having signed and ratified the WHO FCTC, which vows to protect present and future generations from harms caused by tobacco, different government administrations – with rare exceptions – were willfully blind to these challenges. As a result, teenage smoking and vaping has soared over the last few years in Spain.

Despite the relatively high smoking prevalence and constant attacks by the industry, a recent survey conducted by Nofumadores.org suggests that anti-smoking laws have wide support in Spain, with two thirds of the population asking for more restrictions, around 60% in favour of plain packaging, and 7 out of 10 smokers wanting to quit. Clearly more needs to be done to protect the right to health of Spanish citizens, instead of protecting tobacco industry profits.

Spain must look to a future free from tobacco-induced disease and death. Continuing on our current path will not realize this future. Only strong government policies rooted in science can get us there. Spain must accelerate the implementation of the WHO FCTC, and take leadership by implementing novel end game policies aligned with Article 2.1 of the WHO FCTC which states that “in order to better protect human health, Parties are encouraged to implement measures beyond those required by this Convention and its protocols.”

Laurent Huber is the Executive Director of ASH USA. Ubaldo Cuadrado García de Arboleya is the Vice Chair, Raquel Fernández Megina the Chair, and Leonardo Visconti the Strategy Manager of https://nofumadores.org/.

All authors have no conflicts of interest to declare.

Read more (Spanish media):

https://www.apepoc.es/actualidad/146-asociaciones-medicas-y-civiles-exigen-un-final-de-partida-para-el-tabaco-en-2030?jjj=1609343963513

https://www.lavozdelsur.es/actualidad/sociedad/veintena-asociaciones-sanitarias-se-marcan-objetivo-en-2030-apenas-haya-fumadores-en-espana_254037_102.html

https://www.ultimahora.es/noticias/local/2020/12/30/1226397/cruzada-contra-tabaco.html

https://www.que.es/ultimas-noticias/sociedad/asociaciones-prevalencia-fumadores.html

https://m.infosalus.com/actualidad/noticia-asociaciones-medicas-civiles-exigen-gobierno-medidas-alcanzar-prevalencia-fumadores-2030-20201229174934.html

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