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MPOWER Brochure
1. Monitor
tobacco use
and prevention
policies
The WHO Framework Convention
on Tobacco Control states:
Article 20
The Parties shall establish …
surveillance of the magnitude,
patterns, determinants and
consequences of tobacco
consumption and exposure to
tobacco smoke.
… Parties should integrate
tobacco surveillance programmes
into national, regional and global
health surveillance programmes
so that data are comparable and
can be analysed at regional and
international levels …
Population-based national and international monitoring
data are necessary to effectively plan and implement
the WHO Framework Convention on Tobacco Control
(WHO FCTC).
Only through accurate measurement can problems caused
by tobacco be understood and interventions be effectively
managed and improved.
Monitoring can provide policy-makers and public health
authorities with essential information on:
●● The extent of the tobacco epidemic in a country
●● Subgroups in need of tailored policies and programmes
●● Public awareness of the epidemic and attitudes towards
tobacco control
●● Changes in tobacco use following implementation of
policies and programmes
●● Government enforcement and societal compliance with
tobacco control policies, including tax collection and
tax evasion, smoke-free places, and advertising and
marketing bans
●● Tobacco industry practices that may increase tobacco
use or hinder implementation of tobacco control policies
and programmes
Monitoring is also essential to evaluate the effectiveness of
MPOWER implementation. Currently, monitoring systems
are weak in many low- and middle-income countries, where
tobacco use is rising fastest.
Many countries do not
have monitoring data
All countries need effective tobacco surveillance systems.
However, many countries lack national smoking prevalence
data for adults and youth, or have older data or data that
are not representative.
Data on other aspects of the epidemic – such as tobacco-
related disease and death, the economic costs of tobacco
use, public attitudes towards tobacco control and the
extent of tobacco marketing – are also inadequate.
Assessment of tobacco use and its impact must be
strengthened, as monitoring at both global and country-by-
country levels is critical to understanding and contributing
to the information base necessary to reverse the tobacco
epidemic.
Monitoring must be
scientifically valid
Any monitoring system must use standardized and
scientifically valid data collection and analysis practices.
Surveys that use a random population-based sample of
sufficiently large size can provide accurate estimates of
tobacco use at the national level within an acceptable
margin of error. Moreover, surveying a sufficiently large
sample enables accurate estimates of smoking prevalence
among major subpopulations – classified by age, gender,
income, region and other sociodemographic characteristics.
Surveys should be implemented at regular intervals to
ensure that changes in the epidemic are measured.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control (WHO
FCTC) is the pre-eminent global tobacco control instrument,
which contains legally binding obligations for its Parties
and provides a comprehensive direction for tobacco control
policy at all levels. WHO introduced the MPOWER package
of measures to assist in the country-level implementation
of effective measures to reduce the demand for tobacco,
contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
2500
2000
1500
1000
500
0
Numberofpeopleinmillions
5% 6%
8% 8%
9%
ProtectMonitor Offer Warn Enforce Raise
34%
Percentage OF GLOBAL POPULATION COVERED BY , 2008
Monitoring is a
critical tobacco control activity
Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation. Data from 2008. Source:WHO Report on the Global Tobacco Epidemic, 2009. Implementing smoke-free environments. Geneva,World Health Organization, 2009.
3. Protect people
from tobacco
smoke
The WHO Framework Convention
on Tobacco Control states:
Article 8
… scientific evidence has
unequivocally established that
exposure to tobacco smoke
causes death, disease and
disability.
Each party shall adopt and
implement … measures,
providing for protection from
exposure to tobacco smoke
in indoor workplaces, public
transport, indoor public places
and, as appropriate, other public
places.
Second-hand smoke
exposure is deadly
There is no safe level of exposure to tobacco smoke.
Exposure to tobacco smoke is proven to cause heart
disease, cancer and many other diseases.
Just 30 minutes of exposure to tobacco smoke changes
the way in which blood flows and clots, increasing the
risk of heart attack and stroke. Second-hand smoke kills
more than 600,000 people each year. In many countries, it
causes more than 10% of all tobacco-related deaths.
Only 100% smoke-free
environments protect
health
All people have a fundamental right to breathe clean air.
Completely smoke-free indoor environments – with no
exceptions – are the only proven way to protect people.
100% smoke-free environments require the elimination of
all smoking and tobacco smoke indoors. Ventilation cannot
protect against the health risks of tobacco smoke.
Do not allow exemptions
Protection from tobacco smoke should be universal: all
people deserve health protection, all the time.
Exceptions to 100% smoke-free indoor
environments – such as permitting smoking
in designated areas or installing ventilation
systems – do not protect health.
The tobacco industry has acknowledged the effectiveness
of smoke-free environments. Their data show that
exceptions to 100% smoke-free environments undermine
the impact of such regulations.
Smoke-free laws
are popular
Experience consistently shows that smoke-free laws are
practical, popular – even among smokers – and successful,
despite industry claims to the contrary.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control (WHO
FCTC) is the pre-eminent global tobacco control instrument,
which contains legally binding obligations for its Parties
and provides a comprehensive direction for tobacco control
policy at all levels. WHO introduced the MPOWER package
of measures to assist in the country-level implementation
of effective measures to reduce the demand for tobacco,
contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
In 2008, 114 countries lacked or had
minimal smoke-free legislative protection
Smoke-free laws
do not hurt business
A review of the economic effects of smoke-free environments
around the world concludes that they do not have a negative
economic impact on businesses. In many cases, smoke-free
laws have even had a slight positive economic impact.
Economic impact studies of smoke-free laws have shown
no adverse effect on bar and restaurant businesses or
tourism. Evidence of this type can be used to counter false
tobacco industry claims.
Smoke-free laws
protect worker health
The primary purpose of establishing smoke-free workplaces
is to protect workers’ health.
Framing the debate about smoke-free workplaces as a
worker safety issue can help build support.
The International Covenant on Economic, Social and
Cultural Rights recognizes the right of all people to safe
and healthy working conditions. Workers have the right to
earn a living without endangering their health by breathing
second-hand smoke.
Clean air – a basic human right
Not categorized
Up to two categories of
public place (health-care,
educational and government
facilities, universities, indoor
offices, restaurants, pubs,
bars and public transport)
completely smoke-free
Three to five categories of
public place completely
smoke-free
Six to seven categories of
public place completely
smoke-free
All public places completely
smoke-free (or at least 90%
of the population covered by
complete subnational
smoke-free legislation)
High-incomeMiddle-incomeLow-income
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Proportion of countries (Number of countries inside bars)
23
14
3
5
3
60
20
10
1
6
31
12
2
3
1
Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation.
Data from 2008. Source:WHO Report on the Global Tobacco Epidemic, 2009. Implementing smoke-free environments. Geneva,World Health Organization, 2009.
5. Offer help to
quit tobacco use
The WHO Framework Convention
on Tobacco Control states:
Article 14
Each Party ... shall take
effective measures to promote
cessation of tobacco use and
adequate treatment for tobacco
dependence.
Each Party shall endeavour to
design and implement effective
programmes aimed at promoting
the cessation of tobacco use
[and to] include diagnosis and
treatment of tobacco dependence
and counselling services on
cessation of tobacco use in
national health and education
programmes, plans and
strategies ...
More than one billion smokers worldwide – a quarter of all
adults – are victims of the tobacco epidemic. Like people
dependent on any addictive drug, it is difficult for tobacco
users to quit. However, most people want to quit when
informed of the health risks.
Tobacco control policies create the environment in
which users can successfully stop. Cessation support and
medication can increase the likelihood that a smoker will quit
successfully. However, few smokers currently receive the help
and support they need to overcome their dependence.
Health-care systems
are responsible for
treatment
Tobacco dependence treatment is primarily the responsibility
of each country’s health-care system.
Countries should establish programmes that provide low-
cost, effective interventions for tobacco users to stop.
Cost analyses have shown the benefits from tobacco
cessation programmes to be either cost-saving or cost-neutral.
Yet, few smokers currently receive the help and support
they need to overcome their dependence.
Three primary forms of
treatment
Treatment includes various methods, but programmes
should include:
●● Tobacco cessation advice incorporated into primary and
routine health-care services
●● Easily accessible and free telephone help lines (known
as quit lines)
●● Access to free or low-cost cessation medicines
These methods work best when adapted to local conditions
and cultures, and tailored to individual preferences and needs.
Quit advice from all
health professionals is
effective
Clear, strong, personalized advice from all health professionals
about the risks of tobacco use and the importance of quitting
is usually well-received and increases quit rates.
Brief advice (1-3 minutes) is inexpensive when integrated
into existing health-care services.
Health-care systems should encourage
all health professionals to routinely ask
all patients about their tobacco use and
provide advice to stop.
All health-care workers must be motivated to provide
advice.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control (WHO
FCTC) is the pre-eminent global tobacco control instrument,
which contains legally binding obligations for its Parties
and provides a comprehensive direction for tobacco control
policy at all levels. WHO introduced the MPOWER package
of measures to assist in the country-level implementation
of effective measures to reduce the demand for tobacco,
contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
Few smokers get the help they need
Cessation services and
cessation support
All health professionals should offer cessation support to
smokers, or refer smokers to a cessation service where
possible.
Cessation support includes:
●● Promoting the benefits of cessation
●● Assessing the degree of nicotine dependence
●● Assisting smokers in setting a quit date
●● Advising that complete abstinence from smoking is best
●● Arranging effective medication, if available
●● Arranging follow-up
All health-care workers should be trained in giving brief
advice to quit and offering cessation support to tobacco
users.Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation.
In 2008, smokers in 98 countries had to pay for any
tobacco dependence treatment. In 23 countries no
treatment was available
High-income
Middle-income
Low-income
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Proportion of countries (Number of countries inside bars)
1516 113 3
8554 30
14287
National quit line, and some
cessation services and
nicotine replacement therapy
(NRT) cost covered.
Some cessation services
and/or NRT, at least one of
which is cost-covered.
Some cessation services
and/or NRT, neither cost
covered.
None
Data not reported
Data from 2008. Source:WHO Report on the Global Tobacco Epidemic, 2009. Implementing smoke-free environments. Geneva,World Health Organization, 2009.
7. Warn about
the dangers of
tobacco
The WHO Framework Convention
on Tobacco Control states:
Article 11
Each Party shall … ensure that
tobacco product packaging
and labelling do not promote a
tobacco product by any means
that are false, misleading [or]
deceptive …
Each Party shall … ensure that…
tobacco products … carry health
warnings describing the harmful
effects of tobacco use …
Article 12
Each Party shall promote and
strengthen public awareness of
tobacco control issues, using all
available communication tools …
Despite conclusive evidence on the dangers of tobacco, few
tobacco users worldwide understand the full extent of the
health risks.
Many smokers believe that they can reduce or stop tobacco
use before health problems occur.
Both smokers and non-smokers underestimate the
addictiveness of tobacco and the risk it poses to health.
Both smokers and non-smokers also underestimate the
danger of exposure to second-hand tobacco smoke. These
threats have not been adequately explained to the public.
The need for public education is even more pronounced in
low- and middle-income countries, where tobacco use is on
the rise and tobacco control is generally in its early stages.
Effective warning labels, anti-tobacco advertising and the
proactive use of media to influence the public and policy-
makers are three key ways to communicate the health risks
of tobacco .
Warning labels increase
awareness of health risks
Prominent warning labels on tobacco packs are the most
direct way of communicating health risks to tobacco users.
Effective health warnings on cigarette packs encourage
smokers to quit and discourage non-smokers from starting.
Best practice warning labels, that comply
with the Guidelines for implementing
Article 11 of the WHO Framework
Convention on Tobacco Control (WHO
FCTC), reach all tobacco users, increase
their awareness of health risks, are
well-accepted by the public and cost
governments virtually nothing.
Warnings change the
image of tobacco
Comprehensive warnings about the dangers of tobacco are
critical to changing its image, especially among adolescents
and young adults.
People need to associate tobacco use with its actual human
impact, extreme addictiveness and dangerous health
consequences, and to see it as socially undesirable and
negative.
Health warnings and anti-tobacco
advertising encourage tobacco users to
quit and help keep young people from
starting.
Warnings and anti-tobacco advertising also help gain public
acceptance of other tobacco control measures such as
establishing smoke-free environments.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control (WHO
FCTC) is the pre-eminent global tobacco control instrument,
which contains legally binding obligations for its Parties
and provides a comprehensive direction for tobacco control
policy at all levels. WHO introduced the MPOWER package
of measures to assist in the country-level implementation
of effective measures to reduce the demand for tobacco,
contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
56% changed their opinion
about health consequences
of smoking
67% want to quit
as a result
54%
67%
0%
20%
40%
60%
80%
Source: Datafolha Instituto de Pesquisas. Opinião pública, 2002.
Impact of pictorial warnings on Brazilian smokers
Smokers approve of pictorial warnings
76% approve
of health warnings
73%
Few smokers and non-smokers
fully understand the health risks of tobacco
Warning labels on tobacco packaging and hard-hitting mass media campaigns provide crucial
information about the dangers of tobacco use.
Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation.
9. Enforce bans
on tobacco
advertising,
promotion and
sponsorship
The WHO Framework Convention
on Tobacco Control states:
Article 13
… a comprehensive ban on
advertising, promotion and
sponsorship would reduce the
consumption of tobacco products.
Each Party shall … undertake a
comprehensive ban of all tobacco
advertising, promotion and
sponsorship.
The tobacco industry spends tens of billions of US dollars
worldwide each year on marketing through advertising,
promotion and sponsorship.
Advertising, promotion and sponsorship normalize tobacco,
making it seem like any other consumer product. This
increases its social acceptability and hampers efforts to
educate people about the hazards of tobacco use.
Marketing falsely associates tobacco with desirable
qualities such as energy, glamour and sex appeal. It also
strengthens the tobacco industry’s influence over media,
sporting and entertainment businesses.
In countries where partial bans prohibit direct advertising
and promotion of tobacco products in traditional media,
tobacco companies frequently employ indirect marketing
tactics to circumvent the restrictions. Tactics include:
●● sport and music event sponsorship
●● pack designs and displays
●● branded merchandise
●● product placement
●● alleged corporate-social responsibility activities
●● new media technology campaigns
Advertising, promotion
and sponsorship bans
work
Comprehensive bans on direct and indirect advertising,
promotion and sponsorship protect people – particularly
youth – from industry marketing tactics and can
substantially reduce tobacco consumption.
Comprehensive bans significantly reduce the industry’s
ability to market to young people who have not started
using tobacco and to adult tobacco users who want to quit.
Comprehensive bans can be achieved by
following the international best practice
standards outlined in the Guidelines
for implementation of Article 13 of the
WHO Framework Convention on Tobacco
Control (WHO FCTC).
A comprehensive ban on all advertising and promotion
reduces tobacco consumption by about 7%, independent of
other interventions. Some countries have seen consumption
drop by as much as 16%.
Bans must be
comprehensive
To be effective, bans must be
comprehensive and apply to all
types of advertising, promotion and
sponsorship – both direct and indirect.
Bans on direct advertising should cover all types of media
– including print, broadcast, billboards and other outdoor
advertising (such as on transit vehicles and stations), and
the internet.
Legislation should include bans on in-coming and out-going
cross-border advertising, such as tobacco advertising on
international television and Internet sites, and sponsorship
of international sporting and cultural events.
Bans should also cover promotional strategies such as price
discounts and free product giveaways.
Ban point of sale
advertising and
promotion
Point of sale promotion – including price discounts and
product giveaways – can account for more than 75% of
tobacco company marketing expenditure.
Point of sale advertising and in-store displays of tobacco
products should be banned. Bans on product display lead
to reductions in youth smoking and also reduce impulse
purchases among adults wanting to quit.
Keeping tobacco behind the counter and out of public
view can be effective. Even the extra effort required to ask
a retailer for tobacco products is often enough to deter
purchasers.
Certain countries are beginning to require generic
packaging of tobacco products. Requiring plain or generic
packaging – without colour, pictures or distinctive
typefaces, other than health warnings – can neutralize the
value of individual brands.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control (WHO
FCTC) is the pre-eminent global tobacco control instrument,
which contains legally binding obligations for its Parties
and provides a comprehensive direction for tobacco control
policy at all levels. WHO introduced the MPOWER package
of measures to assist in the country-level implementation
of effective measures to reduce the demand for tobacco,
contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
Enforce bans on tobacco advertising, promotion and sponsorship - best practice countries, 2008
Enforce bans on tobacco advertising, promotion and
sponsorship – HIGHEST ACHIEVING countries, 2008
The tobacco industry spends billions to market its deadly products
Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation. Source:WHO Report on the Global Tobacco Epidemic, 2009. Implementing smoke-free environments. Geneva,World Health Organization, 2009.
11. Raise taxes on
tobacco
The WHO Framework Convention
on Tobacco Control states:
Article 6
Price and tax measures are an
effective and important means of
reducing tobacco consumption …
Each Party should … adopt …
tax policies and … price policies
on tobacco products, so as
to contribute to the health
objectives aimed at reducing
tobacco consumption.
Article 15
Elimination of all forms
of illicit trade in tobacco
products, including smuggling,
illicit manufacturing and
counterfeiting … are essential
components of tobacco control.
Increasing the retail price of tobacco products through
higher taxes is the single most effective way to decrease
consumption and encourage tobacco users to quit.
When tobacco prices increase:
●● Fewer people use tobacco
●● People who continue to use tobacco, consume less
●● People who have quit are less likely to start again
●● The young are less likely to start using tobacco
Tobacco taxes are generally well accepted – and even
supported by many tobacco users – because most people
understand that tobacco is harmful.
In high-income countries, a 10% increase in tobacco prices
will reduce consumption by about 4%. The effect of higher
prices on reducing consumption is likely to be greater in
low- and middle-income countries.
Tobacco taxes protect
the poor and the young
Tobacco taxes are particularly effective in preventing
or reducing tobacco use among the young and the
poor. People in these groups are more affected by price
increases.
Tax increases help the poor to stop using tobacco. This
allows tobacco users who quit to reallocate their money
to essential goods, including food, shelter, education and
health-care.
Higher taxes also help poor families improve productivity
and wage-earning capacity by decreasing tobacco-related
illness and death.
Have a simple and
effective tax structure
There are two main types of tobacco excise taxes:
●● Specific taxes – levied on a given quantity of tobacco,
such as a tax paid per pack or carton of cigarettes
●● Ad valorem taxes – based on a percentage of the
wholesale or retail price
In some countries, a combination of excise taxes is used.
●● Specific taxes provide more predictable revenue and
make it harder for the tobacco industry to influence
retail prices.
●● Ad valorem taxes help tobacco prices maintain pace with
inflation.
The overall tax structure should be simple and easy for
countries to implement.
Excise taxes should be levied at the manufacturer level,
rather than at the distributor or retail level. This helps
increase effectiveness by centralizing revenue collections
and minimizing recordkeeping burdens on small businesses.
Monitor Monitor tobacco use and
prevention policies
Protect Protect people from
tobacco smoke
Offer Offer help to quit tobacco use
Warn Warn about the
dangers of tobacco
Enforce Enforce bans on tobacco
advertising, promotion and
sponsorship
Raise Raise taxes on tobacco
The WHO Framework Convention on Tobacco Control
(WHO FCTC) is the pre-eminent global tobacco control
instrument, which contains legally binding obligations
for its Parties and provides a comprehensive direction for
tobacco control policy at all levels. WHO introduced the
MPOWER package of measures to assist in the country-level
implementation of effective measures to reduce the demand
for tobacco, contained in the WHO FCTC.
Additional resources on this topic are available at
www.who.int/tobacco/mpower/publications
When South Africa increased its taxes, smoking rates among the
poor and the young plummeted. Yet tax revenues increased.
When tobacco prices go up,
consumption goes down
Tobacco taxes reduce consumption
Relationship between cigarette consumption and excise tax rate in South Africa
Source: WHO Report on the Global Tobacco Epidemic, 2008.The MPOWER package. Geneva,World Health Organization, 2008.
2 500
2 000
1 500
1 000
500
0
Millionsofpacks
Excisetaxrate(asa%ofretailprice)
1980 1985 1990 1995 2000 2005
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Consumption (left scale)
Excise tax rate (right scale)
Technical input and assistance in publication was provided
by The International Union Against Tuberculosis and
Lung Disease (The Union) with funding from Bloomberg
Philanthropies and support from World Lung Foundation.