Beyond cigarettes

Despite overwhelming evidence of the health, social and economic harms caused by tobacco use,* and the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), tobacco control measures are inconsistently applied and often challenged by industry. Comprehensive policies – such as the Tobacco and Vapes Bill in the UK, which applies to all tobacco products – are essential to reversing the impact of tobacco-related disease.

The importance of tobacco control

Tobacco use remains one of the leading causes of preventable deaths worldwide, responsible for 25% of all cancer deaths. It is the primary risk factor for lung cancer, and contributes to 71% of deaths in men with lung cancer and 46% of deaths in women. Using tobacco also significantly increases the risk of more than 20 different types or subtypes of cancer; beyond cancer, it also contributes to cardiovascular and respiratory diseases, and other serious health problems.

The human cost is mirrored by vast social and economic losses. In 2022, tobacco use led to global damage totalling US $1.7 trillion – equivalent to 1.7% of global GDP.

Strong, comprehensive tobacco control policies can change this trajectory. In Europe alone, effective implementation could prevent 1.65 million people form developing lung cancer over two decades. The WHO FCTC, adopted by the World Health Assembly in 2003, provided a formalised approach to reducing the harms caused by tobacco. However, more than 20 years on, progress remains inconsistent. Despite clear evidence that tobacco harms individual and public health, and that nicotine (which is found in all tobacco) is addictive, the tobacco industry continues to deploy new strategies to protect its profits and resist regulation, undermining public health efforts.

For instance, in the European Region, only 34% of countries have implemented smoke-free legislation so far, compared with the global average of 41%. Additionally, just 13 in 53 WHO European Region countries prohibit the advertising, promotion and sponsorship of tobacco products.

The need for controls on all tobacco products

Despite the clear consensus on the dangers of tobacco and nicotine, industry tactics remain a significant barrier to effective control – and, consequently, the prevention of lung cancer.

The industry often responds to evidence-based tobacco control policies by attempting to influence, delay or challenge their implementation. Some examples include funding selective research, lobbying policy- and decision-makers, or manipulating media narratives to present their products in a more favourable light.

A recent key focus area for policymakers has been protecting young people from nicotine addiction, particularly through restrictions on flavoured or look-alike products. Flavouring agents are widely used in tobacco and nicotine products; they make them more palatable and attractive to people using them for the first time, masking the harshness of smoke. Flavoured tobacco products are known to significantly contribute to the initiation of smoking among young people, often leading to addiction.

Among these, menthol is the most frequently added flavour in cigarettes. In the UK, for instance, tobacco companies have introduced mentholated cigarillos – small, leaf-wrapped cigars that resemble cigarettes and mimic branding and flavours, but fall outside existing regulations such as standardised packaging, flavour bans and minimum pack sizes. Requirements are set out in the Tobacco and Related Products Regulations (2016), but are only applicable to cigarettes and hand-rolled tobacco. Consequently, cigarillos are sold in colourful packs of ten and at lower prices, making them more appealing, particularly to younger consumers.

Recognising the limitations of existing legislation, the UK is taking a bold step to strengthen tobacco control policies with the most significant public health intervention in a generation: the Tobacco and Vapes Bill. The proposed bill seeks to close these loopholes, and is just one example of why comprehensive and effective tobacco control measures require controls on all tobacco products – not just cigarettes.

The possibility of a smoke-free generation

If passed, the UK’s Tobacco and Vapes Bill will make it illegal to sell tobacco to anyone born on or after 1 January 2009, creating the foundation for a smoke-free generation. The Bill centres around reducing the appeal and access to tobacco products to children and young people. It proposes measures to:

• tackle illicit trade through a retailer licensing scheme
• mandate pack inserts that contain quitting support for cigarettes and hand-rolled tobacco, and later for all tobacco products
• regulate flavours, packaging and product display
• expand smoke-free and vape-free zones
• introduce a fixed penalty to help enforcement agencies track retailers that are not obeying the law.

These policies are grounded in evidence. For example, in Canada, where pack inserts have already been introduced, one study found that around a third of people who smoke had read the insert at least once in the previous month, and around a fifth had read the inserts several times or more. In 2016, Australia was the first country to implement plain packaging; smoking prevalence decreased from 19% in 2012 to 17% in 2015, with around 25% of this reduction directly linked to the adoption of plain packaging. These tobacco control measures demonstrate that consistent, evidence-based interventions can yield measurable public health gains.

The universal benefits of reducing tobacco use

The benefits of comprehensive tobacco control extend far beyond national borders.  Investing and implementing nine major tobacco control strategies from the WHO FCTC – such as increasing taxes, introducing plain packaging, adding health warnings, banning advertising and providing cessation support – could reduce global smoking rates by over 50% within 15 years. This could save 42.8 million lives and generate US $6.2 trillion in social and economic benefits, including US $2.3 trillion in healthcare cost savings.

Tobacco control is, fundamentally, a shared global responsibility. It demands vigilance, collaboration and bold policy action from governments, public health institutions and civil society. With continued commitment and stakeholder collaboration – and, crucially, with the ratification and implementation of these commitments – we can create a future where tobacco no longer claims lives or shapes health inequalities.

*Tobacco products include: waterpipe tobacco, cigars, cigarillos, heated tobacco, roll-your-own tobacco, pipe tobacco, bidis and kreteks, and smokeless tobacco products.