WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2019

Offer help to quit tobacco use

Executive summary

fresh and alive

WHO/NMH/PND/2019.5 

© World Health Organization 2019.

Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.

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

Overview
Progress in global tobacco control has been at least one more. This means a total of 36 Unfortunately, only 13 new countries have
strong since MPOWER was introduced in countries introduced one or more MPOWER started providing comprehensive cessation
2007 as a tool to help countries implement measures at the highest level of achievement programmes since 2007. There are now
WHO FCTC demand reduction measures. between 2016 and 2018. 23 countries protected by this measure,
Five billion people – about 65% of the up from 10 countries in 2007. However,
world’s population – are now covered by at in terms of population coverage, progress
least one MPOWER measure at the highest Tobacco cessation needs is still promising. One third of the world’s
level of achievement. This number has attention population – 2.4 billion people in 23
more than quadrupled since 2007 when countries – have access to cessation services
only 1 billion people – 15% of the world’s Offering help to quit – the focus of this provided at best-practice level. This is 2 billion
population – were protected by at least one seventh WHO report on the global tobacco more people (26% of the world’s population)
MPOWER measure (not including Monitoring epidemic – is an essential component of protected by comprehensive cessation
and Mass media campaigns, which are any tobacco control strategy. Global targets support programmes since 2007, meaning
assessed separately). for tobacco use will not be reached unless that cessation programmes are now the
current tobacco users quit, and indeed, many second most adopted MPOWER measure in
Since the last WHO report on the global tobacco users report that they want to quit. terms of population coverage. This is thanks
tobacco epidemic, two years ago, progress With the help of cost-effective population- to two large countries, India and Brazil,
has been steady, with 15 countries that based interventions, as outlined in the “O” adopting comprehensive cessation support at
previously had no best-practice policies measure of MPOWER (Offer help to quit best-practice level.
taking action to reach best-practice level on tobacco use), tobacco users greatly increase
one measure, and a further 21 countries that their chances of successfully quitting.
had at least one measure in place adding

AT LEAST ONE SELECTED TOBACCO CONTROL POLICY AT HIGHEST LEVEL OF

ACHIEVEMENT (2007–2018)
8
Population protected (billions)

Number of countries
200

Total population: 7.6 billion Total number of countries: 195

7
175

6
Countries 150
136
Population (billions)
5 121
125
106 5.0
4.8
4 92 100

75
3 75
55
2.8
2 43 2.4 50
2.2
1.8
1 25
1.1

0 0

2007 2008 2010 2012 2014 2016 2018

WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2019 – EXECUTIVE SUMMARY 3

 Key findings
Each MPOWER measure has been adopted nn  Ten countries (Antigua and Barbuda, Hungary, Ireland, New Zealand, Norway,
at best-practice level by new countries since Azerbaijan, Benin, Congo, Democratic Saudi Arabia, Thailand, United Kingdom and
the last report: Republic of the Congo, Gambia, Uruguay). Plain packaging legislation is also
Guyana, Niue, Saudi Arabia and in progress in at least nine other countries.
nn  Seven countries (Antigua and Barbuda, Slovenia) introduced comprehensive
Benin, Burundi, Gambia, Guyana, Niue bans on tobacco advertising, promotion
and Tajikistan) newly adopted complete and sponsorship (TAPS), including at
Significant progress in low-
smoke-free laws covering all indoor point-of-sale.
and middle-income countries
public places, workplaces and public
nn  Ten countries (Andorra, Australia,
transport. Of the 5 billion people protected by at least
Brazil, Colombia, Egypt, Mauritius,
one complete MPOWER measure, 3.9 billion
nn  Four countries (Czechia, Saudi Arabia, Montenegro, New Zealand, North
Macedonia and Thailand) moved to the live in low- and middle-income countries.
Slovakia and Sweden) advanced to
top group for taxes . Brazil and Turkey, the only two countries
best-practice level with their tobacco
that have adopted all MPOWER measures
use cessation services. However,
during the same time period, six other at the highest level, are both middle-income
Over half of the world’s population – 3.9
countries dropped from the highest countries. In all, 61% of the population living
billion people living in 91 countries – benefit
group, resulting in a net loss of two in low- and middle-income countries are
from large graphic pack warnings featuring
countries. protected by at least one complete MPOWER
all recommended characteristics, making it
measure, and 44% are protected by at least
nn  Fourteen countries (Barbados, the MPOWER measure with both the highest
two complete MPOWER measures.
Cameroon, Croatia, Cyprus, Georgia, population coverage and the most countries
Guyana, Honduras, Luxembourg, covered. It is also important to note that by There has been great improvement in low-
Pakistan, Saint Lucia, Saudi Arabia, the end of 2018, 10 countries had adopted income countries since 2007, when only
Slovenia, Spain and Timor-Leste) adopted legislation mandating plain packaging of three of the 34 countries in this income
large graphic pack warnings, including tobacco products and had issued regulations group had a single measure adopted. Today,
plain packaging for Saudi Arabia. with implementation dates (Australia, France, half (17) of all low-income countries have

THE STATE OF SELECTED TOBACCO CONTROL POLICIES IN THE WORLD, 2018

100% 100% 1
8
Proportion of countries (number of countries inside bars)

10
Proportion of countries (number of countries inside bars)

No known data, or no 23 Data not reported/

27 23
90% recent data, or data not categorized
90% 24
that are not both 43 44
recent and
80% representative 53 No policy or weak
80% 32
policy

70% Recent and 70%

59
representative data 32 Minimal policies
for either adults or
61
60% youth 91
60%

43 Moderate policies
50% 29
Recent and 50% 103
representative data
35 Complete policies
for both adults and
40% youth 40% 116
27
14
62
30% 30%
Recent, representative
and periodic data for 28
both adults and youth 91
20% 20%
74
Note: Bhutan and Brunei
62 Darussalam are excluded
10% 10% 48 from R because sale of
39 38 cigarettes is banned.
23
0% 0% Refer to Technical Note I for
category definitions.
M P O W E R
Monitoring Smoke-free Cessation Pack Mass Advertising Taxation
environments programmes warnings media bans

4 WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2019 – EXECUTIVE SUMMARY

at least one MPOWER measure in place at public transport, laying the groundwork best-practice warnings, show some effort is
best-practice level. There are now eight low- for establishing a fully effective law in the being made to communicate the dangers of
income countries that have one best-practice future. This means that although the partial tobacco use to consumers, and provide an
measure in place, five that have two, three bans do not currently effectively protect avenue for these 61 countries to strengthen
(Chad, Nepal, Senegal) that have three and these populations from the harms of second- their mandated warnings to best-practice
hand smoke, as public support grows for the level in the future.
one (Madagascar) that has four measures in
bans, only amendments to the law will be
place. Disappointingly, of the 17 low-income In addition to the 48 countries that have
needed in some of these countries, whereas
countries with no measures in place at adopted a TAPS ban, another 103 countries
the adoption of a new law will be necessary
best-practice level, only three run a tobacco have partial TAPS bans in place, so at least
in others.
control programme from their Ministry of some forms of advertising, promotion and
Health with at least five staff. While only 23 countries have cessation sponsorship are already illegal.
support measures that meet the criteria
While only 38 countries levy taxes as
for best-practice, there are an additional
high as the WHO-recommended 75% of
116 countries that provide fully or partially
Incomplete or partial policies the retail price of a pack of cigarettes,
cost-covered services in some or most health
are a stepping stone to another 62 countries levy taxes comprising
facilities, and 32 more that provide services
complete policies between 50% and 75% of the price, and
but do not cost-cover them. This makes a
a further 61 levy taxes between 25% and
total of 171 countries in which tobacco 50%. Essentially, these countries are well-
Even where best-practice levels have not
users wanting to quit can find some level of positioned to further raise taxes as tobacco
yet been achieved, each of the MPOWER
support. taxation gains more widespread support.
measures has received some level of
attention in the majority of the world’s In addition to the 91 countries that mandate
countries. In addition to the 62 countries strong graphic health warnings on cigarette
with a complete law on smoke-free packages, 61 other countries have minimal
environments, 70 countries have minimal to to moderate laws that require some kind
moderate laws that ban smoking in some of warning on packs. These less-prominent
but not all public places, workplaces and warnings, while not as effective as the

Increase in the SHARE OF THE world population covered by selected

tobacco control policies, 2007* to 2018
100%
Share of world population

90%

80% 2018

70% 2007

60%

50%
47%
40%

17% -10%#
30%
26% 33%
20%
21% 19%
10% 21% 4%
15% 7%
0% 5% 5% 7%
3% 3%
M P O W E R
Monitoring Smoke-free Cessation Pack warnings Mass media Advertising bans Taxation
environments programmes
Note: The tobacco control policies depicted here correspond to the highest level of achievement at the national level.
* Mass media coverage refers to 2010, not 2007. Taxation coverage refers to 2008, not 2007.
#The population covered by mass media campaigns decreased since 2010.

WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2019 – EXECUTIVE SUMMARY 5

 Conclusion
There has been substantial progress made
globally since the 2003 adoption of the WHO
FCTC. The successful scaling up of MPOWER
measures over the past 10 years to the
best-practice level, adopted by countries
of all sizes and income levels, is evidence
of the successful implementation of the
WHO FCTC demand reduction measures. As
countries continue to work towards creating
and implementing effective tobacco control
strategies they can find encouragement in
the examples set by other countries that
have successfully adopted measures at best-
practice levels.
In the years since MPOWER was launched,
the challenges faced have been great.
There have been, and will continue to be,
setbacks, unexpected barriers, interference
from the tobacco industry and difficult
political obstacles to overcome. Despite
these challenges, there are now 5 billion
people who are protected by at least one
best-practice tobacco control measure – 3.9
billion more than were covered in 2007. On
the other hand, 2.6 billion people remain
unprotected by evidence-based tobacco
control best practices, leaving them at risk
from the health and economic harms caused
by tobacco use.
6 WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2019 – EXECUTIVE SUMMARY
Millions of lives have been saved since wanting to quit. Nevertheless, progress is
the introduction of MPOWER, and it being made – 2 billion more people have
has only been through the coordinated been covered by comprehensive tobacco
focus of a global community that tobacco cessation services since 2007, and there
control efforts have been so successful. are 67 countries that are only one step
Unfortunately, however, the tobacco away from providing comprehensive
epidemic is far from over. Although tobacco tobacco cessation services. Middle-income
use has declined in most countries and countries have made most obvious progress
regions, population growth means the in providing tobacco cessation support in
total number of people using tobacco has primary care settings and operating national
remained stubbornly high. Tobacco control toll-free quit lines since 2007.
programmes are not always quick and easy
Every country has an obligation to protect
to implement, and all countries can benefit
the health of its people, and all Parties
from strengthened tobacco control policy
to the WHO FCTC have made a specific
development and enforcement. Since the last
commitment to implement strong tobacco
report, only one country – Brazil – has joined
control policies, including effective cessation
Turkey in putting all MPOWER measures in
services, as an important means of fulfilling
place at their most comprehensive level, and
their obligation to protect the health of their
there are only a handful of other countries
people. There has been incredible progress
that have more than two measures in place
in the 11 years since MPOWER monitoring
at best-practice levels. Even in countries
began but it is only the beginning. It is
where best-practice policies exist, much
important that we all recommit to ensuring
can be done to strengthen compliance and
all the people of the world are protected
ensure full impact.
fully from the great harms of the tobacco
The focus of this report, Offer help to quit epidemic.
tobacco use, is the “O” of MPOWER. Only
23 countries provide cessation services at
best-practice level, even though in many
countries, many tobacco users report
 The WHO report on the
global tobacco epidemic, 2019
was made possible by funding
from Bloomberg Philanthropies

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