EFMA/WHO Tobacco Action Group Survey


EFMA/WHO Tobacco Action Group Survey


Smoking is the world’s leading preventable cause of premature death and is a Global Public Health Imperative. There are more than 1.3 billion smokers worldwide1.
According to Ezzati & Lopez there were 4.83 millions of premature deaths that could be attributed to smoking in the year 2000, among them 1.69 million due to heart and vascular diseases2. Every 8 seconds a person dies of a smoking-related disease3. Furthermore, Center for Disease Control from Atlanta reports about 20% of all heart and vascular diseases are caused by smoking4. On a global level, morbidity and mortality is constantly growing after WHO reports (2002, 2003)5,6. Tobacco use will kill 1 billion people in the 21st century if current smoking trends continue. By 2010, the WHO estimates the annual global cost of tobacco-related illness to be US$500 billion (approximately €407 billion)7

Table 1: Deaths from Smoking in Europe

  Deaths from smoking
Smoking deaths as % of
all deaths in middle age
Deaths from smoking
Germany 4.800.000 20 109.000
Austria 506.000 25 9.000
Hungary 900.000 30 29.000
Greece 420.000 20 14.000
Ireland 235.000 25 5.700
Spain 1.200.000 15 45.000
Belgium 813.000 25 19.000
Czech R 414.000 30 18.000
Slovakia 162.000 30 8.000
EU 25 24.000.000 25 655.000

Source: www.deathsfromsmoking.net

Tobacco legislation in Europe
A large number of WHO/EURO Member States (mainly in the EU) have enforced bans in health care, education and government facilities and in indoor workplaces and offices since 2002. Although the majority of WHO European countries regulate smoking in public places, either by legal measures or by voluntary agreements (in a few), enforcement levels vary considerably. But there are decisive growing european Tobacco Control Legislative Restrictions. A ban on smoking in all enclosed public places takes effect in many European countries – Ireland, Norway, Italy, Malta, Cyprus, UK, France, Slovenia, Estonia etc.

The role of the physicians
WHO Framework Convention on Tobacco Control (FCTC) emphasizes the importance of active role of Health professionals. The Preamble of the WHO FCTC specifically mentions the role of health professionals in tobacco control8.

Of Particular interest for health professionals are:

  • Article 12 on “Education, communication, training and public awareness”
  • Article 14 on “Demand reduction measures concerning tobacco dependence and cessation”

Clinicians have a duty to give professional advice about smoking cessation and available treatments options. Physician input can have a major impact. Even brief advice from Health Care Professionals can increase tobacco abstinence rates up to 30% 9. Health authorities say that most physicians recognize their role in helping patients to quit.

Advice and Support10,11,12:

  • All smokers should be advised to quit and offered assistance irrespective of motivation
    • The “5As“
  • Direct to best form of treatment available depending on type of smoker and access to available resources
  • There is a strong dose-response relationship between intensity of counseling and its effectiveness
  • The following counseling and behavioral therapies are especially effective for both brief and intensive interventions:
    • Practical counseling (problem solving/skills training)
    • Social support as part of treatment
    • Securing social support outside of treatment

It is important to establish tobacco control measures and public health targets. National Institute for Health and Clinical Excellence (NICE) produced HCP guidance on brief interventions and specialist referrals; outlined approach to delivering smoking cessation services in England13:

  • Simple opportunistic advice to stop
  • An assessment of the patient’s commitment to quit
  • An offer of pharmacotherapy and/or behavioural support
  • Provision of self-help material and referral to more intensive support such as the NHS Stop Smoking Services
  • Offered pharmacotherapy and support by practitioners with suitable training

We were asking ourselves if Health Professionals and leading persons of NMAs are aware enough of the tobacco problems. We decided to sent a short questionnaire about activities of NMAs on Tobacco control.


We prepared some questions that, on our opinion, were important and we sent them by e-mail in the period of March and April 2007 to all members of WHO/EFMA.

Tobacco Action Group Questionnaire:
  • Is your National Medical Association familiar with WHO Framework Convention for Tobacco Control (FCTC) and its topics about the role of Health Professionals?
  • Is your NMA involved in Tobacco Control and Smoking Cessation in your country? If yes, How?
    • On a political level
    • On professional level
    • Preparing undergraduate or postgraduate trainings on these topics
  • Is there a person appointed by your NMA to work on Tobacco Control and Smoking Cessation?
  • Is Tobacco control and Smoking Cessation part of your Medical Curriculum?


We had rather good response from National Medical Associations from the countries:

Belaruse, Czech Republic, Finland, Germany, Ireland, Israel, Slovak Republic, Slovenia, Switzerland and United Kingdom. Most of the answer were short, but we also got three very interesting replies with a lot of comments and presentation of their work. These three were Finnish Medical Association, British Medical Association and Slovak Medical Association and their answers shows very active roles of their members in Tobacco Control and Tobacco cessation. The short answers are summarized in the table No2.

Table 2: NMAs answers

  Belarus Czech R Finland Germany Ireland Israel Norway Slovakia Slovenia Switzerland UK

Is your National Medical Association
familiar with WHO FCTC and its
topics about the role of HP?

yes yes yes yes yes no yes yes no yes yes
Is your NMA involved in Tobacco
Control and Smoking Cessation in
your country?
a. On a political level no yes yes yes yes yes yes yes yes yes yes
b. On professional level yes yes yes yes yes yes yes yes yes yes yes
c. Preparing undergraduate or
postgraduate trainings on these
yes yes yes yes no yes yes yes no yes yes
Is there a person appointed by your
NMA to work on Tobacco Control
and smoking Cessation?
yes yes yes yes no yes yes yes yes yes yes
Is Tobaxxo control and Smoking
Cessation part of your Medical
yes yes yes yes no no yes no yes no yes


We expected more reply but we are satisfied with what we got. Those NMAs, who responded are mostly aware the Tobacco Control problems. They are trying to be more active on the professional and political level. But there are still problems with NMAs who didn’t reply. The question is what were the reasons for not to reply. However Tobacco Action Group should work more to activate and to support all NMAs.

In this matter EFMA/WHO TAG activities and initiatives should be:

  • Letters to Governments in support of the FCTC make available to member associations.
  • All medical associations should encourage governments to sing, ratify and implement the FCTC.
  • Holding events to highlight the special role of doctors and medical associations in preventing deaths caused by tobacco.
  • All medical associations should have had smoke-free meetings, with the aim of having smoke-free premises.
  • All medical associations should receive guidelines on smoking cessation and disseminate them to their members.
  • All members of NMAs should be encouraged to quit smoking.

It is important to engage the medical profession in communicating advances and issues in tobacco control to politicians and the media. It will be good also to engage medical students and use their enthusiasm. Medical Associations should be encouraged to continue the work of having smoke free doctors, be advocates for change and campaign for smoke-free legislation. We are adding the answer from Finnish Medical association as example of good practice.

  1. WHO (2003). World Health Report. 2003. Chapter 6: Neglected global Epidemics: three growing threats. Available online at URL: http://www.who.int/whr/2003. Last accessed September 2006.
  2. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362: 847-52.
  3. World Health Organization (2000). Tobacco Kills – don’t be duped. World No Tobacco Day 31 May 2000. Campaign brochure. Available online at URL: http://www.who.int. Last accessed July 2006.
  4. Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC): adult SAMMEC and maternal and child health (MCH) SAMMEC software. Atlanta, Georgia (USA): Centers for Disease Control and Prevention; 2002. Available from: http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5114a2.htm
  5. World Health Organization. The world health report 2002; reducing risks, promoting healthy life. Geneva (Switzerland): World Health Organization; 2002. Available from: http://www.who.int/whr/2002/en/Overview_E.pdf.
  6. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of joint WHO/FAO expert consultation, WHO technical report series no. 916. Geneva (Switzerland): World Health Organization; 2003. Available from: http://www.who.int/dietphysicalactivity/publications/trs916/download/en/index.html.
  7. The Tobacco Atlas. Second edition. Published by American Cancer Society, 2006.
  8. WHO Framework Convention on Tobacco Control. Available at http://www.who.int/tobacco/framework/en/ . Last accessed June 2006.
  9. World Health Organization. New survey shows lack of training on tobacco cessation techniques for health-profession students. 31 May 2005: World No Tobacco Day. Available online at URL: http://www.who.int. Last accessed September 2005.
  10. Pisinger C, et al. Prev Med. 2005;40:278-284
  11. Fiore MC, et al. Clinical Practice Guideline: Treating Tobacco Use and Dependence. US Department of Health and Human Services. Public Health Service; June 2000. Available at: www.surgeongeneral.gov/tobacco/default.htm.
  12. National Institute for Health and Clinical Excellence. Brief interventions and referral for smoking cessation in primary care. Available at: www.nice.org.uk/page.aspx?o=299611. Accessed September 2006.
  13. National Institute for Health and Clinical Excellence (NICE). Brief interventions and referral for smoking cessation in primary care and other settings, March 2006. Also available at http://www.nice.org.uk. Last accessed September 2006.

Tomaz Caks, MD MSc MPH
Chair of EFMA/WHO Tobacco Action Group
The Medical Chamber of Slovenia