Tobacco control politics aims to help adults to quit smoking and deter children from starting. For developing countries like Romania, if we are looking at the Tobacco Facts 1(1), it’s a whole list of objectives from price measures to non-price measures (advertising and promotion, publicizing tobacco research, warning labels, nicotine replacement therapy, restrictions on smoking in public places and at the workplace, smuggling problems, employment, tax revenues and taxation, trade restriction, prohibition, restriction on teenage smoking, crop substitution etc.).
I will try to analyze all these measures at this moment (January 2017) because, even if Romania ratified the Framework Convention on Tobacco Control (FCTC) on January 2006, many things were applied only from 2016. I have to do this also because we are celebrating the 32nd tobacco-related Surgeon General’s report issued since 1964, highlighting 50 years of progress in tobacco control and prevention, with new data on the health consequences of smoking, and discussing opportunities that can potentially end the smoking epidemic in the United States of America(2). In this report from a country who started all these measures far away from Romania, economic costs attributable to smoking and exposure to tobacco smoke still continue to increase and now approach $300 billion annually, with direct medical costs of at least $130 billion and productivity losses of more than $150 billion per year(2).
Romania has a 26.7% prevalence of smoking in adults(3). The prevalence is much higher among men than women (37.4% vs. 16.7%)(3). 41.2% of students had smoked cigarettes before (boys: 47.1%, girls: 35.4%)(4). 52.8% of Romanian people live in homes where others smoke in their presence(4). Looking at consequences, one of the most important – lung cancer – represents 27.3% of the cancer mortality in males and 10.4% in women(5). Nearly 43,000 Romanian died in 2010 due to an illness caused by smoking. Almost a quarter (23.8%) of all deaths among men and about one in twelve (8.2%) of all deaths among women in 2010 were caused by tobacco(6).
We know that price is the single, cheapest and most effective measure to reduce consumption(1). Comparing the price of cigarettes in Romania with the prices from other countries, there is no good news. Concerning the average annual percent change in real price on the most popular price category of cigarettes in 2008-2012(7),
even if the rise was of 75% taxes on a pack of cigarettes in the EU 2014, denominated in US dollars remains low at 3,31$(8). The internal tobacco crop production (surface) diminished dramatically, but with a rise of import and export of tobacco products between 2000 and 2014(8). The accessibility of cigarettes is greater now for population as it was in 1990(8). Price elasticity – 0.58 in 2016 – is not enough to protect our population(8). The increase of excises on cigarettes to 65% of retail prices would reduce consumption by about 18%, while tax revenues would increase in excise duties on cigarettes by almost 1.35 billion RON(8). In the same area, the authorities try to master this phenomenon of smuggling, but the partnerships with the tobacco industry only pays off these efforts.
If we look at the tobacco control measures, we have some visible progresses. The advertising of tobacco products on radio and television has been banned since 2002 in accordance with the Broadcasting Act (Law no. 504). Even so, the marketing of tobacco products remain widespread in Romania, because there are no limits on advertising in selling places or international newspapers and magazines, the distribution of free samples, discounts promotional prices, sponsorships and other marketing activities. Graphic health warnings on the cigarettes packs are mandatory in Romania since 2008, and require that 30% of the front of the pack and 40% from the back of the pack to be covered by warnings. Only in 2016 the former Parliament voted with a certain delay the Directive 2014/40/EU of the European Parliament and of the European Council of April 3, 2014 on the approximation of the laws, regulations and administrative provisions of the member states concerning the manufacture, presentation and sale of tobacco products and related products, and repealed the Directive 2001/37/EC(9). The warnings must occupy only 50% of the cigarettes packs and Romania will not be in the first line regarding the surface allocated to the pictorials. Cessation therapy for smokers is another action started years before, with information for people in need available at a Quitline. Our today’s problems are that the budget is to low and this program is not covering the whole country. Looking at another crucial problem uncovered by authorities, we can discover that only some non-governmental organizations (NGOs) of professors or children had special actions with teenagers.
The new anti-tobacco law launched on March 17, 2016(10) is without any doubt a progress. The new law prohibits smoking completely in all enclosed public places, in all working spaces, in closed public transport vehicles, including taxis, and also in all playgrounds open or closed. Smoking it’s also banned in institutions of health, education or child protection, regardless of public or private funding. The democratic process which has enabled the law was unique, with the involvement of politicians, NGOs (“Romania is Breathing”) and professional associations (mainly, Romanian Society of Pneumology and Romanian Cardiology Society). This new law also requires public media education campaigns to inform Romanian people about the consequences of smoking, but not all the TV channels respect this paragraph. After this law will entry into force, another program
is very promising: 2035 – Romania’s first tobacco-free generation.
Tobacco control politics in Romania really progress. There are two gains of the years 2016 and 2017 in the field of tobacco control policies: we have a powerful front against smoking and a long-term strategy in this area. Even if our country will not enter the Top 10 of “green” countries, the events of the last two years prove that we are on the right track and we go on a European road to success.
- Prabhat Jha and Frank Chaloupka. Tobacco Control in Developing Countries – Tobacco Facts 1, Media Information, 2000.
- The Health Consequences of Smoking - 50 Years of Progress. A Report of the Surgeon General Executive Summary, U.S. Department of Health and Human Services, 2014, Public Health Service Office of the Surgeon General Rockville.
- GATS Romania 2011.
- GYTS Fact Sheets 2009.
- World Health Organization - Cancer Country Profiles, Romania Profile 2014.
- World Health Organization. WHO Report on the Global Tobacco Epidemic, 2015, Country Profile - Romania. Geneva, World Health Organization, 2015.
- Eriksen M, Mackay J, Schluger N, Gomeshtapeh FI, Drope J. The Tobacco Atlas - 2015, the American Cancer Society, 978-1-60443-235-0.
- Szabo A, Lazăr E, Burian H, Rogers T, Foley K, Abram Z, Meghea C, Ciolompea T, Chaloupka FJ. Economic aspects of the use, production and taxation of tobacco products in Romania - the Palace of Parliament, 2016.
- Directive 2014/40/EU of the European Parliament and of the Europea Council of April 3, 2014 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products and related products and repealing Directive 2001/37/CE.
- Law no. 15/2016 amending and supplementing Law no. 349/2002 on preventing and combating the effects of tobacco products.
- 2035 – The first tobacco-free generation, Romanian AREMPF 2016, Education for Health.