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Of the 121 countries that have ENDS regulations in place, 34 have banned them.
The World Health Organization (WHO) recently released a report on tobacco control, marking the 15th year since introducing its MPOWER anti-tobacco measures. In the report the agency commended the Netherlands and Mauritius for implementing all of the measures, joining Brazil and Turkey. Eight other countries, namely Ethiopia, Iran, Ireland, Jordan, Madagascar, Mexico, New Zealand, and Spain are only one measure away from joining that group.
Aside from the above list of the least tobacco-friendly countries in the world, some more interesting details in the report include the following:
Monitoring tobacco use
Adults and adolescents in 73 countries are regularly surveyed about their tobacco use. Interestingly, the majority of these countries (41 out of 73) are high-income countries with comprehensive monitoring of tobacco use. Since the report says no low-income country had this level of monitoring in 2022, the remaining 32 surveyed countries must be middle-income with mid-level monitoring.
Smoking prevalence
The global average smoking prevalence went from 22.8% in 2007 to 17% in 2021, a relative reduction of 25% of 14 years. Relative reduction in average prevalence over 14 years was 24% in high- and middle-income countries and 28% for low-income countries. WHO says 76% of the world’s smokers live in middle-income countries and 20% in high-income countries. Average smoking prevalence was highest in high-income countries with 21% of adults smoking, followed by 17% in middle-in-come countries and 10% in low-income countries.
Global smoking prevalence among men went from 38% in 2007 to 29% in 2021, with relative re-duction at 23% over that period. Among women, the global smoking prevalence went from 8% in 2007 to 5% in 2021, a 35% relative reduction.
Complete smoking bans
WHO says in 2022, over a quarter of the world’s population, or about 2.1 billion people, lived in the 74 countries where there were complete smoking bans in public places, workplaces, and public transport nationally. This represents almost 40% of all countries. In 2007 only 10 countries had these bans in place, affecting 244 million people. Of the 74 countries with complete bans in place, 45 of them (60%) were middle-income countries.
Out of the countries that either had no or minimal bans, 16 were high-income countries, 25 were middle-income countries, and 12 were low-income countries.
Graphic warnings and plain packaging
The number of countries that require large graphic warnings on tobacco products increased from 9 in 2007 to 103 in 2022. Only 21 countries (4 high-income, 11 middle-income, and 6 low-income) do not require any warning labels, while another 45 countries have warnings that cover less than 50% of the pack, lower than what the WHO Framework Convention on Tobacco Control (FCTC) requires.
By the end of 2022, 22 countries had legislation requiring plain packaging for tobacco products (Australia, Belgium, Canada, Denmark, Finland, France, Georgia, Hungary, Ireland, Israel, Mauritius, Myanmar, Netherlands, New Zealand, Norway, Saudi Arabia, Singapore, Slovenia, Thailand, Turkey, UK, and Uruguay).
Tobacco taxes
In 2022, 41 countries had tax rates at 75% or more of the price of the most popular brand of cigarettes. In the two years be-tween 2020 and 2022, four countries (Australia, Lithuania, Nicaragua, and Vanuatu) raised their tobacco taxes to 75% or more, with the most significant tax increase happening in Nicaragua (from 56.8% to 75.7%) and Vanuatu (from 58.3% to 77.5%). No low-income countries raised their taxes to 75% or above during 2020-2022.
Since 2008 when 23 countries had tobacco tax rates at 75% or more, 11 high-income countries (Andorra, Australia, Croatia, Denmark, Greece, Israel, Latvia, Lithuania, Netherlands, New Zealand, and Slovenia) and 11 middle-income countries and one territory (Argentina, Bosnia and Herzegovina, Brazil, Montenegro, Morocco, Nicaragua, North Macedonia, Palestine, Serbia, Thailand, Turkey, and Vanuatu) raised taxes sufficiently to reach that level. Only one low-income country, Madagascar, began taxing at or above 75% in 2010 and currently remains the only low-income country taxing tobacco at that level. In 2022, 42% of high-income countries (25 countries) and 14% of middle-income countries (15 countries) had tobacco taxes at 75% or more.
In 2022, the average total tax as a proportion of prices was highest in high-income countries, reaching 66.9%, while amounting to 56.5% in low-income countries and 59.1% in middle-income countries.
Electronic nicotine delivery systems (ENDS)
By 2022, 73 countries worldwide were monitoring ENDS use in adults through national population-based surveys and 103 countries were monitoring ENDS use in adolescents through national school-based surveys. Fifty-nine countries monitored both adults and adolescents, while 78 countries had not started monitoring ENDS use at all. ENDS regulations have been adopted in 121 countries globally, 34 of which ban the sale of ENDS (Argentina, Brazil, Brunei Darussalam, Cabo Verde, Cambodia, Democratic People’s Republic of Korea, Ethiopia, Gambia, India, Iran, Iraq, Jordan, Laos, Malaysia, Mauritius, Mexico, Nicaragua, Norway, occupied Palestinian territory, Oman, Panama, Qatar, Singapore, Sri Lanka, Suriname, Syria, Thailand, Timor-Leste, Turkey, Turkmenistan, Uganda, Uruguay, Vanuatu, and Venezuela) while 87 (45% of all countries) allow the sale of ENDS and either fully or partially regulate them, including bans in public indoor areas; bans on advertising, promotion, and sponsorship; health warnings on packaging, age restrictions on sales, and flavor bans.
The remaining 74 countries have no ENDS regulations in place, 7 countries fewer than in 2020 when 81 countries did not regulate ENDS in any way. Based on income levels, 85% of high-income countries have ENDS regulations or sales bans in place while 40% of middle-income and 79% of low-income countries have taken no regulatory action on ENDS. Twenty-two of the countries banning the sale of ENDS are middle-income nations, 7 are high-income nations, and 5 are low-income nations.