As we all know the European Union (EU) has established a comprehensive tobacco control framework aligned with the WHO Framework Convention on Tobacco Control (WHO FCTC). All this happens because tobacco use remains a major public health concern across the EU, contributing significantly to the burden of non-communicable diseases (NCDs). The overview of the current state of tobacco control in the EU, outlining trends in prevalence, key legislative milestones, implementation of the MPOWER package and EU-supported collaboration and research (1), published recently, remains an important tool to evaluate the progress/regress realised in this domain by our country.
We have to go back to 2023, when the EU marked the 20th anniversary of signing the WHO FCTC, reaffirming its commitment to reducing the health and societal burden of tobacco use. In this 20 years, tobacco remains high in many EU Member States, with significant disparities between them and in the same time electronic cigarettes, heat not burning tobacco and nicotine pouches uptake particularly among adolescents – has increased sharply, often outpacing adult use. It remains the continued interference of the tobacco industry trying to delay the improvement of legislative instruments. For achieving the goals of a ‘Tobacco-Free Generation by 2040’, as outlined in ‘Europe’s Beating Cancer’, many steps are still needed and the target seems difficult to be reached in time. If we look back, we observe that after 2003 (the moment when David Byrne the Health and Consumer Protection Commissioner of the European Communities signed the WHO FCTC) (2) despite important achievements, tobacco use in the EU remains high and continues to be one of the most significant public health threats, contributing substantially to the burden of NCDs. The overview of the current state of tobacco control policies in the EU, 20 years after the WHO FCTC entered into force, was a good opportunity to analyse also the position of Romania in this fight. Starting with the prevalence of smoking in the age group of 15 years and older, we can observe that in our country it is over the average of the EU level (30% vs 26.5%) (3). When it comes to youth, data from the ‘European School Survey Project on Alcohol and Other Drugs’ (ESPAD) show substantial variation in current cigarette smoking across EU Member States (4). Current smoking in 2024 (current cigarette use – smoking in the past 30 days) is more prevalent among girls in over half of the Member States, with the widest gender gaps in Bulgaria (+9 percentage points [PP]) and Romania (+8 PP) (4). Also, if are looking at daily smoking, Romania is on frontline with the highest prevalence in 2024 recorded in Bulgaria (19.8%), Croatia (19.6%), Hungary (19.1%) and Romania (15.8%) (4). Conversely, with the lowest prevalence are Sweden (1.8%) and Ireland (2%). Another issue is the current e-cigarette use in EU countries. Since 2019, prevalence has increased in 22 of 25 countries, and in every country, girls report higher use than boys. The largest increases were observed in Croatia (+20 PP), Slovenia (+18 PP), Greece (+16 PP), Romania (+15 PP) and Austria (+14 PP) (4). The largest gender gaps were recorded in some countries. Again, we can find Romania (+11 PP) on this list after Sweden (+13 PP) and Bulgaria (+12 PP) (4). Looking at all this data, it is not surprising that Romania is also on the map of the highest premature NCD mortality rates due to tobacco use, registered among males, together with other countries with noted rates exceeding 100 per 100,000 population among males, after Croatia, Czechia, Greece, Hungary, Latvia, Lithuania, Poland and Romania (5). All these countries figure with mortality rates exceeding those from cardiovascular disease by more than threefold: 17.60 and 5.67 per 100,000 population, respectively (5). These assessments are also linked to smoking control measures. Romania does not excel here. Tobacco control law was frozen in 2016. The ‘Stop Smoking Program’ is dying. Tax hike faces opposition from the tobacco industry. That is why, if we are looking at the cost of a 20-cigarette pack, it varied in 2024 (the price ranged from 6.82 international dollars in Bulgaria to 22.43 international dollars in Ireland); cigarettes have become more affordable since 2014 in Romania alongside 14 other countries (Bulgaria, Croatia, Cyprus, Estonia, Ireland, Latvia, Lithuania, Malta, Poland, Portugal, Slovenia, Spain and Sweden). All these negative signals should be considered by the Romanian authorities and those responsible for medical strategies in the country. To talk about advancing the EU’s Tobacco-Free Generation goal through national tobacco endgame strategies remains an objective still far away for our country at this moment. The road ahead demands renewed commitment, innovation and vigilance. Other proposals from the EU commission and the WHO Regional Office for Europe are as follows:
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a strong need to revise tobacco control legislation;
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to safeguard policymaking processes from commercial interests;
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limiting interactions with the tobacco industry to those strictly necessary for regulation;
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ensuring full transparency;
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avoiding partnerships and non-binding agreements;
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rejecting so-called corporate social responsibility activities;
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preventing and managing conflicts of interest.