The May 31 annual World No Tobacco Day is time to take stock of what Ukraine is doing right and wrong in reducing smoking – an addiction that kills 130,000 Ukrainians prematurely from tobacco-related diseases each year, according to experts.
Ukraine joined the World Health Organization’s Framework Convention on Tobacco Control in September 2006, which was “developed in response to the globalization of the tobacco epidemic.” The treaty outlines a series of regulations surrounding the advertisement, distribution, production, and taxation of tobacco products.
Since then, Ukraine has implemented several laws and regulations in line with those of the FCTC and has witnessed the reduction of tobacco smoking from 28.3 percent in 2010 to 22.8 percent in 2017.
But Ukraine remains far from being smoke-free. Cigarettes remain cheap compared to neighboring countries, fueling smoking and illegal smuggling. A comprehensive approach to tobacco control is the proven solution to both problems.
“Tobacco control policies reinforce each other – you need to beat it with not just the fingers, but the whole fist,” Director of the Ukrainian Center for Tobacco Control Kostyantyn Krasovsky emphasized on tackling the tobacco epidemic.
Kristina Mauer-Stender, program manager at the WHO regional office for Europe, told the Kyiv Post that while “Ukraine is certainly one of the leading countries in terms of tobacco control in Europe… it’s not finished business.”
Global tobacco epidemic
According to the World Health Organization, tobacco kills more than eight million people worldwide per year. And while seven million of those deaths are the result of direct tobacco use, the figure doesn’t account for the 1.2 million deaths due to non-smokers’ exposure to second-hand smoke.
“It’s not a couple of years,” Mauer-Stender emphasized on the years lost to early deaths related to tobacco. “We hear that everybody has to die of something, but we’re talking about dying 15 to 20 years too early.”
Surveys in 2017 found that 23 percent of Ukraine’s adult population (15+) used tobacco products – a total of 8.2 million people.
Of those from the ages of 13-15, 14.9 percent reported using tobacco products, and 46.3 percent were not prevented from purchasing tobacco products at point of sale due to their age.
“There are too many people smoking. But it’s not a choice, it’s an addiction… we are talking about a tobacco epidemic,” Mauer-Stender said.
The FCTC in 2003 was the first treaty created under WHO auspices. Its aim is to “protect present and future generations from devastating health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke.”
The treaty was signed by 168 states, including Ukraine in 2004.
The FCTC realizes these aims through a series of collective standards, which involve both monetary and non-monetary regulations. Such standards include: taxes and pricing on tobacco products, the prohibition of smoking in public spaces, extensive restrictions at point of sale and product-labelling, controls against the tobacco-use of minors, and raising awareness surrounding the negative effects of tobacco.
“If we take one single policy to be the most effective, it is the tobacco taxation and pricing policy,” Mauer-Stender told the Kyiv Post. “However, at the FCTC and in tobacco control we talk about the comprehensive approach – you shouldn’t have one single policy, but a series of policies working together. This gives the best return on investment.”
Steps in right direction
Since 2006, Ukraine has implemented a series of tobacco control laws in line with those of the FCTC.
Regulations are in place that prohibit smoking in a range of public places; the advertising, marketing, and sponsorship of tobacco products is banned; there has been an increase in tobacco pricing via tobacco tax hikes; and tobacco product packaging is required to display extensive health warnings.
“In general, there’s a downward trend,” Krasovsky said of the prevalence of tobacco in Ukraine. “According to official figures from the State Statistics Service in 2008, there were about 10 million daily smokers in Ukraine. In 2018, it was something like 5.5 million… In 2008, 125 billion cigarettes were sold… In 2018, sales were at 56 billion cigarettes – twice less.”
The Global Adult Tobacco Survey compares tobacco-related statistics from Ukraine in 2010 and 2017, and reports that the “prevalence of current tobacco smoking significantly decreased.” The percentage of non-smokers that reported being exposed to second-hand smoke also decreased.
There is still, however, room for improvement.
What’s next?
Ukraine has yet to address elements of the FCTC, such as the display of tobacco products at point of sale and online, the regulation of tobacco contents and emissions, and the ratification of the elimination of illicit tobacco trade.
“The government should take this issue seriously,” Krasovsky said of tobacco control. “Last year, the government got 43 billion hryvnas from tobacco excises and spent zero hryvnas on tobacco control…it’s all done with international money. The government should be spending – it should be financed from the government budget. Cessation services need to be improved, and the Ministry of Health should be more active in tobacco control legislation and tobacco taxation.”
Mauer-Stender maintained that, while Ukraine has done good work with tobacco taxes, “at the same time, if you look at the price of tobacco, it’s still relatively cheap compared to other countries, and to the income of people. So we would encourage Ukraine to continue to take tobacco taxation super seriously, and to increase more taxes… once you get taxes up, consumption goes down.”
Her advice also extended to the critical regulation of electronic cigarettes which, while not explicitly a tobacco product, are increasingly targeted towards women and children – as well as previous non-smokers. This alternative product with colorful advertising, flavoring, and lack of regulation poses a risk.
Ukraine has made significant progress, but it remains critical to spread awareness surrounding the negative consequences of tobacco products, and to maintain and develop rigorous regulations surrounding tobacco control.
“I have worked in tobacco control for more than 20 years, and we have experienced great successes and great failures. I always expect that the next government and next parliament will always be better than the previous one, but this doesn’t always happen,” Krasovsky said of the new administration’s approach to tobacco control.
