Reacción a "Reactions: the Interterritorial Council gives the green light to the Comprehensive Smoking Plan"

In Spain, one in five people aged 15 and over still smoke daily. Tobacco use and exposure to environmental smoke cause the premature death of more than 50,000 people every year and a far greater number of cases of serious illness and avoidable suffering for both the people affected and their families. The number of smokers is slowly declining in our country - partly because society's protection against the onset of smoking in adolescence has improved and partly because many people are able to quit after a few years of smoking - but the burden of disease associated with smoking remains intolerably high.

Smoking contributes to increasing health inequalities. People with lower socio-economic or educational status smoke more and start smoking earlier than the rest of the population. Women who started smoking a few decades ago during their adolescence are beginning to show an increase in mortality from cancer and other tobacco-related diseases that until recently were more common among men. And some groups - such as the homeless, prison inmates or those suffering from various mental disorders - include particularly high proportions of smokers.

In the early years of the 21st century, the push for the Framework Convention on Tobacco Control by the World Health Organisation led to a cascade of international and national legislative measures that made it possible to pass the first Spanish tobacco law in 2005 and its major update in 2010. Despite the initial opposition of some of the pressure groups that usually oppose tobacco prevention and control measures, such as the sectors linked to the production and marketing of tobacco products and some organisations in the hospitality industry, the regulations developed almost two decades ago continue to have a very favourable impact on collective health and have not caused the negative economic consequences announced by the most critical voices.

Almost three years ago, a team led by the Ministry of Health, supported by technicians from the autonomous communities, drafted a Comprehensive Plan for the Prevention and Control of Smoking (PIT). The text was then revised to include the contributions of numerous scientific societies and different institutions of the General State Administration, and has finally been submitted these days to the assessment of different bodies of the Interterritorial Health Council. This last stage has been accompanied by leaks and statements focused on the measures that arouse most media interest, fuel partisan confrontation and activate different pressure groups, such as the ban on smoking in the open-air terraces of cafés and restaurants.

The adoption of measures to limit exposure to tobacco smoke and aerosols and related products is undoubtedly an effective strategy to protect the health of the population, although it will certainly require legislative initiatives in parliamentary chambers. Perhaps not enough attention has been paid to other lines of action included in the draft ITP which are at least as urgent, necessary and effective:

• Revision of taxation to increase the minimum price of tobacco. Currently the selling price of a pack of cigarettes in Spain is well below that of most of the countries around us and there is evidence that raising prices effectively reduces the onset of tobacco use in adolescence and encourages smoking cessation, without undermining public resources.
• Introduction of plain packaging. More than 20 countries around the world have already introduced this measure, which requires that all packs have a uniform outer appearance and that each brand is identified only by its name in a uniform font. Neutral cigarette packaging prevents cigarette packs from being advertising media and helps to reduce the onset of smoking in adolescence without producing the counterproductive effects announced by tobacco multinationals, such as an increase in smuggling.
• Updating regulations affecting some emerging products. The increase in the use of tobacco-related products among adolescents, such as electronic cigarettes, makes it advisable to reinforce control of their promotion and marketing, as they promote the initiation and progression of tobacco consumption and pose health risks.
• Development of communication campaigns to encourage smoking cessation and effective cessation support programmes. Information, advice and different therapeutic measures - behavioural and pharmacological - have been shown to be effective in helping to quit smoking and preventing the development of the diseases it causes.

As called for by the National Committee for the Prevention of Smoking and other social, scientific and professional health organisations, it is desirable that the political and institutional debate gives way as soon as possible to these urgent advances for public health.