Smoking remains one of the main causes of illness and death in Spain. The individual and social costs associated with smoking are extremely high. Epidemiological and public health knowledge is extensive and detailed, since we began to study and understand its consequences in the 1950s. In other words, more than 70 years of scientific evidence. I recommend this video from the British Medical Journal. Nowadays, smoking is only a benefit for the big tobacco companies that are quickly adapting their business to the new generations and getting out of the previous regulations.

The Integral Plan on Smoking in Spain proposes five fundamental and simple points that would be a breakthrough to reduce the disease burden of smoking in our country: prevention, help to quit smoking, reduction of exposure, research and coordination of control. The adoption of this plan would undoubtedly be an advance in health and well-being for our country and its citizens, regardless of their autonomous community of residence. In the most advanced countries in the world, these recommendations have already been implemented by governments of all ideologies.

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.

The Spanish Society of Primary Care Physicians, SEMERGEN, welcomes the approval of the Comprehensive Plan for the Prevention and Control of Smoking, in the understanding that it will help, from a health, educational and regulatory point of view, to prevent tobacco consumption and, equally, will facilitate smoking cessation among smokers. We believe that this recently approved plan is also a success for scientific societies such as SEMERGEN, which for decades have been requesting and demanding regulatory and legislative actions to protect the health of citizens.

However, we regret that there has not been unanimous agreement in all the autonomous communities for all the lines addressed in the plan, and we therefore fear that its application could generate inequalities in the population as a whole.

The Spanish Society of Family and Community Medicine (semFYC), through the Programme of Preventive Activities and Health Promotion, PAPPS, and the Tobacco Control Group, is in favour of promoting all measures aimed at reducing the consumption of tobacco and its derivatives, as well as protecting the health of the population through a new Comprehensive Plan for the Prevention and Control of Smoking (PIT) 2024-2027.
Strategies aimed at increasing the price of tobacco by raising taxes, as well as banning smoking and vaping in certain outdoor community and social spaces, and in private spaces in the presence of minors, could be a significant step towards tackling a major public health problem. Similarly, from semFYC we want to emphasise the importance of expanding access to all evidence-supported treatments that help people to quit smoking.
From semFYC we hope that the autonomous communities will also promote initiatives aimed at tackling this major public health problem, without allowing political interests to hinder their progress towards improving public health.

From the semFYC we want to focus on the need that, as a society, we now have to update strategies for the prevention and control of smoking, as family doctors observe a decrease in the perception of the risk associated with smoking among young people, in many cases, linked to forms of consumption such as vaping, bongs or e-cigarettes. We consider it crucial to regulate these forms of consumption, which have become the main method of initiation to tobacco use among adolescents. According to surveys, nearly 50% of under-17s have experimented with vaping, compared to 38% who have tried cigarettes.

We at semFYC believe that it is essential to reach a broad social consensus to support the regulation of tobacco use and all related products.
Although prevention and treatment interventions should target all professionals in the health system, reality shows us that Primary Care is the most effective point of access for the majority of the population.

We appreciate that the competent administrations and managers take the initiative to carry out intelligent strategies to gain support from civil society, associations and health professionals, in the face of the various pressures that try to stop this initiative aimed at improving public health.

The approval of the Anti-Smoking Plan by the Ministry of Health is a significant step forward in the fight against one of the biggest causes of preventable death in Spain: smoking. The updating of this plan, which had remained unchanged for 14 years, demonstrates the Government's commitment to tackling this major public health problem.
The measures proposed in the plan are comprehensive and ambitious, ranging from preventing smoking to encouraging cessation and reducing environmental exposure to smoke. It is encouraging to see that concrete legislative actions are being considered, such as banning additives (flavourings and flavourings) in tobacco, increasing taxes on products and banning single-use devices.
Particularly notable is the focus on the protection of public and collective spaces, especially those frequented by minors, reflecting a concern for the health of future generations. The expansion of smoke-free environments for tobacco and related products is a positive measure that can help to reduce exposure to environmental tobacco smoke and to denormalise smoking in our society.
In addition, promoting research and working with local authorities to tackle the problem from different angles are important strategies to combat smoking in a comprehensive way.
In summary, the Anti-Smoking Plan is an important step in the fight against smoking in Spain and demonstrates a firm commitment on the part of the Government to protect the health of the population. It is essential that these measures are effectively implemented and that work on smoking prevention and control continues in order to achieve a healthier society.