Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries

Abstract

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Country Differences and Changes in Focus of Scientific Tobacco Control Publications between 2000 and 2012 in Europe

“…We could only identify 17 papers across the 4 study years (0.4% of total) on tobacco taxation, while this has been identified as the most effective tobacco control measure [19] . In Europe, attention has been drawn to the fact that socio-economic inequalities in smoking are widening [20,21]. This recognition is reflected in our finding that the number of research papers that have socio-economic disparities as a study topic increased from around 2% of the total scientific output in 2000 to 5% in 2012.…”

Changes Over Time in Absolute and Relative Socioeconomic Differences in Smoking: A Comparison of Cohort Studies From Britain, Finland, and Japan

“…These policies have likely contributed to the decline of smoking prevalence and may have prevented even larger socioeconomic differences than those observed. 50 Japan provides a divergent case as antismoking policies have been weaker or nonexistent, with prevalence levels among men as high as 55% in 1998 declining to 33% in 2012. 51 Our observations on British and Finnish men and women reconfirm the need for further measures that target smoking in general as well as the large and persistent socioeconomic differences.…”

The Decline in Stroke Mortality

“…New vigorous tobacco control policies in western Europe since the 1990s are likely to decrease tobacco exposure rates of generations that will reach old age in the mid-21st century. 24 Moreover, improvement in environmental and socioeconomic determinants such as the rising educational levels of generations born in the 20th century may contribute to continued declines in stroke incidence in the 21st century. 25 Further evidence to expect such a continued decline comes from a cohort analysis that we performed of the same mortality data and from which we concluded that the mortality declines persisted until the youngest generations, possibly due to improved environmental conditions in early life.…”