WHO report on

the global tobacco

epidemic, 2023
Protect people from tobacco smoke

fresh and alive

WHO report on
the global tobacco
epidemic, 2023
Protect people from tobacco smoke

fresh and alive

Made possible by funding from
Bloomberg Philanthropies

|i
WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke

ISBN 978-92-4-007716-4 (electronic version)

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ii | WHO report on the global tobacco epidemic 2023

| iii
iv | WHO report on the global tobacco epidemic 2023
Second-hand tobacco
smoke kills 1.3 million
non-smokers a year.

|v
vi | WHO report on the global tobacco epidemic 2023
 Smoke-free
environments save
lives and benefit
businesses and
economies.

| vii
viii | WHO report on the global tobacco epidemic 2023
Les enfants et les
adolescents qui
utilisent des inhalateurs
électroniques de nicotine
Effective smoke-free
sont
lawsjusqu’à deux fois plus
are comprehensive
susceptibles de fumer des
and enforced.
cigarettes.

| ix
m Monitor tobacco use and prevention policies

p Protect people from tobacco smoke

o Offer help to quit tobacco use

w Warn about the dangers of tobacco

e Enforce bans on tobacco advertising, promotion and sponsorship

r Raise taxes on tobacco

 The general public
supports smoke-free
measures.

| xi
Contents

xv Foreword by Dr Tedros Adhanom Ghebreyesus, WHO Director-General

xvii Foreword by Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases
xix Foreword by Dr Rüdiger Krech, Director, Department of Health Promotion, WHO
xxi Foreword by Dr Adriana Blanco Marquizo, Head of the WHO FCTC Secretariat

Acknowledgements xxii
Abbreviations xxiii
Summary xxiv
1. The WHO FCTC and the Protocol to Eliminate Illicit Trade in
Tobacco Products 1
2. 15 years of MPOWER progress 7
3. Smoke-free environments: protect people from tobacco smoke 16
4. Tobacco industry interference: Protecting people from tobacco
and related industries 34
Mauritius – an MPOWER success story 40
The Kingdom of the Netherlands: making MPOWER history 42

5. Effective tobacco control measures 45

Monitoring tobacco use and prevention policies 46
Protect people from tobacco smoke 51
Offer help to quit tobacco use 61
Warn about the dangers of tobacco 66
Enforce bans on tobacco advertising, promotion and sponsorship 75
Raise taxes on tobacco 81
National tobacco control programmes 89
Electronic nicotine delivery systems 93

6. Conclusion 100
References 103
Technical note I Evaluation of existing policies and compliance 114
Technical note II Tobacco use prevalence in WHO Member States 122
Technical note III Tobacco taxes in WHO Member States 124
Annex 1 Regional summary of MPOWER measures 133
Annex 2 Regional summary of smoke-free measures 147
Annex 3  Year of highest level of achievement in selected tobacco
control measures 185
Annex 4  Highest level of achievement in selected tobacco control measures in
the 100 biggest cities in the world 199
Annex 5  Status of the WHO Framework Convention on Tobacco Control
and of the Protocol to Eliminate Illicit Trade in Tobacco Products 205
 “The steadfast progress demonstrated by countries over
these years is a testament to what can be achieved when
a clear global health vision is combined with committed
global partnership.”
Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

xiv | WHO report on the global tobacco epidemic 2023

Foreword
5.6 billion people, 71% of the world population, are now
protected by at least one MPOWER measure.

It has been 20 years since the adoption This report focuses on smoke-free Tobacco continues to be one of the top
of the WHO Framework Convention on environments, a measure that aims preventable causes of premature deaths
Tobacco Control (WHO FCTC) and 15 to protect people from second-hand and it is the only commercial product
years since the introduction of MPOWER, smoke. Every year 1.3 million non- that kills half its users when used exactly
the technical package designed to help smokers die from exposure to as intended. The past two decades
countries implement the Convention. second-hand smoke. Smoke-free provide us with rich lessons on how to
The steadfast progress demonstrated public environments not only address this global health threat – we
by countries over these years is a protect bystanders but can also must act now to save lives and stop the
testament to what can be achieved help de-normalize the act of smoking spread of this preventable killer.
when a clear global health vision is across society.
combined with committed global
In 2008, only 5% of the world’s
partnership.
population was covered by
MPOWER provides cost-effective comprehensive smoke-free laws, but
demand-reduction measures to help today over one quarter of the world’s
countries reduce tobacco consumption. population is covered. Countries
Since MPOWER was introduced globally that have not yet done so should ban
15 years ago, an estimated 300 million smoking in all indoor public spaces,
less people are smoking than might workplaces and public transport in line
have been if smoking prevalence had with Article 8 of the WHO FCTC, backed Dr Tedros Adhanom Ghebreyesus
stayed the same. by enforcement mechanisms. Director-General
The number of countries that have But progress so far is being undermined World Health Organization
adopted at least one MPOWER measure by the tobacco industry’s aggressive
at the highest level of achievement promotion of E-cigarettes as a safer
has grown from 44 in 2008 to 151 in alternative to cigarettes. Young people,
2022. However, 44 countries remain including those who never previously
unprotected by any of the MPOWER smoked, are a particular target. In fact,
measures. It is crucial that tobacco E-cigarettes are harmful to both the
control continues to be a global people using them and those around
health priority. them, especially when used indoors.

“In 2008, only 5% of the world’s population was covered by

comprehensive smoke-free laws, but today over one quarter
of the world’s population is covered.”

Foreword | xv
 “Smoke-free laws shield the public from cancer, heart
disease and other deadly effects of inhaling tobacco
smoke. They also help encourage smokers to quit – and
they discourage others, especially young people,
from ever starting.”
Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases
Founder of Bloomberg Philanthropies

xvi | WHO report on the global tobacco epidemic 2023

Foreword
Latest WHO report on the global tobacco epidemic sets out
15 years of meaningful progress around the world and
highlights that much more remains to be done.

For the past 15 years, Bloomberg Over the next decade, the number As the tobacco industry finds new ways
Philanthropies has partnered with the of restaurants and bars in New York to push its deadly products, we must
World Health Organization to combat City, and the number of people they push back harder than ever – and we
tobacco use and prevent related illnesses. employed, grew by nearly 50%. At are. National and local governments
According to the best estimates, these the same time, an estimated 10 000 continue to lead the fight and protect
efforts have saved more than 35 million fewer New York City residents died their citizens against the tobacco
lives. Much of that success is attributable prematurely due to smoking – proving industry. And Bloomberg Philanthropies
to the spread of MPOWER tobacco that when it comes to public health and is strongly committed to curbing
control policies, which now protect more economic growth, governments aren’t tobacco use in low- and middle-income
than 5.6 billion of the world’s 8 billion facing an either/or proposition. The two countries and reducing e-cigarette use
people. Since this work began in 2007, go hand-in-hand. among teenagers in the United States
107 countries have adopted at least one of America.
Today, 74 countries have smoke-free
MPOWER policy at best-practice level.
policies that cover all indoor places, This report recognizes the hard-fought
One of the most effective elements of up from just 10 in 2007. And in 2020, progress that all of us, working together
the MPOWER strategy is “P” – protect 16 years after Ireland became the first with the World Health Organization, are
people from tobacco smoke through country to pass a smoke-free law, the making – and it highlights how much
smoke-free laws, which is the focus of entire continent of South America more remains to be done. I hope it will
this report. Smoke-free laws shield the became smoke-free. In addition, inspire others to join us.
public from cancer, heart disease and countries including Brazil, Mauritius,
other deadly effects of inhaling tobacco Netherlands (Kingdom of the) and
smoke. They also help encourage Türkiye are setting new global standards
smokers to quit – and they discourage for tobacco control, adopting all six
others, especially young people, from MPOWER measures at the highest
ever starting. possible levels.
When New York City enacted the It’s clear that our work is getting
Smoke-Free Air Act in 2003, we saw the results, but too many lives remain
incredible success of such laws first- at risk. Smoking is still the leading
hand. The law banned smoking in all cause of preventable death in the Michael R. Bloomberg
indoor workplaces, including bars and world. Not enough countries are WHO Global Ambassador for
restaurants, and protected every New implementing MPOWER cessation Noncommunicable Diseases and Injuries
Yorker’s right to breathe clean air. Critics and tobacco taxation policies. And Founder, Bloomberg Philanthropies
– and there were many – argued the ban the tobacco industry is relentless,
would scare away visitors and decimate both in its opposition to tobacco
the hospitality industry. They couldn’t control legislation and its targeting
have been more wrong. of teens and children with e-cigarettes
and other heated-tobacco products.

“As the tobacco industry finds new ways to push its deadly
products, we must push back harder than ever – and we are.
National and local governments continue to lead the fight and
protect their citizens against the tobacco industry.”

Foreword | xvii
 “All people have a fundamental right to breathe clean
air and governments are obliged to protect everyone’s
health as a fundamental human right.”
Dr Rüdiger Krech, Director, Department of Health Promotion
World Health Organization

xviii | WHO report on the global tobacco epidemic 2023

Foreword
Seventy-four countries are now covered by comprehensive
smoke-free measures.

This ninth WHO report on the global The tobacco and related industries We can do so much more to protect
tobacco epidemic demonstrates the would have people, and especially everyone from the harms of tobacco
remarkable progress of many countries business owners, believe that smoking and second-hand smoke.
in adopting health-promoting policies bans are detrimental to tourism and
and reducing tobacco use – a risk the hospitality industry. This is not true
factor that kills an astounding 8.7 – this myth has been debunked over
million people every year. And even and again. When effectively enforced,
more shocking is that 1.3 million of businesses have been shown to thrive
these deaths are among people who and the public, including smokers
do not use tobacco, including infants themselves, support, and even play a
and children. Women and children in role in enforcing, smoke-free measures.
particular are vulnerable to
This brings to light the progress
second-hand smoke exposure.
the world has seen in the adoption Dr Rüdiger Krech
This is why smoke-free environments and implementation of smoke-free Director,
are so important. All people have a environments, and acts as a spur to Department of Health Promotion
fundamental right to breathe clean accelerate this progress. It was difficult World Health Organization
air and governments are obliged to imagine 20 years ago that as many as
to protect everyone’s health as a half of all countries would have smoke-
fundamental human right. Smoke-free free laws already in place to protect
environments save lives by reducing people in restaurants and bars. These
exposure to second-hand smoke as measures are working but cannot be
well as by bringing about changes in taken for granted. With the advent of
social norms. When smoking bans new and emerging products, some
work, private spaces are more likely to of which are marketed to undermine
become smoke-free, more smokers are smoke-free environment laws already
motivated to quit and fewer children are in place, where they are not banned,
tempted to try smoking. countries must stand strong and ensure
appropriate regulation of e-cigarettes
and heated tobacco products is firmly
in place.

“When smoking bans work, private spaces are more likely to

become smoke-free, more smokers are motivated to quit and
fewer children are tempted to try smoking”

Foreword | xix
 “Since the Convention’s entry into force in 2005,
there has been significant progress, with 74 countries
now completely smoke-free in all indoor public and
workplaces, up from 10 in 2007. But we are far from
universal implementation of Article 8.”
Dr Adriana Blanco Marquizo, Head of the WHO FCTC Secretariat

xx | WHO report on the global tobacco epidemic 2023

Foreword
Today, the Protocol has increased its number of Parties to
a total of 66.

The Secretariat of the WHO Framework Since the Convention’s entry into force Smoke-free environments – together
Convention on Tobacco Control (WHO in 2005, there has been significant with highly visible health warnings on
FCTC) and its protocols welcome progress, with 74 countries now tobacco packaging about the effects
publication of the WHO report on the completely smoke-free in all indoor of tobacco consumption – are basic
global tobacco epidemic, 2023. public and workplaces, up from 10 measures to ensure that people are
countries in 2007. But we are far from not exposed to avoidable risks in
This latest edition of the report – the
having universal implementation of public spaces and workplaces and
ninth in the series – focuses on the “P”
Article 8. that tobacco users are aware of the
in the MPOWER measures – protect
consequences of such consumption.
people from tobacco smoke through Guidelines for implementation of
These measures enjoy wide acceptance
smoke-free environments. Some 1.3 Article 8 of the Convention, the first set
among populations, are not costly,
million people die annually and many of guidelines adopted by the Conference
and demonstrate a positive return on
more become sick from the effects of of the Parties (COP) to the WHO FCTC in
investment. Most importantly, they
exposure to second-hand smoke and the 2008, set out the ways in which Parties
save lives.
scientific evidence is clear: there is no can meet their obligations in this area,
safe level of second-hand smoke. through evidence-based measures and
Party experience, key means for tobacco
Article 8 of the WHO FCTC recognizes
control improvements. The Guidelines
that “scientific evidence has
urge Parties to strive for universal
unequivocally established that exposure
protection within 5 years of entry into
to tobacco smoke causes death, disease
force of the Convention for the Party.
and disability” and requires Parties
to adopt and implement measures Furthermore, the Eighth session of the
“providing for protection from exposure Conference of the Parties to the WHO
to tobacco smoke in indoor workplaces, FCTC adopted the Global Strategy to
public transport, indoor public places Accelerate Tobacco Control 2019–2025 Dr Adriana Blanco Marquizo
and, as appropriate, other public in order to advance sustainable Head of the WHO FCTC Secretariat
places”. development through WHO FCTC
implementation. Goal 1 of the Strategy
calls for implementation of the time-
bound measures, including Article 8.

“The scientific evidence is clear: there is no safe level

of second-hand smoke.”

Foreword | xxi
Acknowledgements
The World Health Organization Hebe Naomi Gouda coordinated the Other aspects of report were
gratefully acknowledges the production of this report. greatly enriched by inputs from Phil
contributions made to this report by the Chamberlain, Anna Gilmore, and Allen
Marine Perraudin was responsible for
following individuals. Gallagher from the University of Bath,
the country legislation assessment and
the United Kingdom of Great Britain and
WHO African Region analysis.
Northern Ireland (the United Kingdom),
Esther Njinembo Nayeu, Nivo
Alison Commar provided data as well as Jorge Alday and Tracey
Ramanandraibe, Joseph Saysay,
management and data analysis, Johnston from Vital Strategies, the
Noureiny Tcha-Kondor.
and created the tables, graphs and United States.
WHO Region of the Americas appendices. Prevalence estimates
WHO thanks Jennifer Ellis, Kelly
Adriana Bacelar Gomes, Sehr Malik, were calculated by Alison Commar in
Henning, Veronica Lewin, Adrienne
Maxime Roche, Rosa Sandoval, Luciana collaboration with Edouard Tursan
Pizatella, Ben Ramirez of the Bloomberg
Severini, Kavita Singh, Tatiana Villacres. d’Espaignet, with data support from
Initiative to Reduce Tobacco Use, the
Rula Cavaco Dias.
WHO South-East Asia Region United States, for their collaboration.
Jagdish Kaur, Arvind Rinkoo. Simone St Claire was responsible for the
WHO also thanks the WHO GIS Centre for
collection and coordination of the mass
WHO European Region Health for providing the maps.
media data.
Angela Ciobanu, Elizaveta Lebedeva.
WHO would also like to thank Vital
Dongbo Fu assessed the data on
WHO Eastern Mediterranean Region Strategies, the United States, for
tobacco cessation.
Fatimah El-Awa, Radwa El-Wakil, Heba their advice on tobacco control mass
Fouad, Aya Mostafa Kamal Eldin. Analysis of the economics of tobacco, media campaigns, specifically Nandita
including tobacco taxation and prices, Murukutla and Rebecca Perl. Special
WHO Western Pacific Region
was provided for this report by Anne- thanks also to the Campaign for Tobacco
Melanie Aldeon, Mina Kashiwabara,
Marie Perucic with support from Itziar Free Kids, especially Deniece Carrington,
Ada Moadsiri, Xi Yin.
Belausteguigoitia, Mark Goodchild, Kaitlin Donley and Monique Muggli for
WHO Country Offices Maxime Roche and Michal Stoklosa. their constructive exchange of tobacco
We gratefully acknowledge the Tax and price data were collected with control information and legislation.
invaluable input and expertise support from officials from Ministries of Thanks also to Rob Cunningham from
contributed by all our WHO Country Finance and Ministries of Health, and by the Canadian Cancer Society, Canada,
Office colleagues across all six WHO Luk Joossens. Additional support was for exchanging information on health
regions, which has been instrumental also provided for analysis or specific warning labels.
in enhancing the data collection and country data input by Laura Rossouw,
Rüdiger Krech and Vinayak Prasad
verification processes. Rose Zheng, and the University of Illinois
reviewed the full report and provided
Chicago Tobacconomics, United States
WHO Headquarters Geneva final comments.
of America (the United States).
Virginia Arnold, Douglas Bettcher,
Production of this WHO document
Melanie Cowan, Roshan Dauhary, The chapter on the Framework
has been supported by a grant from
Ranti Fayokun, Jaimie Guerra, Convention on Tobacco Control was
Bloomberg Philanthropies. The
Caroline Hartanto, Kritika Khanijo, drafted by Douglas Bettcher and Juliette
contents of this document are the sole
Benn McGrady, Jeremias Paul, McHardy in collaboration with WHO
responsibility of WHO and should not
Leanne Riley, Susannah Robinson, FCTC Secretariat.
be regarded as reflecting the position
Kerstin Schotte.
The chapter on smoke-free of Bloomberg Philanthropies.
WHO would also like to thank the many environments was prepared with
representatives of the Ministries of invaluable inputs from Indu Ahluwalia,
Health and Ministries of Finance globally Jawad Al Lawati, Esteve Angel
that have taken the time to support Fernandez Munoz, Jasper V Been,
our data collection and validation Deniece Carrington, Annette David,
processes. Jeff Drope, Gül Ergör, Ryan Kennedy,
Anthony Laverty, Lazarous Mbulo,
Special thanks to Adriana Blanco Marela Minosa, Matt Myers, Armando
Marquizo, Liu Guangyuan, Mitchel Peruga, Gan Quan, Yolanda Richardson,
Lara and Kelvin Khow Chuan Heng, Ernesto Sebrie, Nichole Veatch, Kathy
WHO Framework Convention on Wright.
Tobacco Control Secretariat, for their
contributions to the WHO Framework
Convention on Tobacco Control chapter,
as well as for their overall contributions
and comments on the draft.

xxii | WHO Report On The Global Tobacco Epidemic 2023

Abbreviations
COP Conference of the Parties
DSR designated smoking room
ENDS electronic nicotine delivery systems
ENNDS electronic non-nicotine delivery systems
GATS Global Adult Tobacco Survey
GYTS Global Youth Tobacco Survey
HTP heated tobacco product
MOP Meeting of the Parties to the Protocol
NCD noncommunicable disease
SDGs Sustainable Development Goals
SHS second-hand smoke
TAPS tobacco advertising, promotion and sponsorship
THS third-hand smoke
TII tobacco industry interference
WHO World Health Organization
WHO FCTC World Health Organization Framework
Convention on Tobacco Control

© WHO/NOOR Sebastian Liste

xxiii
 Summary
With over 8 million tobacco-related The number of countries with one or While progress has been steady since
deaths a year, tobacco use continues more MPOWER measure in place has 2007, the pace has certainly slowed
to be one of the biggest public health more than tripled since 2007 – from since 2018. Since 2020, five countries
threats and tobacco control remains 44 to 151 countries, and the number that previously had no best-practice
a global health priority. This is the of countries with two or more MPOWER measures in place (Cabo Verde,
ninth WHO report on the global tobacco measures in place has increased almost Myanmar, Nicaragua, Sudan and
epidemic and the fifteenth year since 10-fold – from 11 to 101 countries Zambia) have reached the highest
MPOWER was introduced as a technical (Fig. 2). Forty-eight countries have at level of achievement on one or more
package designed to help countries least three policies in place, covering measures. All five countries are low-
implement the demand-reduction 1.5 billion people (see Annex 1). or middle-income countries.
measures of the WHO Framework
Of the 44 countries that have not
Convention on Tobacco Control. This
yet reached the highest level of
report shows that, in 2022, more than
achievement (or best-practice level,
5.6 billion people – 71% of the world’s
meaning they have achieved the criteria
population – were covered by at least
as described in Technical Note 1) for any
one MPOWER measure implemented
MPOWER measure, 31 are just one level
at the highest level (Fig. 1).
away from best-practice for one or more
of their MPOWER measures.

5.6 billion people, over 70% of the world’s population,

are now covered by at least one MPOWER measure at
the highest level of achievement.

Fig. 1. At least one MPOWER measure at highest level of achievement (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7
151
146
6 140 150
Population protected (billions)

125 5.6
Number of countries

5.5
5 5.3
108 5.1

4 93 100
76
3
56 3.0
44 2.5
2 2.3 50
1.8
1
1.1

0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

xxiv | WHO report on the global tobacco epidemic 2023

 15 years since monitoring MPOWER
Smoke-free measures must progress began, almost 2 billion Eight countries are only
be scaled up to protect people have been newly protected one measure away from
by laws mandating 100% smoke-free
people from a major cause environments. achieving all MPOWER
of health burden Despite the evidence demonstrating measures at the highest
Protecting people from tobacco smoke
that designated smoking areas or rooms level of achievement
(DSRs) do not help to protect people
– the “P” of the MPOWER measures –
in public indoor areas, 71 countries Of the 101 countries now covered by at
is the focus of this ninth WHO report
continue to allow them in many venues, least two MPOWER measures, 36 have
on the global tobacco epidemic and
and especially in hospitality-based three measures at the highest level of
is a crucial component of the MPOWER
venues such as restaurants, bars achievement, and eight countries
package. Smoke-free measures in public
and cafés. Simply by removing these have four measures at the highest
indoor areas are highly cost-effective
provisions, 39 of these countries would level of achievement (Ethiopia,
interventions that not only protect
immediately achieve best-practice the Islamic Republic of Iran, Ireland,
non-smokers from the many dangers
status. Jordan, Madagascar, Mexico, New
of second-hand tobacco smoke but
Zealand and Spain). Meanwhile, the total
also “denormalize” the act of smoking Reported compliance is highest
number of countries that have adopted
and can increase smokers’ motivation in health care and educational
all of the MPOWER measures at best-
to try to quit. facilities and lowest in pubs, bars and
practice level has increased by two since
cafés, followed by universities and
Complete smoke-free indoor public the last report, which sees Mauritius
restaurants (see Annex 2.1–2.3). To
places, workplaces and public transport and the Netherlands (Kingdom of the)
ensure compliance, countries must
now cover 2.1 billion people living in welcomed to this rank achieved by Brazil
ensure enforcement mechanisms are
74 countries. This is a seven-fold and Türkiye (see Annex 3, Annex 4).
established and followed. While almost
increase since 2007 and means that
all countries (87% or 170 countries)
smoke-free environments comprise
prescribe fines for violations of smoking
the second most adopted MPOWER
bans, less than one third of countries
measure in terms of the number
have dedicated funds for enforcement.
of countries covered. Over the

Fig. 2. At least two MPOWER measures at highest level of achievement (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7

6 150
Population protected (billions)

Number of countries

5
100 101

4 100
84
71
4.2 4.2
3 3.6
46 3.3
2 37 50
26
1 15 1.4
11 1.1
1.0
0.5 0.5
0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

Summary | xxv
 Over the last 15 years, the number of countries covered by
comprehensive smoke-free environments has increased
from 10 in 2007 to 74 in 2022.
High-income countries are lagging when Six countries have reached best-
More than two billion people it comes to reaching best-practice on practice level since 2020, covering an
remain unprotected by any TAPS bans, with only 15 out of 60 high- additional 260 million people. Although
income countries reaching this level this measure is adopted by very few
of the MPOWER measures (25% of all high-income countries). By countries, these countries are home
at best-practice level contrast, 38 out of 106 middle-income to more than one third of the world’s
countries (36%) and 13 out of 28 low- population, making it the second most
All countries can adopt and implement income countries (46%) have achieved adopted MPOWER measure in terms of
comprehensive tobacco control best-practice level. population covered.
policies to prevent the immense burden Graphic health warning policies at the Monitoring tobacco use, unfortunately,
imposed by tobacco use and exposure highest level of achievement have been continues to be significantly hampered
to second-hand smoke. Yet, in 2022, adopted by 103 countries. This means by the COVID-19 pandemic. Data
44 countries had not yet adopted that more than 4.5 billion people collection efforts were hindered
a single MPOWER measure at best- (or 57% of the world’s population) in many countries during 2020 to
practice level, leaving 2.3 billion people are now protected by large graphic pack 2022, as was the release of results
vulnerable to the harms of tobacco. warnings featuring all recommended for surveys completed before and
characteristics, making it the MPOWER during the pandemic. A total of 74
measure with both the highest countries achieved the highest level of
population coverage and the largest achievement for monitoring tobacco use
Progress in tobacco number of countries covered. It is also in 2022, down from a peak of 82 in 2014.
important to note that by the end
control continues but of 2022, 22 countries had adopted
While raising prices through taxation
is the most effective way to reduce
must be accelerated legislation mandating plain packaging
tobacco use, this measure has been
for tobacco products and had issued
In 2022, the MPOWER measure that saw slow to progress. A large increase
regulations with implementation
the most progress was banning tobacco in population coverage by this measure
deadlines. A handful of other countries
advertising, promotion and sponsorship was observed between 2016 and 2018
have required plain packaging by
(TAPS), with seven countries reaching (from 8% in 2016 to 13% in 2018), but
law but have not yet issued rules for
the highest level of achievement, since then, the proportion of the world’s
implementation.
covering a population of 246 million population protected by taxes at best-
additional people since 2020. Although Few countries have policies on cessation practice level has dropped slightly to
TAPS bans remain an under-adopted services, with only 32 countries 12% in 2022. Fig. 3 shows the overall
measure, almost 2 billion people in providing such services at best-practice status of selected tobacco control
66 countries are now covered. level, covering almost 2.8 billion people. policies globally.

Fig. 3. The state of selected tobacco control policies in the world, 2022

1
100% No known data, 100% 9 Data not
or no recent data reported
90% or data that are
90% 29 41 40
45 22
not both recent
and representative
53 No policy or
weak policy
80% 80%
(Number of countries inside bars)

(Number of countries inside bars)

Recent and 29
Proportion of countries

Proportion of countries

Minimal
representative data 24 112 53
70% for either adults or 70% policies
adolescents
60% 61 60% 44 Moderate
27 policies
Recent and 89
representative data
50% for both adults and 50% Complete
adolescents policies
15 24 104
40% Recent, representative
40% 16 69 Refer to Technical
and periodoc data for Note I for category
30% both adults and 30% definitions.
adolescents 103 31
20% 74 20% 74 Note: Brunei
66 Darussalam
is excluded from R
10% Refer to Technical Note I
10% 32 36 41 because no retail
sale of cigarettes or
for category definitions. renewal of cigarette
0% 0% import licenses
M P O W E R have been reported
Monitoring Smoke-free Cessation Pack Mass Advertising Taxation since May 2014.
environments programmes warnings media bans

xxvi | WHO report on the global tobacco epidemic 2023

 Only 23 countries comprehensively
Countries across the world Two billion people are ban the advertising, promotion and
continue to adopt MPOWER still unprotected by any sponsorship of both ENDS devices and
e-liquids. An additional five countries
measures at a steady pace regulatory restrictions apply these bans only to the devices,
Each MPOWER measure has been
on electronic nicotine while three countries apply them only
to the e-liquids.
newly adopted at best-practice level delivery systems (ENDS)
by additional countries since 2020.  ENDS marketing targets children and
The previous WHO report on the global young people through a number of tactics,
■ Three countries (Belarus, El Salvador tobacco epidemic showed how MPOWER including making ENDS available with
and Mauritius) improved monitoring measures could be applied to ENDS many enticing flavours. Astonishingly,
to best-practice level. and called on countries to regulate very few countries have measures in place
■ Five countries (Kyrgyzstan, ENDS to protect their populations. to protect children from ENDS. Only four
Mauritius, Mexico, Netherlands This new report highlights the fact that countries now ban all flavours while nine
(Kingdom of the), and Ukraine) newly 121 countries regulate ENDS in some others restrict or allow specific flavours,
adopted complete smoke-free laws way. Thirty-four of these countries and 88 countries, covering a population of
covering all indoor public places, (covering 2.5 billion people) ban the sale 2.3 billion people, have no minimum age
workplaces and public transport. of ENDS, and the other 87 countries have at which ENDS may be purchased.
adopted (partially or completely) one or
■ Six countries (Ethiopia, Iran (Islamic more legislative measures to regulate
Republic of), Israel, Mauritius, ENDS, covering 3.3 billion people.
Romania and Zambia) advanced to The current regulatory options taken
best-practice level with their tobacco by 87 countries include a wide range
15 years of MPOWER have
use cessation services. of measures with no globally common made a major impact on
■ Two countries (Benin and Myanmar) approach to address these products. global tobacco control
adopted large graphic pack warnings. Seventy-four countries (seven fewer Since 2007 and the launch of the
■ Seven countries (Cabo Verde, than in 2020) still have no ENDS ban MPOWER technical package, all MPOWER
Kyrgyzstan, Lao People’s Democratic or regulations in place, leaving over measures have made notable progress.
Republic, Mexico, Netherlands 2 billion people particularly vulnerable Fig. 4 illustrates how graphic health
(Kingdom of the), Sudan and to the activities of the tobacco and warnings have made the most progress
Ukraine) introduced comprehensive related industries. compared with the other measures,
bans on tobacco advertising, Particularly relevant to smoke-free protecting an additional 52% of the
promotion and sponsorship, environments, only 42 countries world’s population since 2007, while
including at point-of-sale. completely ban the use of ENDS in all offering cessation services, successfully
indoor public places, workplaces and adopted in some populous countries
■ Four countries (Australia, Lithuania,
public transport (although this is an like India, is second with an additional
Nicaragua and Vanuatu) moved to
improvement on the 36 countries with 30% of the global population protected
the best-practice group by levying
the presence of such bans in 2020). since 2007. Tobacco taxation has been
taxes that comprise at least 75% of
the slowest measure to progress, with
retail price.
only an additional 5% of the population
covered in the last 15 years.

Fig. 4. Increase in the world population covered by selected tobacco control policies, 2007a to 2022

60%

50%
Share of world population

2022
40%
25% −13% b 2007
30% 52%

20% 30%
24% 32% 22%
10% 24% 5%
3% 5% 5% 3% 7%
0%
M P O W E R
Monitoring Smoke-free Cessation Pack Mass Advertising Taxation
environments programmes warnings media bans
a 2010 for W mass media, 2008 for R taxation. b The share of the world's population covered by mass media campaigns decreased since 2010.

Summary | xxvii
 Four countries have now achieved the full MPOWER
package at best-practice level, and a further eight
countries need only to attain one more measure
before they have the full MPOWER package.

© WHO/Alasdair Bell

xxviii | WHO report on the global tobacco epidemic 2023

1. The WHO FCTC and the Protocol
to Eliminate Illicit Trade in Tobacco
Products
The Protocol provides a framework for between Parties and offer technical
Introduction to the WHO international cooperation, including assistance to Parties implementing the
FCTC and Protocol on global tracking and tracing, and Protocol. It also highlighted the need for
prescribes a comprehensive set of Parties and the Convention Secretariat
The WHO Framework Convention on measures, such as supply-chain control to collectively establish mechanisms
Tobacco Control (WHO FCTC) and and due diligence obligations, to combat and procedures for sharing experiences,
the Protocol to Eliminate Illicit Trade the illicit tobacco market. best practices and other information on
in Tobacco Products are evidence- the implementation of the Protocol.
based, legally binding international At both COP9 and MOP2, the Parties
instruments. With 182 and 67 Parties adopted decisions for establishing
respectively as at June 2023 (Annex 5), Update on COP9 and MOP2 the WHO FCTC Investment Fund
these treaties are unifying frameworks and the Protocol Investment Fund.
for intergovernmental cooperation and In November 2021, the Ninth Session These new financing mechanisms will
are fundamental to combatting the of the Conference of the Parties to the provide sustainable funding for the
global tobacco epidemic and upholding WHO FCTC (COP9) and the Second implementation the WHO FCTC and the
the right of all people to the highest Session of the Meeting of the Parties to Protocol in alignment with COP and MOP
attainable standard of health. the Protocol (MOP2) were held.1 decisions, workplans and budgets.
Since its entry into force on 27 February A major outcome was the Declaration
2005, the WHO FCTC has included a core on the WHO FCTC and recovery from
set of mutually reinforcing obligations the Coronavirus disease (COVID-19)
pandemic, which called for measures
to reduce the demand for, and supply
to prevent tobacco industry efforts to WHO FCTC progress report
of, tobacco products (see Table 1). The
implementation of these measures is exploit the public health emergency
WHO FCTC implementation is aligned
supported by an equally important set as a means of furthering its own
with the COP-adopted Global Strategy
of general obligations for advancing interests and undermining tobacco
to Accelerate Tobacco Control (Global
progress and cooperation on tobacco control measures (1). It emphasized
Strategy 2025) and contributes to the
control locally, nationally, regionally the deadly interplay between tobacco
achievement of the SDGs. SDG Target
and globally. Of these, Article 5.3 and use and COVID-19, with the former
3.a calls for the strengthening of the
its Guidelines for implementation having exacerbated both COVID-19
implementation of the WHO FCTC in all
provide crucial safeguards against risk and severity during the pandemic,
countries to reduce tobacco use and
tobacco industry influence over, and which in turn increased health system
its related health, social, and economic
interference in, tobacco control policies. vulnerability. It also emphasized the
impacts. In line with the strategy, as well
These general obligations are reinforced importance of fully implementing the
as Article 21 of the WHO FCTC and Article
by other measures such as Article 19 WHO FCTC as a means of addressing the
32 of the Protocol, the Convention
on liability, which innovatively targets vulnerabilities which underlay the crisis,
Secretariat produces a biennial progress
the industry’s deceptive, profit-driven achieving the Sustainable Development
report on implementation for each
tactics. Goals (SDGs) and overcoming the
treaty – the Global progress report on
devastation caused by the pandemic.
The Protocol, which entered into implementation of the WHO FCTC –
At MOP2, Parties adopted the Decision
force on 25 September 2018, focuses which provides an overview of the status
on assistance and cooperation, which
on eliminating illicit trade in tobacco of the Convention’s implementation.
reinforced the indispensability of
products. It was developed to build mutual assistance and international
on Article 15 of the Convention in cooperation in enforcement,
recognition of the complexity of investigation and prosecution, and
addressing illicit trade, its significant also in administrative, legislative and
contribution to the global tobacco scientific domains for the achievement
epidemic, and the threat it poses to key of the Protocol’s objectives. In
demand-reduction measures (especially particular, it mandated the Convention
price measures and health warnings). Secretariat to facilitate cooperation

1 The COP and MOP are the governing bodies for, respectively, the WHO FCTC and the Protocol. They are the sole bodies for authoritative
interpretations of their respective treaties with responsibilities for reviewing and guiding their implementation, adopting measures in response to
emerging issues, and fostering international cooperation.

1
Table 1. Key WHO Framework Convention on Tobacco Control provisions

Demand-reduction Article 6: Price and tax measures to reduce the demand for tobacco
measures Article 8: Protection from exposure to tobacco smoke
Article 9: Regulation of the contents of tobacco products
Article 10: Regulation of tobacco product disclosures
Article 11: Packaging and labelling of tobacco products
Article 12: Education, communication, training and public awareness
Article 13: Tobacco advertising, promotion and sponsorship
Article 14: Demand-reduction measures concerning tobacco dependence and cessation

Supply-reduction Article 15: Illicit trade in tobacco products

measures Article 16: Sales to and by minors
Article 17: Provision of support for economically viable alternative activities

General obligations Article 4: Guiding principles

Article 5: General obligations
■ 5.1: Comprehensive multisectoral, national tobacco control strategies, plans
and programmes
■ 5.2: National coordinating mechanism or tobacco control focal point

■ 5.3: Protecting tobacco control policies from the tobacco industry’s

commercial and vested interests

Other measures Article 18: Protection of the environment and the health of persons
Article 19: Liability
Article 20: Research, surveillance and exchange of information
Article 21: Reporting and exchange of information
Article 22: Cooperation in the scientific, technical and legal fields and provisions of
related expertise

The data collection underpinning the The report also highlights challenges in provisions for evaluation, including
report also supports monitoring of implementation of Articles 17, 18 and 19 those related to licensing, tracking
progress on the indicators set out in the on economically viable alternatives to and tracing, law enforcement, and
Global Strategy 2025. By disaggregating tobacco, environmental protection, and international cooperation. It notes
progress on each of the core articles of industry liability. that most Parties remain at early-stage
the WHO FCTC (5, 6, 8, 11 and 13) into implementation, with progress very
various indicators, the report illustrates uneven among the various Parties
the comprehensiveness of progress and elements of individual articles.
made by the Parties. The latest report Protocol progress report With respect to establishing tracking
(2021) shows that while implementation and tracing systems, almost half of
rates of individual measures are high, The 2021 Global progress report respondent Parties confirmed some
many measures are not implemented in on implementation of the Protocol level of implementation. The greatest
full. Parties report that Articles 5 and 11 to Eliminate Illicit Trade in Tobacco level of progress was found in measures
are the most advanced while Article 13 Products was the first of its kind and relating to licensing and control,
is the least advanced. provides an overview of progress made proscribing unlawful conduct and
by Parties. It also focuses in on key establishing prosecution and sanctions.

2 | WHO report on the global tobacco epidemic 2023

The most underreported measure implemented of the WHO FCTC’s
was international cooperation. It is substantive articles despite evidence of WHO FCTC and measures
important to take this into account since encouraging progress on key measures to protect people from
the key barriers to progress reported by for each article. Accordingly, this focus
Parties, such as insufficient technical will provide an opportunity to bridge the tobacco smoke
capacities and financial resources, implementation gap.
could be addressed through improved Overview of Article 8 and related
Additionally, COP10 is scheduled to
international cooperation.
address forward-looking tobacco control articles
measures in relation to Article 2.1 of the The focus of this report, implementing
WHO FCTC, which stipulates Parties are smoke-free environments, aligns
not confined to the provisions of the with Article 8 of the WHO FCTC. This
Highlights for COP10 and WHO FCTC and are thus not prevented Article mandates Parties to adopt
MOP3 from imposing stricter requirements and implement effective legislative,
than those it contains. This encourages executive, and administrative measures
To guide and maintain momentum on and empowers Parties to implement to protect people from exposure to
implementing the WHO FCTC and the novel measures to accelerate progress tobacco smoke. COP decisions to
Protocol, the upcoming COP10 will take in tobacco control such as tobacco- date aim to provide guidance and
place in Panama in November 2023 free generation policies, which aim support for Parties in implementing
under the theme “Together, promoting to prevent entire generations from Article 8 and achieving its objectives.
healthier lives”, which reflects the ever initiating tobacco use, and other In the 2021 Global progress report on
extent to which success in tobacco end-game approaches for eliminating implementation of the WHO FCTC, the
control hinges on partnership and tobacco consumption all together majority of Parties reported some
cooperation across the whole of society, using strategies for de-nicotinization level of implementation of Article 8
government, and the world. The theme and policies for restrictions on retail provisions but they reported a much
for MOP3 is “More Parties, greater availability, among others. lower rate of implementation when it
traceability, less illicit trade”, which came to comprehensive implementation
emphasizes the significance of rising of all key measures under Article 8. This
numbers of Parties to the Protocol and shows considerable room for progress.
the establishment of a global tracking COP10 to raise tobacco
and tracing regime, and the need for the industry accountability Retrospective of COP decisions
Protocol’s reach to be expanded further. pertaining to “P”
Key areas of focus at COP10 include It is also anticipated that COP10 will
tobacco product regulation, forward- grapple with measures that require Since the adoption of the WHO FCTC,
looking tobacco control measures in tobacco industry accountability for several decisions have been taken by
relation to Article 2.1 of the WHO FCTC, the impact of their products – in line the COP in relation to Article 8 and the
and implementation of Article 19 of the with Article 19. Industry accountability protection of people from exposure to
WHO FCTC. These and all discussions at encompasses past, present and future tobacco smoke. The importance of this
the meeting will be guided and informed loss of life, detriment to health, loss Article and the high priority it has been
by the Global Strategy 2025 as well as of productivity, health care expenses, accorded is reflected in how –at the
the findings of the recent WHO FCTC health system fragility, exacerbation of first meeting of the COP – the Parties
progress report. the COVID-19 pandemic, occupational approved templates for the elaboration
health hazards, and environmental of guidelines for the implementation of
damage. Article 8 and requested the Convention
Secretariat to initiate work on these
Finally, the COP’s agenda is likely to guidelines (2). Consequently, the
Tobacco product regulation feature items on the tobacco industry’s Guidelines for implementation of Article
to be COP10 highlight new strategies for evading and 8 were the first adopted by the COP (at
undermining tobacco control. Such only its second meeting) for any WHO
Tobacco product regulation is set to strategies include novel and redesigned FCTC article (3).
be a highlight with an emphasis on tobacco and nicotine products; and
developing and implementing evidence- marketing tactics and misinformation The Guidelines for implementation
based measures to reduce the appeal, campaigns to circumvent regulations, of Article 8 provide a comprehensive
addictiveness, and toxicity of tobacco maintain existing customers, and extend framework for the design and
products – in line with Articles 9 and reach to younger generations. The implementation of measures to
10 as well as the Partial Guidelines ever-evolving nature of tobacco industry universally protect people from
for implementation of Articles 9 and tactics will make COP10 oversight over exposure to tobacco smoke. They
10. As set out in the recent progress these strategies invaluable. emphasize the importance of adopting
report, these two are among the least a comprehensive approach, including

1. The WHO FCTC and the Protocol to Eliminate Illicit Trade in Tobacco Products | 3
the establishment of 100% smoke- in other articles, since they generally recognized that these claims and
free environments, public education fall within the jurisdiction of ministries the properties of HTPs “may pose
and awareness-raising campaigns, of health and are implementable by regulatory challenges regarding their
and monitoring and enforcement decree or other executive decision. definition and classification … and
mechanisms. They make explicit that Both their substantive and procedural that these may pose challenges for the
the language of Article 8 provides for interconnection emphasize the need for comprehensive application of the WHO
further evidence-informed measures a comprehensive approach, integrating FCTC”. In the Decision, Parties noted
that extend protections to settings smoke-free environments with health the particular challenge for smoke-free
beyond those in its non-exhaustive list. warnings and labelling regulations, legislation and requested that all Parties
as well as public awareness raising, prioritize particular measures, including
The Guidelines for implementation
to strengthen the overall impact of protecting “people from exposure to
of Article 8, alongside the content
tobacco control measures. their emissions” and explicitly extending
of other guidelines, make clear the
“the scope of smoke-free legislation
necessity of Article 8’s comprehensive
Decisions relating to heated to these products in accordance with
implementation alongside other
Article 8 of the WHO FCTC”(8).
interdependent WHO articles (4). In tobacco products (HTPs)
particular, package and labelling HTPs are tobacco products that produce In response to the issues around
warnings (Article 11) and awareness aerosols containing nicotine and other classifying the emissions of HTPs, the
raising (Article 12) shift behavioural chemicals by heating tobacco units (7). Convention Secretariat and WHO were
norms to reinforce the effectiveness In 2018, COP8 recognized that HTPs requested to examine and report back
of regulation in protecting people “are tobacco products and are therefore at COP9 on the health impacts of HTP
from exposure to tobacco smoke, subject to the provisions of the WHO emissions for non-users and related
while going further to protect people FCTC” (8). Since their emergence, HTPs challenges for the application of the
in private spaces who are outside the have been marketed by the tobacco parts of the WHO FCTC and it guidelines
realm of even the most comprehensive industry with health and cessation that refer to tobacco smoke (8). The
regulatory approaches (4–6). This claims that are not supported by resulting report concluded that the
is important because exposure to independent, robust evidence (9). One aerosols commonly emitted by HTPs
tobacco smoke occurs most in private main health claim is that they do not do fall under the definition of tobacco
settings, such as homes, with a combust tobacco or produce smoke smoke (9). It was further detailed that
disproportionate impact on women and that this makes them “reduced the evidence shows that non-users
and children (4). Progress with any of risk” products (8). At COP8, the Parties are exposed to toxicants from HTP
these articles also enables advances emissions (9, 10).

© Secretariat of the WHO FCTC/P Albouy

The plenary discussions during the Ninth Session of the Conference of the Parties (Hybrid format).

4 | WHO report on the global tobacco epidemic 2023

Decisions relating to ENDS beyond superficial measures and ensure
The growing power of comprehensive enforcement. Recent
ENDS and electronic non-nicotine
delivery systems (ENNDS) do not Article 8 to protect from data, however, show the considerable
benefits of implementing MPOWER
necessarily contain tobacco and instead tobacco measures and the demand-reduction
vaporize a solution composed of
provisions of the WHO FCTC, including
numerous compounds, which include Article 8 of the WHO FCTC is a critical
Article 8, with a rate of return of US$
nicotine in the case of ENDS, or may element of global tobacco control
7.11 for every dollar invested (13).
not contain nicotine in the case of efforts that protect our right to health
This emphasizes the importance of
ENNDS. Their emissions do include and is the focus of the WHO report on
sustained commitment, investment,
toxicants and exposure to them poses the global tobacco epidemic, 2023. It
and support from Member States
risks to non-users (11). COP6 set out corresponds to “MPOWER measure
and Parties in, respectively, using the
the basic objectives to be pursued in P” – “protect from tobacco smoke” –
MPOWER package and in advancing the
addressing ENDS/ENNDS including the and extends protection to many of the
Convention’s implementation.
protection of non-users from exposure most vulnerable groups in society. To
to their emissions (12). At COP7, Parties be fully effective, these protections
were also invited to apply regulatory need to be mandated and enforced
measures to prohibit or restrict the across a wide range of settings and
manufacture, import, distribution, need to be implemented as part of a
Urgent need to do more
presentation, sale and use of ENDS/ comprehensive package alongside with Article 8
ENNDS, as appropriate. Parties that other complementary measures
have not totally banned those products (such as Articles 11 and 12 in the WHO As has been shown, despite significant
were invited to follow a non-exhaustive FCTC that correspond to the “W” progress since the WHO FCTC came
list of regulatory options for pursuing MPOWER measure – “warn about the into force 18 years ago and since
the objectives set out in the COP6 dangers of tobacco”). In designing and MPOWER was established 15 years
decision – provided in a report prepared implementing measures to protect ago, implementation of Article 8 and
by WHO – that were endorsed for people from tobacco smoke, the WHO of “P” remains insufficient in many
consideration by the Parties (11, 12). FCTC and related COP decisions and countries as shown by both this report
Such regulation entails the application guidelines provide a crucial resource and the 2021 progress report. There
of many of the WHO FCTC’s measures and support. is, accordingly, an urgent need to seize
for ENDS/ENNDS, prominently including the moment to make progress on this
The second WHO Report on the global foundational measure. It is, out of all the
minimizing exposure to emissions by
tobacco epidemic, in 2009, also WHO FCTC Articles, evidently among the
prohibiting their use in indoor spaces
had “P” as its focus. This reflects most feasible to implement at a low-cost
and other places where smoking is not
the importance of the measure for across a variety of national settings.
permitted and requiring health warnings
saving and improving lives as well as It is also among the Articles with the
about their risks – in line with Articles 8
how feasible and acceptable it is for most expansive and rich evidence base
and 11 (11).
implementation. However, despite to support both the benefits of smoke-
this prominence under both MPOWER free environments and the absence
and the COP’s own agenda, various of negative effects. Urgent efforts
challenges and successes have emerged are crucial to ensure the timely and
in implementing Article 8, including lack successful implementation of Article 8
of political will and resources to move and other related WHO FCTC provisions.

Article 8 of the WHO FCTC is a critical element

of global tobacco control efforts that protect
our right to health.

1. The WHO FCTC and the Protocol to Eliminate Illicit Trade in Tobacco Products | 5
 © WHO/Alex Swanepoel

6 | WHO report on the global tobacco epidemic 2023

2. 15 years of MPOWER progress

“MPOWER was designed to catalyse global

action on tobacco control. In protecting
over 5 billion people, I am proud to say
that it has delivered on its promise. But it
is a promise that must be kept. We must
continue to prioritize tobacco control to
protect the health of billions more people in
Dr Margaret Chan
the future.” Former WHO Director General (2007-2017)
Dean of Vanke School of Public Health,
Tsinghua University

“The tobacco industry infiltrates our lives

from so many doors. MPOWER tools and
measures work to close off all doors. That
is why the full power of MPOWER is only
unleashed when countries fulfill
all measures. I urge all to act fast before
the tobacco industry reverses all our
efforts in protecting our populations and in HRH Princess Dina Mired of Jordan
Past President Union For International
unburdening our health systems.” Cancer Control (UICC)
Former Director General of the King Hussein
Cancer Foundation (KHCF)

“The original motivation for MPOWER

was to obtain change rather than be a
monitoring exercise alone. It was designed
to measure progress and enable national
governments to compare their policies with
other countries; to complement the WHO
FCTC; and to offer a practical roadmap for
implementing key anti-tobacco measures. Dr Judith Mackay
Asian Consultancy on Tobacco Control
Importantly, MPOWER also includes
Special Advisor to WHO FCTC Secretariat’s
jurisdictions not Parties to the WHO FCTC. Knowledge Hub on Article 5.3
MPOWER has exceeded its initial goals Honorary Professor University of Hong Kong
and is an invaluable tool: reader-friendly
maps, charts and graphics help translate
hundreds of tobacco statistics into easily
understood formats.”

7
4
More and more countries are achieving
best-practice level across all MPOWER
measures. Today, 44 countries only
countries have one or two more measures to
adopt before they achieve the full
with all MPOWER
measures at best- MPOWER package (see Fig. 5 and Fig. 6).
practice level

8 countries
with only one more
measure to go to achieve
the full MPOWER package
“No treaty, no set of public health solutions, has
saved more lives, more quickly than the WHO

36
Framework Convention on Tobacco Control and
the MPOWER package designed to help countries
countries implement it. It is because the MPOWER package
provides a legally enforceable proven road
with only 2 more
map of concrete, evidence-based measures
measures to go to
whose benefits have been and continue to be
achieve the full MPOWER
package
demonstrated in the real world across different
political systems and cultures and on every
continent. Fifteen years after the adoption of

300
the MPOWER package one thing can be said
with certainty: MPOWER has saved lives in every
million country where one or more components of
MPOWER have been adopted.”
fewer smokers today than
if the rates in 2007 had Matthew L Myers
never declined President
Campaign for Tobacco-Free Kids

8 | WHO Report
report On
on the
Theglobal
Globaltobacco
Tobaccoepidemic
Epidemic 2023
2023
Fig. 5. Countries that moved up one or more categories,
by MPOWER measure 2007–2022

Already in the top Moved up but did not Reached top group
group in 2007 reach the top group by 2022

M 50 25 32

P 10 29 64

O 10 65 26

W 9 45 94

E 8 31 58

R 23 45 22

2. 15 years of MPOWER progress | 9

 All MPOWER measures are evidence-based
and highly cost-effective across all country
income levels. As a result, all MPOWER
measures are recognized as NCD Best-Buy
interventions in the WHO Global Action
Plan for the Prevention and Control of
Noncommunicable Diseases 2013–2030 (14).

“In Thailand we use the MPOWER “MPOWER brought needed

package to communicate structure to global tobacco
effectively the best-buy tobacco control, guiding what we do and
control strategies. I feel the helping to track what we have
global tobacco control done. MPOWER’s persistence
community should all express for 15 years speaks to its utility.”
our thankfulness to those who Dr Jonathan M Samet
ingeniously created this Dean and Professor
Colorado School of Public Health
invaluable communication tool.”
Dr Prakit Vathesatogkit
Secretary General
Action on Smoking and Health Foundation
Thailand (ASH Thailand)
Recipient of the MPOWER Award 2009

10 | WHO Report
report on
Onthe
Theglobal
Globaltobacco
Tobacco
epidemic
Epidemic
2023
2023
MPOWER MEASURES are designed to work together to reach the goal of reduced tobacco use and
healthier populations

Reduced tobacco use and

improved health impact

Protecting non-smokers Motivating and supporting Preventing the uptake and

from tobacco smoke smokers to quit initiation of tobacco use

MPOWER
“We have come a long way and WHO’s global tobacco
control report has been there to document our journey
toward freeing the world from the harms of tobacco.
Today, 5.6 billion people are protected by at least one
best-practice WHO MPOWER measure, five times more
than 15 years ago. This means fewer children buying
cigarettes, fewer people breathing harmful second-hand smoke, and
some 35 million lives saved. We are proud to have been part of the
team that developed MPOWER and championed it over the years.”
José Luis Castro
President & Chief Executive Officer
Vital Strategies
2. 15 years of MPOWER progress | 11
 © WHO/Rooftop

“MPOWER enabled us to focus “MPOWER, as a means of operationalizing

attention and resources on high the WHO FCTC, has been instrumental
-impact interventions that include in reducing tobacco use and the massive
advertising and sponsorship bans, harm it causes globally. As a recent
bans on smoking in public places, Lancet comment highlights, while the
enforcement of warnings on cigarette burden of tobacco-related disease
packs and raising taxes. These are remains unacceptably high, progress
areas that many African countries to date has been enormous. The single
have now recorded successes and we greatest barrier to progress remains the
attribute that to the clarity provided by tobacco industry.
MPOWER.”
Fully addressing tobacco industry
Dr Akinbode Oluwafemi interference as outlined in Article 5.3
Executive Director
Corporate Accountability and Public and its Guidelines will be key to enabling
Participation Africa (CAPPA) full implementation of the MPOWER
Recipient of the MPOWER Award 2009
measures and preventing millions more
totally avoidable profit-driven deaths.”
Professor Anna Gilmore
Professor of Public Health & Director
Tobacco Control Research Group (TCRG)
Department for Health, University of Bath

12 | WHO report on the global tobacco epidemic 2023

 “The tobacco industry has an arsenal of vile
tactics to undermine, frustrate and sabotage
legitimate and effective tobacco control
measures. It refuses to stop. Monitoring the
industry is crucial to expose these forms of
industry interference in public policy. Evidence
is our fire power to protect public health.”
Dr Mary Assunta
Head, Research and Advocacy,
Global Center for Good Governance in Tobacco Control.

Senior Policy Advisor

Southeast Asia Tobacco Control Alliance (SEATCA)

Fig. 6. Countries on track to achieving the global target of a 30% relative reduction in tobacco use
by 2025

If current trends continue,

56 the voluntary target of a
30% relative reduction
between 2010 and 2025
is likely to be achieved
Likely to achieve a decrease
94 in prevalence between 2010
and 2025 but, if current
trends continue, not likely
to achieve the 30% relative
reduction voluntary target
If current trends continue,
8 there will be no significant
increase or decrease in
prevalence between 2010
and 2025
If current trends continue,
7 there is likely to be an
increase in prevalence
between 2010 and 2025

2. 15 years of MPOWER progress | 13

15 years of MPOWER
as a tool of global health leadership
MPOWER has inspired and paved
the way for multiple global health
technical packages

MPOWER is helping us reach the

SDGs: the indicator for SDG 3a is the
reduction of tobacco use.

MPOWER is helping to strengthen

global health leadership and bringing
tobacco control to the global agenda

14 | WHO report on the global tobacco epidemic 2023

MPOWER accelerating into the future
The ingredients that can help accelerate MPOWER adoption
and tobacco control are (15):

1 Ensure political will: One of the most important factors to ensure that the MPOWER
technical package is adopted and implemented is the backing and commitment from all levels
of government (16). Stakeholders must be made aware of the huge burden imposed by tobacco
and the impact it has on their country’s health and economic outcomes. Effective tobacco
control measures, like MPOWER, save lives and money.

Encourage multisectoral action: Tobacco control cannot be effectively implemented

through the Ministry of Health alone. For example, tobacco taxes are one of the most effective
2 tobacco control interventions and require collaboration and leadership from the Ministry of
Finance. It is crucial to strengthen to use a whole of government approach to ensure policy
coherence on tobacco control by supporting the development and adoption of multisectoral
strategies and programs and the establishment of coordinating mechanisms for tobacco control.

Build strong local and global partnerships: Partnerships across government

3 and with nongovernmental organizations and academia, help to strengthen and magnify the
efforts of all. In collaboration partners can leverage each other’s strength to reach the common
aim of reducing the impact of tobacco on populations globally.

Maintain a strong stance against tobacco industry interference:

The tobacco and related industries, like that producing electronic nicotine products, utilize
4 a suite of evolving tactics to maintain and grow their consumer base. Countries must remain
vigilant in implementing WHO FCTC Article 5.3 and be prepared for the attempts by industry to
challenge and undermine tobacco control efforts.

Commit to evidence generation and knowledge transfer: Data and

5 evidence not only help to drive policy progress but also policy implementation. Countries
should conduct representative surveys and appropriate research to continuously evaluate the
effectiveness of adopted policies, and to help adapt implementation to ensure that the whole
population is protected from and well-informed about the harms of tobacco.

Invest in tobacco control: Develop and use investment cases to demonstrate to

decision-makers the cost-effectiveness and the return on investment that is possible with
6 tobacco control as has been conducted by WHO (13, 17, 18) and the WHO FCTC (19). While tobacco
control is known for being highly cost-effective, it is important to ensure that countries invest in
their human resources with appropriate training to effectively develop legislation, stand up to
the tobacco and related industries and ensure compliance with tobacco control measures
in place.

“The MPOWER initiative has been a great milestone in

global tobacco control. Today, almost three-quarters
of the world’s population is now protected by at least
one measure.”
Professor Ala Alwan
Former Regional Director for the WHO Eastern Mediterranean Region (2012–2017)
Former Assistant Director General for Noncommunicable Diseases and Mental
Health (2008–2012) Former Minister of Health of Iraq (2003–2005)

2. 15 years of MPOWER progress | 15

3. Smoke-free environments: protect
people from tobacco smoke
Second-hand smoke (SHS) is harmful and is estimated to cause the deaths of 1.3 million non-
smokers each year. Smoke-free environments therefore play a crucial role in tobacco control and
public health. They protect people from exposure to known carcinogenic and toxic substances;
denormalize smoking in public places; and promote the spread of smoke-free environments even
into private spaces. These societal changes can encourage tobacco users to attempt quitting,
enhance their success in doing so, and discourage young people from ever starting to use
tobacco.

Box 1. Smoke-free environments and the WHO FCTC – the story so far

In 2009 WHO published the WHO report on the global However, there remain many public spaces and
tobacco epidemic: smoke-free environments. Each workplaces that are not protected by smoke-free laws
biennial report published since then has either focused and many more that do not comply with smoke-free
on a different MPOWER measure or has addressed the laws. For this reason we need to accelerate efforts
issue of emerging tobacco and nicotine products. Now, in to protect all people from SHS. In our first report on
2023, we revisit the theme of smoke-free environments. smoke-free environments in 2009, we highlighted the
effectiveness of smoke-free laws to reduce exposure
Since 2009, smoke-free environments have gone from
to SHS; the public support this measure garnered; and
being an innovative policy intervention in a handful
the need for smoke-free laws to be comprehensive. In
of high- and middle-income countries to becoming
this report we reiterate and build upon many of these
a worldwide feature of tobacco control. Now an
important points, as well as review the current evidence
almost equal proportion of low-income countries as
on the burden caused by SHS, assess the global progress
high-income countries have adopted comprehensive
on the adoption of smoke-free measures, and present
smoke-free legislation to protect people at all times
up-to-date evidence and recommendations on the
from tobacco smoke in all enclosed public areas and
implementation and enforcement of smoke-free laws.
workplaces.

Any level of exposure to second-hand smoke is

detrimental to the health of children and adults.

Sometimes called “passive smoke”, in the room months after the active and maintained that refraining from
“environmental tobacco smoke” or smoking took place – this is known smoking in public places was purely a
“tobacco air pollution”, SHS is the as “third-hand smoke” (THS) – now a matter of courtesy (and not a way to
mixture of compounds released by recognized consequence of SHS. The protect bystanders from grave danger)
tobacco smoked by others (the “active evidence suggests that THS, which (Box 1).
smoker”). Of the 7000 compounds is also known as “residual tobacco
However, the adverse health impact
released, at least 69 can cause cancer. smoke” or “aged tobacco smoke”
of SHS is now irrefutable. All major
SHS includes both the side-stream may be harmful to those exposed (20)
medical and scientific organizations,
smoke from the end of the cigarette (research is underway to explore ways to
including WHO IARC (22), the US Surgeon
and the smoke exhaled by smokers. remediate exposed environments and
General (23), and the United Kingdom
The smoke produced in one room protect future occupants of those spaces
Scientific Committee on Tobacco and
spreads to other rooms in the building from THS) (21).
Health (24) confirm that SHS harms
regardless of whether doors are kept
In the early 2000s, with limited evidence non-smokers and that there is no safe
closed or windows kept open. Even with
of SHS harms, the tobacco industry level of exposure. Breathing in even a
open windows and air filters, the toxic
strained to “frame” the problem of SHS small amount of SHS can be dangerous
compounds from SHS cling to rugs,
as a mere annoyance for non-smokers, to health (25–27).
curtains, clothes, food etc. and remain

16
 Smoke-free environments help guarantee the right
of non-smokers to breathe clean air, motivate smokers
to quit, and allow governments to take the lead in
tobacco use prevention through highly popular
public health measures.

The burden caused by second- to SHS (29, 30). Young children are related to transmissible spongiform
hand smoke is huge particularly vulnerable as they breathe encephalopathies – including shortness
more rapidly than adults, and their lungs of breath and a dry cough; and to
The most recent Global Burden of and bodies are still developing. Smoking miss school as a result of illness (31).
Disease (2019) (28) estimates that by parents and other household Adolescents exposed to SHS are also
1.3 million of the 8.7 million tobacco- members causes respiratory symptoms more likely to experience symptoms of
related deaths each year are among and slows lung growth in their children depression (32).
non-smokers exposed to SHS – almost (23). The 2019 Global Burden of Disease
equivalent to the number of people that Increasingly, evidence indicates that
(28) estimates that globally about
die in road traffic crashes every year. In SHS exposure during childhood is not
51 000 children and adolescents under
addition to deaths, many people suffer only detrimental during childhood but
the age of 20 years die every year from
ill-health as a consequence of SHS continues to play a negative role in
SHS exposure. Almost all of these
exposure. In adults, SHS exposure is health into adulthood. A recent study
children (almost 47 000) are under the
associated with stroke, coronary heart conducted in Japan (33) demonstrated
age of 5 years and these estimates do
disease, cancer, chronic obstructive that adults who were exposed to SHS
not take account of the health impact
pulmonary disease, respiratory during childhood are more likely to
on newborns when pregnant woman are
infections and other conditions die from coronary heart disease than
exposed to SHS.
(see Fig. 7). those who were not. These results
Adolescents exposed to SHS were are supported by another large study
Foetuses, infants and children more likely to experience respiratory conducted over 25 years in Finland
cannot choose the environment tract infection symptoms and to seek showing how adults exposed to SHS
they are exposed to and are the treatment at an urgent care or hospital as children demonstrate a number of
emergency department (31). One study cardiovascular risk factors that are
most vulnerable to SHS
found that adolescents aged 12–17 markers of atherosclerosis (34). This
Severe asthma, respiratory tract years who self-reported exposure to large cohort study has also shown the
infections, ear infections, and sudden SHS were more likely to experience impact of childhood SHS exposure on
infant death syndrome are all more difficulty exercising; wheezing during bone health, including osteoporosis, in
common among children exposed or after exercise; having symptoms adulthood (35).

Fig. 7. Main causes of death due to second-hand smoke exposure

400 000

350 000
Number of deaths per year

300 000

250 000

200 000

150 000

100 000

50 000

0
Ischemic Chronic Stroke Lower Type 2 Lung Breast
heart obstructive respiratory diabetes cancer cancer
disease pulmonary disease
disease

3. Smoke-free environments: protect people from tobacco smoke | 17

Exposure to SHS during pregnancy In the United Kingdom, children living Other evidence points to inequalities in
is detrimental to fetal growth and in smoke-free homes rose from 63% in exposure based upon geography with
development, leading to adverse birth 1998 to 93.3% in 2018 (38). However, rural children in LMICs more exposed to
outcomes such as preterm birth, low more recent trends are not as optimistic. SHS but amongst poorer children, those
birth weight, and perinatal and infant The Eurobarometer survey of 28 in urban settings were exposed to higher
mortality. Exposure to SHS during European countries indicates a stalled concentrations of SHS than those in
pregnancy is linked to a 23% increased trend between 2006 and 2017 (39). One rural settings (43).
risk of stillbirth and 13% increased large global study looking at the trends
risk of congenital malformation (36). The burden of death related to SHS
of SHS exposure among adolescents
Exposure to SHS during pregnancy is exposure is disproportionately borne by
demonstrated that while exposure at females: around 10% of male tobacco-
particularly relevant to many low- and
home decreased between 1999 and related deaths, (excluding deaths from
middle-income countries, where few
2018, exposure in public domains may chewing tobacco) are among non-
women smoke but live with men
have increased (40). smokers who were exposed to SHS,
who do.
almost one third of all female tobacco-
Furthermore, some people are more related deaths, (excluding chewing
The burden caused by second- likely to be exposed to SHS than tobacco again) result from SHS exposure
hand smoke impacts some others. Of the 1.3 million SHS-related (Fig. 8). The inequalities observed
people more than others deaths, almost 1.2 million (close to in death rates between males and
90%) occur in low- and middle-income females are apparent where morbidity
As the presence of smoke-free
countries. Within countries, trends is concerned as well. Females therefore
environments has risen globally and in the prevalence of SHS exposure pay a heavy price for others’ smoking.
the prevalence of smoking has declined are complex. Studies show exposure Insufficient protection may be due to
in most countries, exposure to SHS to SHS is generally higher among the complete absence of comprehensive
would also be expected to decline – and disadvantaged groups of people smoke-free legislation or the existence
overall, the trend over the last 20 to (36, 41). In a study of 15 countries, the of partial smoke-free laws; the lack
30 years suggests that SHS exposure relationship between socioeconomic of effective implementation and/or
is declining. In the United States for status and exposure in low- and compliance; and/or due to exposure
example, between 1988 and 2018, middle-income countries suggests where laws do not apply, for example in
exposure to SHS among non-smokers that exposure at home is reduced with private property (see Box 2).
declined from 87.5% to 24.6% (37). increasing education (42).

Fig. 8. Global total deaths due to smoking and

SHS by sex, 2019
Box 2. Second-hand smoke exposure
Smoking deaths SHS deaths may have increased during the
COVID-19 pandemic

During the COVID-19 pandemic, many governments

implemented “stay at home” policies and people
were asked to work from home. In some contexts, this
pattern of work persists to this day. Evidence suggests
that smoking behaviours in response to the pandemic
varied widely across countries, with some smokers
finding the motivation to quit due to health concerns
while others consumed more than usual. Given that
Males Females many were confined to their homes however, it is
possible that smokers smoked more at home and
therefore exposed their families and others sharing
Source: Global Burden of Disease 2019(28)
their residence to more SHS. It is important to increase
awareness about these behaviour changes and their
harmful consequences (44-48).

18 | WHO report on the global tobacco epidemic 2023

Second-hand smoke imposes The economic burden is also felt Today there is robust evidence that
by individuals and families. When comprehensive smoke-free laws result
major costs on households and
a family member suffers a chronic in reduced hospital admissions for
the broader economy health condition, the resulting health acute coronary syndrome and reduced
While the health burden related to care costs can be debilitating, and the mortality from smoking-related
SHS is borne by those exposed to it, death of a working family member can illnesses (56). For example, a study in
the economic burden of SHS is felt be catastrophic to a family’s future Argentina, where smoke-free measures
much more widely. It is estimated that financial stability. Given that tobacco were at first adopted differently
in the United States in 2018, cigarette use is often higher among those who in different provinces and cities,
smoking cost US$ 600 billion. Of this total are economically disadvantaged, SHS demonstrated the immediate decrease
amount, US$ 7 billion resulted from lost exposure is higher among non-smokers in admissions for acute coronary
productivity due to premature deaths in these communities, contributing to a syndrome following implementation
caused by SHS exposure (49). With almost vicious cycle of tobacco use and poverty of a smoke-free policy in Santa Fe (a
70% of the population exposed to SHS in (52, 53). 13% reduction, by -2.5 admissions per
2018, one study has estimated that the 100 000 population), compared with
economic burden of SHS in China will Effective smoke-free policies no change in Buenos Aires city where
cost up to US$ 321 billion over the period the policy allowed for DSRs and other
save lives
2015 to 2030 (50). A recent study using exceptions. In Santa Fe, the immediate
data from the Global Burden of Disease There is evidence that, whenever effect was followed by a persistent
estimated that the economic burden smoke-free laws are implemented, they decrease in acute coronary syndrome
imposed by SHS was equivalent to up are followed by an almost immediate admissions (57).
to US$ 7 billion among the Cooperation drop in SHS pollution levels and by
marked improvements in respiratory Smoke-free laws also reduce neonatal
Council for the Arab States of the Gulf
health (54). In one of the earliest studies and infant mortality, as well as adult
countries (comprising Bahrain, Kuwait,
on SHS conducted on bar workers in deaths and illness from respiratory
Oman, Qatar, Saudi Arabia and the
Scotland reported a 26% decrease in disease and heart disease (58, 59).
United Arab Emirates) (51) – comprising
respiratory symptoms, and asthmatic Within months to a year after being
20.4% of the total economic burden of
bar workers had reduced airway implemented, smoke-free environments
smoking and SHS exposure combined in
inflammation within 3 months after reduce the incidence of heart attacks
those countries.
comprehensive smoke-free legislation among the general population (60–63).
was enacted (55).

© World Health Organization

3. Smoke-free environments: protect people from tobacco smoke | 19

Smoke-free laws can Plan for the Prevention and Control of To effectively protect people,
Noncommunicable Diseases 2013–2030 smoke-free policies must be
denormalize smoking and
(73) listing the NCD best-buys for
inspire smoke-free homes addressing the NCD burden estimate
comprehensive
Making indoor public places smoke- a very low implementation cost for Comprehensive smoke-free policies
free by law also promotes non-smoking smoke-free policies relative to the mean that all indoor public places;
as a norm. Evidence shows that when beneficial health impacts they generate all indoor workplaces; all public
smoke-free policies are implemented, 1 international dollar per healthy life transport; and possibly other (outdoor
tobacco smoking in public spaces year gained (14, 74). or quasi-outdoor) public places are
becomes less acceptable and private free from exposure to tobacco smoke.
spaces are also more likely to become The elimination of smoking and
Governments should be tobacco smoke should be absolute
smoke-free (e.g. smoke-free homes/
reassured that public support to create a comprehensively smoke-
cars), resulting in reduced exposure to
SHS at home (a major risk for pregnant for smoke-free measures is high free environment. Other approaches
women and children of all ages who Decision-makers may be concerned or including ventilation, air filtration and
live with smokers) (64–66). People may be led to believe by the tobacco the use of DSRs have repeatedly been
can also be encouraged to make their and related industries, that the general shown to be ineffective, and conclusive
homes smoke-free through appropriate public will be discontented by smoke- evidence exists that engineering
campaigns to increase knowledge about free measures. A recent systematic approaches do not protect against
the harms people are exposed to in their review of data from 33 countries exposure to tobacco smoke (see Table
homes and how they can make their demonstrates that support for smoke- 2). Voluntary smoke-free policies are not
homes safer (See Table 2). free environments is generally high, effective and the adoption of effective
especially in areas where children legislative, executive or administrative
measures is necessary. Partial smoke-
Smoke-free laws can encourage might be exposed, like cars. This study
also revealed that where measured, free laws simply fail to protect people
people to quit and prevent the from the harms of SHS (83,84).
support typically increased after
initiation of smoking
implementation of smoke-free laws.
Another major benefit of effective Support was particularly strong among Designated smoking areas or
smoke-free measures is that smokers non-smokers and increased over time rooms do not protect people
are more likely to try to quit (67) seek post-implementation for smokers (75).
tobacco cessation support (68) and
from tobacco smoke
ultimately to successfully quit (69). Research in a variety of countries
In 2014, the U.S. Surgeon General Smoking bans have positive demonstrates that the impact of
concluded that smoke-free laws in economic impacts upon smoke-free laws is maximized when
workplaces and communities help businesses and tourism they are comprehensive and allow no
smokers quit and reduce tobacco exceptions (85). Indeed, this is the only
use (70). Furthermore, if children and Smoking bans are beneficial for way to ensure that smoke-free laws
adolescents observe less smoking, they businesses, contrary to the arguments are enforceable, fair, and effective at
are less likely to initiate tobacco use. put forward by the tobacco and protecting everyone from the harms
One study conducted in China showed related industries who challenge and of SHS. DSRs do not protect people
that smoking in the home is also linked undermine them in the hospitality from SHS, complicate enforcement,
to children being more likely to take up sector and encourage hospitality and are likely to reduce compliance.
smoking themselves (71). Another study businesses to join them in their fight. Data over the years demonstrate that in
in the United Kingdom suggested that Such arguments claim that smoking many countries fewer DSRs are allowed
children who are cared for by smokers bans reduce revenue and increase in health facilities and educational
are almost 70% more likely to try costs in smoke-free venues such as facilities (10% of those with smoke-
smoking by the age of 15 (72). restaurants and bars, as smokers will free laws as compared with 20% in
visit them less frequently or for shorter 2008) but exceptions often still exist for
Implementation of smoke-free periods of time. They also argue that restaurants, pubs and bars, with up to
to implement and enforce the policies, 40% of countries with smoke-free laws
measures is cost-effective
businesses have to pay to establish and still allowing DSRs in cafés and bars (see
Smoke-free measures are one of the maintain smoking and non-smoking “Protect people from tobacco smoke”
most cost-effective public health sections, and that smoking employees results chapter, page 53, for more
interventions. For every dollar spent will become less productive as they information) (see Box 3).
implementing a smoke-free measure, take longer or more frequent breaks for
significant numbers of lives will be smoking. However, there is now ample
saved and lifespans extended. Properly and global evidence that counters these
enforced comprehensive smoke- claims and clearly demonstrates that
free policies are found to be highly smoke-free policies cause no adverse
cost-effective in reducing smoking economic outcomes for businesses,
prevalence to yield positive health including restaurants and bars. In fact,
outcomes. Analyses conducted for smoke-free policies often have a positive
the recently updated Global Action economic impact on businesses (76-82).

20 | WHO report on the global tobacco epidemic 2023

Table 2. Debunking myths associated with second-hand smoke

Myth Fact

Smoking near a Smoking near or leaning out of an open window does not protect your family. SHS drifts into
your house. At the same time, by doing this, you may expose your neighbours to SHS
window eliminates
SHS

Smoking in one Designating a specific room for smoking does not offer effective protection from SHS as it
drifts into the rest of the house
room with closed
doors protects
from SHS

Using ventilation, These systems do not get rid of SHS and may even distribute it throughout a building. Only
avoiding smoking inside or near a house protects from SHS
air conditioning or
opening windows
removes smoke

Smoking on a SHS can get into your home when you open the balcony door. Moreover, THS still persists
on a balcony and can be brought inside the home. So this kind of behavior does not protect
balcony protects from exposure
from SHS

Source: WHO Regional Office for Europe (86)

Box 3. Governments are obliged to protect their populations’ health

Smoke-free air is a human rights issue Smoke-free air is a child rights issue
All people have a fundamental right to breathe clean Unlike adults, children are unable to regulate their own
air and governments are obliged to protect everyone’s exposure to tobacco smoke. Children are forced to live
health as a fundamental human right. This duty is in the environment provided for them. International
implicit in the right to life and the right to the highest treaties, including the Convention on the Rights of the
attainable standard of health as recognized in many Child, are clear that States should ensure the survival
international legal instruments, including the Universal and development of children. Tobacco use poses a risk to
Declaration of Human Rights, the International Covenant children’s survival, health and development. As children
on Economic, Social and Cultural Rights, the Convention are dependent on decisions made by adults about their
on the Elimination of All Forms of Discrimination against tobacco use, tobacco control policies to inform the
Women, and the Convention on the Rights of the Child. public of the dangers of smoking around children are
These are formally incorporated into the Preamble of the critical. Children deserve and require clean, safe and
WHO Framework Convention on Tobacco Control, and secure environments, and the evidence clearly shows
have been ratified by more than 100 countries. Voluntary that these need to be completely smoke-free, including
agreements, often promoted by the tobacco industry from before birth.
as a “compromise”, have proven insufficient to achieve
public health goals because they do not eliminate, and at WHO Framework Convention on Tobacco Control
best only reduce, exposure to the harmful health effects Article 8 requires that Parties adopt effective measures
of SHS – to which both smokers and non-smokers alike to protect people from exposure to tobacco smoke in (1)
are vulnerable. indoor workplaces; (2) indoor public places; (3) public
transport; and (4) “as appropriate” in “other public
places”. This creates an obligation to provide universal
protection by ensuring that all indoor public places, all
indoor workplaces, all public transport and possibly
other (outdoor or quasi-outdoor) public places are free
from exposure to second-hand tobacco smoke. No
exemptions are justified on the basis of health or law
arguments.

3. Smoke-free environments: protect people from tobacco smoke | 21

Some countries have adopted and a number of surveys indicate that income countries were first to show
legislation to extend smoke- there is public support for bans in cars notable progress but some low- and
(89–91) that can successfully reduce SHS middle-income countries soon followed,
free environments into private exposure (92). One study across three with Uruguay becoming the first such
spaces and outdoor public countries demonstrated that while country to adopt the measure in 2005
places exposure in cars was falling prior to (see “Protect people from tobacco
As described in the previous chapter, policy implementation, a 22% relative smoke” results chapter, page 51).
Article 8 of the WHO FCTC requires that reduction in addition to this trend was
Today, 74 countries (21 high-income
all indoor workplaces, indoor public observed one year after policy adoption
countries, 45 middle-income countries
places, public transport as well as (93). These findings are consistent with
and 8 low-income countries) have
“other public places as appropriate”, are findings in Canada and California
protected their populations with best-
smoke-free. Some countries have taken (94 ,95) although exposure to SHS in cars
practice smoke-free measures. One
steps to make outdoor public spaces has remained high in some contexts,
major recent achievement is that all
smoke-free, for example, outdoor places particularly among adolescents (96).
countries in South America now have
like playgrounds, school campuses and smoke-free legislation at best-practice
the grounds of health care facilities, as Twenty years ago the world level in place (see Box 5).
well as quasi-outdoor spaces, such as began to take serious action
terraces or doorways, where vulnerable Twenty years ago, it was almost
against second-hand smoke unimaginable that restaurants and bars
populations, such as children or hospital
patients, may be exposed to SHS. Bus In 2004, Ireland became the first country would be covered by comprehensive
stops and train platforms, are examples to adopt and implement national smoke-free laws. Today, 74 countries
of outdoor public areas where people smoke-free measures in indoor areas are covered by smoke-free measures
who do not want to be exposed to SHS (see Box 4). The policy measure was at best-practice level in all indoor
may be forced to wait for transport and considered an innovative and radical public spaces. This is an outstanding
consequentially breathe in SHS (see move at the time and faced push achievement, but it is not enough.
“Protect people from tobacco smoke” back from the industry and from the Almost 6 billion people are still
results chapter, page 51). hospitality sector where there was unprotected by comprehensive smoke-
significant fear that the ban would result free measures globally.
Private spaces can, also be legislated
in reduced business. The evidence Governments face specific challenges
for. Smoking in cars, for example, is
accumulated over the years however and obstacles when drafting and
known to lead to particularly high levels
has proven that these fears were adopting smoke-free legislation.
of SHS exposure for child passengers
unfounded (97). Barriers faced in adopting smoke-
(87, 88). Countries such as Australia and
the United Kingdom have taken steps There have been significant advances free environments can be effectively
to ban smoking in cars where there is in the number of countries adopting addressed. Table 3 provides some ideas
a passenger under the age of 18 years smoke-free measures since 2004. High- on how to address commonly faced
challenges.

Box 4. Smoke-free bars in Ireland: a runaway success

On 29 March 2004, Ireland became the first country in the

world to implement smoke-free legislation in workplaces
including bars and restaurants. At the time, there was a great
deal of negative rhetoric surrounding the initiative in Ireland
by vested interests. But by the start of 2005 a programme
broadcasted on national television presented market research
carried out on the Irish population asking “2004: How was it
for you?” and found that the implementation of smoke-free
measures was ranked as the top of a list of 30 positive events
occurring in Ireland in 2004. “…it [smoke-free measures] Newspaper headline from 2019, Ireland
was a clear winner – 15% ahead of the second placed event,
Ireland’s only 2004 Olympic Games gold medal win” (98, 99).

22 | WHO report on the global tobacco epidemic 2023

 Box 5. Smoke-free South America

The 10 countries of South America constitute the first

subregion to achieve full smoke-free status. This was
achieved with Paraguay passing the hard-won Decree
4624 in December 2020.
The 10 countries took different paths to adopt this public
health measure, either through executive or legislative
measures, or a combination of both.
A few countries, including Argentina, Brazil, and
Venezuela (Bolivarian Republic of), started implementing
smoke-free environments at the subnational level and
gradually expanded to the national level (100).

Map of the smoke-free subregion of South America

© World Health Organization

3. Smoke-free environments: protect people from tobacco smoke | 23

Table 3. Challenges and Opportunities: progressing the adoption of smoke-free measures

Challenges Potential approaches

The next chapter provides more detail on the ways in which the tobacco industry interferes
Tobacco with smoke-free environments. Some ways to address this challenge are:
and related ■ be prepared to counter claims by the industry and front groups that DSRs provide
industries’ reasonable protection;
interference ■ be vigilant against of research affiliated with the tobacco industry and their front groups;
■ protect indoor smoke-free environments from new and emerging tobacco and nicotine
products;
■ ensure high compliance through enforcement so that the industry cannot argue that
legislation is ineffective;
■ counter the “loss of business” arguments, and keep the debate focused on health and
protecting everyone from SHS;
■ ensure the tobacco and related industries are not involved in legislation and that legal
measures are in line with WHO FCTC Article 8 and its implementation guidelines (101).

Build a strong evidence base for the impact of SHS on the local health and economic
Perceived or real burden to inform advocacy efforts.
push-back from Ensure that evidence on the impact of smoke-free measures on businesses and tourism is
the business carefully and robustly conducted.
community Consider setting up a coalition or working group to support businesses and address local
concerns.

Develop and share polling data showing public support for smoke-free laws.
Perceived or real
Identify business owners who support smoke-free legislation and share their stories.
lack of political
will Identify workers employed in smoke-filled workplaces who can speak of the impact on
their health.
Advocates for tobacco control should use the appropriate evidence to spur action and to
identify gaps that must be addressed to protect people from SHS. For example, evidence
on the economic costs of SHS and the benefits to businesses of smoke-free legislation can
be leveraged to convince decisions-makers.
Adopting local and subnational level smoke-free environments is a way to spur national
action, gradually building up to 100% comprehensive smoke-free coverage across the
country.

Some countries are challenged by limited resources to implement public health

Limited resources interventions. Some ways to address this include:
■ ensuring that decision-makers are aware of the robust evidence indicating that
smoke-free measures are highly cost-effective, and highlighting the health and
economic benefits from their implementation (see Tobacco control investment
cases and Return on Investment analyses);
■ utilizing existing infrastructure for inspections and enforcement;
■ collaborating with civil society or building a voluntary task force to enforce
smoke-free laws;
■ raising and/or using tobacco tax revenue to offset implementation costs.

Evaluate and track public knowledge and opinions of smoke-free measures. Surveys can
Concerns reveal that a public awareness campaign is needed to reinforce the public’s understanding
about public of the harms of SHS or the existence of smoke-free laws. Most often, such surveys also
disapproval of indicate that the public is in favour of smoke-free measures in public places, which often
increases after implementation of the measure, and this evidence can be valuable in
smoke-free laws galvanizing political will.
Sensitize the public to the harms of SHS and empower them to demand smoke-free
environments. Building public support for smoke-free environments can in turn help
strengthen political will.

24 | WHO report on the global tobacco epidemic 2023

Subnational and local-level Many studies, conducted in subnational ■ Homes, dwellings and vehicles can
laws can help protect people areas (e.g. states, provinces, cities) of also be places of work. For example,
countries in which smoke-free laws have prisons and nursing homes. These
from SHS and spur action at not been enacted nationally, have been venues require careful consideration.
national level able to demonstrate the positive impact
■ Careful consideration of the specific
Many countries have a government of such laws on population health
venues. Some legislation lists the
system in which state/provincial and (103,104). One recent study examined
type of venues where the smoking
local jurisdictions have significant the gradual implementation of smoke-
ban is to be applied, but this risks
legislative and administrative power free environments and the impact these
the possibility of unintentional
and can enact and enforce smoke- actions had on infant mortality in Brazil.
exclusion. If legislation lists the types
free legislation (and other laws) The study demonstrated that 15 000
of venues, it should be indicative and
independently from, and sometimes infant lives were saved during
not exhaustive.
more effectively than, national 2000–2016 as a result of the policy. The
governments. Therefore, cities and study also estimated that an additional ■ There should be no DSRs allowed
subnational jurisdictions like provinces 10 000 infant lives could have been regardless of the level of technical
and states can protect their citizens saved if the intervention had been requirements associated with them.
even before national legislation is in implemented comprehensively across
■ The law should clearly identify and
place. A number of studies have indeed all states simultaneously since 2000.
articulate the authority responsible
shown that local-level legislation may
for implementation, who the law
not only be more feasible for some Clear formulation of smoke-free applies to and their responsibility
countries but also allows policy-makers
the opportunity to better counter
legislation is an important step for enforcement, such as the
responsibility of venue operators to
the influence of the tobacco industry Weak legislation can leave loopholes
enforce restrictions.
which may be focused at national level. for the tobacco and related industries
Smoke-free measures at the subnational to exploit or lead to confusion and ■ Mechanisms should be described in
level are common where public health disagreement in interpretation and the legislation to ensure effective
legislation is decentralized, such as therefore weakened implementation. coordination between all relevant
Indonesia and India, and progress at Smoke-free legislation has been agencies, with a clearly designated
subnational level should be encouraged formulated differently in different lead agency responsible for
at the same time as supporting and contexts as a result of unique cultural, coordination.
driving national progress. This type of legal and economic factors. When
■ Giving the Minister of Health (or
progress often leads to national laws, formulating legislation, some important
other) the authority to include
such as in Argentina and Brazil, where aspects to note include:
DSRs in specified or unspecified
subnational laws ultimately led to
■ Carefully consider the definitions of venues leaves the law vulnerable to
national legislation (102).
important terms such as “smoking” subjective influence and vulnerable
and “indoor places”. Smoke-free to private interests.
laws should cover use of inhaled
tobacco (including HTPs) and inhaled
nicotine products, such as ENDS.

© WHO/Uma Bista

3. Smoke-free environments: protect people from tobacco smoke | 25

Apart from the physical requirements Informing people of the cancer and responses have varied across
of smoke-free environments (see Fig. 9), dangers of SHS is important to countries. In China only 50% of people
the implementation of smoke-free reportedly know that SHS can cause
legislation requires strong planning
ensure support for smoke-free heart attacks while in Türkiye almost
and clearly articulated mechanisms of environments and effective all (95.6%) of those asked were aware
enforcement. To prepare a strong and protection (Fig. 10). One recent study conducted in
effective plan, countries can assess the If people do not know or do not believe Malaysia revealed that male smokers had
current smoke-free situation, convene that SHS is a danger to their own limited knowledge about the health risks
an implementation task force composed and others’ health, they will be less linked to SHS and that this shaped the
of the relevant stakeholders and create likely to support and/or comply with men’s home-smoking behaviour (106).
an enforcement strategy. Ideally, the smoking bans or to voluntarily limit Gauging people’s understanding of the
public comes to appreciate smoke-free their exposure and that of others (105). harms associated with smoking and SHS
environments such that a smoke-free Global Adult Tobacco Surveys (GATS) is important for improving support for,
policy will eventually become self- have asked people if they believe SHS and compliance with, smoke-free laws.
enforcing. causes serious illness, heart attacks, and

Where smoke-free environments exist, sustainable

enforcement mechanisms must be developed and
applied to ensure people are protected from SHS.

Fig. 9. Physical requirements of a smoke-free environment:

“No smoking” signs Removal Clearly displayed The observance of the

Clear, bold and legible in of all ashtrays instructions on how rules must be supervised
the appropriate languages Ashtrays can act as cues to report a violation The designated responsible
for smoking A telephone number and person must take reasonable
the name of the person specified steps to discourage
on the premises to whom or stop a person from
complaints should be directed smoking on the premises

26 | WHO report on the global tobacco epidemic 2023

 It is crucial therefore to raise awareness developing voluntary compliance and and penalties for violations were the
of the harms of SHS as well as the self-enforcement. The other category enforcement strategies most frequently
benefits of smoke-free environments. is active enforcement which includes cited as being associated with
To bring about the best chances approaches that monitor compliance successful policy enforcement.
of successful implementation, all and hold people accountable for
stakeholders should be engaged violations. This includes compliance Monitoring and evaluating
including, but not limited to, the general checks, designated complaints
smoke-free policies will
public, decision-makers, opinion mechanisms, and the issuing of
leaders, researchers, the tourist and penalties or sanctions to violators help implement them more
hospitality sectors, businesses and the of smoke-free laws (107). Successful effectively
media. implementation includes aspects of As with most public health
both of these approaches. interventions, policy monitoring and
Compliance with smoke-free While approaches to strengthening
evaluation allows for strengthening and
measures is critical and requires improving the programme over time.
enforcement of, and compliance with,
Monitoring policies to track where they
sustained enforcement smoke-free laws need to be relevant
have been implemented (or not) and
Enforcement approaches fall into two to the specific context in which the
where they are successful (or not) can
categories – those that build voluntary law is implemented, there is a growing
help adapt and amend the approach
compliance (for example, by ensuring literature on the topic that can help
to strengthen the implementation of
that people are aware of the policy guide countries in establishing robust
the intervention and strengthen the
and what it entails); mobilizing the mechanisms (see Table 4). A recent
public health impact. It is also useful to
community and building support review of evidence published between
monitor the knowledge and attitudes of
for legislation through education 1980 and 2017 found that policy
the public and key populations to help
campaigns and public health messaging promotion and awareness-raising
target messaging and media campaigns
will increase the likelihood of activities, signage, enforcement officers,
(see Table 4).

Fig. 10. Percentage of adults (≥15 years) who believe that exposure to SHS causes heart attacks in
non-smokers, selected countries (GATS 2008–2018)
100
Proportion of people asked

80

60

40

20

0
China (2018)

of Tanzania (2018)
Kazakhstan (2014)

Viet Nam (2015)

Ethiopia (2016)

Kenya (2014)

Senegal (2015)

India (2017)

Nigeria (2012)

Thailand (2011)

Poland (2009)

Indonesia (2011)

Cameroon (2013)

Uganda (2013)

Federation (2016)
Panama (2013)

Mexico (2015)

Philippines (2015)

Pakistan (2014)

Ukraine (2017)

Brazil (2008)

Malaysia (2011)

Costa Rica (2015)

Romania (2011)

Bangladesh (2017)

Argentina (2012)

Greece (2013)

Uruguay (2017)

Qatar (2013)

Egypt (2009)

Türkiye (2016)
United Republic

Russian

Source: GATS 2008–2018

3. Smoke-free environments: protect people from tobacco smoke | 27

Table 4. Approaches to implementing smoke-free environments

Approach Description and evidence-base

Inform, consult and involve the public

Raise awareness The more public support there is for smoke-free measures, the more effective
they are likely to be. Ensuring that people are aware of the harms caused by
about the harms second-hand smoke and the benefits of banning smoking public areas can help
of second-hand to build this support. Mass media campaigns and graphic health warnings on
smoke tobacco packaging can help lay the foundations for smoke-free environments.

Raise awareness It is crucial that business owners and the public are on board and understand
the measures in place, and what the consequences are of failing to meet the
about the requirements. If awareness and support for the law is low then compliance will be
measures in low and enforcement will be more challenging to implement. The public should
place be empowered to demand smoke-free environments and to lodge complaints
where violations occur.

Support Countries can help support businesses by providing capacity building

opportunities (e.g. workshops on ways to implement smoke-free policies)
businesses and recognizing those that have demonstrated commitment to smoke-free
and the tourist environments (e.g. through awards schemes).
industry Develop and disseminate materials (print or digital, depending on resources) that
business can use for signage, patron education, etc. as the law goes into effect.

Penalties for Fines and sanctions on the individual can be effective when vigilantly enforced
but by applying fines on the establishment, the accountability lies with the
noncompliance business/venue and this can help ensure that enforcement is enacted by those
who are most likely to observe violations.

Recruit and Empowering people in society that are in positions of oversight or authority (such
as health care workers, social workers and teachers) to enforce smoke-free laws
train key staff
Enforcement and Compliance

can be a highly cost-effective approach.

as enforcement
officers

Establish citizen Expanding the authority to report on smoke-free violations to citizens and
bystanders through clear and simple mechanisms can help to improve
complaint compliance (108). Instructions on how to report smoking ban violations should be
mechanisms clearly displayed on no-smoking signage and digital tools, like mobile apps, may
help facilitate citizen reporting (see Box 6) (109, 110)

Ensure Legislation should address enforcement processes and structures and assign
enforcement authority to the appropriate agencies, with clear powers and duties.
enforcement
capacity Having dedicated human resources and capacity for smoke-free enforcement is a
major factor of success. Enforcement officers should be well-trained.
Assigning “duty of compliance” and responsibility to enforce smoke-free laws to
a broad range of stakeholders, such as business owners, teachers and health care
workers can expand capacity for enforcement.

28 | WHO report on the global tobacco epidemic 2023

Table 4. (continued) Approaches to implementing smoke-free environments

Approach Description and evidence-base

Plan for Countries can develop a sustainable source of funding for enforcement
(potentially using income gained from fines imposed for breaking smoke-free
sustainability laws or from earmarked tobacco taxes).
Enforcement and Compliance

Utilizing existing networks and mechanisms, such as existing food safety

inspectors, to take on enforcement activities can save resources and improve
sustainability.

Strategize Ideally, after the smoke-free law is adopted, all stakeholders will support
smoke-free laws and the measure will become self-enforcing. To achieve this a
enforcement for combination of active and soft enforcement approaches may be necessary. For
best effect example, if the law is in force it may be recommended to begin with a period
where violators are cautioned, giving the community a chance to adapt before
strengthening enforcement and meting out penalties.
High-profile prosecutions can help to relay the message that the noncompliance
will not be tolerated.

Remove all Studies show that DSRs not only reduce the effectiveness of smoke-free areas
but also reduce the likelihood that the law will be enforced effectively, and
designated compliance is likely to suffer (111).
smoking areas/
rooms

Monitor and A better understanding of where measures have, or have not, penetrated, where
they are succeeding and how they are being managed can help to improve and
evaluate strengthen enforcement and compliance and can also help to build the evidence
enforcement base for advocacy.
and compliance Consider engaging civil society partners in compliance monitoring and reporting.
Use monitoring mechanisms to ensure equitable protection from SHS.
Monitoring and Evaluation

Monitor public Monitor the knowledge and attitude of stakeholders, including the general public,
on SHS and to garner opinions on the implementation of smoke-free measures.
knowledge and This information will help to strengthen implementation approaches and can
attitude about help target messaging.
SHS and smoke-
free measures

Monitor Some of the key questions to monitor are:

outcomes of ■ Does the smoke-free law lead to a reduction in SHS exposure and air
smoke-free pollution in indoor places and in private homes?
measures ■ Does the smoke-free law lead to a reduction in SHS-related deaths
and illness?
■ Does the smoke-free law lead to a reduction in smoking prevalence?
■ What is the economic impact of implementing of the smoke-free law?

3. Smoke-free environments: protect people from tobacco smoke | 29

Addressing inequalities should (GYTS) surveys show that young New and emerging tobacco and
be part of every implementation females are more likely than young nicotine products pose a serious
males to be exposed in both home and
plan public environments. People living
threat to smoke-free measures
Ensure adoption, implementation of, in disadvantaged communities are Tobacco and related industries market
and compliance with, smoke-free laws more likely to be exposed to SHS (115). e-cigarettes and other new and
across all geographies and contexts: Women, who are more likely to be non- emerging nicotine and tobacco products
Smoke-free measures cannot effectively smokers compared with men, are often as alternatives and/supplementary
protect people from SHS if compliance exposed to high levels of SHS in their products to conventional cigarettes that
with the law is not upheld, and there homes and carry a larger health burden can be used in indoor public areas, even
are a number of factors that affect from SHS relative to their consumption where smoking bans exist (119). These
compliance. Even in contexts where (116). Females in the Western Pacific products include, nicotine pouches,
there are comprehensive laws and high countries, for example, carry a large e-shishas, e-pipes and e-cigars. Through
compliance, smoke-free laws may not portion of the burden due to SHS such marketing tactics, these industries
penetrate all parts of society. Rural and exposure. Pregnant women in low- and explicitly or implicitly implies that the
remote areas, for example, are less likely middle-income countries also report emissions that result from the use of
to be monitored for enforcement and higher levels of exposure to SHS than these products are harmless to those
therefore more likely to demonstrate women who are not pregnant as they exposed. The use of these products
lower rates of compliance (112). are more likely to spend more time at poses several risks. The exposure to
home (117). In some contexts, non-urban smoke or aerosols is harmful (although
Ensure awareness of the impact of SHS
youth are more likely to be exposed to the extent of that harm is still under
in private spaces: Inequalities related
SHS in their homes and in vehicles than investigation) and breathing clean
to SHS exposure within countries can
urban youth (118). air that has no additional toxicants
arise from exposure in private spaces
compared with the ambient air is every
(113, 114). Global Youth Tobacco Survey
citizen’s right (Box 7).

Box 6. Digital solutions for enforcement

Digital approaches have been developed in recent years to help improve enforcement of smoke-free areas. Digital
technologies can be employed to send people messages about the smoke-free policy of the venue they are in, thus
increasing awareness, while apps that allow for quick and easy reporting of smoke-free violations by citizens can help
provide the capacity where enforcement officers are in short supply. One example is the Complaint Map in Beijing:
“The Complaint Map visually displays the reported violations on a map of Beijing in real time. The general public can
access the Complaint Map at any time to see which venues and locations have been reported. It is used by tobacco
control volunteers, who are recruited and trained to address complaints and promote compliance. It is also used by the
government’s enforcement team for targeted inspections.” (110)

Visual display of violation on the Complaint Map

30 | WHO report on the global tobacco epidemic 2023

Also, the difficulty associated with and emit tobacco smoke to second-hand aerosols was 16%,
distinguishing the different products (7, 121–123). Therefore, it is often a ranging from 4.3% in Spain to 29.6% in
and the aerosols that result from challenge to determine which product England (125). Smoking bans adopted
these products makes enforcement of is being used, making the enforcement before the advent of e-cigarettes often
smoke-free laws intended to protect the of smoke-free laws difficult, where they do not include emerging products,
bystander almost impossible. exist. Thus, for the purpose of their such as e-cigarettes and their use in
use in public places, they should fall public places, so their use may, by law,
There is also significant and legitimate
under existing smoking restrictions or be permitted. And because of the way
concern that new and emerging
bans. Lastly, although the evidence on “smoking” was defined in older laws,
products have the potential to
the negative health effects of newer their use may also be unintentionally
renormalize the act of smoking,
products is still mounting, we know they excluded from long-standing smoke-free
thereby undermining progress made
are harmful. laws. It is important to note that even
in protecting people through smoke-
if the sale, manufacture and import of
free policies (120). The act of using Countries need a strong response to
these products are banned, measures
some of these products is very similar those pushing for the use of ENDS,
are still required to ensure use in public
to that of smoking and the more they ENNDS and HTPs in indoor spaces. In
places is also banned. However, it is to
are seen as acceptable, particularly in a recent survey of European attitudes
be noted that many countries apply their
indoor environments, the more likely towards tobacco and e-cigarettes, about
existing policies, including smoke-free
smoking itself will become more socially one quarter of respondents reported
laws, to HTPs (Box 8).
acceptable. It is also important to note having seen people using e-cigarettes in
that some newer products that look very drinking establishments (124). In a study
much like ENDS (and could be confused in 12 European countries, moreover, the
with ENDS, like HTPs) contain tobacco self-reported prevalence of exposure

© WHO/Mukhsindzhon Abidzhanov

3. Smoke-free environments: protect people from tobacco smoke | 31

 Box 7. SHS, second-hand aerosols (SHA) and their health effects

■ Waterpipes are increasing in popularity and create ■ When used indoors, ENDS and ENNDS, like
large volumes of SHS. They are often used in e-cigarettes, raise airborne concentrations of
communal spaces and very often indoors. Studies particulate matter above background levels
have demonstrated that the air quality in rooms (131, 132). The levels of nicotine (for ENDS but
where waterpipes have been used is just as bad as not ENNDS); particulate matter and potential
those where cigarettes have been smoked (126–128). carcinogens in second-hand aerosols exceed the
maximum recommended levels set out in the WHO
■ HTPs heat tobacco to produce a nicotine-infused
FCTC Guidelines (101). This is of concern, as studies
vapor. Evidence shows that HTPs contain hazardous
evaluating human exposure to particulate matter
chemicals, and some of these compounds may
generated by the use of ENDS – including fine and
even be found in higher quantities than found
ultrafine particles (which may penetrate the alveoli),
in conventional cigarettes. Recent evidence has
volatile organic compounds, heavy metals and
indicated that exposure to SHS from HTPs is
nicotine – suggest an increased risk of heart and
associated with asthma and asthma-like symptoms,
lung disorders. Although the health risks associated
as well as sore throat, headache and chest pain in
with second-hand aerosols (SHA) from ENDS/ENNDS
bystanders (129, 130).
are not yet well understood, a systematic review
concluded that ENDS “vapour” has the potential to
cause harm to bystanders. Further research is needed
to fully understand the health effects of second-hand
aerosols (121, 133–135).

If we continue at the current rate of policy

adoption, it will be another 50 years
before the rest of the world is protected
from second-hand smoke. Acceleration of
progress is critical.

Box 8. Smoke-free legislation must cover new and emerging nicotine and tobacco
products and be future-proofed against tobacco industry tactics

■ ENDS, ENNDS and HTP non-users should be protected ■ In drafting legislation, terminology used to describe
from the emissions of these products. smoking is critical and should cover the use of new
and emerging products. The industry attempts
■ Smoke-free legislation should encompass new and
to argue that HTPs are not “smoked”, “burned”
emerging nicotine and tobacco products and specific
or “combusted”. Therefore, if the definition of
products, like ENDS, should never be excluded from
“smoking” in smoke-free legislation is restricted to
its provisions.
the use of these terms it may result in the exclusion of
■ WHO FCTC Decision FCTC/COP8 (22) asks Member HTPs from the law and expose bystanders to harms.
States to “ban the use of HTPs where smoking
is prohibited, making sure that legislation for
smoke-free environments complies with all
recommendations of Article 8 Guidelines for
implementation and treats HTP use as smoking”.

32 | WHO report on the global tobacco epidemic 2023

Recommendations for adopting and implementing
smoke-free environments
Legislation should be comprehensive Authority to enforce the law must be Enforcement must be sustainable.
and align with WHO FCTC Article 8 clearly designated and articulated An implementation and enforcement
and its implementation guidelines to clearly where possible in the legislation. plan, together with effective awareness-
effectively protect people from SHS raising campaigns, a well-coordinated
Legal action should be adopted at any
exposure. Countries should adopt enforcement infrastructure (involving
and all jurisdictional level(s) where
legislation that mandates completely all relevant agencies) and ensuring
effective legislation can be achieved.
smoke-free environments with no DSRs. high-profile prosecutions include fines
Physically separating smokers from non- Anticipating and responding to the or the closing down of businesses that
smokers (for example by establishing tobacco industry’s opposition, often repeatedly violate the law, are critical
DSRs providing ventilation of smoking mobilized through third parties, is for successful implementation.
areas) does not eliminate the health risk crucial. The next chapter will discuss
Monitoring of implementation
resulting from exposure to SHS. some of the key actions that
and compliance is essential, as is
can be taken to address the many ways
Smoke-free legislation should be measurement of the impact of smoke-
the industry tries to hinder progress.
simply and clearly articulated. Laws free environments; ideally, people’s
should be written in clear language Involving civil society is central experiences should also be documented
with the aim to limit misinterpretation, to achieving effective legislation. and the results made available to other
ensure the inclusion of novel and Effective partnerships and stakeholder jurisdictions, and others in the tobacco
emerging tobacco and nicotine products engagement can be very powerful tools control community, to support their
and, as far as is possible, provide to coordinate advocacy efforts and efforts to successfully introduce and
sufficient opportunity for countries to bolster political will. implement smoke-free legislation.
cover any foreseeable future scenarios. Robust research is encouraged to
Raising awareness, and consultation
better inform enforcement strategies
Smoke-free legislation should be with stakeholders are necessary to
in different contexts.
enforceable and mandatory because ensure early adoption and smooth
voluntary policies are not effective implementation of smoke-free
substitutes to legislation. legislation.

© WHO/Ala Kheir

3. Smoke-free environments: protect people from tobacco smoke | 33

4. Tobacco industry interference:
Protecting people from tobacco and related industries
Tobacco use is responsible for causing TACTIC 1 TACTIC 6
over 8 million deaths every year and
Building increasingly elaborate alliances Influencing “upstream” policies,
causes more disability and ill health
and front groups to represent its case- including trade and investment
than any behavioural risk factor. Yet
the “third party technique” agreements, to make it harder to pass
still the tobacco industry aggressively
public health regulations
market its products worldwide and,
goes out of its way to undermine the TACTIC 2
implementation of the WHO FCTC and TACTIC 7
Attempting to fragment and weaken the
the MPOWER package. Some of the public health community Litigating or threatening litigation
tactics the industry deploys are (136):
TACTIC 3 TACTIC 8
Disputing and suppressing public health Facilitating and causing confusion
information around tobacco smuggling, and using
this confusion to undermine tobacco
TACTIC 4 control
Producing and disseminating
TACTIC 9
misleading research and information
Seeking to manage and enhance its own
TACTIC 5 reputation by rebranding themselves
as environmentally and socially
Directly lobbying and influencing policy-
responsible to increase the ability to
making
influence policy

The tobacco industry’s latest efforts to bolster its reputation and expand its
reach into both policy and the commercial markets is to seek to transform itself
towards wellness and health care areas by investing and acquiring ownership of
pharmaceutical and well-being companies.

© WHO/Karen Reidy

34
Countering tobacco industry tactics

The tobacco industry attempts to organizations, business and ■ Putting in place and enforcing
present itself as a partner in tobacco trade associations, consumer effective conflict of interest
control, while simultaneously groups, think tanks, professional policies for policy-makers and
blocking regulatory efforts. associations and others seeking officials engaged in developing,
Therefore, partnerships with involvement or input in tobacco implementing and enforcing
tobacco and related industries control policies. tobacco control policies.
should be rejected, and there should
■ Rejecting partnerships and ■ No government privileges or
be clear rules regarding conflicts of
non-binding or non-enforceable influence should be afforded
interest for government officials and
agreements with the tobacco to any tobacco and nicotine
government employees.
industry and those working companies and state-owned
WHO FCTC Guidelines for in its interests, including tobacco enterprises should
implementation of Article 5.3 – financial support, incentives be treated the same as other
adopted by the Conference of and endorsement of tobacco tobacco companies.
Parties in 2008. to help countries industry activities related to
■ Ensuring that health and non-
meet their legal obligations to the tobacco control.
health agencies take consistent
Article – are based on both scientific
■ Raising awareness about the action, adhering to Article 5.3
evidence and the countries’
known addictive and harmful and applying the Guidelines for
experiences. These guidelines
properties of tobacco and implementation.
continue to be instrumental in
nicotine-containing products,
combatting industry interference ■ Blocking interaction between
and about tobacco industry
and should be applied in relation government and front groups
interference with tobacco
to both conventional and emerging that are funded by tobacco and
control policies.
nicotine and tobacco products. related industries “purporting
■ Denormalizing and, to the to work for a smoke-free
Effectively addressing and
extent possible, regulating world” (speech by Dr Tedros
countering tobacco industry
and banning publicity around Ghebreyesus)
interference requires a whole-
activities described as “socially
of-government approach which Governments should also encourage
responsible” by the tobacco
ensures all sectors, including, for and empower civil society to play a
industry.
example, ministries of trade or role in preventing and addressing
commerce, are engaged in the ■ Prohibiting the dissemination of tobacco and related industries’
enforcement of tobacco control misleading information relevant interference (such as those that
policies and upholding Article 5.3. to tobacco control policies. are involved in the production
Government action to counter or sale of nicotine products
■ Requiring that information
tobacco industry interference like ENDS). Effective advocacy
from the tobacco industry
should include the following: against the tobacco and nicotine
on marketing, lobbying
industries requires skills training,
■ Requiring disclosure of, and and philanthropic activities
capacity building and longer-term
clearly communicating, funding is disclosed and that the
investments from donors to ensure
sources for research institutions, information provided by them
sustainability.
academics, and scientific studies be transparent and accurate,
to prevent unseen biases in with regular, truthful, complete There are also significant global
science on which policy may be and precise information on efforts to expose and curb tobacco
based, as well as to clarify the tobacco industry activities. All industry interference and tactics
motivations of nongovernmental government interactions with the (see Box 9). For example, the Global
industry should be recorded and Tobacco Industry Interference Index
made available to the public. is a global scorecard highlighting
how governments are resisting
tobacco industry interference.

4. Tobacco industry interference: Protecting people from tobacco and related industries | 35
 Box 9. Helpful resources to address tobacco industry interference

Global and regional partnerships governmental alliances assisting ■ “Implementing article 5.3 of
and alliances: countries in their respective the WHO FCTC: From policy
regions to address and stand up to practice”: an online course
■ Stop Tobacco Organizations
to tobacco industry interference coordinated by the Convention
and Products (STOP): this global
(e.g. see SEATCA resources and Secretariat and the Global Centre
tobacco industry watchdog is a
ATCA resources for Good Governance in Tobacco
network of academic and public
Control. (LEARN – Simple.
health organizations working
WHO technical reports: Practical. Empowering.)
to expose and counter the
industry’s relentless efforts to ■ Tobacco industry interference
Research institutions:
sell harmful, addictive products with tobacco control. Geneva:
(STOP). As part of this initiative, World Health Organization; 2008. ■ TobaccoTactics: a source
national surveys of industry (Tobacco industry interference of research on the tobacco
activity and government efforts with tobacco control) industry hosted by the Tobacco
to protect policy are collated and Control Research Group
■ Tobacco Industry Interference:
analyzed by the Global Center within the University of Bath
A Global Brief. Geneva: World
for Good Governance in Tobacco (TobaccoTactics)
Health Organization; 2012.
Control (GGTC) to produce
(Tobacco Industry Interference - ■ Centre for Tobacco Control
the Global Tobacco Industry
A Global Brief) Research and Education at
Interference Index (GTI)
University of California San
■ Tobacco Industry Interference
■ Some regional partnerships Francisco (WHO Collaborating
in the WHO European Region.
like the Southeast Asia Tobacco Centre on Tobacco Control)
Copenhagen: World Health
Control Alliance (SEATCA) and the
Organization; 2012. (Tobacco
African Tobacco Control Alliance
Industry Interference in the WHO
(ATCA) are multisectoral non-
European Region)

Effectively addressing and countering tobacco industry

interference requires a whole-of-government approach.

© WHO/Vismita Gupta-Smith

36 | WHO report on the global tobacco epidemic 2023

Tobacco industry tactics used to undermine
smoke-free environments

Discrediting scientific Building alliances and Conflating product

information and front groups to pressure categories to confuse
manufacturing governments and delay the general public and
alternative science implementation of smoke- the regulators, and slip
free measures through through the smoking bans
The tobacco industry is known for
creating scientific controversy in litigation Today, the number and types of tobacco
order to challenge, undermine and and nicotine products sold are prolific,
counter restrictions to tobacco use As early as the 1980s, tobacco diverse, and rapidly evolving – and some
(137). Similarly, over the years the manufacturers financially backed can be very difficult to distinguish from
tobacco industry has worked to existing hospitality groups and one another. This complexity leads to
refute evidence of the health effects even created them from scratch in confusion about product categories
of second-hand smoke (138). In the order to lend them an appearance of and makes regulation and enforcement,
early years of the 21st century, as the independence. The tobacco industry especially in resource—limited
evidence on the health impact of SHS manipulated hospitality owners and environments, extremely challenging.
was still accumulating, the industry their representatives into believing that The industry uses this confusion to
hired scientists and epidemiologists their businesses would suffer gravely get around legislative loopholes. For
to promote the message that SHS was or indeed fail as a result of a smoking example, in countries where ENDS
not a danger to non-smokers. They ban. This continues today, with the regulation is weak, tobacco companies
tried to portray the hazard of SHS as a tobacco industry and its allies mounting pitch HTPs as electronic products
“mere annoyance” for bystanders (139) numerous legal challenges to prevent or “similar to ENDS”. Yet, where ENDS are
or just a matter of courtesy on the part delay smoke-free legislation from being banned, HTPs are pitched as tobacco
of smokers to reduce the exposure of enacted. Usually when the industry products that do not fall within existing
smoke to non-smokers. attempts to use litigation (either directly categories (150, 151). Alternatively, HTPs
or through front groups) or threatens might be introduced to the market in
Today, evidence on the harms of SHS is litigation in the context of smoke-free
overwhelming and there is no denying one country as a smokeless tobacco
policies, the main claims used are product (because the regulation on
the impact SHS has on the health of (146–149):
non-smokers. So, the industry today smokeless tobacco products is weak
deploys a new strategy to create the ■ They claim that smoking is a or nonexistent), yet be introduced as a
impression that products like ENDS do fundamental right of individuals; smoking product in country B (because
not produce second-hand smoke and smokeless tobacco products are banned
■ They stoke anger by claiming that in this country); this creates confusion
that they are “clean” alternatives to
smokers and business owners are about these products, both among
cigarettes (140). They claim that aerosols
not being supported; the general public and for regulatory
of these new and emerging products
are “mainly composed of water, glycerin ■ They claim that procedural due purposes, and can influence whether
and nicotine”, and therefore not harmful process to the passing of smoke-free these products are permitted or banned
to bystanders. However, this is not laws has not been met; in indoor smoke-free environments
true, as the aerosols generated by (150, 152). Indeed, if HTPs are
■ They argue that voluntary categorized as a smokeless tobacco
ENDS typically raise the concentration
restrictions are sufficient; and product, “smoking” bans do not
of particulate matter in indoor
environments and contain nicotine ■ They make out that smoke-free laws necessarily apply to them. Regulators
and other potentially toxic substances are very difficult or expensive to should therefore not fall into these
that are harmful to both users and enforce. tobacco industry traps and should
non-users exposed to the aerosols always include ENDS, ENNDS and heated
It is important to note, however, that tobacco products in the scope of smoke-
second-hand (141–143). Additionally,
the vast majority of such cases do free legislation.
there is evidence that ENDS aerosols
not succeed, but they often delay
can lead to respiratory symptoms (144).
implementation of smoke-free policies
The full extent of risk posed by new
and cast doubt in the minds of policy-
and emerging products like ENDS and
makers elsewhere.
ENNDS have not yet been quantified
and are not fully understood (145). In the
meantime, we must not let the tobacco
industry repeat their lies and no credit
should be given to their false claims.

4. Tobacco industry interference: Protecting people from tobacco and related industries | 37
 as noted above, HTPs do by definition
Attempting to coopt Directly lobbying and produce smoke. In addition, the use of
tobacco control language influencing policy-making products like these in public areas poses
the potential to undermine current
New and emerging nicotine and The tobacco industry influences tobacco control efforts by renormalizing
tobacco products, like ENDS and policy-making while legislation is being smoking (See Box 11 and Box 12).
HTPs, have enabled the industry to drafted or amended (162, 163), for
appropriate the term “smoke-free” ENDS have created new ways for
example by suggesting changes that the tobacco industry to sidestep
for its own gain (153). In the case of weaken the outcome of the legislation,
HTPs, the device heats the tobacco to laws governing not only smoke-free
or influencing the process through environments but also advertising bans
temperatures below those reached by
political donations and lobbying. The (ENDS have been openly advertised),
burning cigarettes (154). Consequently,
industry may also target legislation that health warning requirements and
they market HTPs as ”alternatives” to
is being reviewed and amended, looking bans on sale to minors. After decades
smoked tobacco products and argue
that they can be used in indoor spaces to create loopholes that allow new of marketing restrictions, the tobacco
(121, 155). Through this marketing tactic and emerging tobacco products to fall industry is once again using traditional
the industry intends to weaken any through existing or potential regulatory media channels such as television and
comprehensive smoke-free provisions gaps, for example where smoke-free print media, which were previously
that currently exist in countries. environments are involved (See Box 10). used to target youth and young adults
Research, however, demonstrates that (164, 165), in addition to flooding social
exposure to particulates, nicotine and media with direct and indirect
other components of HTP aerosols pose advertising on ENDS (166–168). Where
risks to non-users (156, 157). Undermining existing countries do not prohibit brand
The report of the 9th session of the
Conference of the Parties to the WHO
tobacco control measures stretching (the use of tobacco brands
on non-tobacco products) companies
FCTC on “Challenges posed by and The industry argues that HTPs and ENDS can use tobacco product brand names
classification of novel and emerging are less harmful to both the user and the on ENDS, thereby advertising tobacco
tobacco products”, noted that novel bystander and therefore, restrictions, products and seeking to create brand
and emerging tobacco products,
such as indoor smoking bans, should loyalty. While the vast majority of
in particular HTPs, emit pyrolysis
not be applied to them or should be countries in the world ban the sale of
products, such as volatile aldehydes, in
less stringent than for conventional tobacco products to minors, a much
their aerosols which clearly fall within
the scientific definition of smoke. tobacco products. However, as noted smaller number of countries ban the
Therefore, any smoke emitted by HTPs above, evidence suggests that ENDS sale of ENDS to minors (169), thus
is unambiguously “tobacco smoke” do indeed produce airborne particles facilitating their first contact with,
(9, 122, 158). that may be harmful to non-users and, among other things, nicotine.

Box 10. Attempt to return smoking to public indoor places in wartime, Ukraine

Between July and August 2022, there were two attacks on A coalition of NGOs organized a public campaign to
Ukraine’s smoke-free legislation (strengthened by the newly disclose policy-makers’ vested interests and expose
adopted law No. 1978-IX). The first one appeared in the the negative consequences of the amendment. WHO’s
shape of registered draft law No. 7597 (159), which intended country office in Ukraine issued a letter to parliament and
to allow smoking and the use of tobacco and nicotine the Ministry of Health, warning of the threat and urging
products in designated places in cafés, bars and restaurants. public health policy protection, and participated in public
The registered draft law was justified by the claim that it events to advocate against harmful policy changes. The
would provide “economic support” to the hospitality sector NGOs organized an information campaign and collected
during a time of crisis due to ongoing war. The parliamentary signatures from international organizations under an open
health committee rejected the draft law in February 2023 letter to parliament. As a result, even with substantial MPs’
on the basis that it was an attempt to discredit the newly support, the majority in parliament dismissed the harmful
improved tobacco control legislation, particularly smoke- amendments and protected the smoke-free legislation.
free norms.
Parallel to this, in August 2022, a group of MPs again
attempted to diminish Ukraine’s smoke-free norms by
registering amendments to draft law No. 5616, which aimed
to return smoking and tobacco use to the premises of
restaurants, cafés, bars, hotels and other indoor workplaces.
Such actions were deliberately hidden from the public,
misled parliamentarians from other committees, and © Ukrinform, Ukraine
became a serious public health threat (160).
WHO - NGO Life press conference to advocate against
weakening the smoke-free legislation

38 | WHO report on the global tobacco epidemic 2023

Box 11. ASA Adjudication on Imperial Tobacco Ltd

In the United Kingdom, a poster for a smartphone app definition of “tobacco products” and only provided
stated: “Smoke Spots: The Smoker’s Social Home. You information about locations where it was legal and
chose where you drink, why not where you smoke? ” Find appropriate to smoke.
the best spots to smoke by location or event. Results
The ASA held that the ads did not include any reference
matched specifically to your needs.” Cancer Research
to tobacco products but related directly to a service that
United Kingdom challenged this advertisement through
provided information about locations where smoking was
the Advertising Standards Authority (ASA) alleging that
permitted. Therefore, the ads did not promote tobacco
the advertisement (a) promoted a tobacco product and (b)
products. However, elements of the ad presented smoking
normalized smoking and could encourage non-smokers
in a positive light and the overall impression of the ad was
to start smoking or existing smokers to continue. Imperial
normalizing of smoking. It was held that the ad was harmful
Tobacco UK Ltd. responded by claiming that the “smoke
and irresponsible on that point.
spots” service being promoted did not fall within the

Box 12. Driving Addiction: Netflix, F1 and Tobacco Advertising

STOP, a network of academic and public health Research conducted for the report estimates that a
organizations operating globally to expose and counter the staggering 1.1 billion minutes of Drive to Survive, Season
tobacco industry, has published three Driving Addiction 4 content, viewed globally, contained tobacco company-
reports to expose the problematic collaboration between related branding. Given Netflix’s global reach, in order
tobacco companies and Formula 1. The 2023 report focuses to protect consumers from tobacco advertising and
on the impact of the Netflix docuseries, Formula 1: Drive to sponsorship, the report calls upon governments to ask
Survive, which enjoys a younger audience than that for F1 Netflix to remove the programme where it violates national
races. Through this programme, viewers are inundated with restrictions and to strictly enforce national legislation with
tobacco company branding, like that of BAT’s Vuse brand (an respect to violations.
e-cigarette) on McLaren team cars, including in countries
where tobacco advertising and sponsorship are expressly
prohibited. For instance:
■ Brazil has banned the import, sale and advertising of
e-cigarettes since 2009, but F1 and Drive to Survive
fans are still exposed to e-cigarette advertising due
to broadcast coverage of races in other countries, the
Netflix and F1-related social media content.
■ India, home to an estimated 31 million F1 fans, has
prohibited e-cigarettes and nicotine products, and
there is a comprehensive prohibition on tobacco
advertising. However, viewers are still exposed
to tobacco company messaging and e-cigarette
branding while watching the Drive to Survive series
and F1 races.

The STOP Report on the collaboration between tobacco

companies and Formula 1

4. Tobacco industry interference: Protecting people from tobacco and related industries | 39
Mauritius – an MPOWER success story
History of tobacco control in Mauritius

■ Mauritius’ achievements in ■ Armed with data compiled ■ The new regulations

tobacco control began in 2003, through the ITC survey, comprehensively strengthened
when the Ministry of Health and Mauritius was in a stronger Mauritius’ tobacco control
Wellness began work towards position to further strengthen its framework by introducing plain
implementing tobacco control commitment to tobacco control, tobacco packaging and eight
laws. Soon after, on February 27, and in 2018 became a Party to new larger pictorial health
2005, Mauritius was among the the Protocol to Eliminate Illicit warnings with provision to
first countries to become Party Trade in Tobacco Products rotate images every 2 years.
to the WHO FCTC. The regulations also introduced
■ From 2018 to 2022, the Ministry
a complete smoking ban in
■ In 2008, the first tobacco control of Health and Wellness
all indoor workplaces as well
regulation was published worked with WHO to revise
as in many outdoor public
under the Public Health and strengthen the 2008
spaces. Additionally, a ban was
(Restrictions on Tobacco Public Health (Restrictions on
imposed on the manufacture,
Products) Regulations. These Tobacco Products) Regulations.
import, distribution and sale
regulations mandated a set This was achieved with the
of waterpipes, ENDS and
of eight pictorial and written strong support and close
warnings to be displayed on collaboration of the Mauritius ENNDS (including e-liquids),
65% of the surface areas of Attorney General’s Office and and heated tobacco products
cigarette packaging. Health engagement across relevant (including tobacco products
messages were also required on government agencies. for their use). The regulations
cigar, cigarillo and pipe tobacco impose the same ban on
■ Amended Public Health smokeless tobacco products;
packaging. A comprehensive ban
(Restrictions on Tobacco tobacco products with a
on advertising, promotion and
Products) Regulations were put characterizing flavour; roll-your-
sponsorship of tobacco products
in place in 2022 (See Fig. 11). own tobacco and accessories;
was also implemented, and tax
was introduced. any other product containing
nicotine; and any device used
for tobacco consumption
Fig. 11. MPOWER progress since 2007: Mauritius that may be manufactured
or marketed to replace or
2007 2008 2010 2012 2014 2016 2018 2020 2022 imitate a tobacco product, not
M Monitoring including products prescribed
P Smoke-free environments by medical practitioners (e.g.
O Cessation support
nicotine replacement therapy).
W Health warnings on packs
The new regulations also
E Advertising bans
R Raise taxes
imposed stringent reporting
W-MM Mass media campaigns
requirements for tobacco
NTCP National tobacco control program importers and introduced new
tobacco product regulations,
MPOWER Score colour key
including reduced ignition
No data No measure or weak measure Minimal measure Moderate measure Complete policies
propensity for cigarettes.

Tobacco use in Mauritius is declining

■ National noncommunicable this rate had fallen to 19.7%. The epidemic among adolescents
disease surveys show the 2021 survey showed a further aged 13 to 15 years. The current
impact of Mauritius’s tobacco decrease to 18.1%. tobacco use rate was around
control measures since efforts 18%, which indicated more
■ The Global Youth Tobacco
began. The 2009 survey showed effort was needed to prevent
Survey carried out in 2016–2017
that 21.7% of Mauritians were youth uptake.
provided insight on the tobacco
currently smoking, and by 2015,

40 | WHO report on the global tobacco epidemic 2023

MPOWER measures in Mauritius

Protecting people from packets of cigarettes and the ■ No advertisement or promotion

percentage display was set at of tobacco products is permitted
tobacco smoke of 60% on the front and 70% at at points of sale, including
As stated by the WHO FCTC, the back. The graphic health promotion through price
voluntary smoke-free policies alone warnings depicted health- lists, as the prices of tobacco
are not as effective as mandatory related consequences of tobacco products on sale are required
ones, and enforceable legislation consumption such as oral to be displayed according to a
needs to be expedited. Following cancer, impotence, stroke, and prescribed, standardized layout.
an initial ban on smoking in public addiction.
places and public transport in 2008, ■ Sale of tobacco products at
the new regulations released in ■ Health warnings on the harmful retail outlets or through vending
2022 banned smoking in all outdoor effects of tobacco consumption machines was prohibited in
and indoor spaces, but also within on packaging of cigars, cigarillos 2008, and online sales were
a radius of 10 m of any opening and pipe tobacco were also banned in 2022.
in a building. This also covers the imposed in 2008.
■ Online advertising and
outdoor areas of restaurants and In 2018, a new set of eight
drinking facilities.
■ promotion of tobacco products
pictorial warnings were has also been expressly banned.
■ Mauritius has gone a step designed and tested, based
further, too, banning smoking in on health risks that had not
previously been addressed, such Raising taxes
gardens to which the public has
access, as well as when while as miscarriage, ageing, toxicity ■ The total tax share as a
driving or travelling in a vehicle of cigarette consumption, and proportion of the retail price of
carrying passengers; or while cardiovascular diseases. the most sold brand in Mauritius
stationary in a vehicle carrying stood at 78.2% in 2022.
■ On 31 May 2023, plain packaging
passengers. was implemented on tobacco ■ Mauritius applies a uniform
■ By broadening its definition of products and a new set of health specific excise tax on cigarettes,
what is considered a “public warnings, both graphic and text, a best-practice policy. The
place”, Mauritius aims to become were enforced. The combination excise rate amounted to 6188
a “smoke-free” country. of health warnings has now a Mauritian rupees per 1000 pieces
percentage display comprising in 2022. When compared with
100% of the available area on 2008, the first year with relevant
Offering help to quit the back of the pack, 80% on data in the WHO Report on the
■ Since 2010, tobacco cessation the front and 75% on the lateral global tobacco epidemic, excise
services have been free of charge sides of packets of cigarettes. tax doubled in real terms over
through eight cessation clinics a period of 12 years, making
around the island. One more ■ The new regulations mandate
the display of warning signs cigarettes less affordable over
clinic was inaugurated in April time to discourage consumption.
2023. The tobacco cessation prohibiting the sale of tobacco
clinics dealt with more than products to minors at all points ■ For each of the financial years
10 000 cases between 2018 of sale, together with increased 2022–2023 and 2023–2024, a
to 2022. penalties for non-compliance. 10% tax increase on tobacco
Mauritius has taken many products has been imposed
■ Cessation support started in ■
opportunities to share its as Mauritius is aiming to
2010 in one primary care facility
graphic health warnings with achieve the 30% reduction
and has since been extended
numerous countries such as in the prevalence of tobacco
to all regional hospitals, two
Cambodia, Ethiopia, Pakistan, consumption in adults aged
community hospitals and the
Seychelles and Sudan, and to 15 years and above by 2030.
Diabetic & Vascular Health
Centre. provide assistance and share
its experience in the field of
■ Since 2011, a toll-free quit line tobacco control.
has been available for those
who wish to stop smoking. The
number is advertised through
Enforcing bans on
public campaigns. advertising, promotion
and sponsorship
Warning about the dangers ■ Bans on advertising, promotion
of tobacco and sponsorship of tobacco
products have been in place Poster promoting the tobacco quitline
■ Since 2008, under the initial in Creole 2018
since 2008. There is rigorous
regulations, a set of eight
monitoring through the various
pictorial health warnings were
enforcement bodies.
designed for and required on

4. Tobacco industry interference: Protecting people from tobacco and related industries | 41
The Kingdom of the Netherlands:
making MPOWER history

History of tobacco control in Netherlands (Kingdom of the)

■ In 1957 the Dutch Health Council ■ and in 1977 the Tobacco ■ In 2018 a National Prevention
published an advisory report, Memorandum was presented, Agreement (NPA), which
Smoking and health, which which recommended gradual included an extensive package
confirmed the association implementation of the measures of policy measures to address
between smoking and lung proposed by the Health Council. excessive alcohol use,
cancer. In response, health overweight and obesity, and
■ Netherlands’ (Kingdom of the)
organizations such as the Dutch tobacco use, was signed, and
first health warnings appeared
Cancer Society became actively a year later adopted by the
on cigarette packs in 1982 (with
involved in tobacco control. House of Representatives. This
the legend “Smoking threatens
partial agreement on smoking
■ There were further influential health”), alongside the first
was signed by the government
Health Council reports during mandatory information about
and 70 organizations with the
the 1970s, including Measures tar and nicotine content. And
aim that by 2040, Netherlands
to reduce smoking, which in 2005 Netherlands (Kingdom
(Kingdom of the) would have
stated at the outset, “public of the) became a Party to the
less than 5% of its population as
health interests must prevail WHO Framework Convention on
smokers, as well as no children
above economic interests”, Tobacco Control.
or pregnant women smoking
and contained a comprehensive
■ Following the 2014 rise in the (170).
and integrated set of policy
legal age of purchase of tobacco
proposals, most of which were ■ In 2020 Netherlands (Kingdom
(from 16 to 18 years of age,
not translated into policy at of the) became a Party to the
as provided for in the 2002
that time. Protocol to Eliminate Illicit
amendment to the Tobacco Act),
Trade in Tobacco Products and
■ By 1975 a national institute for in November 2015 the “Smoke-
started implementation of track
tobacco control was formulated free Generation” campaign was
and trace system to combat
and this led to the foundation launched by the Dutch Alliance
illicit tobacco trade, and in the
of the Netherlands Expertise for a Smoke-free Society. It
same year a ban on tobacco
Center for Tobacco Control received wide support from
vending machines was also
(STIVORO), which became the general public and later
implemented. In 2021, many
responsible for implementing transformed into the “Smoke-
longstanding tobacco control
tobacco control interventions free Generation movement”.
gaps were closed, such as
such as educational campaigns A year later, Netherlands
banning advertising of tobacco
and for providing smoking (Kingdom of the) started
products at points of sale and
cessation support. The following implementing EU Tobacco
allowing no DSRs in public
year an advisory report by the Products Directive II, restricting
places, workplaces and public
Meulblok Committee on tobacco the use of flavourings and
transport (Fig. 12).
advertising was published, dangerous additives in tobacco.
■ Smoking prevalence among
adults in Netherlands (Kingdom
Fig. 12. MPOWER progress since 2007, Netherlands (Kingdom of the)
of the) has declined over time.
Current smokers were 25.7% of
2007 2008 2010 2012 2014 2016 2018 2020 2022 the population in 2014 and by
M Monitoring
2021 this rate had fallen to 20.6%
P Smoke-free environments
(Fig. 13).
O Cessation support
W Health warnings on packs ■ While fewer women smoke
E Advertising bans compared with men, the
R Raise taxes
prevalence of smoking among
W-MM Mass media campaigns
both men and women has been
NTCP National tobacco control program
declining at comparable rates.
MPOWER Score colour key
No data No measure or weak measure Minimal measure Moderate measure Complete policies

42 | WHO report on the global tobacco epidemic 2023

Tobacco use in Netherlands (Kingdom of the) is declining

Fig. 13. Prevalence of smoking in Netherlands (Kingdom of the)

40%
covering 30% of the front of the
35%
29.6% 30.0% 28.9% pack and 40% of the back, with
30% 27.0%
25.7% 26.3%
24.1%
25.7% 25.4%
22.8%
24.7% rotating texts.
25% 23.1% 22.4% 21.7% 20.6%
20.2%
20% 21.9% 22.6% ■ And a large-scale campaign to
19.5% 19.2% 19.2%
15% 18.1% 17.7% 16.6% support smokers who wanted to
10% quit (“Netherlands (Kingdom of
5% the) starts quitting”) was run by
0% STIVORO in 2004, linked to the
2014 2015 2016 2017 2018 2019 2020 2021
implementation of the smoking
Men Women Total population
ban.
Source: Nominal values were adjusted by inflation rates from the IMF’s World Economic Outlook
database of April 2023 (172).
■ Implementation of the EU
Tobacco Products Directive II
began in 2016, which included
Protecting people from Offering help to quit pictorial health warnings covering
tobacco smoke ■ A national quitline has been 65% of the front and the back of
■ In 1990 the Tobacco Act, adopted available in Netherlands tobacco packs, and by 2020, plain
in 1988, came into effect. It (Kingdom of the) since 2002. packaging for cigarettes and roll-
included a smoking ban for indoor When the first health warnings your-own tobacco.
venues in government-owned appeared on the tobacco
buildings and properties open to packaging one of the messages Enforcing bans on
the general public. However, the included was: “Ask for help with
smoking cessation: DEFACTO advertising, promotion
ban was not comprehensive as
the law allowed introduction of 0900-9390 (0,10 Euro cent/min) and sponsorship
smoking areas. or www.stoppen-met-roken. ■ In 2002 the Tobacco Act was
nl or consult your physician strengthened by an amendment
■ In 2002 an amendment to the or chemist”. DEFACTO’s 0900 incorporating new bans, including
Tobacco Act was adopted, number was the national quit line on advertising tobacco products
requiring smoke-free workplaces but it was not yet toll-free (171). in media, on billboards and
(with the exception for hospitality outdoors, as well as indirect
sector) and public transport, ■ In 2016, a new, toll-free,
advertising bans such as free
except in DSRs. national smoking quit line was
distribution or promotional
established and in 2019 a chat
In 2008 the smoking ban was offers, and a ban on sponsorship.
■ service was added. By 2021,
extended to the hospitality the national smoking cessation ■ And as a complementary measure
sector. However, smoking was still telephone quit line and chat to these bans, Parliament
allowed in designated areas with service had answered more than adopted an amendment to the
closed doors where personnel 3200 questions about smoking Tobacco Act in 2019 that included
did not serve, and on covered cessation. a ban on the advertising and
terraces as long as one side was display of tobacco products at
open. Over the next few years, ■ And Netherlands (Kingdom
point of sale. In 2021 this ban was
there were several suspensions of the) Expertise Centre for
extended to all selling venues,
of smoking bans in small bars Tobacco Control initiated a
with the exception of specialized
without personnel, which resulted network for tobacco quit lines
tobacco stores.
in smoking being allowed again in in Europe, which since 2020
this type of establishment since has enabled them to exchange
2011. In 2014, however, small cafés best-practice, new insights, and Raising taxes
and bars were included again in latest developments in the field ■ Over recent years Netherlands
the general smoking ban, except of smoking cessation and tobacco (Kingdom of the) has increased
in smoking rooms. products. excise tax on tobacco products
and this has been followed by real
■ In 2020 the grounds of all price increases over time. These
educational premises in
Warning about the dangers
of tobacco tax increases led to the total tax
Netherlands (Kingdom of share as percent of the price of
the) – from primary schools to ■ In 2002, four months earlier than the most sold brand to reach the
universities – became smoke- required, Netherlands (Kingdom highest level of achievement by
free, and by 2022 a ban on DSRs of the) implemented health 2020 – a situation that remained
came into force. Smoking areas warning provisions set out by the the case in 2022 (172).
are no longer allowed in any EU Tobacco Products Directive
indoor public places, workplaces, (TPD-1) stipulating that cigarette
and public transport. packs had to carry warnings

4. Tobacco industry interference: Protecting people from tobacco and related industries | 43
44 | WHO report on the global tobacco epidemic 2023
5. Effective tobacco control measures

m Monitor tobacco use and prevention policies

p Protect people from tobacco smoke

o Offer help to quit tobacco use

w Warn about the dangers of tobacco

e Enforce bans on tobacco advertising, promotion and sponsorship

r Raise taxes on tobacco

45
 Monitoring tobacco use
and prevention policies
Article 20 of the WHO FCTC states:

“…Parties shall establish …surveillance of the magnitude,

patterns, determinants and consequences of tobacco consumption and exposure to tobacco
smoke… Parties should integrate tobacco surveillance programmes into national, regional and
global health surveillance programmes so that data are comparable and can be analysed at the
regional and international levels…” (173)

(see Box 13 and Box 14). Data on trends smokeless tobacco products (oral or
Monitoring supports and in tobacco use and exposure give
■
nasal tobacco);
enhances all tobacco policy-makers the evidence they need
■ novel and emerging tobacco
control efforts to advocate for more tobacco control
products such as tobacco vaporizers;
efforts and implementation resources,
Monitoring patterns and trends in thereby strengthening the role of the ■ non-tobacco forms of nicotine
tobacco use and exposure generates WHO FCTC (173, 174). (e.g. ENDS);
reliable, timely data that are Key elements to track include use of: ■ tobacco industry activities, where
fundamental to helping countries
feasible.
understand the impact of tobacco ■ cigarettes and other forms of
control policy interventions and smoked tobacco (e.g. cigar, pipe,
thereby combat the tobacco epidemic bidis, water pipe, HTPs);

Fig. 14. Monitoring the prevalence of tobacco use – highest achieving countries, 2022

Best-practice countries or areas

Other countries or areas; Data not
available
Not applicable

0 1000 2000 4000 km

Countries with the highest level of achievement: Armenia, Australia, Austria, Azerbaijan, Belarusa, Belgium, Bhutan, Brazil, Brunei
Darussalam, Bulgaria, Cambodia, Canada, Chile, China, Cook Islands, Costa Rica, Croatia, Cyprus, Czechia, Denmark, Ecuador,
El Salvadora, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Indonesia, Iran (Islamic Republic of), Ireland, Italy,
Japan, Kazakhstan, Lao People’s Democratic Republic, Latvia, Lebanon, Lithuania, Luxembourg, Malaysia, Malta, Mauritiusa, Mongolia,
Montenegro, Netherlands (Kingdom of the), New Zealand, Norway, Palau, Peru, Philippines, Poland, Portugal, Republic of Korea, Republic
of Moldova, Romania, Russian Federation, Serbia, Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sweden, Switzerland, Tajikistan,
Thailand, Türkiye, Ukraine, the United Kingdom, the United States, Uruguay, Viet Nam. 
a
Country newly at the highest level since 2020.

46 | WHO report on the global tobacco epidemic 2023

 15 years of MPOWER has helped reduce the global
prevalence of tobacco smoking from 22.8% to 17.0% in 2021.
If the prevalence in 2007 had not reduced there would be
300 million more smokers today.

resources, 32% of high-income countries Owing to the challenges of running

The majority of countries have not completed best-practice-level national population-based surveys
(83%) asked respondents monitoring of their populations over the during the COVID-19 pandemic, many
last 5 years. A total of 46 of the world’s surveys planned in 2020 and 2021
about tobacco use in a countries have not completed any were delayed or cancelled. In this
recent population survey recent national surveys since 2016 report we have made allowances for
(Fig. 15, Fig. 16). delayed survey implementation by
Since 2007, an additional 2 billion extending the 5-year “interval between
people in 24 countries are now covered surveys” criterion to 7 years, but
by tobacco use monitoring at best- despite this, COVID-19 has contributed
practice level (Fig. 14). The COVID-19 pandemic to a stagnation in progress on the “M”
measure.
Almost half of the world’s population – has delayed many
Ninety two percent of high-income
3.8 billion people in 73 countries –are population-level surveys countries and 75% of middle-income
regularly asked about their tobacco use
in nationally representative surveys Since 2020, the number of countries countries have completed at least one
among adults and adolescents. Most monitoring at best-practice level has national survey among adults or youth
of these countries (41 out of 73) with increased by just 3 countries, and the in the past 5 years. However, under 50%
comprehensive monitoring are high- population living in countries who of low-income countries (12 countries)
income countries, while no low-income monitor at best-practice level remained have done so.
countries achieved this best-practice static at 3.8 billion (Table A1).
level in 2022. Despite having adequate

Fig. 15. Progress in monitoring (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150

5 Number of countries

4 4.5 100
82 80
71 75 3.9 3.9
3 62 3.2 3.1 79
50 2.7 71 74
2 2.2 50
2.1
1.9
1

0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

5. Effective tobacco control measures | 47

 Fig. 16. Monitoring, by country income group, 2022

100% No known data, or no recent data or data

5 that are not both recent and representative

90% 26 Recent and representative data

for either adults or adolescents
11
80% Recent and representative data
(Number of countries inside bars)

14 for both adults and adolescents

Proportion of countries

70% 3
Recent, representative and periodic
data for both adults and adolescents
60% 36

50%

40%
41 12
30%
14
20%
33
10%

0%
High-income Middle-income Low-income

As 76% of the world’s smokers live 38% in 2007. In relative terms, smoking
Smoking prevalence reduces in a middle-income country, the rates among men reduced by 23% over
as MPOWER ramps up global smoking prevalence is strongly the period. Among women, the global
influenced by the smoking rates of average rate reduced by 35% – from 8%
Between 2007 and 2021, the global middle-income countries, where the of women smoking in 2007 to 5%
average smoking prevalence has average is also 17%. High-income in 2021.
reduced from 22.8% to 17.0%. This is countries, where 20% of the world’s
Currently there is no WHO estimate of
a relative reduction of 25% over 14 smokers live, have the highest average
global ENDS use among adults because
years. Smoking rates have been falling rate at 21% of adults smoking. Only
the data are still scant in many regions
in all income groups of countries (see 4% of the world’s smokers live in low-
of the world.
Technical Note II). The relative reduction income countries, where the average
in average prevalence over 14 years prevalence of smoking is also lowest Despite most countries banning sales
was 24% for high- and middle-income at 10%. to minors – an estimated 24 million
countries, and was 28% for low-income children aged 13–15 years around the
Among men, the global prevalence of
countries. world smoke.
smoking in 2021 was 29%, down from

© WHO/Blink Media - Nadège Mazars

48 | WHO report on the global tobacco epidemic 2023

Box 13. Surveillance helps drive a decline in tobacco use, Philippines

Over the past two decades the based tobacco control policy and The landmark Sin Tax Law 2012
Philippines has conducted repeated interventions. used the findings from the 2009
national surveys to monitor GATS as evidence of the high rates of
Since the launch of the Philippines’
tobacco use and evaluate progress smoking (28.2%) in the Philippines,
first National Tobacco Control
in tobacco control, including the particularly among men (47.6%), and
Global Adult Tobacco Survey Strategy in 2012, sustainable
kickstarted a series of tax reforms
(GATS) in 2009, 2015, and 2021; and surveillance and monitoring
adopted between 2012 and 2020
the Global Youth Tobacco Survey systems (including regular funding
that increased tax rates and made
(GYTS) in 2000, 2003, 2007, 2011, and use of evidence for policy
tobacco products less affordable. As
2015, and 2019. Completing six action) have formed one of the
a result, the prevalence of tobacco
rounds of GYTS and three rounds country’s key strategies to advance
use among adults fell from 29.7% to
of GATS to date, the Philippines has tobacco control. Strengthening
19.5% between 2009 and 2021, while
invested in sustainable monitoring surveillance data was also one of
tobacco smoking among adults fell
and surveillance systems to enable the priority areas of the second
from 28.2% to 18.5% during the
the formulation, tracking, and National Tobacco Control Strategy
same period (See Fig. 17a and Fig.
implementation of evidence- 2017–2022.
17b).

Fig. 17a. Overall prevalence of current tobacco use and tobacco smoking
among adults, 2009, 2015, and 2021
35

29.7 28.2
30

23.8 22.7
25
19.5 18.5
20

15

10

0
2009 2015 2021
Current tobacco use Current tobacco smoking

Fig. 17b. Overall smoking prevalence among adults, and average cost of 20 cigarettes
PHP

30 120
28.2 107.8

25 100
22.7
20 18.5 80

57.7
Prevalence (%)

15 60

10 29.6 40

5 20

0 0
2009 2015 2021
Current tobacco smoking Average cost per 20 manufactured cigarettes (PhP)

5. Effective tobacco control measures | 49

 Box 14. Kazakhstan continues to track and monitor tobacco use and key tobacco
control measures

Kazakhstan conducted its first ■ a partial ban on the sponsorship by adults, including by smokers –
Global Adult Tobacco Survey (GATS) of tobacco and tobacco similar to survey outcomes in other
in 2014 and has used the findings products. countries.
as the baseline for monitoring
In 2019 Kazakhstan conducted Infographics with key 2019 GATS
tobacco use in the country ever
its second GATS to assess the results in the Russian and Kazakh
since. The survey also informed
implementation of tobacco control languages were developed and
the development and adoption of
policies over the prior 5 years. posted across different media
a number of important legislative
The survey showed that overall, channels, increasing the visibility of
tobacco control measures,
prevalence of current tobacco use in this work.
including:
Kazakhstan (smoking or the use of
And in relation to monitoring
■ a ban on the sale of the tobacco smokeless and/or heated tobacco)
youth tobacco use, Kazakhstan
product nasvay; did not change significantly
successfully completed surveys
between the two surveys, falling
■ a ban on the display of in 2004, 2009 and 2014, and is
only slightly from 22.9% in 2014
misleading or false information planning a fourth round in 2024.
to 21.5% in 2019. However, a
on tobacco packaging and Data from multiple GATS, GYTS
significant relative decrease among
labelling that creates a false and other national surveys present
males (11.8%) and a significant
impression of the product being opportunities for Kazakhstan to
relative increase among females
less harmful, or that leads to any reduce and prevent the burden of
(42.3%) were observed over the
association with fruits, berries tobacco use and enforce existing
same 2014–2019 period. It also
and/or confectionery; and laws and policies to keep its citizens
showed that tobacco control
tobacco-free.
measures were actively supported

Tobacco use survey reports from Kazakhstan (175)

50 | WHO report on the global tobacco epidemic 2023

 Protect people from
tobacco smoke
Article 8 of the WHO FCTC states:

“… [S]cientific evidence has unequivocally established that

exposure to tobacco smoke causes death, disease and disability … [Parties] shall adopt
and implement … measures providing for protection from exposure to tobacco smoke in indoor
workplaces, public transport, indoor public places and, as appropriate, other public places”.
WHO FCTC Article 8 guidelines are intended to assist Parties in meeting their obligations under
Article 8 of the WHO FCTC and provide a clear timeline for Parties to adopt appropriate measures
(within 5 years after entry into force of the WHO FCTC for a given Party) (173).

places that are smoke-free, or just one

Over one quarter of the or a maximum of two. Together with
If 24 countries completely
world’s population are 25 out of 106 middle-income countries banned smoking in just
and 12 out of 28 low-income countries, one or two more places,
protected by complete a total of 2.8 billion people are not
smoking bans in public protected by life-saving smoke-free an additional 22% of
places, workplaces and
environment laws (Fig. 19).  the world’s population
public transport 
However, in the past 2 years, five would be protected by
countries, with a combined population
of almost 200 million, have joined comprehensive smoke-free
In 2007 only 10 countries in the world
had a comprehensive smoking ban
the group of countries providing laws 
protection at best-practice level,
in place, covering 244 million people.  There are nine countries, home to
with all public places now completely
Over the ensuing 15 years, 1.9 billion 81 million people, that need only to
smoke-free in 2022 (Fig. 20). All of these
additional people in 64 additional cover one more place with a 100%
countries improved their earlier, more
countries are now covered by best- smoking ban to join the 74 countries
lenient laws: Mexico (see Box 15) and
practice smoke-free laws. This means with comprehensive smoke free laws.
Netherlands (Kingdom of the) achieved
that there is now a total of 2.1 billion A further 15 countries with 1.6 billion
this by disallowing DSRs in all venues
people (over one quarter of the world’s people need only to cover two more
where they were previously allowed;
population) living in 74 countries where places with a 100% smoke-free ban
Kyrgyzstan by adding indoor offices and
they are protected by smoking bans at to achieve a comprehensive ban on
workplaces to the list of places where
best-practice level (Fig. 18 and Fig. 19).  smoking in public places. Of the 546
smoking is banned, and disallowing
While around one third of countries DSRs in venues where they were million people (6.9% of the world’s
in each World Bank income group are previously allowed; and Mauritius and population) who live in one of the
covered by comprehensive smoke-free Ukraine by adding indoor offices and world’s 100 largest cities, 327 million
bans, 60% of countries (45 out of 74 workplaces to venues with a smoking people (in 53 cities) are protected by
countries) with comprehensive smoking ban, which had been the only provision a comprehensive smoke-free law (see
bans are middle-income countries missing from their earlier smoke-free Table A4). Five of these cities (Bandung,
(see Box 15). The complete absence of laws. Beijing, China, Hong Kong Special
smoking bans, or minimal bans that do Administrative Region (Hong Kong SAR),
Three countries, with 7 million people in Jakarta and Medan) are covered by city-
not adequately protect people from
total (Cabo Verde, Georgia, and Qatar) level smoke-free laws (as in 2020); seven
the dangers of second-hand smoke, are
have improved their smoke-free laws are covered by state- or province-level
remarkably common in high-income
since 2020 but did not reach best- smoke-free laws (Brisbane, Hyderabad,
countries: 16 countries, with almost 50%
practice level in 2022 (Table A1). London, Los Angeles, Melbourne,
of the total population of high-income
countries, provide either no public Sydney and Toronto); and the remaining
41 are covered by national laws. The
remaining 47 cities currently not
protected by a national best-practice
policy could – instead of waiting for a
national policy to be put in place – move
ahead with a city, state or provincial
level policy to more swiftly protect their
large populations.

5. Effective tobacco control measures | 51

Fig. 18. Smoke-free environments, highest achieving countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries and territories with the highest level of achievement: Afghanistan, Albania, Antigua and Barbuda, Argentina, Australia,
Barbados, Benin, Bolivia (Plurinational State of), Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Burundi, Cambodia, Canada, Chad,
Chile, Colombia, Congo, Costa Rica, Ecuador, Egypt, El Salvador, Ethiopia, Gambia, Greece, Guatemala, Guyana, Honduras, Iran (Islamic
Republic of), Iraq, Ireland, Jamaica, Jordan, Kyrgyzstana, Lao People’s Democratic Republic, Lebanon, Libya, Madagascar, Malta,
Marshall Islands, Mauritiusa, Mexicoa, Namibia, Nauru, Nepal, Netherlands (Kingdom of the)a, New Zealand, Niue, North Macedonia,
Norway, occupied Palestinian territory, including East Jerusalemb, Pakistan, Panama, Papua New Guinea, Paraguay, Peru, Republic of
Moldova, Romania, Russian Federation, Saint Lucia, Seychelles, Spain, Suriname, Tajikistan, Thailand, Trinidad and Tobago, Türkiye,
Turkmenistan, Uganda, Ukrainea, the United Kingdom, Uruguay, Venezuela (Bolivarian Republic of).
a
Country newly at the highest level since 2020.
b
Hereinafter referred to as “occupied Palestinian territory”.

Fig. 19. Progress in smoke-free legislation (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150
Number of countries

4 100
74
69
3 64
58
52
45
2 50
32 2.1
1.7 1.8 1.9
15 1.6
1 10 1.4
1.0
0 0.2 0.4 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

52 | WHO report on the global tobacco epidemic 2023

 Fig. 20. Smoke-free legislation, by country-income group 2022

100% Data not reported

90% 25 Complete absence of ban, or up to two

16 public places completely smoke-free

80% 12 Three to five public places

(Number of countries inside bars)

completely smoke-free
Proportion of countries

70% Six to seven public places

23 completely smoke-free
60% 16 All public places completely smoke-free
(or at least 90% of the population covered by
50% 14 5
complete subnational smoke-free legislation

40% 7
3
30%

20% 45
21
8
10%

0%
High-income Middle-income Low-income

Almost 40% of countries, making up over one quarter of the

world’s population, are now protected by comprehensive
smoke-free legislation.

© WHO/Christopher Black

5. Effective tobacco control measures | 53

 had smoke-free educational facilities. Compliance is reported highest in health
Complete smoking bans By 2022, the number of countries with care and educational facilities and
have progressed globally 100% smoke-free educational facilities lowest in cafés, pubs and bars, followed
reached 149, and the number of by universities and restaurants (Table
across all indoor venues countries with smoke-free health care A2). To encourage high compliance,
facilities reached 142 (Fig. 21). countries should establish and fund
Progress in adopting smoke-free
enforcement mechanisms. While almost
measures has been made across all
all countries (87%) issue fines to the
indoor venues during the past 15
patron or the establishment or both for
years. In 2007, only 15 countries had
100% smoke-free cafés, pubs and bars
Compliance with smoke- smoking ban violations, less than one
third of countries have dedicated funds
– a figure that increased to 88 countries free laws in hospitality for enforcement.
by 2022 (although these types of venues
remain the least-protected of all under
settings is weak
national smoke-free laws). And in 2007, Compliance with smoke-free laws varies
81 countries had 100% smoke-free according to the type of venue.
health care facilities and 78 countries

Fig. 21. Complete smoke free legislation, by venue, 2022

200 Increase by 2022

180 2007 bans

Number of countries with a complete ban

160

140

120
61 71
100
83
80 79
78
60 77 74 73
40 81 78
53 44
20 39
21 19 15
0
Health care Educational Universities Governmental Indoor private Restaurants Cafes, pubs Public
facilities facilities, except facilities offices and and bars transport
universities workplaces

Health care facilities in 53 countries and educational

facilities in 46 countries still do not have complete
smoking bans.

54 | WHO report on the global tobacco epidemic 2023

 Fig. 22. Comprehensive smoking bans and those with DSRs allowed, by venue, 2022

200 No restrictions
on smoking

180 DSR allowances

160 100% bans

140
Number of countries

120

100

80

60

40

20

0
2007 2022 2007 2022 2007 2022 2007 2022 2007 2022 2007 2022 2007 2022 2007 2022
Health care Educational Universities Governmental Indoor private Restaurants Cafes, pubs Public
facilities facilities, except facilities offices and and bars transport
universities workplaces

countries have newly allowed DSRs passengers under the age of 18 years
Designated smoking in one or more venues under their illegal, and 60 countries ban smoking
areas or rooms should be smoke-free legislation. Cafés, pubs, and in children’s outdoor areas such as
bars have seen the biggest increase in playgrounds.
disallowed under smoke- DSR provisions, with 50 countries now
Even in 2007, many countries realized
free legislation  allowing them, compared with only 23 in
that going beyond the minimum
2007. In contrast to these 50 countries,
requirements of WHO FCTC Article
Despite evidence that DSRs do not fully 88 countries have legislated for 100%
8 would improve the impact of their
protect people in indoor public areas, smoke-free cafés, pubs, and bars to
smoke-free laws. Fifty-two countries
71 countries continue to allow them better protect staff and patrons alike.
already had legislated smoking bans
in many venues, especially hospitality covering at least one of the other venues
venues such as restaurants, cafés, listed in Annex 2.2, or outdoors at
pubs, and bars (Fig. 22). While DSRs can venues specified in Article 8. The most
be found around the world, over 50% Countries are increasingly protected type of additional venue in
of high-income countries allow them extending smoke free laws 2007 was that of cultural facilities, with
in some venues, and over 30% allow 40 banning smoking in such spaces.
them in restaurants, bars, and cafés. to other public venues and Twenty-eight countries already banned
By contrast, under the law, only 32% of outdoor spaces smoking in shops, and 26 banned
middle-income countries and 21% of smoking in airports (Fig. 23).
low-income countries allow DSRs in any Cultural facilities, such as theatres and
venue. By simply removing allowances cinemas, are the most covered venues
for DSRs in smoke-free legislation, an (118 countries) followed by shops (109
additional 39 countries globally would countries) and public areas of hotels
achieve best-practice level. (94 countries). While most countries
now prohibit smoking on aircraft, only
Since 2007, 25 countries have amended
88 have adopted 100% smoking bans
their laws to disallow DSRs in one or
with no DSRs in airports, meaning 107
more venues where they were previously
countries do not fully protect airport
allowed. The venues benefiting most
staff and passengers from second-hand
from the removal of DSRs in the past
smoke.
15 years are educational facilities and
universities, with nine fewer countries Recognizing that children are a
allowing DSRs in educational facilities vulnerable population for second-hand
and five fewer allowing DSRs in smoke exposure, a total of 25 countries
universities. Unfortunately, 46 other now make smoking in cars with

5. Effective tobacco control measures | 55

 Fig. 23. Additional indoor and outdoor smoke-free venues, 2007 and 2022

Increase by 2022
Number of countries with a complete ban

160
2007 bans
140

120

100

80 78
81
60 73 77 71
62
65
40 60
54
20 40
26 21 20 28 23 24 24
11 1 6
0
Airports Hotels - Hotels - Prisons Shops Cultural Other Private vehicles Outdoor Outdoor areas
public areas rooms facilities indoor with children areas for of at least
areas aged < 18 years children one public
place, workplace
or public
transport
venue

Almost all countries (170 countries or mandate penalties for the smoker while Just over half of high-income countries
87% of all countries) prescribe fines for only 60% mandate penalties for the have an established complaint system
the patron, the establishment or both establishment not requiring a person to that requires an investigation and just
in cases of smoking ban violations, yet stop smoking where prohibited. Among over one quarter have dedicated funds
less than one third of countries have low-income countries, 80% apply fines for enforcement. This is below what is
dedicated funds for enforcement. on the smoker violating the smoking observed for middle income countries
ban, but under 30% apply fines to the where almost 40% have dedicated funds
While fining the smoker may help build
establishment. Very few countries, set aside for enforcement.
compliance, fining the establishment
a total of 29, apply penalties for not
is important for ensuring compliance.
removing ashtrays from the smoke-free
Despite this, over 80% of countries
vicinity (Fig. 24).

Fig. 24. Smoke-free environment enforcement mechanisms, 2022

100 High-income
countries

90
% of countries in the WB income group with

Middle-income
countries
this provision in their smoke-free law

80 Low-income
countries

70

60

50

40

30

20

10

0
for allowing for not posting for not removing Fines on the The law dedicates There is a
patrons to smoke the required non ashtrays smoker for smoking funds for complaints
smoking signs where prohibited enforcement system that
requires an
investigation
Fines on the establishment Other fines and characteristics

56 | WHO report on the global tobacco epidemic 2023

 have been successful in enacting free legislation at national level (see
Subnational smoke-free their own comprehensive smoke-free examples in Box 16 and Box 17), and
legislation can be a way legislation (Table 5). Often, it is more an additional 2% are covered at the
politically feasible to enact smoke- subnational level. If all subnational
forward free legislation that covers a smaller jurisdictions with the legal authority to
population, such as a specific city or implement comprehensive smoke-free
Among the large number of countries
province. policies were to do so, an additional 4
that have not enacted comprehensive
billion people would be protected from
smoke-free legislation at the national Currently, 27% of the world’s population
second-hand tobacco smoke.
level, some subnational jurisdictions are covered by comprehensive smoke-

Table 5. Complete smoke-free bans in subnational jurisdictions, 2022

COUNTRY COMPLETE SMOKE-FREE LEGISLATION IN PERCENTAGE OF NATIONAL POPULATION

SUBNATIONAL JURISDICTIONS, 2022 COVERED (%)

NUMBER OF POPULATION COVERED (‘000)

JURISDICTIONS

Australia 7 26 013 99
Canada 11 38 718 99
India 1 49 577 3
Indonesia 3 16 021 6
Micronesia (Federated States of) 3 79 69
United Republic of Tanzania 1 735 1
United States 3 45 452 14

© WHO/Kiana Hayeri

5. Effective tobacco control measures | 57

 Box 15. Hard-won success in going smoke-free, Mexico

In 2004, Mexico became the first in the House of Representatives, control measures to policy-makers;
country in the WHO Region of the and securing its assignment in the coordinated communication
Americas to ratify the landmark Senate’s agenda and, ultimately, its strategies that included working
WHO FCTC. Four years later, in 2008, approval. closely with the local press; and
it took the major step of approving engaged in subnational efforts to
The amendment was successfully
its General Law on Tobacco Control garner support for national reform
passed in December 2021, and
– though measures relating to (178). A supportive letter and the
the new regulations were enacted
smoke-free environments and TAPS World No Tobacco Day 2022 Special
in December 2022. These efforts
bans adopted through this process Award was also presented by WHO’s
represent a significant milestone in
only partially complied with the Director-General to the President of
Mexico’s progress towards tobacco
WHO FCTC. Next, in 2009, Mexico Mexico [DECM1] (179).
control and have culminated in
instituted policies to implement
Mexico becoming an entirely smoke- This coalition of actors played a
graphic health warnings on tobacco
free country (smoke-free measures decisive role in engaging political
packaging in alignment with WHO
also apply to ENDS/ENNDS), with a leaders who supported the
FCTC Article 11.
complete ban on TAPS, including process and countered the tobacco
In the years following the a ban on the display of tobacco industry’s substantial interference,
enactment of the 2008 law, over products at points of sale (176, 177).  particularly during the final stages
100 bills relating to tobacco control of the amendment’s approval in
This success is the result of several
were presented in Congress – some Congress.
crucial factors: the commitment
aimed at making the law more
and persistence of various actors, The Region of the Americas now
WHO FCTC compliant, while others
including collaboration and boasts 24 countries with 100%
included provisions supporting the
coordination between the executive smoke-free environments, the
interests of the tobacco industry
and legislative branches of highest of all WHO regions, as well
and allies. During the following 13
national authorities in Mexico, civil as nine countries achieving total
years, strategic partnerships of
society organizations, academia TAPS bans (6). Today, at least 647
key stakeholders worked to avoid
and international organizations. million and 430 million persons
any erosion of progress enabled
Over 10 years, these actors have in the region are protected from
by the General Law, and to amend
provided technical and legal second-hand exposure to tobacco
the General Law so that it fully
assistance; showcased the health smoke and TAPS, respectively.
aligned with the WHO FCTC. This
and economic benefits of tobacco
involved promoting the amendment

Campaign for smoke-free environments, Mexico

58 | WHO report on the global tobacco epidemic 2023

Box 16. Collaborating and focusing on smoke-free legislation, Kyrgyzstan

In July 2021, Kyrgyzstan’s Supreme 74 countries. Initiatives such as new law met with resistance
Council adopted the Law entitled the smoke-free Games are rare in from tobacco companies, the
“On protecting the health of Kyrgyzstan, and have not remedied government has stood firm in its
citizens of the Kyrgyz Republic the issue of widespread exposure commitment to protecting public
from the consequences of tobacco to tobacco smoke in public places. health. Furthermore, several other
consumption, nicotine and As a result, and through meticulous factors have contributed to the
exposure to second-hand tobacco work and joint efforts of various successful adoption of a strong
smoke and aerosol”. This law stakeholders, a tobacco control and comprehensive law (with
requires all workplaces and public law was developed, and adopted in TAPS now completely banned),
places – including public transport, 2021. including the mobilization of civil
stations and taxis – to be 100% society; creation of a support group
Kyrgyzstan’s new smoking ban
smoke-free. that includes decision-makers;
is very comprehensive as it also
strong international support; and
In a country where half of all men includes the use of hookahs,
continuous pressure maintained
smoke, effective measures to e-cigarettes and HTPs. Article 5 of
to secure the process without
combat tobacco use and protect the Law specifically states that its
interruption.
the population from the harmful provisions apply to e-cigarettes
consequences of exposure to and e-liquids, and that the use of
second-hand smoke are hugely e-cigarettes and HTPs is considered
important. Over the past few years, as smoking under the Law.
Kyrgyzstan has taken steps to
In a separate by-law, a new no-
promote smoke-free environments
smoking sign has been approved
as part of wider measures to reduce
that depicts a cigarette, a hookah,
tobacco consumption – one of
an HTP and an e-cigarette. All these
the most notable examples being
graphics are crossed out with a
the Smoke-free III World Nomad
red line, meaning a complete ban.
Games, held in Kyrgyzstan in
In accordance with the legislation
September 2018. The Games were
in force in Kyrgyzstan, the sign
a success, attracting over 70 000
will be placed at the entrance A new no-smoking sign that depicts
spectators from across the world,
to buildings and in areas where a cigarette, a hookah, an HTP and an
and more than 2300 athletes from
smoking is prohibited. While the e-cigarette, Kyrgyzstan

5. Effective tobacco control measures | 59

 Box 17. Bengaluru makes strides to comply with state-level and national smoke-free
laws, India

Since 2017, the Karnataka state the regulation. Alongside these 225% increase in the display of “No
capital Bengaluru has worked to drives, Bengaluru’s authorities Smoking” signages in public venues
reduce smoking in public places also bolstered existing legislation (from a rate of 23% in 2017 to 75%
across the city, with support from by removing illegal designated in 2021).
the Partnership for Healthy Cities. smoking areas within the city,
In March 2023, Bengaluru received
towards creating new 100% smoke-
Local enforcement plays a an international award for its efforts
free spaces.
significant part in ensuring that to reduce smoking in public places
national law, the Cigarette and To complement the emphasis on and improve compliance with
Other Tobacco Products Act enforcement capacity, the city also existing smoke-free laws. And as a
(COPTA), is able to deliver its prioritized citizen awareness. New city, Bengaluru will continue to work
intended benefits on the ground, “No Smoking” signs were displayed towards becoming 100% smoke-
by ensuring that citizens comply in public places, clearly indicating free by 2025.
with the laws in practice. A major that smoking was not permitted and
part of Bengaluru’s effort has been that those violating the law would
its focus on increasing city-level be fined. A series of communication
compliance with national and state- campaigns was also run, covering
level smoke-free regulation – a both the risks of tobacco use and
critical component of local action the effects of second-hand smoke,
in tobacco control. Between 2017 thereby reinforcing the need for
and 2023, Bengaluru’s authorities 100% smoke-free environments.
– coordinated by the municipality’s
A local study conducted by Vital
“tobacco control cell” – conducted
Strategies demonstrated that
102 enforcement drives with
Bengaluru’s focused efforts resulted © Bruhat Bengaluru Mahanagara Palike, India
36 enforcement officer training
in a near 27% reduction of smoking
sessions in a bid to significantly Smoke-free enforcement team in
in public places (down from a rate
increase capacity for enforcing Bengaluru, India
of 18% in 2017 to 13% in 2021) and a

© WHO/Maria Gutu

60 | WHO report on the global tobacco epidemic 2023

 Offer help to quit tobacco use
Article 14 of the WHO FCTC states:

“Each Party shall … take effective measures to promote cessation of tobacco use and adequate treatment
for tobacco dependence…. Each Party shall … design and implement effective programmes aimed at
promoting the cessation of tobacco use”. WHO FCTC Article 14 guidelines are intended to assist Parties in
meeting their obligations under Article 14 of the WHO FCTC) (173).

■ Toll-free quit lines help potential smoking) can increase the chances
Help for tobacco users to tobacco quitters to access brief and of a successful quit attempt by up
quit is vital to their success potentially intensive behavioural to 15%.
counselling. They can increase the
■ Combining different types of NRTs,
New tobacco users (usually adolescents) absolute quit rate by 4% – a doubling
pharmacotherapies and behavioural
can become dependent after smoking of success. “Proactive” quit lines,
interventions, under the guidance of
only four cigarettes (180). And while where counsellors make follow-up
a qualified health care professional,
many may eventually want to quit (the calls to potential tobacco quitters,
can further increase NRT
health benefits can be felt within hours), can further improve the success rate
effectiveness (182, 185).
only around 4% will succeed without (183).
adequate support (181). Established, ■ Mobile phone-based cessation
evidence-based and cost-effective
interventions to help people quit
interventions are also promising, Over one third of the
with text-message interventions
include the following. increasing the absolute quit rate
world’s population are
by 4% (184). covered by comprehensive
Behavioural interventions can
cessation services
help people decide to quit and Pharmacological interventions
help increase their chances of are safe and highly effective Currently, 32 countries are covered
success ■ Nicotine Replacement Therapy by comprehensive cessation services
■ “Brief advice” from health (NRTs), which come in the form of (Fig. 25). Since 2007, 22 countries have
professionals – given as part of a patches and gums, can increase quit adopted comprehensive cessation
routine consultation or interaction – success by 6% - more than double support services and 2.4 billion
makes efficient use of existing health the absolute quit rate. additional people are now protected
care services and is an opportunity by this measure, bringing the total to
■ Other pharmacotherapy 2.8 billion people in 32 countries
to reach people who might not
interventions such as Buproprion (Fig. 26).
yet have considered quitting
and Varenicline (which reduce the
and provide them personalized
cravings and the pleasure effects of
counselling (182).

5. Effective tobacco control measures | 61

Less than one third of high-income implementation: (i) a national toll-free
countries, 10% of middle-income Cessation services must be quit line; (ii) cost-coverage of NRT; or (iii)
countries and 7% of low-income ready to support increased cost-coverage of cessation services in
countries offer comprehensive clinical settings or in the community. Of
cessation support at best-practice numbers of potential these 62 countries, 23 need only to add
level (Fig. 27). Globally, almost all quitters a national toll-free quit line in order to
high-income countries (88%) offer at bring comprehensive tobacco cessation
least partial coverage of the cost of Since 2020, six countries with a support to an additional 710 million
cessation services. Most middle-income combined population of 262 million people; while 36 need to offer cost-
countries (72%) do the same, while 21% (Ethiopia, Iran (Islamic Republic of), covered NRTs to cover an additional
of low-income countries offer some Israel, Mauritius, Romania and Zambia) 1.3 billion people; and three countries
cost-coverage for services. There are have started offering comprehensive need to cost-cover one or more of its
29 countries that provide no cessation cessation services, increasing the cessation services in clinical settings or
support at all. Only three low-income number of countries doing so from 26 the community so that an additional
countries (Democratic People’s Republic to 32 and increasing the proportion 52 million people will be covered.
of Korea, Ethiopia and Zambia) make of the world’s population covered by
comprehensive cessation services from Of the 546 million people (6.9% of the
cost-covered NRTs available to those
32% to 35% in the past world’s population) who live in one of
who want to quit tobacco and only
2 years (Fig. 26). the world’s 100 largest cities, only 280
three have established national toll-free
million (in 53 cities) are protected by a
quit lines (Burkina Faso, Ethiopia and
Three high-income countries, covering comprehensive cessation service (Table
Zambia) (see Box 18 and Box 19 for
a population of 4.7 million, offer no A4). Two of these cities are covered by
examples of quit lines). These numbers
support to help users quit, while 13 city-level policies (China, Hong Kong
show that while work has begun, there is
middle-income countries, with a total SAR, and London). The remaining 48 are
still much more to be done (Fig. 27).
population of 89 million, and 13 low- covered by national policies. Instead of
income countries, with 244 million waiting for a national policy to be put in
inhabitants, offer no support to place, the remaining 47 large cities not
tobacco users. currently protected by a national best-
practice policy could move ahead with
Sixty-two countries – home to 2 billion
a city, state or provincial-level policy to
people – provide cessation support
protect their large populations sooner.
packages that are missing only one
element to achieve best-practice

Fig. 25. Tobacco dependence treatment , highest achieving countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries with the highest level of achievement: Austria, Brazil, Canada, Cook Islands, Costa Rica, Czechia, Denmark, Ethiopiaa, India,
Iran (Islamic Republic of)a, Ireland, Israela, Jamaica, Jordan, Kuwait, Luxembourg, Mauritiusa, Mexico, Netherlands (Kingdom of the),
New Zealand, Philippines, Republic of Korea, Romaniaa, Saudi Arabia, Singapore, Slovakia, Sweden, Tonga, Türkiye, United Arab
Emirates, the United States, Zambiaa.
a
Country newly at the highest level since 2020

62 | WHO report on the global tobacco epidemic 2023

 Fig. 26. Progress in tobacco dependence treatment (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150

Number of countries
5

4 100

3
2.8
2 2.5 2.4 2.5 50
32
25 24 26
15 16 18 19
1 10
0.9 0.9 1.0
0.8
0 0.4 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

35% of the world’s population is covered by

comprehensive cessation services – second only
to graphic health warnings.

Fig. 27. Tobacco dependence treatment, by country-income group, 2022

100% 1 Data not reported

3
13
90% 4
None

80% 17 NRT and/or some cessation

(Number of countries inside bars)

services, neither cost-covered

13
Proportion of countries

70% NRT and/or some cessation services,

at least one of which is cost-covered
60% 34
National quit line, and both NRT and
some cessation services cost-covered
50%

40% 66
8
30%

20%
19 4
10%
11 2
0%
High-income Middle-income Low-income

5. Effective tobacco control measures | 63

 Box 18. Tobacco cessation services go nationwide, Islamic Republic of Iran

In 2021, the Islamic Republic of By adding a national toll-free quit

Iran’s Ministry of Health and Medical line and covering the cost of NRTs
Education (MOHME) established a for tobacco users, Iran (Islamic
national tobacco cessation helpline Republic of) has progressed to
and tobacco cessation service meet the highest level of the
clinics nationwide (186). “O” component of the MPOWER
package for tobacco control. This
The free tobacco cessation
key achievement was possible with
helpline is available 9am to 3pm ,
WHO’s technical assistance and
offers evidence-based support to
the support of the WHO TFI Unit. © Ministry of Health, Iran (Islamic Republic of)
people who want to quit tobacco,
The efforts led to establishing the
i.e., counseling and referrals to 4030 Quit smoking helpline,
Iranian comprehensive national
tobacco cessation service clinics Iran (Islamic Republic of)
cessation service including
for medication. The cessation
improving the management
clinics operate in 63 medical
of tobacco cessation services,
science universities (UMSs) – set up,
developing and operating a national
supported and led by the Mental
toll-free quit line; capacity building
Health and Substance Abuse
for primary health care staff
Prevention Department of MOHME.
working in selected comprehensive
The tobacco cessation clinics (based
health centres offering free tobacco
in primary health care centres under
cessation services; advocacy
supervision of the UMSs or specialist
and social awareness-raising on
centres) can provide prescriptions
tobacco cessation; and boosting
from general practitioners for the
the visibility of tobacco cessation
NRT – which is fully covered by the
services.
insurance system, and affordable
also for those who want to use it
without a prescription.
Promotion message for quit smoking
helpline, Iran (Islamic Republic of)

Box 19. Ethiopia and Zambia build upon existing resources to adopt cessation tobacco
quitlines.

Lifeline/Childline Zambia (LLCZ) Other services provided by LLCZ support of WHO, the Ministry of
is a Zambian NGO founded in include WhatsApp, web-based Health trained 31 counsellors on
2003 to respond to the HIV/AIDS assisted tobacco interventions, and tobacco cessation and quit line
pandemic. It runs two 24-hour text messaging, as well supporting protocols. In the space of only 4
toll-free lines – Lifeline 933 and 116 family, friends, and health care months the line received 112 calls
for Childline – providing support professionals who want to help from people seeking support on
to vulnerable women and children tobacco users to quit. addictive substances and 61 of
facing abuse, mental health issues, these were specific to tobacco use.
National Health information and
and other challenges. Since 2022 Currently the toll-free health hotline
counseling (952) is a toll-free health
the call centre has also received and is serving the community using
hotline run by Ethiopia’s Ministry
responded to calls about tobacco more than five languages and is
of Health that provides accurate
addiction and offers assistance open 10 hours a day, 5 days a week.
information, counseling and referral
to those attempting to quit. The
services on different health topics.
helpline provides one-on-one
It was an important source of
counselling, coping strategies, and
information during the COVID-19
referrals to resources and local
pandemic. In March 2022, with the
cessation programmes.

64 | WHO report on the global tobacco epidemic 2023

© WHO/Mobeen Ansari

5. Effective tobacco control measures | 65

 Warn about the dangers
of tobacco
Article 11 of the WHO FCTC states:

Each Party shall … adopt and implement … effective measures to ensure that … tobacco product
packaging and labelling do not promote a tobacco product by any means that are false, misleading,
deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards
or emissions”. WHO FCTC Article 11 guidelines are intended to help Parties meet their obligations under
Article 11 of the WHO FCTC, which provides a clear timeline for Parties to adopt appropriate measures
(within 3 years after entry into force of the WHO FCTC for a given Party) (173).

More countries have adopted

Graphic health warning Health warnings are most strong graphic health warnings
labels reliably reach users effective when they: than any other MPOWER
with critical information on ■ are illustrated using pictures or measure
dangers of tobacco graphics (191); Since 2007, 94 countries have adopted
strong graphic package warnings,
Many tobacco users are ill-informed ■ use strong words to describe the thereby covering 4.2 billion additional
about the dangers to which they expose harms caused by tobacco (192, 193); people and bringing the total number
themselves and others by consuming ■ cover at least half of a package’s of people protected by this measure to
tobacco, and they have a right to be surface (front and back) (194) 4.5 billion across 103 countries. Of all
warned about the health impacts of the (see Box 20); MPOWER measures, large graphic pack
products they consume (187, 188). warnings on cigarettes have seen most
■ refer to specific health problems that progress since 2007 – both in terms of
Accurate, prominent and strong arise from tobacco use; countries deploying, and population
warnings on tobacco packaging reliably
■ are rotated on a regular basis to covered by, a best-practice policy
reach the users who purchase tobacco,
maintain their impact (195). (Fig. 28 and Fig. 29).
increase knowledge about the harms
of tobacco, prompt tobacco users to The tobacco industry also uses
think about quitting, and can result in packaging to market their brands and
decreased tobacco use (189, 190). include deceptive terms like “light”
or “low tar”. To address this, plain
packaging is an increasingly adopted
intervention that can reduce the impact
of these marketing strategies and
improve people’s understanding (196).

Over the 15 years of MPOWER, the number of countries

with large pictorial health warnings has increased from
9 to 103, a 10-fold increase.

66 | WHO report on the global tobacco epidemic 2023

Fig. 28. Health warning labels – highest achieving countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries with the highest level of achievement: Albania, Argentina, Armenia, Australia, Austria, Bangladesh, Barbados, Belarus,
Belgium, Benina, Bolivia (Plurinational State of), Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Cambodia, Cameroon, Canada,
Chad, Chile, Costa Rica, Croatia, Cyprus, Czechia, Denmark, Djibouti, Ecuador, Egypt, El Salvador, Estonia, Ethiopia, Fiji, Finland, France,
Gambia, Georgia, Germany, Ghana, Greece, Guyana, Honduras, Hungary, India, Iran (Islamic Republic of), Ireland, Italy, Jamaica,
Kazakhstan, Kyrgyzstan, Lao People’s Democratic Republic, Latvia, Lithuania, Luxembourg, Madagascar, Malaysia, Malta, Mauritania,
Mauritius, Mexico, Mongolia, Montenegro, Myanmara, Namibia, Nepal, Netherlands (Kingdom of the), New Zealand, Niger, Nigeria,
Pakistan, Panama, Peru, Philippines, Poland, Portugal, Qatar, Republic of Moldova, Romania, Russian Federation, Saint Lucia, Samoa,
Saudi Arabia, Senegal, Seychelles, Singapore, Slovakia, Slovenia, Solomon Islands, Spain, Sri Lanka, Suriname, Sweden, Tajikistan,
Thailand, Timor-Leste, Trinidad and Tobago, Türkiye, Turkmenistan, Ukraine, the United Kingdom, Uruguay, Vanuatu, Venezuela
(Bolivarian Republic of), Viet Nam
a
Country newly at the highest level since 2020

Fig. 29. Progress in health warning labels (2007–2022)

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150

Number of countries
5 101 103
93
4 77 4.5 4.5 100
4.1
3 3.7

2 43 50
29
1 14 18 1.5
9 1.1
0.6 0.8
0 0.4 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

5. Effective tobacco control measures | 67

 Fig. 30. Health warning labels, by country-income group, 2022

Data not reported

100%
6
No warning or small warnings
90% 2 23
(Number of countries inside bars)

80% 12
Medium size warnings missing some or many appropriate characteristics
OR large warnings missing many appropriate characteristics
12
Proportion of countries

70% 16 Medium size warnings with all appropriate characteristics OR large

warnings missing some appropriate characteristics

60% 11
Large warnings with all appropriate characteristics

50%
6
40%
40
30% 4
57
20%

10% 6

0%
High-income Middle-income Low-income

This means that strong health warnings

now cover over half of the global
An increasing number of Strong graphic health
population (57%) and over half of countries mandate plain warnings appear on
all countries: 67% of high-income packaging of tobacco cigarette packaging in over
countries, 53% of middle-income
countries and 21% of low-income products half of all countries
countries. Only 21 countries (four high-
income, 11 middle-income and six low- Despite tobacco industry lobbying, Eight countries, with 443 million people,
income) have not adopted any warning several countries are moving forward need only raise the pack coverage by
labels, and 45 others have issued with plain packaging. By the end of 2022, 20% or less to meet all best-practice
warnings that cover less than 50% of the 22 countries had adopted legislation criteria for large graphic pack warnings.
principal package display areas (below mandating plain packaging of tobacco An additional 14 countries have
the coverage required by the WHO FCTC) products and had issued regulations mandated large warnings (at least 50%
(Fig. 30). with implementation dates (Australia, of the pack) and need only add one
Belgium, Canada, Denmark, Finland, criterion to achieve best-practice. Seven
In the past 2 years, two additional France, Georgia, Hungary, Ireland, of these 14 countries, representing 153
countries (Benin and Myanmar) (see Israel, Mauritius, Myanmar, Netherlands million people, need only mandate that
Box 21), with a combined 1% of the (Kingdom of the), New Zealand, Norway, strong graphic health warnings appear
world’s population, have joined the 101 Saudi Arabia, Singapore, Slovenia, on each package and any outside
countries that required large graphic Thailand, Türkiye, the United Kingdom, packaging used in the retail sale. Five
warning labels on tobacco products in and Uruguay). One area of innovation countries, with a total 18 million people,
2020. Both countries are middle-income is the application of health warnings need only add a graphic image to their
countries. on individual cigarettes. Canada will be current text-only warnings.
the first country to use this intervention
Of the 546 million people (6.9% of the
when the regulation comes into force in
world’s population) who live in one
August 2023.
of the world’s 100 largest cities, only
397 million (in 68 cities) are informed
about the dangers of tobacco use by the
display of large graphic warning labels
on their cigarette packs (Table A4). One
of these cities is covered by city-level
policies (China, Hong Kong SAR) and the
remaining 67 are covered by national
laws.

68 | WHO report on the global tobacco epidemic 2023

Box 20. Tunisia becomes first country in WHO Eastern Mediterranean Region to adopt
70% pictorial health warnings

Since 1999, tobacco packaging Secretariat supported Tunisia’s Warnings include written health
in Tunisia had featured only a tobacco control efforts through an messages in Arabic which describe
single written health warning, but anti-tobacco investment case study the harmful effects of smoking.
in 2022 the Tunisian Ministry of (199, 200). For every Tunisian dinar The warnings are approved by
Health issued a new requirement invested, pictorial health warning the Ministry of Health, printed in
for the placement of two annually labels alerting people to the clear characters and images on
rotating pictorial health warnings dangers of tobacco use generated a contrasting background, are
that occupy at least 70% of the 163 Tunisian dinars – making the apparent and understandable, and
principal display areas of tobacco labels one of the three highest must not appear in a place where
packages (197). This decision has return-on-investment strategies. they risk being damaged when
made Tunisia the country with the Based on this evidence, WHO and the package is opened, and not
largest pictorial health warnings WHO FCTC supported the Tunisian appear on the transparent sheet
on tobacco packages in the WHO Ministry of Health to issue the order or on any other outer wrapping.
Eastern Mediterranean Region (198). and to develop pictorial health The requirement to rotate health
warnings for display on tobacco warnings is designed to minimize
This key achievement was a result
products. any “wear out” of the warnings’
of the WHO FCTC 2030 project, in
impact.
which WHO and the WHO FCTC

Graphic health warnings on cigarette packages, Tunisia WHO FCTC Investment case: demonstrating the
return-on-investment of tobacco control in Tunisia (200)

5. Effective tobacco control measures | 69

 Box 21. Tobacco warnings go from strength to strength, Benin

When the newly adopted WHO large pictorial health warnings to be to Eliminate Illicit Trade in Tobacco
FCTC was closed for signature on displayed on tobacco packages for Products that Benin ratified in 2018.
29 June 2004, Benin was one of the the first time in Benin. On 11 June The latter requires the validation
168 signatories. Signing the Treaty 2021, the Minister of Health signed of mock-ups of tobacco product
was a political act that indicated Decree No. 2021-0065 prescribing packaging by the Ministry in charge
the agreement of a Member State the graphic and written health of health before the issuance of
to ratify it and its commitment to warnings to be printed on the approval to import and market
implement its the provisions. One packaging of cigarettes and other tobacco products in Benin.
year later, on 3 November 2005, tobacco products in 2022. Four
Benin ratified the Treaty, and new health warnings are required,
became a Party to the WHO FCTC each of them being accompanied
three months later. with a descriptive picture. The
four warnings will rotate every
Soon after this, on 7 August
two years. The image cover 60%
2006, the national assembly
of front and rear surfaces of the
adopted the Law No. 2006-12
packages, and the textual warning
Concerning Regulation of the
covers an additional 30% of these
Production, Commercialization
surfaces, which means 90% of front
and Consumption of Cigarettes and
and rear of the tobacco packages
Other Tobacco Products. Under
are used for displaying mandatory
this law, for the first time in Benin,
health warnings and labelling
a textual warning was required to
requirements.
be displayed on at least 30% of the
main areas of tobacco packages. This was followed by Decree
This single textual warning was still No. 2022-073 of February 9,
displayed until recently. 2022 setting the conditions and
procedures for issuing approvals
Indeed, in 2017, Law No. 2017-27of
for the manufacture and import of
December 18, 2017 relating to the
tobacco, its derivatives and similar
production, packaging, labelling,
in the Republic of Benin, initiated
sale and use of tobacco and similar Graphic health warning, Benin
by the Ministry in charge of trade
products was adopted, requiring
pursuant to Article 8 of the Protocol

70 | WHO report on the global tobacco epidemic 2023

Anti-tobacco mass media campaigns
Article 12 of the WHO FCTC states:

“Each Party shall promote and strengthen public awareness of tobacco control issues, using all available
communication tools, as appropriate. … each Party shall … promote … broad access to effective and
comprehensive educational and public awareness programmes on the health risks including the addictive
characteristics of tobacco consumption and exposure to tobacco smoke; … [Each party shall promote]
public awareness about the risks of tobacco consumption and exposure to tobacco smoke, and about the
benefits of the cessation of tobacco use and tobacco-free lifestyles; … [each party shall promote] public
awareness of and access to information regarding the adverse health, economic, and environmental
consequences of tobacco production and consumption” (173).

■ include toll-free quit line numbers Of the 36 countries that ran an anti-
Mass media campaigns on campaign products, e.g. at the tobacco mass media campaign since
are essential to all bottom of posters or at the end of TV 2020, 16 were high-income countries
advertisements. (27% of high-income countries); 18 (17%)
comprehensive tobacco were middle-income countries; and
control strategies or two (7%) were low-income countries
(see Box 22 and Box 23) (Fig. 33). More
programmes Less than one quarter of than half of the countries in the world
(112 countries) have run no sustained
Anti-tobacco mass media campaigns are the world’s population was campaign or have not reported data
effective interventions that can quickly exposed to a best-practice in the past 2 years, leaving about 24%
and efficiently reach large populations
mass media campaign in of the world’s population not covered
and help to reduce tobacco use, increase
by this measure. This means that an
quit attempts, lower youth initiation rates 2022 estimated 217 million tobacco users
and reduce second-hand smoke exposure
have not been exposed recently to any
in all countries (201–204). Mass media Less than one quarter of the world’s anti-tobacco mass media campaign.
campaigns should: population (1.5 billion people) live in
a country that has aired at least one
■ be well-designed through a
national best-practice anti-tobacco
collaborative approach involving
mass media campaign in the past 2
health professionals, researchers,
years (see Fig. 31). Another quarter National anti-tobacco mass
creative designers and the media
(205);
of countries conducted mass media media reach continues to
campaigns of at least 3 weeks’ duration,
■ be hard-hitting, emotionally with some but not all best-practice shrink
evocative and/or testimonial in criteria.
nature (206); People in low-income countries are the
The first year for which mass media least exposed to anti-tobacco mass
■ involve multiple communication campaigns were monitored was media: over 80% of the population
channels (i.e. TV, radio and the 2010, and for the ensuing 4 years the of low-income countries, living in 25
Internet),which are more likely proportion of the world’s population countries, have not been exposed to
to have a longer-term impact on exposed to a best-practice mass any kind of campaign in the past 2 years
tobacco-use behaviour (207); media campaign rose, reaching 4.3 (Fig. 33).
billion people in 39 countries in 2014.
■ be sustained over time (although
Regrettably, by 2022 this number had
campaigns with a duration of as little
dropped by more than half, to 1.5 billion
as 3 weeks can also have a positive
people in 36 countries (Fig. 32).
impact) (208–210);

5. Effective tobacco control measures | 71

Fig. 31. Anti-tobacco mass media campaigns, highest achieving countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries and territories with the highest level of achievement: Bahraina, Cuba, Estonia, Ethiopia, France, Gambiaa, Ireland, Israela,
Japan, Jordana, Kenyaa, Malaysia, Monaco, Morocco, Naurua, Netherlands (Kingdom of the)a, New Zealand, Norway, occupied Palestinian
territorya, Panamaa, Republic of Korea, Russian Federation, Saint Lucia, South Africaa, Sri Lankaa, Thailand, Timor-Leste, Tonga, Tunisia,
Türkiye, Turkmenistan, Ukraine, the United Kingdom, the United States, Uruguaya, Viet Nam
a
Country newly at the highest level since 2020

6.4 billion people have not been warned about the dangers
of tobacco by a best-practice mass media campaign in the
last 2 years.

Fig. 32. Progress in anti-tobacco mass media campaigns, 2010–2022

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150
Number of countries

4 4.3 100
4.1
3 3.4 3.3
2 2.6 39 42 44
37 39 36 50
35
1.8
1 1.5

0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

72 | WHO report on the global tobacco epidemic 2023

 Fig. 33. Mass media campaigns by country-income level, 2022

Data not reported

100%
No national campaign conducted between July 2020
90% and June 2022 with a duration of at least three weeks
(Number of countries inside bars)

80% National campaign implemented with 1-4

appropriate characteristics
27
60
Proportion of countries

70% National campaign implemented with 5-6 appropriate characteristics,

or with 7 characteristics excluding airing on TV and/or radio

60% National campaign implemented with at least seven appropriate

characteristics including airing on TV and/or radio
25
50% 8
40% 8
9
30%
21
20%
16
10% 18 1
2
0%
High-income Middle-income Low-income

Box 22. “United against tobacco and COVID-19” campaign success,

occupied Palestinian territory

In the occupied Palestinian throughout the campaign, including The campaign achieved its
territory, the Palestinian Ministry of video interviews with children (held predefined target by reaching
Health successfully aired its “United with their parents’ permission) in more the 3 million Palestinian
against tobacco and COVID-19” which they expressed their opinions people, despite the challenges
mass media campaign between about smoking (211–214). faced. The Palestinian Ministry
June and September 2022, despite of Health used the timing of
Public surveys and focus group
the ongoing emergency situation the campaign to open smoking
discussions were used to research
that deepened during the COVID-19 cessation clinics at all primary
the views of the target audience
pandemic (211–214). The campaign health care centres in 14 districts
and inform and develop the
was also conducted in Egypt, Iraq, and used the campaign platform
campaign messages, and to pre-test
Jordan, and Türkiye (213), and to start conversations with local
the campaign materials before
was funded by the Centers for communities to enact policies to
roll-out. The Ministry of Health
Disease Control and implemented decrease smoking prevalence.
monitored the campaign to ensure
by Global Health Development A post-implementation impact
the campaign materials were
Eastern Mediterranean Public evaluation of the campaign
used as planned, and worked with
Health Network (GHD|EMPHNET) was held.
journalists to gain publicity.
with technical assistance from Vital
Strategies (215).
The campaign, covering villages,
cities, and refugee camps, was run
in parallel with other campaigns
and highlighted the harms of
tobacco and the benefits of tobacco
cessation to smokers, their families
and friends, and others (211–214).
Built on five key activities, the
campaign was aired on television
and radio, and advertised via
billboards, SMS messages, pre-
paid Internet adverts, social media
platforms, and posters on public
transport. In addition, supporting United against tobacco and COVID-19 campaign- The risk of Argileh Smoking, occupied
activities were developed Palestinian territory

5. Effective tobacco control measures | 73

 Box 23. Successful, sustained national tobacco control mass media campaigning,
Viet Nam

Since 2015, the Viet Nam Tobacco education settings, and provincial voices of millions of secondary and
Control Fund (VNTCF) at the Ministry television. high school students against new
of Health has conducted successful tobacco and nicotine products.
Using insights into women’s
mass media communication
concerns about the harms of Annual evaluations of national mass
campaigns to promote behaviour
second-hand smoke, VNTCF and media campaigns have consistently
change and influence social norms
Vital provided strategic support shown recall by more than half of
among adults, youth and children.
to mass media campaigns run the population aged 15 years and
Campaigns also discouraged
by the Viet Nam Women’s Union, older, and support for tobacco
young people from starting and
which has a network of around control policies. Campaigns also
can mobilize non-smokers such
20 million women. ‘Quit Smoking increased smokers’ and non-
as women to support policy and
to Protect Your Loved Ones’ and smokers’ knowledge and concerns
change norms.
‘Women create smoke-free homes” about the harms of smoking and
The campaigns were carried carried messages including the exposure to second-hand smoke.
out with technical support from personal stories of women harmed Smokers said they were more likely
partners including Vital Strategies by others’ smoking into the homes to attempt to quit after seeing the
(Vital), the Campaign for Tobacco of women across Viet Nam. Youth campaigns. Non-smokers said they
Free Kids, the Viet Nam Public were another target audience. were more likely to complain about
Health Association and the WHO Partnering with the Youth Union, being exposed to smoke in public
Country Office in Viet Nam, and which has a membership of more places.
funded by a percentage of tobacco than 7.3 million people aged
tax revenue earmarked for tobacco 18–35 years, the team ran national
control activities. Campaign design, competitions about the harms of
including audience selection, tobacco and electronic cigarettes
objectives, messages, materials which achieved millions of views on
and planning, was data-driven the Union’s social media platforms.
and evidence-based. Sources This campaign mobilized the voices
included the Global Adult Tobacco of youth to support tobacco control
Survey of 2010 and 2015, and policies, and reject smoking and
formative research from previous e-cigarettes.
campaigns. Messages reached
To protect children, VNTCF and
audiences through earned and paid
partners worked with the Ministry
media such as TV and billboards,
of Education and Training to raise
as well as social media including
awareness and support schools and
the Vn0koithuoc (Smoke-free
students to say no to new tobacco
Vietnam) Facebook page. Support
and nicotine products.
by VNTCF through the 63 provincial
Centers for Disease Control and Training curriculum and school-
Prevention enabled messages to be based communication products A campaign poster illustrating a child
disseminated through provincial were developed with the affected by second-hand smoke in a
cities, in hospital waiting rooms, engagement of teachers and café, Vietnam
buses, train stations, community parents’ associations, raising the

74 | WHO report on the global tobacco epidemic 2023

 Enforce bans on tobacco
advertising, promotion
and sponsorship
Article 13 of the WHO FCTC states:
“... [A] comprehensive ban on advertising, promotion and sponsorship would reduce the consumption
of tobacco products. Each Party shall ... undertake a comprehensive ban of all tobacco advertising,
promotion and sponsorship. … [W]ithin the period of 5 years after entry into force of this Convention
for that Party, each Party shall undertake appropriate legislative, executive, administrative and/or other
measures and report accordingly in conformity with Article 21”. WHO FCTC Article 13 guidelines are
intended to assist Parties in meeting their obligations under Article 13 of the WHO-FCTC (173).

■ discrediting the evidence base for Moreover, legislation must be

TAPS bans protect children restrictions; coupled with strong enforcement and
from tobacco advertising ■ using lobbyists and litigation to
monitoring, with high financial penalties
for violations (173). Bans must cover all
and marketing tactics avoid TAPS bans (222).
TAPS activities, including:

Tobacco companies claim that the TAPS bans are an effective ■ direct promotion (e.g. TV
billions of dollars they spend annually advertising, radio, print publications
on advertising serve only to increase tobacco control measure to and billboards as well as advertising
their market share at the expense of reduce tobacco use at points of sale);
competitors, but there is indisputable ■ indirect promotion (e.g. brand
evidence that TAPS activities also TAPS bans effectively reduce tobacco stretching and brand sharing,
increase or sustain tobacco use by sales and tobacco consumption in all free distribution, price discounts,
effectively recruiting new tobacco users parts of the world (223) and their impact product placement on TV/films and
and discouraging current users from may be strongest in low- and middle- sponsorships including “corporate
quitting (216–218). Tobacco companies income countries (224). Comprehensive social responsibility” programmes)
use a mix of TAPS techniques, including: bans on all TAPS activities are a key (229) (See Box 24 and Box 25);
tobacco control strategy and policy
■ developing new products (e.g. point of sale product displays that
measure (173) – one of only two WHO ■
ENDS) that circumvent regulations “normalize” tobacco products,
FCTC provisions with a mandatory
and attempt to maintain social prompt people to smoke, encourage
timeframe for implementation.
acceptability of tobacco use (219).; impulse purchases, interfere
■ targeting young people and women, with quitting, and increase the
especially in low- and middle- susceptibility of children and youth
income countries (220, 221) – such Bans must cover all TAPS to see and try the products (230, 231);
promotion increases the likelihood
that adolescents will start to use
activities ■ financial or in-kind contributions
that tobacco companies may make
tobacco which may lead to a higher TAPS bans must be comprehensive, to another entity for deserving
prevalence of adult tobacco users in as partial bans have little or no effect or socially responsible causes –
the future; (225,226) and allow tobacco companies contributions that fall within the
■ activities that can influence the to exploit legal loopholes or shift their definition of tobacco sponsorship in
businesses that may benefit from the investments to forms of promotion that article 1(g) of the WHO FCTC (232);
billions of dollars invested in TAPS are not banned (227). Legislation to ban
TAPS should use clear, uncomplicated ■ corporate social responsibility
themselves; activities that aim to convince
language and unambiguous definitions,
■ attempts to avoid regulation by and avoid providing lists of prohibited governments to delay and refrain
adopting weak voluntary advertising activities that are, or could be from implementing tobacco control
codes; understood to be, exhaustive (228). programmes (233).

5. Effective tobacco control measures | 75

TAPS bans should protect The number of countries 24 countries are close to a
children and adolescents covered by TAPS bans complete TAPS ban
from exposure through continues to steadily rise A best-practice TAPS ban has 10
digital media Today 66 countries are covered by
appropriate characteristics. In 2022,
24 countries covering 656 million
TAPS activities can appear via multiple best-practice TAPS bans (Fig. 34).
people had mandated nine of these 10
social media platforms and children and Since 2007, 58 countries have adopted
characteristics and thus are only one
adolescents are particularly exposed comprehensive TAPS bans. 1.8 billion
provision away from achieving a best-
(234), not least through social media additional people are now protected by
practice ban. The most common missing
influencers, spokespeople, and brand- this measure, bringing the total to just
provision is banning brand stretching
sponsored contests that are used to under 2 billion people in 66 countries.
(eight countries), followed by banning
promote tobacco products (235, 236). In 2007 there were only eight countries advertising at point of sale (six countries).
Countries’ existing TAPS ban legislation –3% of the world’s population – with The others are banning sponsorship
may not necessarily clearly or explicitly best-practice TAPS bans in place (four countries), banning promotional
include a ban on advertisements on the (Fig. 35). discounts (three countries) and banning
Internet, so ensuring that bans cover the appearance of tobacco products or
Internet-based media is crucial. In some brands in TV and/or films (one country).
cases, enforcing TAPS bans on social Thirty-nine countries, with 1.1 billion
media sites may require cross-border Almost half of low-income people, have a complete absence of TAPS
legislation, and for this reason, countries bans, or very minimal restrictions.
will need to cooperate and coordinate countries have complete
Over one third of the 546 million people
efforts (237) (see Box 26). TAPS bans who live in the world’s 100 largest cities
In 2022, of the 66 countries with are protected by TAPS bans. Thirty-six of
comprehensive TAPS bans, 13 are low- the cities are covered by comprehensive
income countries, 38 are middle-income national laws (Table A4). Instead of
countries and 15 are high-income waiting for a national policy to be put in
countries. While almost half of all low- place, the remaining 64 of the world’s
income countries have a best-practice largest cities not currently protected by a
TAPS ban in place, only one third of national best-practice policy could move
middle-income countries and one- ahead as appropriate with a city, state
quarter of high-income countries have or provincial level policy to protect their
achieved this (Fig. 36). large populations sooner.

Fig. 34. Enforcement bans on advertising, promotion and sponsorship – highest achieving
countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries and territories with the highest level of achievement: Afghanistan, Albania, Algeria, Antigua and Barbuda, Armenia,
Azerbaijan, Bahrain, Benin, Brazil, Cabo Verdea, Chad, Colombia, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti,
Eritrea, Ethiopia, Finland, Gambia, Ghana, Guinea, Guyana, Iceland, Iran (Islamic Republic of), Iraq, Jordan, Kenya, Kiribati, Kuwait,
Kyrgyzstana, Lao People’s Democratic Republica, Libya, Madagascar, Maldives, Mauritania, Mauritius, Mexicoa, Mongolia, Nepal,
Netherlands (Kingdom of the)a, Niger, Nigeria, Niue, occupied Palestinian territory, Panama, Qatar, Republic of Moldova, Russian
Federation, Saudi Arabia, Senegal, Seychelles, Slovenia, Spain, Sudana, Suriname, Togo, Türkiye, Tuvalu, Uganda, Ukrainea, United Arab
Emirates, Uruguay, Vanuatu, Venezuela (Bolivarian Republic of), Yemen 
a
Country newly at the highest level since 2020
76 | WHO report on the global tobacco epidemic 2023
 Fig. 35. Progress in bans on tobacco advertising, promotion and sponsorship, 2007–2022

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150

Number of countries
5

4 100

3 66
59
53
2 42 50
33
26 2.0
19 1.7
1 8 12 1.3 1.5
0.7 0.9
0 0.2 0.2 0.4 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

With seven new countries at best-practice level in 2022,

one third of countries and 25% of the world population
is covered by TAPS bans.

Fig. 36. Bans on advertising, promotion and sponsorship, by country-income level

Data not reported

100%

90% 11 19 Complete absence of ban, or ban that does not

cover national TV, radio and print media

10
(Number of countries inside bars)

80% Ban on national TV, radio and print media only

Proportion of countries

70% Ban on national TV, radio and print media as well as on some
but not all other forms of direct and/or indirect advertising

60% 50
Ban on all forms of direct and indirect advertising (or at least
90% of the population covered by complete subnational bans)
5
34
50%

40%

30%
13
20% 38
15
10%

0%
High-income Middle-income Low-income

5. Effective tobacco control measures | 77

 Box 24. Cabo Verde strengthens legislative field regarding tobacco advertising

New legislation to ban tobacco The new tobacco legislation also According to a STEPS non-
advertising in Cabo Verde was prohibits smoking (including communicable disease survey
approved by the country’s through the use of e-cigarettes) conducted in 2020, the prevalence
parliament in 2022, stipulating in places where sovereign bodies, of tobacco use in Cabo Verde is
that “all forms of direct or indirect, public administration services and 12.5% and 15% of the population
hidden, concealed and subliminal bodies, and State companies are is exposed to second-hand smoke
advertising and promotion of located, as well as in hospitals, (238).
tobacco companies and their brands buildings serving people under the
are prohibited”, alongside all types age of 18 years; and sports facilities,
of sponsorship or information among others.
campaigns.
It also sets out the prohibition of
The ban on direct tobacco the sale, supply and consumption
advertising includes advertising of tobacco by people under
in international magazines and the age of 18 years, and a “ban
© WHO/Antonio Preito, Cabo Verde
newspapers, international television on the marketing of tobacco in
and radio, national television establishments, particularly March for tobacco control – Santa
and radio, local magazines educational, health and sports Catarina, Cabo Verde
and newspapers, posters and establishments, thus limiting
outdoor advertising, point-of-sale young people’s access to tobacco
advertising and Internet advertising. products”.

Box 25. Law tightens to include sponsorship ban and other key measures, Sudan

In 2005, Sudan adopted a national Despite the emergency situation Interference from the tobacco
tobacco control law prohibiting in Sudan, the Federal Ministry of industry has been a major
tobacco advertising and promotion. Health successfully issued the challenge, as they used to support
However, tobacco sponsorship was relevant tobacco control regulations events and projects targeting
not addressed by the 2005 law, in 2021, which put in place a young people and children. But
leaving legislative gaps that the total ban on tobacco advertising, this regulation will lessen tobacco
tobacco industry was exploiting promotion, and sponsorship. Article companies’ interference. This
(239). 22 of the 2021 tobacco control legislative accomplishment allowed
regulations includes a ban on Sudan to advance to the highest
In 2018, the Government of Sudan
the tobacco industry’s corporate degree of MPOWER component E
asked the WHO FCTC Secretariat to
social responsibility activities. compliance.
conduct a joint needs assessment
Also, it prohibits the entities that
mission for tobacco control in
produce or import tobacco and its
Sudan considering its obligations
products from funding or making
under the Convention, during which
contributions to social, academic,
an international team interacted
health, sports, and other activities.
with Sudan’s Federal Ministry
The legislation also covers further
of Health and various national
tobacco control measures, such as
stakeholders; the WHO regional
requiring graphic health warnings
and country offices; and the United
on 75% of all tobacco product
Nations resident coordinator (240).
packaging and preventing exposure © Ministry of Health, Sudan
Banning sponsorship was among
to tobacco smoke in some indoor
the development areas identified
public places.
during the mission in order for
Tobacco control workshop, Sudan
the tobacco control legislation
to comply with Article 13 of the
WHO FCTC.

78 | WHO report on the global tobacco epidemic 2023

Box 26. Strengthening tobacco marketing regulations using continuous digital media
monitoring

Digital media, particularly social Indonesia and Mexico. TERM uses

networking sites, continue to an artificial intelligence platform
increase in popularity as more of to scan for tobacco marketing
the world becomes connected on social networking sites using
to the Internet. Globally, there keyword-based searches. These
are now more than 5 billion findings are then thoroughly
Internet users and 4.7 billion vetted by local experts to identify
social media users (241, 242). This hidden forms of marketing, such
growth is accompanied by a rise as surrogate marketing and
in tobacco marketing (243) using brand extensions, and to identify
social networking sites to reach evolutions in tobacco marketing,
younger audiences with interactive including digital marketing trends
content that often features social such as gaming and advertising in
media influencers who have large the metaverse.
followings (244). A bidi company in India shares a greeting
TERM analysis is summarized in for International Women’s Day.
Currently, not all TAPS clear reports that help governments
bans explicitly ban Internet in India, Indonesia and Mexico
advertisements (245). Even make the case for stronger
where they do, the expansive tobacco marketing interventions.
and user-controlled nature of This includes elevating tobacco
social networking sites makes marketing issues in the media
enforcement a challenge. and guiding counter-marketing
Monitoring and reporting of tobacco campaigns in all three countries,
marketing on social networking and energizing coalitions to advocate
sites is crucial to identify ways to for stronger consumer protection
strengthen TAPS policies, as well as and digital safety laws in Indonesia.
evolving industry marketing trends. The TERM approach can be adapted
The WHO FCTC acknowledges this, for use elsewhere, and the data it
urging governments to work with gathers is available to governments
civil society partners to closely and tobacco control advocates.
monitor and improve tobacco Further details are available at A “metaverse party” promotes tobacco
on social networking sites in Indonesia.
marketing regulations and promote https://termcommunity.com
global collaboration.
Digital media monitoring can
The Tobacco Enforcement and play a critical role in supporting
Reporting Movement (TERM) is government action to strengthen
a continuous, real-time digital tobacco control policies and counter
monitoring system that catches industry interference. A partnership
online tobacco marketing as it between governments and civil
happens. It was launched by Vital society organizations is important
Strategies with input from local to the successful implementation of
governments and partners and MPOWER policies.
is currently operational in India,

5. Effective tobacco control measures | 79

 © WHO/Martha Tadesse

80 | WHO report on the global tobacco epidemic 2023

 Raise taxes on tobacco
Article 6 of the WHO FCTC states:

“...[P]rice and tax measures are an effective and important means of reducing tobacco consumption...
[Parties should adopt]...measures which may include:...tax policies and...price policies on tobacco
products so as to contribute to the health objectives aimed at reducing tobacco consumption” (173).

that tax measures on tobacco can be

Raising taxes to increase an effective means of reducing tobacco
Tobacco tax policies need
the price of tobacco consumption and health care costs and strong tax administration
that they represent a revenue stream for
products is the most financing for development (252). Of the different types of tax levied on
tobacco products, excise taxes are the
effective tobacco control most effective at raising prices and
measure generating a significant health impact
(248, 254). Simple tax structures are
A report published in 2019 estimated Taxes should be raised easiest to administer – while complex
that 27.2 million premature deaths periodically to offset structures and tiered excise taxes
could be averted globally within a 50 should be avoided to diminish incentives
year period if countries raised the price inflation and income for companies to price tobacco products
of tobacco by 50% using tax increases growth in ways that can undermine the health
(245). This is equivalent to eliminating and revenue impact of tobacco taxes
all global cancer deaths for a span of 3 Governments must monitor tobacco (248).
years (around 9 million deaths per year). tax rates and prices relative to real
On average, a 10% price increase will Key interventions to improve tax
income and significantly raise tax rates
reduce consumption by 5–8% in low- administration include:
at regular intervals to ensure that
and middle-income countries, and by tobacco products do not become more ■ ensuring compliance (through
about 4% in high-income countries (245). affordable – a trend common in many licensing, detailed tax declaration
Tobacco taxation is rightly considered countries where income and purchasing requirements and advanced
a highly cost-effective “best-buy” power are growing rapidly (248). Despite information technology);
intervention, meaning that its returns some of these countries raising tobacco
and economic benefits are several ■ ensuring control and enforcement
tax rates, they have not offset inflation
times higher than its costs (13, 14, 246) on the supply chain (through, for
and income growth, causing an erosion
– indeed, in low- and middle-income example, the use of risk-based
of the tax’s value and effectiveness in
countries such tax increases can cost as approaches for enforcement targets,
reducing consumption (248). Nominal
little as US$ 0.05 per capita each year to tax stamps, track and trace systems,
tax increases that do not make tobacco
administer (247). implementing anti-forestalling
products less affordable are unlikely
methods);
to reduce consumption or encourage
cessation (see Box 27). ■ following clearly defined procedures
after detecting illicit trade of tobacco
Tobacco tax revenues can Amidst the persistently high core
(including high penalties) (248).
inflation faced by several countries,
help the government fund particularly emerging and developing Experiences from numerous countries
a sustainable tobacco economies, it becomes imperative for show that illicit trade of tobacco
governments to safeguard the real value products can be successfully addressed
programme of tobacco taxes. Although inflationary even when taxes and prices are
pressures are anticipated to decrease increased, hence the threat of tax
Tax increases generate government
in 2023, they are expected to remain evasion should not be used as a reason
revenue (248, 249) that could be used
at elevated levels for an extended to forgo tax increases (248, 255).
for tobacco control programmes as
period; hence, policy-makers should
well as other important health and
take proactive measures to ensure that
social initiatives, which have now been
tobacco products remain unaffordable
successfully demonstrated in some
in light of the ongoing inflationary
countries (250, 251). In fact, the Addis
challenges (253).
Ababa Action Agenda 2015 recognizes

5. Effective tobacco control measures | 81

 The total number of countries that have Of these 24 countries, 11 are high-
Political will is critical to raised tobacco taxes to a level at (or income countries that have raised taxes
ensure adoption of tax above) 75% of the price of the most sold sufficiently to reach the highest level
brand of cigarettes between 2020 and of implementation (Andorra, Australia,
reforms 2022 remained constant, but because Croatia, Denmark, Greece, Israel, Latvia,
some countries were replaced with Lithuania, Netherlands (Kingdom of
Pre-empting the “SCARE” tactics
others the number of people protected the), New Zealand, and Slovenia). Eleven
(Smuggling and illicit trade, Court and
by this level of tax decreased from 1.1 middle-income countries and one
legal challenges, Anti-poor rhetoric
billion to 1 billion (Fig. 38). territory have reached the highest level
or regressivity, Revenue reduction,
of taxation since 2008 (Argentina, Bosnia
Employment impact) (248) deployed Between 2020 and 2022, four countries
and Herzegovina, Brazil, Montenegro,
by the tobacco industry to block any (Australia, Lithuania, Nicaragua, and
Morocco, Nicaragua, North Macedonia,
major tobacco tax reforms can greatly Vanuatu) increased their taxes to
occupied Palestinian territory, Serbia,
help the smooth adoption of important best-practice levels, while another four
Thailand, Türkiye and Vanuatu). One
tobacco tax reforms. Experience from countries lost their position in this top
low-income country began taxing at
countries around the world shows that group (Egypt, Georgia, Sri Lanka and
or above 75% in 2010 (Madagascar)
these arguments are either unfounded Ukraine) (see Technical Note III). The
and currently remains the only low-
or greatly exaggerated and that tax most significant tax share increase in the
income country at the highest level of
increases are in fact good for health, four countries raising taxes was made by
implementation (Fig. 39).
for equity, for revenues and for the Nicaragua (from 56.8% in 2020 to 75.7%
economy overall, with very little risk in 2022), and Vanuatu (from 58.3% in Today, middle-income countries
of facing legal threats, especially when 2020 to 77.5% in 2022). No low-income constitute more than half of the
laws are carefully designed and enacted countries have raised taxes to 75% or population (52%) protected by this
(248) (see Box 28). above since 2020, but eight countries, measure. Only 3% of protected people
all in the African Region, increased taxes live in low-income countries.
The evidence on tobacco interventions
enough since 2020 to move one category
indicates that the most effective and Of the 546 million people who live in one
closer to best-practice level (Table A1).
efficient way to reduce tobacco use is of the world’s 100 largest cities, only
to raise the price of tobacco through In 2008, globally, 23 countries had tax 127 million (in 24 cities) are protected
tobacco taxes. However, tobacco tax is rates at 75% or more of the price of a by tobacco taxation (Table A4). No city
the least-adopted MPOWER measure. In pack of cigarettes, covering only half has yet, independently of national
2022 only 12% of the world’s population a billion people or 7% of the world’s government, introduced taxes on
living in 41 countries were protected by population. Since then, an additional tobacco products that have resulted in
tax rates at 75% or more of the price of half a billion people in 24 more countries raising the share of total taxes to 75% or
the most popular brand of cigarettes have become covered by best-practice more of the retail price.
(Fig. 37). taxation levels, while only six countries
lost their position in this top group.

Fig. 37. Raising taxes on tobacco, best-practice countries, 2022

Best-practice countries or areas

Other countries or areas
Not applicable

0 1000 2000 4000 km

Countries and territories with the highest level of achievement: Andorra, Argentina, Australiaa, Belgium, Bosnia and Herzegovina, Brazil,
Bulgaria, Chile, Croatia, Czechia, Denmark, Estonia, Finland, France, Greece, Ireland, Israel, Italy, Jordan, Latvia, Lithuaniaa, Madagascar,
Malta, Mauritius, Montenegro, Morocco, Netherlands (Kingdom of the), New Zealand, Nicaraguaa, North Macedonia, occupied
Palestinian territory, Poland, Portugal, Serbia, Slovakia, Slovenia, Spain, Thailand, Türkiye, the United Kingdom, Vanuatua
a
Country newly at the highest level since 2020

82 | WHO report on the global tobacco epidemic 2023

 Fig. 38. Progress in total tax on cigarettes ≥ 75% of retail price, 2008–2022

8 200
Total population: 7.9 billion Total number of countries: 195
7
Population protected (billions)

6 150

Number of countries
5

4 100

2 38 41 41 50
28 31 33 32
23
1
1.1 1.1 1.0
0.5 0.6 0.6 0.6 0.6
0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022

Population (billions) Countries

One billion people are covered by high tobacco taxes.

Fig. 39. Total tax on cigarettes, by country-income level, 2022

100% 2 1
Data not reported
3 13
90% 4 6 <25% of retail price is tax

80% ≥25% and <50% of retail price

is tax
70% ≥50% and <75% of retail price
40 6
(number of countries inside bars)

is tax
Proportion of countries

25
60%
≥75% of retail price is tax

50%

40% 9

38
30%

20% 25

6
10%
15
1
0%
High-income Middle-income Low-income

5. Effective tobacco control measures | 83

 Furthermore, only 5% of high-income There is a strong case for all countries,
Total tax on cigarettes countries do not tax tobacco at a particularly low- and middle-income
minimal level (i.e. under 25% of the retail countries, to increase their excise taxes
price), 15% of low- and middle-income further, which will have the effect
Today, 18 countries need
countries are missing the opportunity of making cigarettes less affordable
raise taxes only an additional to save lives by raising taxes above the (Fig. 40).
5% or less of the retail price basic level (see Annex 1).
to reach best-practice level – Affordability should be
protecting an additional 659 continuously decreased through
million people. regular and ambitious tax
Low- and middle-income
In 2022, 42% of high-income countries increases
(25 countries), 14% of middle-income countries have much
The affordability of cigarettes is
countries (15 countries) levied taxes progress to make to raise measured by the per capita GDP
at best-practice level. Only one low-
income country – Madagascar – had taxes and prices required to purchase 2000 cigarettes
of the most sold brand reported in a
taxes at the highest level. However, given year. The average change over the
Price and tax levels are highest in high-
18 countries (nine high-income, eight period 2012–2022 was calculated for
income countries, even when adjusting
middle-income and one low-income) are this current report. Using this measure,
for differences in purchasing power.
just 5 percentage points away from the cigarettes have become less affordable
Cigarette pack prices, total taxes and
best-practice level and have tax rates in 64 countries and did not significantly
the tobacco excise component as a
between 70% and 75% of retail price. If change in 88 countries, while they
share of pack prices are all lower in
these countries increased their tax rates became more affordable in 25 countries.
low- and middle-income countries,
to 75%, an additional 660 million people Of those 25 countries, 17 were low- and
with average total tax as a proportion
would be covered by the most effective middle-income countries (see Annex 1).
of price amounting to 56.5% in low-
measure to reduce tobacco use.
income countries and 59.1% in middle-
income countries. This proportion
reaches 66.9% in high-income countries.

Fig. 40. Weighted average retail price and taxation (excise and totals) of most sold brand of cigarettes,
2022

Price minus taxes

Other taxes

Price:PPP $ Excise tax per pack

9.78
Prices and taxation per pack (PPP dollars)

3.24

Price:PPP $
5.95
1.34 Price:PPP $
5.07
Total taxes = 2.29
PPP $ 6.54
(66.9% of
2.07 Price:PPP $
pack price) 3.10
0.95
5.20 0.88 1.35

Total taxes = 0.41 Total taxes = Total taxes =

PPP $ 3.00 PPP $ 1.75 2.71 PPP $ 3.66
2.13
(59.1% of (56.5% of (61.6% of
1.34 pack price) pack price)
pack price)

High-income Middle-income Low-income Global

Note: Averages are weighted by WHO estimates of number of current cigarette smokers ages 15+ in each country in 2022.
Prices are expressed in Purchasing Power Parity (PPP) adjusted dollars or international dollars to account for differences in the
purchasing power across countries. Based on 55 high-income, 103 middle-income and 21 low-income countries with data on
prices of most sold brand, excise and other taxes, and PPP conversion factors.

84 | WHO report on the global tobacco epidemic 2023

Those are concerning changes Furthermore, the shift from ad valorem signifies progress towards maximizing
when compared with the change in taxes to mixed excise or specific excise the impact of tobacco taxes on public
affordability calculated over the period taxes is an encouraging development. health by reducing price differentials
of 2010–2020 in the previous report. The In 2008, 54 countries relied on ad and deterring consumers from switching
number of countries where cigarettes valorem taxes, which can be less to cheaper alternatives. Overall,
have become less affordable was effective in reducing tobacco use as the data suggest a positive trend in
84 (compared now to 64), while the they may increase price dispersion and adopting best practices in tobacco tax
number of countries with no change encourage substitution to lower-priced policies. However, there is still room for
in affordability was 68 (compared now alternatives. However, by 2022 the improvement, particularly in countries
to 88), and those with an increased number of countries using ad valorem that continue to rely heavily on ad
affordability were 20 (compared now taxes had decreased to 34. During the valorem taxes and those that have
to 25). Countries need to implement same period, the use of mixed excise or not implemented any excise taxes.
more ambitious tax increases in order specific excise taxes had increased to
to reduce affordability in a significant from 48 countries to 64, and from 56 to
way over time (Fig. 41). 70, respectively (Fig. 42).
It is noteworthy that in 2008, of the
More countries are adopting 48 countries using a mixed system,
better tax structures over time 56% relied more on the ad valorem
In 2008, 22 countries had no excise taxes component, indicating a need for
on tobacco – a clear illustration of how better alignment of tax structures
taxation was under-used as a policy with best-practice. By 2022, the
tool to influence tobacco consumption. balance had shifted, with only 40% of
However, by 2022 this number had the (now) 64 countries using a mixed
halved, suggesting a positive trend system relying more on the ad valorem
towards implementing tobacco taxation component and 60% relying more
as a public health measure. on the specific component. This shift

Since 2020, 21 countries have made incremental progress

in tobacco taxes and shifted to a higher MPOWER group.

Fig. 41. Change in affordability of cigarettes, 2012–2022

100%
5
11 3
90%

80%
9
70%

38 14
60% 50

50%

40%
5
30%

20%
21 27 8
10% 4

0%
Cigarettes became less Affordability did not change Cigarettes became more Could not be assessed due to
affordable affordable insufficient data

High-income Middle-income Low-income

5. Effective tobacco control measures | 85

 Fig. 42. Number of countries with different excise tax structures over time, 2008–2022

80

70 70

64
60
56
54
50
48
Number of countries

40

34
30

22
20

12
10

0
2008 2010 2012 2014 2016 2018 2020 2022

Specific excise Ad valorem Mixed excise No excise

© WHO/Alex Swanepoel

86 | WHO report on the global tobacco epidemic 2023

Box 27. Historic levels of tobacco taxation are reached, Peru

Peru is a regional and global tax in Peru’s history. The total tax by modifying the methodology to
leader in tobacco taxation, ranking share (taxes as a percentage of calculate its amount-specific excise
among the top 10 countries the price of the most sold brand) tax on cigarettes so that it would
implementing tobacco taxes by jumped from 37.8% to 49.5%. automatically account for inflation,
the Tobacconomics Cigarette Tax This was a win for reducing the thus preserving the real value of the
Scorecard – a tool that evaluates affordability of cigarettes (by tax over time.
cigarette tax policies based on nearly 2%) and for simultaneously
Peru currently boasts a 73.3% total
their structure, tax share, price, increasing tax collection. As a
tax share, the highest ever recorded
and affordability. The scorecard result, in 2017, Peru’s Ministry of
by the country. Yet there is room for
assigned Peru a score of 4.13/5 – the Economy and Finance was selected
improvement – prices have been
second-highest score among Latin as one of WHO’s World No Tobacco
declining since the last adjustment.
American countries after Ecuador Day Award recipients, an award
Challenges for the future include
and significantly higher than that “recognizes institutions,
pushing affordability levels lower
regional and global averages organizations, and individuals
and the tax rate higher to achieve
who have made outstanding
This achievement has been years the WHO-recommended 75% total
contributions in the fight against
in the making. Since the 1990s, tax share thresholds.
smoking in their country”.
Peru has applied an excise tax on
cigarettes, but between 1999 and This trend continued, and in 2018
2009, tobacco tax policy, from a another increase of the specific
health perspective, moved slowly. excise was implemented – along
In 2010, the excise tax design was with adjustments for alcohol,
strengthened when a specific sugar-sweetened beverages,
(quantity-based) component was and fuel taxes – marking the first
introduced to replace the ad- time such a tax adjustment was
valorem structure. Between 2010 introduced in the country with an
and 2016, no further adjustments explicit public health rationale. In
took place. Then, in 2016, the a celebrated move, Peru then took
a further step in 2020 to protect News article informing of the
government increased the specific
Government’s actions to raise taxes
excise by more than 150% – the public health and implement a on cigarette, sugary and alcoholic
largest increase in tobacco excise key WHO FCTC Article 6 guideline beverages, Peru

Box 28. Cigarette tax hikes pave the way for a healthier future, Timor-Leste

Timor-Leste is one of the newest The Minister’s UHC Day speech Evidence collected for this report
countries in the world and its fast- announced that Timor-Leste would shows the immediate impact of
growing population is one of the significantly increase excise taxes these excise tax increases, with the
world’s youngest. In his speech on unhealthy products like tobacco, retail price of cigarettes increasing
for Universal Health Coverage emphasizing that, “these taxes by 75% – from US$ 2 in 2020 to US$
(UHC) Day in December 2022, are considered win-win policies 2 .25 in 2022 and US$ 3.50 per pack
the country’s Finance Minister because not only do they save in 2023. The share of tax in the retail
highlighted this, noting that in lives and prevent disease, but they price of cigarettes increased from
order to “reap the advantage of this promote health equity and they 21.8% in 2020 to 47.2% in 2022 and
demographic dividend, our people are a great source of financing the to 59.8% in 2023. While it is still too
need to be healthy, educated state budget”. Most notably, the early to assess the impact of these
and live with confidence”. This excise tax on tobacco has increased increases on tobacco use, there is
observation reflects the high levels dramatically – from US$ 19/kg in little doubt that Timor-Leste has
of tobacco use and other causes December 2021 to US$ 50/kg in become a global leader for health
of noncommunicable diseases to January 2022, and US$ 100/kg in taxes and, in turn, has promoted
which the population is exposed. January 2023. a healthier – more sustainable –
future for generations to come.

5. Effective tobacco control measures | 87

 © WHO/Ilyas Ahmed

88 | WHO report on the global tobacco epidemic 2023

National tobacco control programmes
The WHO Framework Convention on Tobacco Control strongly suggests that countries set up a national
tobacco control programme (NTCP) to lead their tobacco control efforts. To this end, WHO FCTC Article
5 states that: “Each Party shall develop, implement, periodically update and review comprehensive
multisectoral national tobacco control strategies, plans and programmes … [and] establish or reinforce
and finance a national coordinating mechanism or focal points for tobacco control.” In addition, WHO
FCTC Article 26.2 sets out that: “Each Party shall provide financial support in respect of its national
activities intended to achieve the objective of the Convention” (173).

A national tobacco control ■ ensure that population subgroups Over the 14 years since NTCP data
programme can provide a with disproportionately high rates of were first collected (in 2008), progress
tobacco use are reached by policies has been achieved with a total of 16
strong foundation for tobacco and programmes tailored to their countries, home to 748 million people,
control efforts. needs (259). establishing a well-staffed national team
The WHO FCTC strongly suggests that working full time on tobacco control. It
all countries set up a national tobacco is worth noting that this measure may
control programme (NTCP, or similar NTCPs should involve civil underestimate the true extent of NTCPs
coordination mechanism) to lead the in countries because information on
development and maintenance of society and must exclude tobacco control programme staffing at
sustainable policies that can reverse the the tobacco industry national level is incomplete, and there is
tobacco epidemic (256). While ministries no formal mechanism for collecting this
of health – or equivalent government NTCPs require the involvement information (Fig. 44).
agencies – take the lead on strategic of appropriate nongovernmental Twenty-one countries (with almost 300
tobacco control planning and policy organizations and other civil society million people) have no national agency
setting, other ministries or agencies can groups to maintain progress on national for tobacco control, including 17 low-
report to the NTCP (257). NTCPs should: as well as global tobacco control efforts. and middle-income countries (Fig. 45).
■ be adequately financed and clearly NTCPs must specifically exclude the
tobacco industry and its allies, which In the past 2 years, four countries
focused;
cannot be legitimate stakeholders in (Austria, Japan, Palau, and Samoa)
■ be integrated into countries’ broad tobacco control efforts (256). enhanced their national tobacco control
health and development agendas programmes sufficiently to reach
(258); Fifty-eight countries have a national the highest level of adoption, adding
agency with responsibility for tobacco 133 million people to the population
■ be decentralized subnationally control objectives staffed by at least five covered. At the same time, five countries
where necessary (e.g. in large full-time equivalent people, meaning (Lebanon, Marshall Islands, Mongolia,
or federal countries) to allow that 67% of the world’s population are Tuvalu, and Uruguay) dropped below
flexibility in policy development protected by such an agency (Fig. 43) best-practice level – leaving 12 million
and programme implementation; (see Box 29). An additional 113 countries people less protected (Box 29).
■ be resourced to build (home to another third of the world’s
implementation capacity that can population) are working on tobacco
be sustained over time; control objectives with fewer staff (81
countries), or with an unknown number
■ enable policies and programmes of staff (32 countries).
to reach as wide a population as
possible;

6. National tobacco control programmes | 89

 Fig. 43. National tobacco control programmes, highest-achieving countries, 2022

Countries with the highest level of achievement: Albania, Australia, Austriaa, Bhutan, Brazil, Brunei Darussalam, Burkina Faso, Burundi,
Cambodia, Cameroon, Canada, Chad, China, Côte d’Ivoire, Democratic People’s Republic of Korea, El Salvador, Ethiopia, Fiji, Ghana,
Guinea, Honduras, Hungary, India, Indonesia, Iran (Islamic Republic of), Iraq, Ireland, Japana, Kyrgyzstan, Madagascar, Malaysia,
Mauritius, Mexico, Micronesia (Federated States of), Nepal, New Zealand, Nigeria, Norway, Pakistan, Palaua, Qatar, Republic of Korea,
Samoaa, Saudi Arabia, Senegal, Singapore, Spain, Sri Lanka, Sudan, Sweden, Syrian Arab Republic, Thailand, Trinidad and Tobago,
Türkiye, Venezuela (Bolivarian Republic of), Viet Nam, Yemen, Zambia.
a
Country newly at the highest level since 2020

Fig. 44. Progress in national tobacco control programmes, 2008–2022

8 200
Total population: 7.9 billion Total number of countries: 195
7

6 150
Population protected (billions)

5 5.3 Number of countries

5.1 5.1 5.1 5.2
4.9 5.0
4.6
4 100

3 58 59 58
52 55
49
42 44
2 50

0 0
2007 2008 2010 2012 2014 2016 2018 2020 2022
Population (billions) Countries

90 | WHO report on the global tobacco epidemic 2023

 Fig. 45. National tobacco control programmes (2022)

2 1 1
100% Data not
4 14 3
reported
90%
No national
agency for
80%
(Number of countries inside bars)

tobacco control
Proportion of countries

70% Existence of
national agency
with responsibility
13
60% 38 61
for tobacco control
objectives with less
than 5 staff or staff
50% not reported

40% Existence of
national agency
with responsibility
30% for tobacco
control objectives
and at least 5
20% 11 staff members

16 31
10%
0%
High-income Middle-income Low-income

Box 29. A decade of strong tobacco control, Suriname

Suriname’s National Tobacco Despite these advancements, sectors such as the Environmental
Control Program (NTCP) has worked challenges in enforcement persisted and Labor Inspectorate, and the
hard over the years to advance the due to unfinished administrative Economic control unit.
country’s tobacco control agenda, procedures related to compliance
Currently, the National Strategy
and in particular on building and enforcement, insufficient
and Plan of Action is in the final
multisectoral action through intersectoral collaboration and the
stages of drafting and expected to
networking and consultations absence of a national strategic plan
be approved in the coming months.
with policy-makers from different for tobacco control, among others.
Throughout these processes,
government sectors as well as non-
To address these challenges, the the Suriname National Tobacco
state actors. The NTCP successfully
NTCP in Suriname actively sought Control Program demonstrated
mobilized resources and led a
support from the FCTC 2030 commendable leadership and
dialogue with diverse areas to
project. This project facilitated efforts emphasizing the crucial role
build consensus towards keeping
dialogue with key stakeholders and of national programs in in fostering
tobacco control as a priority within
international experts, assessing the consensus and prioritizing tobacco
a National NCD strategic plan
needs for investing in key tobacco control as public health priority for
(2021–2028).
control measures and developing a Member States.
In 2013, Suriname made history national Tobacco Control Strategy
as the first CARICOM country and Plan of Action. These efforts
to implement a comprehensive aimed to strengthen the Tobacco
Tobacco Control Act, aligning with Control Act and enhance its
WHO FCTC Articles 8, 11, and 13. enforcement. Notably, on the tenth
This milestone achieved 100% anniversary of the Act, necessary
smoke-free environments, graphic legal measures were approved
health warnings covering 50% of to fine violators of its provisions.
© Ministry of Health, Suriname
tobacco packaging, and a complete The NTCP will plan the effective
ban on tobacco advertising, implementation by training Taxation workshop for stakeholders in
promotion, and sponsorship. enforcement officers from relevant Suriname

6. National tobacco control programmes | 91

 © WHO/Olivier Asselin

92 | WHO report on the global tobacco epidemic 2023

Electronic nicotine delivery systems
Decision FCTC/COP7(9) invites Parties to consider applying regulatory measures
(such as those referred to in document FCTC/COP/7/11) to prohibit or restrict the
manufacture, import, distribution, presentation, sale and use of ENDS, as
appropriate to their national laws and public health objectives (11).

ENDS and ENNDS heat a liquid to create

aerosols that are inhaled by the user. ENDS marketing is targeted E-cigarette use in the
These “e-liquids” contain nicotine at young people population should
(but not tobacco) and other additives,
flavours and chemicals – some of which ENDS are marketed and promoted by
be incorporated into
are toxic to people’s health. ENNDS tobacco and related industries using nationally representative
are essentially the same as ENDS but many well-known, and some newer,
the e-liquid used is marketed as free of covert tactics, including on social media
surveys
nicotine. MPOWER measures, as well as to target their products at young people More and more countries are asking
other policy measures (including age (264). ENDS are targeted specifically at people about their use of e-cigarettes in
restrictions on sales, and flavour bans or children and young adults and marketed nationally representative population-
restrictions) can be applied to ENDS. in thousands of flavours, the majority based surveys among adults and school-
of which increase the palatability of the based surveys among adolescents. By
products and are appealing to younger 2022, 73 countries were using national
people (265). population-based surveys to monitor
ENDS are addictive and use of e-cigarettes among adults
harmful, particularly for (generally among people aged 15 years
young people and above, but different surveys use
ENDS undermine tobacco different age ranges). Many countries
have concerns around uptake of ENDS
ENDS contain nicotine – the highly control progress and among young people, and currently 103
addictive substance in tobacco.
Using ENDS poses the risk of nicotine threaten smoke-free countries are monitoring e-cigarette
use among adolescents through
addiction, including among children and environments national school-based surveys. Over 3
adolescents. Research findings show
that non-smoking young people who In many social contexts, thanks to the billion people live in the 59 countries
use ENDS are more likely to become success of smoke-free environment which monitor e-cigarette use among
cigarette smokers, exposing them to the policies, smoking tobacco has been both adults and adolescents. Still, 78
harmful effects of smoking, including “denormalized”, particularly in indoor countries, with a combined population
addiction to tobacco (260). public areas (266). The use of ENDS of 1.9 billion people, have not started
risks renormalizing smoking behaviour, monitoring e-cigarette use and have no
ENDS are undoubtedly harmful (261). For data to guide local policy and regulatory
example, nicotine can have deleterious particularly among younger populations
(267–269). ENDS advocates and those decisions (Fig. 46).
impacts on brain development,
leading to long-term consequences for in the tobacco and related industries Of the 59 countries that monitor
children and adolescents in particular have tried to undermine indoor smoking e-cigarette use among both adults and
(262). ENDS use among children and bans by lobbying for exceptions for adolescents, 21 are middle-income
adolescents under the age of 20 years the use of ENDS in indoor areas (270). countries and 38 are high-income
is of concern in many countries, not ENDS products generate aerosols that countries. While no low-income
only because of the detrimental effects look similar to tobacco smoke – an countries are among them, Togo
of nicotine in this age group but also association further complicated by and Yemen conduct surveys among
because most young ENDS users are the difficulty in distinguishing these adolescents that incorporate questions
non-tobacco users (263). products from HTPs, which, contain about e-cigarette use.
tobacco. It is often difficult to tell if a
person is smoking a tobacco product or
using an ENDS.

7. Electronic nicotine delivery systems | 93

Fig. 46. E-cigarette use monitoring among adolescents and adults through nationally
representative surveys

Monitored both among adults

and among adolescents
Monitored among adults but not
among adolescents
Monitored among adolescents
but not among adults
No monitoring in national surveys
Not applicable

0 1000 2000 4000 km

Countries that monitor e-cigarette use among both adults and adolescents: Argentina, Australia, Austria, Belarus, Bolivia (Plurinational
State of), Brunei Darussalam, Bulgaria, Cambodia, Canada, China, Colombia, Croatia, Cyprus, Czechia, Denmark, Ecuador, El Salvador,
Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Latvia, Lithuania, Malaysia, Malta,
Marshall Islands, Netherlands (Kingdom of the), New Zealand, Norway, Panama, Philippines, Poland, Portugal, Qatar, Republic of Korea,
Republic of Moldova, Romania, Russian Federation, Saint Lucia, Saudi Arabia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland,
Ukraine, United Kingdom, the United States, Uruguay, Uzbekistan, and Viet Nam.

bans on advertising, promotion and in 2020, when 81 countries were not

Too many countries do not sponsorship; the application of health regulating ENDS in any way. 
regulate ENDS warnings on packaging; age restrictions
While 85% of high-income countries
on the sale of ENDS; and flavour bans
have either a regulation or a sales ban in
Globally, 121 countries have adopted or restrictions (see Box 31). Countries
effect, 40% of middle-income countries
measures addressing ENDS (Fig. 47): 34 that levy excises on ENDS are noted
and 79% of low-income countries have
of these countries ban the sale of ENDS separately. The remaining 74 countries,
taken no regulatory action concerning
(e.g. see Box 30), while 87 countries home to almost one third of the world’s
ENDS. Of the countries that have banned
(45% of all countries) covering 3.3 billion population (over 2 billion people), have
the sale of ENDS, 22 are middle-income
people allow the sale of ENDS and have no regulations in place addressing
countries, seven are high-income
adopted one or more measures either ENDS (including no ban on use in public
countries and five are low-income
fully or partially to regulate them. places, no labelling requirements, no
countries (Fig. 48).
These measures include bans on the bans on advertising and promotion).
use of ENDS in public indoor areas; This is seven fewer countries than

Where not banned, ENDS must be strictly regulated.

94 | WHO report on the global tobacco epidemic 2023

Fig. 47. Measures to regulate ENDS – full, partial or no ban, 2022

Sale is banned
Full or partial measures adopted
No measure or ban
Not applicable

0 1000 2000 4000 km

ENDS are regulated in: Albania, Algeria, Andorra, Armenia, Australia, Austria, Azerbaijan, Bahrain, Barbados, Belarus, Belgium, Benin,
Bolivia (Plurinational State of), Bulgaria, Cameroon, Canada, Chile, China, Congo, Costa Rica, Côte d’Ivoire, Croatia, Cyprus, Czechia,
Denmark, Dominican Republic, Ecuador, Egypt, El Salvador, Estonia, Fiji, Finland, France, Georgia, Germany, Greece, Guyana, Honduras,
Hungary, Iceland, Ireland, Israel, Italy, Jamaica, Kazakhstan, Kenya, Kuwait, Kyrgyzstan, Latvia, Lebanon, Lithuania, Luxembourg,
Malta, Monaco, Montenegro, Nepal, Netherlands (Kingdom of the), New Zealand, Niue, North Macedonia, Palau, Papua New Guinea,
Paraguay, Philippines, Poland, Portugal, Republic of Korea, Republic of Moldova, Romania, Russian Federation, Saint Lucia, Samoa,
San Marino, Saudi Arabia, Serbia, Slovakia, Slovenia, Spain, Sweden, Tajikistan, Togo, Tuvalu, Ukraine, United Arab Emirates, United
Kingdom, the United States, Uzbekistan
Sale of ENDS is banned in: Argentina, Brazil, Brunei Darussalam, Cabo Verde, Cambodia, Democratic People’s Republic of Korea,
Ethiopia, Gambia, India, Iran (Islamic Republic of), Iraq, Jordan, Lao People’s Democratic Republic, Malaysia, Mauritius, Mexico,
Nicaragua, Norway, occupied Palestinian territory, Oman, Panama, Qatar, Singapore, Sri Lanka, Suriname, Syrian Arab Republic,
Thailand, Timor-Leste, Türkiye, Turkmenistan, Uganda, Uruguay, Vanuatu, and Venezuela (Bolivarian Republic of).

42 countries completely ban the use of ENDS in all indoor

public places, workplaces and public transport – six more
than in 2020.

7. Electronic nicotine delivery systems | 95

Fig. 48. Status of measures to regulate ENDS, by country-income level

High-income countries Middle-income countries Low-income countries

Sale is banned Full or partial measures adopted No measure or ban

Health warning labels on The European Union Tobacco Products

Measures include: packaging as well as advertising Directive revision of 2014 set out to ban
ingredients that increase inhalation.
■ Prohibiting the use of ENDS in indoor and promotion bans or This may be interpreted to include
public places restrictions should be applied to menthol flavours.
■ Health warnings applied to ENDS (devices and/or e-liquids)
packaging ENDS users should be warned about the Age restrictions on the sale of
■ Prohibiting the advertisement,
products they use. Of the 161 countries ENDS have been adopted by
which allow the sale of ENDS, 97 do not only 73 countries
promotion and sponsorship of ENDS
require any health warnings labels on
■ Minimum age restrictions applied to the packages of these products and 64 Of the 161 countries that permit the sale
sale of ENDS impose the display of health warnings of ENDS, 73 countries limit their sale to
(on either the packaging of ENDS a minimum age (18 years of age in 65
■ Ban of flavours countries, 19 years of age in one country
devices, e-liquids or both).
and 21 years of age in seven countries),
ENDS use in public indoor In total, 105 countries do not ban or while the other 88 countries do not. This
restrict the advertising and promotion means 45% of countries ban the sale of
places, workplaces and public
of ENDS, including half (17) of the 34 ENDS to minors, compared with 90% of
transport should be banned to countries where the sale of these countries that apply age restrictions to
protect public health products is banned. tobacco purchases.
Using ENDS in public places where
smoking is banned can re-normalize Flavours should be banned
smoking in public. Only 42 countries to reduce the appeal of ENDS
completely ban the use of ENDS in all
indoor public places, workplaces and
products to children and
public transport – though this is an adolescents
improvement on the 36 countries with a Excluding countries that ban the sale of
complete ban in 2020. ENDS, only four countries have adopted
a ban on the characterizing flavours
An additional 45 countries ban
in ENDS (Finland, Hungary, Lithuania,
e-cigarette use in some public places
Montenegro). Nine other countries
but not all. The remaining 108 countries
ban only selected flavours or permit
have either no smoke-free places (37
specific flavours (China, Denmark,
countries), or ENDS are not explicitly
Egypt, Estonia, Germany, New Zealand,
covered by smoke-free measures where
Philippines, Saudi Arabia, Ukraine).
they exist for cigarettes (71 countries).

96 | WHO report on the global tobacco epidemic 2023

There is no consistency in taxing In countries where an excise tax is Measures applied to ENNDS are
ENDS or ENNDS products, and imposed on ENDS e-liquids, the tax is often not consistent with those
generally quite low, with the majority
taxes are too low of countries having a total tax share applied to ENDS
Given the large heterogeneity of those below 25% of the retail price (21 out of Data collected on ENNDS indicate that
products, data were collected for 50 countries with estimates for open although 29 countries that ban the sale
e-liquids used in open systems, closed systems, 36 out of 48 countries with of ENDS also ban the sale of ENNDS,
systems that are rechargeable, and estimates for rechargeable closed and 58 countries that regulate ENDS
disposable systems. Open systems are systems and 40 out of 48 countries also regulate ENNDS, yet others have
products that allow the user to fill their with estimates for disposable closed differing approaches for these products,
device with the mixtures they want systems). including banning the sale of one when
(with no nicotine, different nicotine allowing the sale of the other. Only
concentrations and/or flavours and The tobacco control community 31 countries completely ban the use
e-liquids). Closed systems are products of ENNDS in all indoor public places,
that come with a pre-filled container
must anticipate that nicotine workplaces and public transport, and
(called a cartridge, pod or tank) and products and tobacco products another 29 ban their use in some public
where own mixes are not possible. Some will evolve rapidly, and plan for places. Twenty-seven countries who
closed systems are rechargeable, others their regulation fully or partially ban use of ENDS in
are disposable. public places have no explicit ban on the
In recent years, newer nicotine and
use of ENNDS in those same places. A
Of the 50 countries where data are tobacco products have been introduced
total of 105 countries with over 3 billion
available for open-system ENDS, 20 to several markets. These are rapidly
people are not covered by any measures
countries (40%) impose no excise tax evolving and may have implications for
that specifically address ENNDS.
on open-system e-liquids. And of the regulation. Therefore, the availability,
48 countries where data are available characteristics, and use of these and
for rechargeable closed systems, 21 other emerging products should be
countries (43.8%) impose no excise tax closely monitored and regulations
on closed-system e-liquids (commonly should be future-proofed as much as
sold as pods). Finally, of the 48 countries possible to cover these products. This
where data are available for disposable report did not collect data on nicotine
products, 23 countries (47.9%) impose pouches or other novel nicotine
no excise tax on the product. products.

Only 45% of countries ban the sale of ENDS to minors.

© WHO/Nazik Armenakyan

7. Electronic nicotine delivery systems | 97

 Box 30. Implementing a ban on ENDS, Lao People’s Democratic Republic

In November 2021, the Lao tobacco products. Data from the tobacco industry. Cross-sectoral
People’s Democratic Republic took country’s Global Youth Tobacco coordination and collaboration at
significant action to protect its Survey 2016 had shown that 4.3% all levels of governance is key for the
population from the detrimental of students were using electronic implementation of the law.
health, social, environmental cigarettes (5% of boys and 3.7%
and economic consequences of of girls).
tobacco by adopting amendments
To address this threat, the 2021
to strengthen its National Tobacco
amended law clearly articulates
Control Law. Following evidence-
regulations applied to new and
based awareness-raising by the
emerging products. Despite tobacco
Ministry of Health, international
industry attempts to interfere with
NGOs and other stakeholders to
the legislative process, amendments
garner support for stronger national
to the law included banning © WHO Country Office, Lao People’s
tobacco control laws, the country’s Democratic Republic
the production, import, export,
National Assembly unanimously
distribution, trade, sale and use of Dr Snong Thongsana, Honourable Vice
passed a strengthened law. One
electronic cigarettes (ENDS, ENNDS), Minister for Health of Lao People’s
rapidly growing market targeted by Democratic Republic, and Ministry of
HTPs, and baraku (shisha).
the strengthened law was that of Health staff actively raise awareness
ENDS products – a market presenting This noteworthy step will help about the ENDS ban on World No Tobacco
a threat to the hard-won progress protect the population from the Day 2023.
in tobacco control achieved by harms of these products – including
the country to date, including its the children and adolescents
comprehensive smoke-free law, who, as a potential new user
large pictorial health warnings, and group, are particularly exposed
age restrictions on the purchase of to aggressive marketing by the

Box 31. Netherlands (Kingdom of the) protects young people by addressing point of sale
advertising of ENDS

In order to protect youth, by more targeted inspections, and and sober description and without a
Netherlands (Kingdom of the) has inspections based on complaints. picture). However, compliance lags
introduced measures to make Most inspections were conducted behind in small shops, such as night
tobacco products and related in response to complaints from shops and mini markets, that are not
products like ENDS less visible, members of the public recorded affiliated with a trade association.
applying restrictions on the through the website and based on
The main challenges and lessons
advertising and display of these results of compliance monitoring
learned are: where possible,
products at points of sale. Since July inspections. The sanctions consist
inform and educate the different
2020, supermarkets in Netherlands of formal warnings and fines.
trade associations to promote
(Kingdom of the) are prohibited Arrangements were made with online
compliance, inform the general
from displaying tobacco products, national marketplaces to proactively
public as well, and provide a
e-cigarettes, and e-liquids. Since remove advertisements in which
transition period. Exceptions to the
January 2021, the points of sale tobacco products, e-cigarettes or
display ban for certain shops can
display ban also applies to other e-liquids were displayed.
complicate enforcement because
retail outlets, including fuel stations
After intensive monitoring and the requirements for specialty shops
and online shops. Since July 2021 the
inspections of the advertising ban, have to be checked and assessed.
ban also applies to specialty shops.
compliance by online shops is
Enforcement of the display ban considered fair to good (65% of the
consisted of monthly compliance online shops indicate the products
monitoring inspections followed for sale only by means of a neutral

98 | WHO report on the global tobacco epidemic 2023

© WHO/Sergey Volkov

7. Electronic nicotine delivery systems | 99

6. Conclusion
MPOWER was introduced 15 years year, new and emerging threats such as While 71% of the world’s population
ago. At the time 1.1 billion people those posed by ENDS and the ongoing is afforded protection from MPOWER
were protected by at least one MPOWER presence of an ever-shifting industry, we policies in place, 2.3 billion people, in
measure at best-practice level. Now still have so much work to do. 44 countries, are not covered by any
more than 1.5 billion are covered by evidence-based demand-reduction
This year we are very pleased to
at least three of these measures and tobacco control measures, leaving them
congratulate two countries, Mauritius
5.6 billion people are protected at most risk of health and economic
and Netherlands (Kingdom of
by at least one. harms of tobacco use. And although the
the), which join Brazil and Türkiye
prevalence of smoking has declined in
The MPOWER technical package has as countries that have accomplished
most countries, as the total population
achieved some huge successes. Fifteen the landmark achievement of putting
grows, the total number of people
years of dedicated collaboration have in place the full MPOWER package
smoking decreases at a slower pace.
seen the global prevalence of smoking at best-practice level. And with only one
The gaps in MPOWER adoption need
reduce from 22.8% in 2007 to 17.0% in measure left to adopt, a further eight
to be filled much faster.
2021. If this prevalence had not declined, countries can soon join their ranks.
there would be 300 million additional Establishing all MPOWER measures This report, which focuses on measures
smokers today. This reduction in the at best-practice level means that aimed at protecting people from
prevalence of smoking has come about the combined impact of these measures tobacco smoke, brings our attention
through the collective and coordinated will be greater than their parts, and to the need to accelerate the adoption
efforts of a global community dedicated is the best way to protect a country’s of smoke‑free environments and
to tobacco control and remaining population and give them the best strengthen implementation to ensure
steadfast against the interference from chance to reduce tobacco use and compliance with such laws. Smoke‑free
the tobacco and related industries. But improve the health of generations indoor public places protect non-
with more than 8 million people dying to come. smokers and encourage smokers
from tobacco-related diseases every to quit so that smoking is viewed

100
© | WHOBank/Trevor
World report on theSamson
global tobacco epidemic 2023
increasingly as socially unacceptable hand smoke have extended to outdoor have dedicated funds for enforcement
by generations to come. In spite of the and private places. Sixty countries have written into their legislation and 91 are
strong opposition from the tobacco adopted smoke‑free playgrounds and 25 required by law to have an established
and related industries, almost half of require cars transporting children below complaint mechanism system.
the world’s countries have managed to the age of 18 to be smoke‑free.
This year we not only celebrate the
extend 100% smoke‑free laws to the
To effectively protect people from fifteenth year of MPOWER but also the
venues most vigorously defended by
the dangers of second-hand tobacco twentieth anniversary of the WHO FCTC,
industry lobbyists: restaurants, cafés,
smoke, enforcement of smoke‑free reminding us that every government
pubs and bars, including not allowing
legislation is essential to ensuring has an obligation to protect the
designated smoking areas or rooms or
compliance with the law. Currently, health of its people, and that is why all
other exceptions under the law. And
111 countries use fines to penalize Parties to the WHO FCTC have made
studies have demonstrated both the
both the patron and the establishment a commitment to implement strong
health and economic benefits reaped
for violations of smoking bans, an tobacco control policies as an important
as a result. This illustrates what can be
additional 7 countries fine only the means of doing so. There is still more
achieved.
establishment where the violation work to do but with these established
Health care and educational facilities occurred and 52 countries fine only the and powerful global health tools we are
have progressed further than venues customer who smoked, amounting to a in an excellent position to accelerate
associated with hospitality, and now total of 170 countries that fine smoking progress and make bold strides to a
75% of countries have comprehensive in a smoke‑free place. Establishments healthier future.
legislation protecting people in these can also be fined for failing to display
spaces. In some countries, measures no-smoking signs in 117 countries, and
to protect children, an especially for allowing ashtrays in smoke‑free
vulnerable population, from second- areas in 29 countries. Only 61 countries

8. Conclusion | 101
102
© | WHO report
WHO/Blink on the
Media global Valencia
- Daiana tobacco epidemic 2023
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© WHO/Alasdair Bell
TECHNICAL NOTES
TECHNICAL NOTE I Evaluation of existing policies and compliance
TECHNICAL NOTE II Smoking prevalence in WHO Member States
TECHNICAL NOTE III Tobacco taxes in WHO Member States

ANNEXES
ANNEX 1. Regional summary of MPOWER measures
ANNEX 2. Regional summary of smoke-free measures
ANNEX 3.  Year of highest level of achievement in selected
tobacco control measures
ANNEX 4.  Highest level of achievement in selected tobacco
control measures in the 100 biggest cities in the world
ANNEX 5.  Status of the WHO Framework Convention on
Tobacco Control and of the Protocol to Eliminate
Illicit Trade in Tobacco Products

113
TECHNICAL NOTE I

Evaluation of existing policies and

compliance
This report provides summary indicators of country achievements for each of the MPOWER
measures, and the methodology used to calculate each indicator is described in this Technical Note.
To ensure consistency and comparability, the data collection and analysis methodology used in this
report are based on previous editions of the report. Some details of the methodology employed in
earlier reports, however, have been revised and strengthened for the present report. Where revisions
have been made, data from previous reports have been re-analysed so that results are comparable
across years.

■ For W (mass media): data on anti- Based on these sources of information,

Data sources tobacco mass media campaigns WHO assessed each indicator as at 31
were obtained from Member States. December 2022. Exceptions to this cut-
Data were collected using the following In order to avoid unnecessary off date were tobacco product prices
sources: data collection, WHO conducted and taxes (cut-off date 31 July 2022) and
■ For all measures: official reports a screening for anti-tobacco mass anti-tobacco mass media campaigns
from WHO FCTC Parties to the media campaigns in all WHO (cut-off date 30 June 2022).
Conference of the Parties (COP) and Country Offices. In countries
their accompanying documentation.1 where potentially eligible mass
media campaigns were identified,
■ For M (monitoring): tobacco focal points in each country were Data validation
prevalence surveys not reported contacted for further information
through the COP reporting on these campaigns, and data on For each country, every data point for
mechanism were collected mainly eligible campaigns were gathered which legislation was the source was
through WHO Regional and WHO and systematically recorded. assessed by two expert staff from two
Country Offices. Technical Note II different WHO offices, generally one
provides further details. ■ For O (offer help to quit tobacco use): from WHO headquarters and the other
data not reported under the COP from the respective WHO Regional
■ For P (protect people from tobacco reporting mechanism were collected Office. Any inconsistencies were
smoke), W (warn about the dangers mainly through WHO Regional and reviewed by the two WHO expert staff
of tobacco) and E (enforce bans on WHO Country Offices. involved and, if needed, by one third
tobacco advertising, promotion
For R (raise taxes on tobacco): the expert staff member not yet involved
and sponsorship): original tobacco ■
prices of the most sold brand of in the appraisal of the legislation.
control legislation (including
regulations) adopted in all Member cigarettes, the cheapest brand and a Disagreements in the interpretation
States that relate to smoke-free premium brand were collected from of the legislation were resolved by:
environments, packaging and ministries of health or finance and, (i) checking the original texts of
labelling measures and tobacco in fewer cases, from online stores the legislation; (ii) trying to obtain
advertising, promotion and through regional data collectors. consensus from the two expert staff
sponsorship. Tobacco control laws Information on the taxation of involved in the data collection; (iii)
and regulations as well as product cigarettes (and when possible, most trying to obtain clarification from the
regulations are also the sources commonly used other smoked, national tobacco control focal point
of data for ENDS and ENNDS. smokeless tobacco products, heated in the Ministry of Health, or if needed
In cases where a law had been tobacco products and cheapest from judges or lawyers in the concerned
adopted by 31 December 2022 but brands of e-liquids of Electronic country; and (iv) the decision of the
had not yet entered into force, the Nicotine and Non-Nicotine Delivery third expert in cases where differences
respective law was assessed, and Systems), tax structure, use of remained. Data were also checked for
data were reported with an asterisk stamps or fiscal marks and revenues completeness and logical consistency
denoting “Provision adopted but from tobacco taxation was collected across variables in the MPOWER
not implemented by 31 December from ministries of finance. Technical database.
2022”. In cases where a law had Note III provides the detailed
been adopted but not yet the methodology used.
implementing regulations, the note
“Regulations are pending” is added.

114 | WHO report on the global tobacco epidemic 2023

 When country or population totals information, subnational surveys or
Data sign-off for MPOWER measures are referred to national surveys of specific population
collectively in the analysis section of groups provide insufficient information
Final, validated data for each country
this report, only the implementation of to enable tobacco control action for
were sent to the respective governments
tobacco control measures (smoke-free the total population.) Surveys were
for review and sign-off. To facilitate
legislation, cessation services, warning considered periodic if the same survey
review by governments, a summary
labels, advertising, promotion and or a survey using the same or similar
sheet was generated for each country
sponsorship bans, and tobacco taxes) is questions was run at least once during
and was sent for review prior to the
included in these totals. the 5 years prior to the most recent
close of the report database. In cases
survey. Due to COVID-19, it is assumed
where national authorities requested Monitoring of tobacco use and anti-
that planned surveys may have been
data changes, the requests were tobacco mass media campaigns are
delayed up to 2 years, therefore this
assessed by WHO expert staff according reported separately.
5-year period is exceptionally extended
to both the legislation/materials and
to 7 years in this report. Countries who
the clarification shared by the national
were at the highest level of achievement
authorities, and data were updated or
in the previous report have not been
left unchanged. In cases where national Correction to previously downgraded in this report.
authorities explicitly did not agree with
the data, this is specifically noted in the
published data The following definitions apply to
annex tables. Further details about the The 2020 data published in the last adolescent and adult surveys:
data processing procedure are available report were reviewed, and about 3% of
from WHO. data points were corrected. The full set Adolescent surveys:
of MPOWER data revised for all years School-based surveys of students
back to 2007 is available in the WHO aged 13–15 years or other age range
Global Health Observatory at https:// encountered during secondary-level
Data analysis www.who.int/data/gho/data/themes/ school. The questions asked in the
theme-details/GHO/tobacco-control. surveys should provide indicators that
It is important to note that data about
laws reflect the status of legislation are consistent with those specified
adopted by 31 December 2022 that in the Global Youth Tobacco Survey
has a stated date of effect and is not questionnaires and manuals.
undergoing a legal challenge that could
Monitoring of tobacco use
impact the date of implementation. Data and prevention policies Adult surveys:
from laws not in effect by 31 December Population-based surveys that provide
2022 have a footnote stating this. The The strength of a national tobacco
indicators for adults aged 15 years and
summary measures developed for this surveillance system is assessed by the
over (or another age range starting
report are the same as those used for frequency and periodicity of nationally
around 15 and including people older
the 2021 report. representative surveys among the adult
than 15), consistent with those specified
and adolescent population in countries.
The report provides analysis of progress in the Global Adult Tobacco Survey
Countries are grouped in the top
made between 2020 and 2022, and questionnaires and manuals.
Monitoring category when all criteria
between 2007 and 2022 using the latest listed below are met for both adolescent The groupings for the Monitoring
assessment of the status of measures and adult surveys: indicator are listed below.
in each year so that the results are
comparable across years. For R, the ■ whether a survey was carried out
earliest comparable data are 2008 and recently (in the past 5 years); No known data or no recent* data
or data that are not both recent*
for mass media, data are available only whether the survey was
■ and representative**
from 2010. To calculate the change in the representative of the country’s Recent* and representative** data
percentage of the population covered population; for either adults or adolescents
by each policy or measure over time,
whether a similar survey was Recent* and representative** data
population estimates for the year 20222 ■
for both adults and adolescents
were used. Using a static year eliminates repeated within 5 years of a previous
survey (periodic); and Recent*, representative** and
the effect of population growth when periodic*** data for both adults
measuring change over time. Indicators ■ whether the adolescent and adult and adolescents
from previous years have been populations were surveyed through
recalculated, according to legislation/ * Data from 2017 or later.
school-based and household ** Survey sample representative of the national
materials received after the assessment population-based surveys population.
period of the respective report or respectively. *** Collected at least every 5 years.
according to changes in the indicator
methodology. All income groups used Surveys were considered recent if
for this report derive from the World conducted in the past 5 years. For this
Bank income-group classification report, this means 2017 or later. Surveys
published on 1 July 2022 by the World were considered representative only if a
Bank.3 Upper-middle and lower-middle scientific random sampling method was
income groups are combined into one used to ensure nationally representative
group for this report. results. (Although they provide useful

Technical note I: Evaluation of existing policies and compliance | 115

 Not reported
Smoke-free legislation Complete absence of bans, or up Tobacco dependence
There is a wide range of places and
to two public places completely treatment
smoke-free
institutions that can be made smoke- Three to five public places The indicator of achievement in
free by law. Smoke-free legislation completely smoke-free treatment for tobacco dependence
can be in place at the national or Six to seven public places is based on whether the country has
subnational level. The report includes completely smoke-free available:
data based on national legislation, and All public places completely
legislation in subnational jurisdictions smoke- free (or at least 90% of the ■ nicotine replacement therapy (NRT);
where available and where smoke- population covered by complete ■ tobacco cessation support;
free national laws are incomplete. The subnational smoke-free legislation)
assessment of subnational smoke- ■ reimbursement for any of the above;
free legislation includes first-level and
administrative subdivisions of a country,
In addition to the data used for the ■ a national toll-free quit line.
as listed in ISO3166. Subnational
above groupings of the smoke-free
data only reflect the content of the Despite the low cost of quit lines, few
legislation indicator, other related data
subnational laws. Provisions covered by low- and middle-income countries have
were collected for this round of the
national legislation are indicated by an implemented such programmes. Thus,
report, and are reported in Annex 2. This
informative note next to the subnational national toll-free quit lines are included
includes the additional questions on
data. In cases where the status of as a qualification only for the highest
outdoor places mentioned above as well
smoke-free legislation is not reported category. Reimbursement for tobacco
as new questions about specific indoor
for some or all subnational jurisdictions, dependence treatment is considered
places (airports, indoor waiting areas
we assume the existing national law only for the top two categories to
of public transport, hotels, cultural
applies. Legislation was assessed to take restricted national budgets of
facilities, shops, private cars with the
determine whether smoke-free laws many lower-income countries into
presence of a child under 18 years
provided for a complete 4 indoor smoke- consideration.
old) as well as new questions on fines
free environment at all times, in all the
and on the requirement of displaying The top three categories reflect varying
facilities of each of the following eight
non-smoking signs where smoking is levels of government commitment to
places:
banned. the provision of nicotine replacement
■ health care facilities; therapy and cessation support.
A number of countries include
■ educational facilities other than exceptions to their smoke-free law that The groupings for the tobacco
universities; allow for the provision of smoking areas dependence treatment indicator are
or designated smoking rooms (DSRs) in listed below.
■ universities;
certain public places and workplaces.
■ governmental facilities; This is reported as a “No”. For the small
number of countries where DSRs are Not reported
■ indoor offices and workplaces not None
allowed under “very strict technical
considered in any other category; NRT* and/or some cessation
requirements”, 5 this is reported in
■ restaurants or facilities that serve the Annex tables as a “No” with an services** (neither cost-covered)
mostly food; asterisk instead of a “Yes”. If DSRs are NRT* and/or some cessation
allowed but the very strict requirements services** (at least one of which is
■ cafés, pubs and bars or facilities that cost-covered)
are missing or not mentioned in the
serve mostly beverages; National toll-free quit line, and
legislation, this is reported as a “No”.
The groupings for smoke-free laws treat both NRT* and some cessation
■ public transport.
services** (cost-covered)
an asterisk the same as a “No”, because
Groupings for the smoke-free legislation a law that allows DSRs in any form does * Nicotine replacement therapy.
indicator are based on the number of not provide complete protection. ** Tobacco cessation support available in any
the above eight places where indoor of the following places: health clinics or other
smoking is completely prohibited. For the first time the smoke-free status primary care facilities, hospitals, office of a
of outdoor areas of these eight places health professional, the community or other
Countries with no complete smoking settings
ban at national level but where at least was also assessed. A clear and explicit
90% of the population is covered by mention of the outdoor place was
complete subnational smoke-free laws required. When the outdoor smoking
are grouped in the top category. ban was complete, a “yes” was reported; In addition to data used for the grouping
when the outdoor smoking ban was of the tobacco dependence treatment
The groupings for the smoke-free incomplete (some outdoor places indicator, other related data such as
legislation indicator are listed below. smoke-free, but smoking areas were information on countries’ essential
allowed) it was reported “partial”. medicines lists, etc. were collected.
When there was no clear mention of the
outdoor area, or no smoking ban, a “no”
was reported. The sum of “yes” and/or
“partial” in the eight places assessed is
reported in Annex 2.

116 | WHO report on the global tobacco epidemic 2023

 The groupings for the health warnings ■ black and white or two other
Warning labels on tobacco indicator are listed below. contrasting colours, as prescribed by
packaging Data not reported
national authorities;

No warnings or small warnings1 ■ nothing other than a brand name, a

The section of the report that assesses
Medium size warnings2 missing product name and/or manufacturer’s
each country’s legislation on health
some3 or many4 appropriate name, contact details and the
warnings includes the following
characteristics5 OR large warnings6 quantity of product in the packaging,
information about cigarette package
missing many4 appropriate without any logos or other features
warnings:
characteristics5 apart from health warnings, tax
■ whether specific health warnings are Medium size warnings2 with all stamps and other government-
mandated; appropriate characteristics5 OR mandated information or markings;
large warnings6 missing some3
■ the mandated size of the warnings, appropriate characteristics5 ■ prescribed font style and size for the
as a percentage of the front and back Large warnings6 with all above elements;
of the cigarette package; appropriate characteristics5 ■ standardized shape, size and
■ whether the warnings appear on 1 Average of front and back of package is less materials;
individual packages as well as on any than 30%.
2 Average of front and back of package is ■ there should be no advertising or
outside packaging and labelling used
between 30 and 49%. promotion inside or attached to the
in retail sale;
3 One to three. package or on individual cigarettes
■ whether the warnings describe 4 Four or more. or other tobacco products.
5 Appropriate characteristics:
specific harmful effects of tobacco ■ specific health warnings mandated;
use on health; Countries with a law requiring plain
■ appearing on individual packages as well packaging but with no implementing
whether the warnings are large, as on any outside packaging and labelling
■
used in retail sale; rules or regulations yet adopted, will not
clear, visible and legible (e.g. specific be reported as having introduced plain
describing specific harmful effects of
colours and font styles and sizes are ■
packaging but will have the footnote
tobacco use on health;
mandated); “Legislation enabling plain packaging
■ are large, clear, visible and legible (e.g.
■ whether the warnings rotate; specific colours and font style and sizes but regulations pending” added in the
are mandated); report. This is also the case for countries
■ whether the warnings are written in ■ rotate; that have required health warnings by
(all) the principal language(s) of the ■ include pictures or pictograms; law without having yet issued the proper
country; ■ written in (all) the principal language(s) of texts and/or images by decree, rule,
■ whether the warnings include the country. regulation, etc.
pictures or pictograms. 6 Average of front and back of the package is at
least 50%.
The size of the warnings on both In addition to the data about cigarettes
the front and back of the cigarette used for the grouping of the health Anti-tobacco mass media
pack were averaged to calculate the
percentage of the total pack surface
warnings indicator, data about campaigns
other smoked tobacco products and
area covered by warnings. This smokeless tobacco products, as well Countries undertake communication
information was combined with the as other related data such as the activities for many reasons, including
warning characteristics to construct appearance of the quit line number, the improving public relations, creating
the groupings for the health warnings requirement for plain packaging, etc. attention for an issue, building support
indicator. were collected. for public policies, and prompting
behaviour change. Anti-tobacco
Plain packaging (also called
communication campaigns, which are
standardized packaging) is defined
a core tobacco control intervention,
by WHO FCTC Article 11 guidelines as
must have specified features in order
a measure “to restrict or prohibit the
to be minimally effective: they must
use of logos, colours, brand images or
be of sufficient duration and must be
promotional information on packaging
designed to effectively support tobacco
other than brand names and product
control priorities, including increasing
names displayed in a standard colour
knowledge, changing social norms,
and font style”.
promoting cessation, preventing
In order for a country to appear in tobacco uptake, and increasing support
this report as having introduced plain for good tobacco control policies.
packaging, the following criteria
(established by WHO FCTC Article 13
guidelines) are requested by a law and
the implementing rules:

Technical note I: Evaluation of existing policies and compliance | 117

With this in mind, and consistent with 7. An outcome evaluation process was ■ point of sale (indoor);
the definition of “anti-tobacco mass implemented to assess campaign
■ free distribution of tobacco products
media campaigns” in the last report, impact.
in the mail or through other means;
only mass media campaigns that were:
8. The campaign was aired on television
■ promotional discounts;
(i) designed to support tobacco control; and/or radio.
■ non-tobacco products identified
(ii) at least 3 weeks in duration; and The groupings for the mass media
with tobacco brand names (brand
campaigns indicator are listed below.
(iii) implemented between 1 July 2020 stretching);6
and 30 June 2022 were considered
■ brand names of non-tobacco
eligible for analysis. For the sake Data not reported
products used for tobacco products
of logistical feasibility and cross- No national campaign conducted
(brand sharing);7
country comparability, only national- between July 2020 and June 2022
level campaigns were considered with a duration of at least 3 weeks ■ appearance of tobacco brands
eligible. National campaign conducted (product placement) or tobacco
with one to four appropriate products in television and/or films;
Consistent with the last report and to characteristics
enable greater accuracy, materials from National campaign conducted ■ sponsorship (contributions and/or
campaigns had to be submitted and with five to six appropriate publicity of contributions).
verified based on the eligibility criteria characteristics, or with seven
for all countries. characteristics excluding airing on The first four types of advertising
television and/or radio listed are termed “direct” advertising,
Eligible campaigns were assessed and the remaining six are termed
National campaign conducted
according to the following with at least seven appropriate “indirect” advertising. Complete bans
characteristics, which signify the use characteristics including airing on on tobacco advertising, promotion and
of a comprehensive communication television and/or radio sponsorship usually start with bans on
approach: direct advertising in national media and
1. The campaign was part of a progress to bans on indirect advertising
comprehensive tobacco control as well as promotion and sponsorship.
programme. Bans on advertising, The basic distinction for the two
2. Before the campaign, research was promotion and sponsorship lowest groups is whether bans cover
undertaken or reviewed to gain national television, radio and print
a thorough understanding of the The report includes data on legislation media or not, and the remaining
target audience. in national as well as subnational groups were constructed based on how
jurisdictions. The assessment of comprehensively the law covers bans
3. Campaign communication materials subnational legislation on advertising, of the other forms of direct and indirect
were pre-tested with the target promotion and sponsorship bans advertising included in the analysis. In
audience and refined in line with includes first-level administrative cases where the law did not explicitly
campaign objectives. subdivisions as listed in ISO3166. address cross-border advertising, it
4. Air time (radio, television) and/ was interpreted that advertising at both
Subnational data only reflect the
or placement (billboards, print domestic and international levels was
content of subnational laws. Provisions
advertising, etc.) were obtained by covered by the ban only if advertising
covered by national legislation are
purchasing or securing it using either was totally banned at national level.
indicated by an informative note next
the organization’s own internal to the subnational data. In cases where The groupings for the bans on
resources or an external media the status of advertising, promotion and advertising, promotion and sponsorship
planner or agency (this information sponsorship legislation is not reported indicator are listed below. Countries
indicates whether the campaign for some or all subnational jurisdictions, where at least 90% of the population
adopted a thorough media planning we assume the existing national law were covered by subnational
and buying process to effectively and applies. legislation completely banning tobacco
efficiently reach its target audience). advertising, promotion and sponsorship
Country-level achievements in banning
5. The implementing agency worked are grouped in the top category.
tobacco advertising, promotion and
with journalists to gain publicity or sponsorship were assessed based on
news coverage for the campaign. whether the bans covered the following
6. Process evaluation was undertaken types of advertising:
to assess how effectively the ■ national television and radio;
campaign had been implemented.
■ local magazines and newspapers;
■ billboards and outdoor advertising;

118 | WHO report on the global tobacco epidemic 2023

 Data not reported Cigarettes less affordable – per
Complete absence of ban, or Tobacco taxes capita GDP needed to buy 2000
ban that does not cover national YES cigarettes of the most sold brand
television (TV), radio and print Countries are grouped according to the increased on average between
media percentage contribution of all tobacco 2012 and 2022
Ban on national TV, radio and print taxes to the retail price of a pack of 20 Cigarettes more affordable – per
media only of the most popular brand of cigarettes. capita GDP needed to buy 2000
Ban on national TV, radio and print Taxes assessed include excise tax, value NO cigarettes of the most sold brand
media as well as on some (but not added tax (or sales taxes), import duty declined on average between 2012
all) other forms of direct* and/or (when the cigarettes were imported) and 2022
indirect** advertising and any other taxes levied. In the case No trend change in affordability of
Ban on all forms of direct* and of countries where different levels of cigarettes between 2012 and 2022
indirect**advertising (or at least taxes applied to cigarettes are based Insufficient data to conduct a trend
...
90% of the population covered by on length, quantity produced, or price analysis
subnational legislation completely level, only the rate that applied to
banning tobacco advertising, the most popular brand is used in the
promotion and sponsorship) calculation.
* Direct advertising bans:
■ national television and radio;
Given the lack of information on country National tobacco control
■ local magazines and newspapers;
and brand-specific profit margins of programmes
retailers and wholesalers, their profits
billboards and outdoor advertising;
■
were assumed to be zero (unless Classification of countries’ national
point of sale (indoor). tobacco control programmes is based
■
provided by the national data collector).
** Indirect advertising bans: on the existence of a national agency
■ free distribution of tobacco products in The groupings for the tobacco tax with responsibility for tobacco control
the mail or through other means; indicator are listed below. Please refer objectives. Countries with at least five
■ promotional discounts; to Technical Note III for more details. full-time equivalent staff members
non-tobacco goods or services identified
working at the national agency with
■
with tobacco brand names (brand
stretching); Data not reported responsibility for tobacco control meet
■ brand names of non-tobacco products < 25% of retail price is tax the criteria for the highest group.
used for tobacco products (brand ≥ 25% and < 50% of retail price is The groupings for the national tobacco
sharing); tax control programme indicator are listed
■ appearance of tobacco brands (product ≥ 50% and < 75% of retail price is
placement) or tobacco products in below.
tax
television and/or films;
≥ 75% of retail price is tax
■ sponsorship (contributions and/or Data not reported
publicity of contributions).
No national agency for tobacco
control
Existence of national agency with
In addition to the data used for the Trend in affordability of responsibility for tobacco control
grouping of the bans on advertising, the most sold brand of objectives with no or fewer than
five full-time equivalent staff
promotion and sponsorship indicator,
other related data, such as bans on cigarettes members
Internet sales or on display of tobacco Existence of national agency with
The affordability of cigarettes was responsibility for tobacco control
products at points of sale were computed as the percentage of per objectives and at least five full-time
collected. capita GDP required to purchase equivalent staff members
2000 cigarettes of the most popular
brand in each year of this report from
2012 to 2022. GDP per capita data in
local currency units were sourced
from IMF’s World Economic Outlook MPOWER summaries
(WEO) database. The least-squares The MPOWER groups, coded by colour
annual growth rate of affordability was as described above, are summarised in
computed by fitting a linear regression Annex 1.
trend line to the logarithmic values of
the affordability measure.
The groupings for the affordability
indicator are listed below. Please refer
to Technical Note III for more details.

Technical note I: Evaluation of existing policies and compliance | 119

 policies and no points for minimally
Data collected and Compliance assessment enforced policies, with a potential
reported for ENDS and Compliance with national and
minimum of 0 and maximum of 10
points in total from these five experts.
ENNDS in relation to the P, comprehensive subnational smoke-free
legislation as well as with advertising, The compliance assessment was
W and E measures promotion and sponsorship bans was obtained for legislation implemented
This report includes some data collected assessed by up to five national experts, by 1 April 2022. For countries with more
about ENDS and ENNDS (Annex 2). For P, who scored the compliance in these recent implementation, compliance
W and E related data, the methodology two areas as “minimal”, “moderate” or data are reported as “not applicable”.
used to collect and validate the data as “high”. These five experts were selected
The compliance assessments are
well as the criteria used, were identical according to the following criteria:
listed in Annex 2. Annex 1 summarizes
to those described earlier in this ■ person in charge of tobacco this information. Compliance scores
Technical Note. However, no subnational prevention in the country’s ministry are represented separately from the
legislation was assessed for these of health, or the most senior grouping (i.e. compliance is not included
products (only national legislation). government official in charge of in the calculation of the grouping
tobacco control or tobacco-related categories).
Specifications on data about conditions;
ENDS and ENNDS ■ the head of a prominent
In terms of product regulation, ENDS nongovernmental organization
and ENNDS were categorized based dedicated to tobacco control;
Background chapters
on provisions in national legislation or All background chapters were
■ a health professional (e.g. physician,
regulations. For countries where the sale developed as brief summaries of
nurse, pharmacist or dentist)
of ENDS and ENNDS is banned, we have the topic areas covered and are not
specializing in tobacco-related
nonetheless reported on regulations intended to be comprehensive reviews
conditions;
relating to their use, advertising, of the existing literature.
promotion, and sponsorship. For W and ■ a staff member of a public health
E, a distinction was made between the university department; All recommendations presented are
regulation applicable to the electronic based upon pre-existing Member State
■ the tobacco control focal point of agreements or published technical
devices and the one applicable to the
the WHO Country Office. guidance.
e-liquids.
The experts performed their
The questions used for the groupings
assessments independently. Average
of the P, W and E measures described
scores were calculated by WHO from the
earlier were all assessed, and other
five individual assessments by assigning
related data such as minimum sale age,
two points for highly enforced policies,
or regulation of flavours, were also
one point for moderately enforced
collected.

1 Parties report on the implementation of the WHO Framework Convention on Tobacco Control according to Article 21. The objective of reporting is
to enable Parties to learn from each other’s experience in implementing the WHO FCTC. Parties’ reports are also the basis for review by the COP of
the implementation of the WHO FCTC. Since 2012, all Parties submit their reports at the same time once every 2 years. For more information please
refer to https://www.who.int/fctc/reporting/en/.
2 United Nations Department of Economic and Social Affairs, Population Division in World population prospects 2022 (median fertility projection for
the year 2022). For more information please refer to https://population.un.org/wpp/Download/Standard/Population/.
3 The World Bank: World development indicators published July 1, 2022. For more information please refer to https://datahelpdesk.worldbank.org/
knowledgebase.
4 “Complete” is used in this report to mean that smoking is not permitted, with no exemptions allowed, except in residences and indoor places that
serve as equivalents to long-term residential facilities, such as prisons and long-term health and social care facilities such as psychiatric units
and nursing homes. Ventilation and any form of designated smoking rooms and/or areas do not protect from the harms of second-hand tobacco
smoke, and the only laws that provide protection are those that result in the complete absence of smoking in all public places.
5 Designated smoking room exceptions in the legislation that include at least three out of the six following characteristics, and include at least
criteria 5 or 6, are denoted in the annex tables with an asterisk. The designated smoking room must:
■ be a closed indoor environment;
■ be furnished with automatic doors, generally kept closed;
■ be non-transit premises for non-smokers;
■ be furnished with appropriate forced-ventilation mechanical devices;
■ have appropriate installations and functional openings installed, and air must be expelled from the premises;
■ be maintained, with reference to surrounding areas, in a depression not lower than 5 Pascals.
6 When legislation did not explicitly ban the identification of non-tobacco products with tobacco brand names (brand stretching) and did not
provide a definition of tobacco advertising and promotion, it was interpreted that brand stretching was covered by the existing ban of all forms of
advertising and promotion when the country was a Party to the WHO FCTC, assuming that the WHO FCTC definitions apply.
7 When legislation did not explicitly ban the use of brand names of non-tobacco products for tobacco products (brand sharing) and did not provide
a definition of tobacco advertising and promotion, it was interpreted that brand sharing was covered by the existing ban of all forms of advertising
and promotion when the country was a Party to the WHO FCTC, assuming that the WHO FCTC definitions apply.

120 | WHO report on the global tobacco epidemic 2023

© WHO/Julie Desnoulez
TECHNICAL NOTE II

Tobacco use prevalence in WHO

Member States
Monitoring the prevalence of tobacco use is central to efforts to control the global tobacco
epidemic. Reliable prevalence data on the magnitude of the tobacco epidemic and its influencing
factors provide the information needed to plan, adopt and evaluate the impact of tobacco control
interventions. This report contains information on the prevalence of tobacco use sourced from
the most recent surveys run by each Member State among the general population and among
adolescents. WHO-modelled, age-standardized prevalence estimates for daily smoking among
people aged 15 years and over are presented in Annex 1. This technical note provides information
on the method used to generate the WHO prevalence estimates.

For the analysis, information from

Sources of information surveys conducted since 1990 was used Analysis and presentation
if it:
For modelling of WHO estimates of of tobacco use prevalence
was officially recognized by the
tobacco use prevalence, the following ■
national health authority;
indicators
sources of information were explored
(where official survey reports explaining included randomly selected
the sampling, methodology and
■
Estimation method
participants who were
detailed results were not publicly representative of the general A statistical model based on a Bayesian
available, Member States were asked to population (school-based surveys negative binomial meta-regression was
provide them): were specifically excluded); used to model crude adjusted and age-
standardized estimates for countries
■ information on surveys provided by ■ provided data for one or more of for each indicator (current and daily
Parties to the WHO FCTC Secretariat six tobacco use definitions: daily tobacco use, current and daily tobacco
in Party reports; tobacco user, current tobacco smoking, and current and daily cigarette
■ information collected through WHO user, daily tobacco smoker, current smoking) separately for men and
tobacco-focused surveys conducted tobacco smoker, daily cigarette women. A full description of the method
under the aegis of the Global smoker or current cigarette smoker; is available as a peer- reviewed article
Tobacco Surveillance System – in and in the Lancet, volume 385, No. 9972,
particular, the Global Adult Tobacco p966–976 (2015).
■ was disaggregated prevalence values
Survey (GATS); by age and sex. Once the prevalence rates from national
tobacco information collected surveys were compiled into a dataset,
■ The above indicators provide for the
through other WHO-supported the model was fit to calculate trend
most complete representation of
surveys including WHO STEPwise estimates for the six indicators specified
tobacco use across countries and at the
surveys and World Health Surveys; above.
same time help minimize attrition of
■ other systems-based surveys countries from further analysis because The model has two main components:
undertaken by cross-national of lack of adequate data. Although
differences exist in the types of tobacco (a) adjusting for missing indicators and
organizations, including surveys age groups, and (b) running a regression
such as the Demographic and Health products used in different countries
and grown or manufactured in different to generate an estimate of trends over
Surveys (DHS) and the Multiple time as well as the credible interval
Indicator Cluster Survey (MICS); and regions of the world, data on at least
one of these six indicators are available around the estimate.
■ an extensive search through WHO in most countries, thereby permitting Depending on the completeness of
regional offices and WHO country robust statistical analyses.2 survey data from a particular country,
offices to identify country-specific the model at times makes use of
surveys not part of international The information identified above is
data from other countries to fill gaps.
surveillance systems – such as the stored in the WHO Tobacco Control
Countries with data gaps “borrow
National Survey of Risk Factors in Global DataBank and, along with the
information” from “priors” calculated
Argentina, or the Mauritius Non- source code used for generating the
from their data pooled with data from
Communicable Diseases Survey. WHO smoking prevalence estimates,
countries in the same UN subregion.3
is published alongside this report at
https://www.who.int/health-topics/
tobacco/.

122 | WHO report on the global tobacco epidemic 2023

Differences in age groups To allow global comparability, the trend applying the age-specific rates by sex
covered by each survey calculation is the same for all countries. in each population to one standard
Countries with few surveys will have population (this report uses the WHO
Prevalence rates for any one country more borrowed information blended Standard Population, a fictitious
were sometimes reported for a variety into their trend line than countries with population whose age distribution is
of different age groups, according to the many surveys. No allowances are made largely reflective of the population
age range of each survey. Where rates for inflection points in the specific years age structure of low-and middle-
were not collected for any age group when tobacco control policies were income countries). The resulting age-
in the range of 15 years and above, the introduced or improved. Therefore, standardized rates refer to the number
model uses data from other surveys in WHO estimates and projections may of smokers per 100 WHO Standard
the country’s dataset to estimate the differ from countries’ own estimates and Population. As a result, the rates
age pattern of tobacco use. For ages projections. generated using this process are only
that the country has never surveyed, the hypothetical numbers with no inherent
average age pattern seen in countries in For this report, country-level trends
meaning. They are meaningful only
the same UN subregion is applied to the have been summarized into average
when comparing rates across countries
country’s data. trends for high-income countries,
or over wide time frames.
middle-income countries, low-income
Differences in the indicators of countries and a global average. The
estimated rates for the years 2007 and
tobacco use measured 2021 are presented.
Countries may report different Comparison with smoking
In this report, comparable estimates
indicators across surveys (e.g.
of current tobacco use among people
estimates in earlier editions
current smoking in one survey and
daily smoking in another, or tobacco aged 15 years and over are presented of this report
smoking in one and cigarette smoking at country-level for the year 2021. The
rates are comparable because the The estimates in this report are
in another). Where data are missing for consistent with each other but not with
any indicator, the model uses data from model has standardized the survey
results as described above, and then estimates produced for earlier editions
other surveys in the country’s dataset of this report. While the method of
to estimate the missing information. age-standardized as described below.
estimation is the same, the updated
For indicators on which the country When calculating global and World data set for the period 1990–2022 is
has never reported, the average Bank income group average prevalence much more complete.
relationships seen in countries in the rates, countries without estimates were
same UN subregion are applied to the included in the averages by assuming For example, since the WHO report on
country’s data. their prevalence rates are the same the global tobacco epidemic, 2021, 243
as the average rates seen in the UN national surveys from 100 countries
Modelled results subregion to which they belong.3 have been added to the data set, and
40 existing surveys have been updated
The model was run for all countries with with additional data points. Each round
surveys that met the inclusion criteria. Age-standardized prevalence of WHO estimates is calculated using all
Results for countries with insufficient rates available survey data back to 1990. The
survey data (e.g. no surveys with a more data points available, the more
Comparison of crude rates between
detailed age breakdown of prevalence robust the trend estimates are. Each
two or more countries at one point
for both sexes) were not reported. estimation round therefore improves
in time, or of one country at different
The output of the model is a set of trend points in time, can be misleading if the upon earlier published estimates, and
lines for each country that summarize two populations being compared have only the latest round should be used.
its prevalence history from 2000 to the significantly different age distributions
While country-level estimates in this
year of the most recent survey. If the or differences in tobacco use by sex.
report pertain only to 2021, the trend
most recent survey was earlier than Age-standardization is a method
from 2000 to 2025 is published in the
2021, the trend is projected to 2021. The commonly used to overcome this
biennial WHO global report on trends in
projection assumes that the pace and problem and to allow for meaningful
tobacco smoking 2000–2025.
level of adoption of new policies during comparison of prevalence between
the period covered by the countries’ countries, once all other comparison
national surveys continued unchanged issues described above have been
to 2021. addressed. The method involves

1 Tobacco smoking includes cigarette, cigar, pipe, hookah, shisha, water-pipe, heated tobacco products and any other form of smoked tobacco.
2 For countries where prevalence of smokeless tobacco use is reported, we have published these data.
3 For a complete list of countries by UN subregion, please refer to pages ix to xiii of World population prospects: the 2019 revision, published by the UN Department
of Economic and Social Affairs at https://population.un.org/wpp/Download/Standard/Population/ (accessed December 17, 2020). Please note that, for the
purposes of tobacco use analysis, the following adjustments were made: (i) Eastern Africa subregion was divided into two regions: Eastern African Islands and
Remainder of Eastern Africa; (ii) Armenia, Azerbaijan, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Tajikistan, Uzbekistan and Turkmenistan were
classified with Eastern Europe; (iii) Cyprus, Israel and Türkiye were classified with Southern Europe; (iv) Central Africa and Southern Africa were combined into one
subregion; (v) Melanesia, Micronesia and Polynesia subregions were combined into one subregion; and (vi) Ireland and the United Kingdom were combined with
Northern America.

Technical note II: Tobacco use prevalence in WHO Member States | 123
TECHNICAL NOTE III

Tobacco taxes in WHO Member States

This report includes appendices containing information on the share of total and excise taxes in the
price of the most widely sold brand of cigarettes, based on tax policy information collected from
each country. This note contains information on the methodology used by WHO to estimate the
share of total and tobacco excise taxes in the price of a pack of 20 cigarettes using country-reported
data. It also provides information on other data collected for this report in relation to tobacco
taxation. There is also price and tax data on heated tobacco products or nicotine and non-nicotine
delivery systems.

through the wealth of work and knowledge and contribute the most to increasing the price
1. Data collection accumulated by WHO working directly with
ministries of finance on tobacco taxation since
of tobacco products and subsequently reducing
consumption. Thus, rates, amounts and point of
All data were collected between June 2022 and 2009. Other sources, including tax law documents, application of excise taxes are central components
February 2023 by WHO regional data collectors. decrees and official schedules of tax rates and of the data collected.
The two main inputs into calculating the share structures and trade information, when available,
were either provided by data collectors or were Certain other taxes, in particular direct taxes such
of total and excise taxes were (1) prices and (2) as corporate taxes, can potentially impact tobacco
tax rates and structure. Prices were collected downloaded from ministerial websites.
prices to the extent that producers pass them
for the most widely sold brand of cigarettes, the The tax data collected focus on indirect taxes on to final consumers. However, because of the
least-expensive brand and a premium brand for levied on tobacco products (e.g. excise taxes practical difficulty of obtaining information on
July 2022. of various types, import duties, value added these taxes and the complexity in estimating their
Data on tax structure were collected through taxes), which usually have the most significant potential impact on price in a consistent manner
contacts with ministries of finance. The validity impact on the price of tobacco products. Within across countries, they are not considered.
of this information was checked against other indirect taxes, excise taxes are the most important
sources. For many countries, this was done because they are applied exclusively to tobacco

© WHO/Blink Media - Daiana Valencia

124 | WHO report on the global tobacco epidemic 2023

The table below describes the types of tax information collected.

1. Specific excise A specific excise tax is a tax on a selected good produced for sale within a country or
taxes imported and sold in that country. In general, the tax is collected from the manufacturer or
at the point of entry into the country by the importer, in addition to import duties. These
taxes come in the form of an amount per stick, pack, per 1000 sticks, or per kilogram.
Example: US$ 1.50 per pack of 20 cigarettes.

2. Ad valorem An ad valorem excise tax is a tax on a selected good produced for sale within a country or
excise taxes imported and sold in that country. In general, the tax is collected from the manufacturer
or at the point of entry into the country by the importer, in addition to import duties.
These taxes come in the form of a percentage of the value of a transaction between two
independent entities at some point of the production/distribution chain; ad valorem taxes
are generally applied to the value of the transactions between the manufacturer and the
retailer/wholesaler. Example: 60% of the manufacturer’s price.

3. Import duties An import duty is a tax on a selected good imported into a country to be consumed in that
country (i.e. the goods are not in transit to another country). In general, import duties are
collected from the importer at the point of entry into the country. These taxes can be either
specific or ad valorem. Specific import duties are applied in the same way as specific excise
taxes (e.g. an amount per 1000 sticks). Ad valorem import duties are generally applied to
the CIF (cost, insurance, freight) value, i.e. the value of the unloaded consignment that
includes the cost of the product itself, insurance and transport and unloading. Example:
50% import duty levied on CIF.

4. Value added The value-added tax (VAT) is a “multi-stage” tax on all consumer goods and services
taxes and sales applied proportionally to the price taxes the consumer pays for a product. Although
manufacturers and wholesalers also participate in the administration and payment of
taxes the tax all along the manufacturing/distribution chain, they are all reimbursed through a
tax credit system, so that the only entity who pays in the end is the final consumer. Most
countries that impose a VAT do so on a base that includes any excise tax and customs duty.
Example: VAT representing 10% of the retail price.
Some countries, however, impose sales taxes instead. Unlike VAT, sales taxes are generally
levied at the point of retail on the total value of goods and services purchased. For the
purposes of the report, care was taken to ensure the VAT and/or sales tax shares were
computed in accordance with country-specific rules.

5. Other taxes Information was also collected on any other tax that is not called an excise tax, import
duty, VAT or sales tax, but that applies to either the quantity of tobacco or to the value of a
transaction of a tobacco product, with as much detail as possible regarding what is taxed
and how the base is defined.

Technical note III: Tobacco taxes in WHO Member States | 125

 the duty, care was taken to ensure that waterpipe tobacco) was calculated for
2. Data analysis the import duty was not taken into 48 countries, while the calculation for
account in calculating taxes levied. smokeless tobacco products (chewing
The price of the most sold brand
tobacco, dry snuff, moist snuff or nose
of cigarettes was considered in the “Other taxes” are all other indirect taxes
tobacco ) was made for 16 countries.
calculation of the tax as a share of the not reported as excise taxes, import
Price and tax was also calculated for
retail price. In the case of countries duties or VAT. An example of such tax is
HTPs for 53 countries, for the e-liquid
where different levels of taxes are the environmental levy.
of a closed rechargeable electronic
applied on cigarettes based on length
The next step of the exercise was to nicotine or non-nicotine delivery
of cigarette, quantity produced, or
convert all taxes to the same base – systems for 48 countries, for the e-liquid
type (e.g. filter vs. non-filter), only the
in our case, the tax- inclusive retail of closed disposable ENDS/ENNDS for
relevant rate that applied to the most
sale price (hereafter referred to as P). 48 countries and for the e-liquid of an
sold brand was used in the calculation.
Standardizing bases is important in open electronic nicotine or non-nicotine
In the case of Canada and the United calculating tax share correctly, as the delivery systems for 51 countries.
States, national average estimates example in the table below shows.
calculated for prices and taxes reflect Country B apparently applies the same
the fact that different rates are applied ad valorem tax rate (20%) as Country
by state/province over and above the A, but in fact ends up with a higher tax 3. Calculation
applicable federal tax. In the case of rate and a higher final price because the
Brazil, where state VATs vary, the highest tax is applied later in the distribution As an example of the calculations
rate, which is applied in most States, chain. Comparing reported statutory ad performed, denote Sts as the share of
was applied. In the Federated States valorem tax rates without taking into taxes in the price of a widely consumed
of Micronesia, which also has varying account the stage at which the tax is brand of cigarettes (20-cigarette pack or
VAT rates across states, the VAT rate applied could therefore lead to biased equivalent). Then,
applicable to the state where price data results. Sts = Sas + Sav + Sid + SVAT  1
was collected (Pohnpei) was used. A
A similar methodology was used to Where:
weighted average of retail price and
calculate the price and tax share of the
tax was calculated for China given the Sts = Total share of taxes in the price
most common type of smoked (other
very large array of brands sold in the of a pack of cigarettes;
than cigarettes) and smokeless tobacco
market: the most sold brand changing
products, as reported by each country. Sas = Share of amount-specific
almost every year and representing a
The calculation was made for the price excise taxes in the price of a pack of
very small share of the market was not
of a product for 20 grams of any smoked cigarettes;
representative.
or smokeless tobacco product, 20 sticks
The import duty was only used in the of cigarettes, bidis and heated tobacco Sav = Share of ad valorem excise
calculation of tax shares if the most products (HTPs) and one stick of cigars taxes in the price of a pack of cigarettes;
sold brand of cigarettes was imported and cigarillos. For the e-liquid of closed Sid = Share of import duties in the
into the country. Import duty was not electronic rechargeable and disposable price of a pack of cigarettes (if the most
applied in total tax calculation for nicotine or non-nicotine delivery popular brand is imported);
countries reporting that the most sold systems (ENDS/ENNDS) the price and
brand, even if an international brand, tax was calculated for 1 ml while for SVAT = Share of the value added tax in
was produced locally. In cases where open systems, it was calculated for the price of a pack of cigarettes.
the imported cigarettes originated 10 ml. Price and tax for smoked tobacco
from a country with which a bilateral products (including bidis, cigarillos,
or multilateral trade agreement waived cigars, pipe tobacco, roll-your-own or

Country A Country B
(US$) (US$)

[A] Manufacturer’s price (same in both countries) 2.00 2.00

[B] Country A: ad valorem tax on manufacturer’s price (20%) = 20% x [A] 0.40 -

[C] Retailer’s and wholesaler’s profit margin (same in both countries) 0.20 0.20

[D] Country B: ad valorem tax on retailer’s price (20%) = 20% x [E] - 0.55

[E] Final price = P = [A]+[B]+[C] or [A]+[C]+[D] 2.60 2.75

Total tax share (as % of P) 0.40/2.60 = 15.4% 0.55/2.75 = 20%

126 | WHO report on the global tobacco epidemic 2023

Calculating Sas is straightforward and existence – or not – of ad valorem and WHO, the retailer’s or wholesaler’s
involves dividing the specific tax amount specific excise taxes, and whether margin would be assumed to be nil for
for a 20-cigarette pack by the retail sales the most popular brand was locally domestically produced brands.
price. Unlike Sas, the share of ad valorem produced or imported. In many cases
For countries where the most popular
taxes, Sav, depending on the base it is (particularly in low- and middle-income
brand is imported, the import duty
applied on, can be much more difficult countries) the base for ad valorem
is applied on CIF values, and the
to calculate and would involve making excise tax was the manufacturer’s price
consequent excise taxes are typically
some assumptions described below. or CIF value. But in fact, the base of the
applied on a base that includes the
Import duties are sometimes amount- ad valorem varies a lot around the world
CIF value and the import duty, but not
specific, sometimes value-based. Sid and can include other bases, such as
the importer’s profit. For domestically
is therefore calculated the same way retail price, retail price net of some taxes
produced cigarettes, the producer’s
as Sas if it is amount-specific and the (and/or some predefined margins), retail
price includes its own profit, so
same way as Sav if it is value-based. VAT price net of all taxes, etc.
it is automatically included in M.
rates reported for countries are usually
Given knowledge of price (P) and However, the importer’s profit can be
applied on the VAT-exclusive retail sale
amount-specific excise tax (Tas), the relatively significant and setting it to
price but are also sometimes reported
share Sas is easy to recover (=Tas/P). The zero (as in the case of domestically
on VAT-inclusive prices. SVAT is calculated
case of ad valorem taxes (and, where manufactured cigarettes) would
to consistently reflect the share of the
applicable, Sid) is fairly straightforward substantially overestimate M, and
VAT in VAT-inclusive retail sale price.
when, by law, the base is retail price. The thereby substantially overestimate the
The price of a pack of cigarettes can be calculation is more complicated when share of ad valorem tax in final price.
expressed as the following (in the case the base is the manufacturer’s price (M) For this reason, M had to be estimated
of a country applying a specific excise and needs to be recovered to calculate differently for imported products: M*
and ad valorem excise applicable on the amount of ad valorem tax. In most (or the CIF value) was calculated either
the manufacturer’s price or CIF value + of the cases, M was not known (unless based on information reported by
import duty): specifically reported by the country), countries or using secondary sources
and therefore had to be estimated. (data from the United Nations Comtrade
P = [(M + M×ID) + (M + M×ID) × Tav% + Tas +
database2). M* was normally calculated
π] × (1 + VAT%), or Using equation (2), it is possible to
as the import price of cigarettes in a
recover M:
P = [M × (1×ID) × (1+Tav%) + Tas + π] × country (value of cigarette imports
(1 + VAT%)  2  3 divided by the quantity of cigarette
imports for the importing country).3
Where:
However, in a small number of cases
P= Price per pack of 20 cigarettes where no such data were available
of the most popular brand consumed (Bhutan, Cook Islands, Equatorial
locally; Guinea, Kiribati, Liberia, Marshall
π, or wholesalers’ and retailers’ profit Islands, Tuvalu and Vanuatu), the export
M = Manufacturer’s/distributor’s
margins, are rarely publicly disclosed price was considered instead. The ad
price, or import price if the brand is
and will vary from country to country. valorem and other taxes were then
imported;
For domestically produced most calculated in the same way as for local
ID = Import duty rate (where popular brands, we considered π to cigarettes, using M* rather than M as the
applicable) on a pack of 20 cigarettes;1 be nil (i.e. =0) in the calculation of M base, where applicable.
because the retailer’s and wholesaler’s
Tav = Statutory rate of ad valorem In the case of VAT, in most of the
margins are assumed to be small.
tax; cases the base was P excluding the
Setting the margin to 0, however,
VAT (or, similarly, the manufacturer’s/
Tas = Amount-specific excise tax on would result in an overestimation of
distributor’s price plus all excise taxes).
a pack of 20 cigarettes; M and therefore of the base for the ad
In other words:
valorem tax. This will in turn result in
π = Retailer’s, wholesaler’s SVAT = VAT% × (1 - SVAT), equivalent
an overestimation of the amount of
and importer’s profit per pack of 20 to SVAT = VAT% ÷ (1+ VAT%)
ad valorem tax. Since the goal of this 4
cigarettes (sometimes expressed as a
exercise is to measure how high the
mark-up); In some cases, however, we were
share of tobacco taxes is in the price of
informed that the VAT was not
VAT = Statutory rate of value added a typical pack of cigarettes, assuming
effectively collected at all levels of the
tax on VAT-exclusive price. that the retailer’s/wholesaler’s profit
supply chain and was mainly levied at
(π) is nil, therefore, does not penalize
Changes to this formula were the importing or manufacturing gate. In
countries by underestimating their ad
made based on country-specific this case, the VAT was calculated on the
valorem taxes. Considering this, it was
considerations such as the base for basis of M (or M*) and the different taxes
decided that unless country-specific
the ad valorem tax and excise tax, the collected at this stage, mainly import
information was made available to

1 Import duties may vary depending on the country of origin in cases of preferential trade agreements. WHO tried to determine the origin of the pack
and relevance of using such rates where possible.
2 https://comtradeplus.un.org/
3 When quantity was reported in weight (kg) rather than number of sticks, the conversion was made assuming one stick contained one gram of
tobacco.

Technical note III: Tobacco taxes in WHO Member States | 127

duties and excise taxes (Angola, Benin, 2. Kiosk/newsagent/tobacconist/ on brand market shares reported from
Cabo Verde, Cook Islands, Equatorial independent food store: small secondary sources, which is validated
Guinea, Ghana, Guinea-Bissau, Kiribati, convenience stores, retail outlets by countries. It is also worth noting that
Malaysia, Mali, Mauritania, Sudan, selling predominantly food, the EU tables use a WAP calculated from
Suriname, Tonga, Uganda Tuvalu and beverages and tobacco or a cigarette market data derived from
Vanuatu). combination of these (e.g. kiosk, the previous year (due to availability of
newsagent or tobacconist) or a wide data), which means that it would not
In sum, tax rates are calculated using the
range of predominantly grocery reflect a price change that may have
formula:
products (independent food stores or occurred following a tax increase in the
Sts = Sid + Sas + Sav + SVAT  5 independent small grocers). next year. It also means that the tax
share may not be representative of the
Sas = Tas ÷ P Most sold brands have been used
actual tax share since the WAP and the
consistently over time to gain a better
Sav = (Tav % × M) ÷ P or (Tav % × M*× tax rates are from different years. Excise
reflection of the change in prices.
(1+ Sid)) ÷ P4 if the most popular brand and VAT rates are still collected from
However, in some cases where the
was imported the EU published tables. This means,
market share of the brand initially
however, that tax shares as computed
Sid = (TID % × M*) ÷ P (if the import duty is used was considered to have changed
and reported in this report will not
value-based) or ID ÷ P (if import duty is a substantially, a change was made to
necessarily be similar to the rates
specific amount per pack) the new, more prevalent brand. In 2022,
published by the EU. This is mainly due
changes in the brand were made for
SVAT = VAT% ÷ (1+ VAT%) to the calculation of the specific excise
Democratic Republic of the Congo, Iraq,
tax rates as a percentage of the retail
Mali, Niger, Micronesia (Federated States
price, which will vary depending on the
of, Morocco (different brand but same
price used.
4. Prices price category), Antigua and Barbuda,
Kiribati (cheaper brand category),
Primary collection of price data in this Bahamas, Dominica, Ghana, Panama,
and previous reports involved surveying Senegal, Turkmenistan and Ukraine
retail outlets. Price data was collected (more expensive brand category).
5. Considerations in
from two different types of outlets.
In 8 other countries (Albania, Bosnia
interpreting tax share
Questionnaires sent to data collectors and Herzegovina, Estonia, Latvia, changes
were pre-populated with the names Lithuania, Maldives, Japan and Marshall
of the highest selling brand in each Islands) the brand reported in 2022 was Changes in tax as a share of price are not
country. The popular brand was a variant of the brand reported in 2020, only dependent on tax changes but also
identified using data collected from with similar price levels and these were on price changes. Therefore, despite
the 2020 questionnaires, through treated as identical in both years for an increase in tax, the tax share could
reports from data collectors in 2022 and purposes of price comparisons. remain the same or go down; similarly,
through WHO’s close collaboration with sometimes a tax share can increase even
ministries of finance. When possible, the As in 2012, 2014, 2016, 2018 and 2020, if there is no change/increase in the tax.
identified most sold brand was cross- the price used for each of the 27
countries of the European Union (EU) In the current database, there are
checked with estimates of brand market cases where taxes increased between
share of Euromonitor. For the countries was the most sold brand collected
by WHO. Prior to 2012, price and tax 2020 and 2022 but the share of tax as a
where such data were not available, percentage of the price went down. This
data collectors were asked to indicate information were taken entirely from
the EU’s Taxation and Customs Union is mainly due to the fact that, in absolute
the names of the popular brands and terms, the price increase was larger
provide their prices. And in a small website. The price used by the EU in the
past to calculate tax rates was the most than the tax increase (particularly in the
number of countries (around seven), case of specific excise tax increases).
prices of specific products including popular price category (MPPC), which
was assumed to be close to the most For example, in Colombia, the specific
HTPs and ENDS/ENNDS e-liquids were excise tax increased from
collected from online shops. sold brand price category collected in
this report. However, since 2011, the EU 2 430 Colombian pesos per 20 cigarettes
The two types of retail outlets were calculates and reports tax rates based in 2020 to 2 800 Colombian pesos per
defined as follows: on the Weighted Average Price (WAP) 20 cigarettes in 2022 (a 15.2% increase),
and therefore information on the MPPC while the price of the most sold brand
1. Supermarket/hypermarket: chain increased from 5 571 to 7 138 Colombian
or independent retail outlets with is no longer readily available for EU
countries. Consequently, in order to be pesos per pack (an 28.1% increase).
a selling space of over 2500 square In terms of tax share the excise
metres and a primary focus on selling consistent with past years’ estimates
and to ensure comparability with other represented 43.6% of the price in 2020
food/beverages/tobacco and other and it went down to 39.2% of the price
groceries. Hypermarkets also sell a countries, WHO decided in 2012 to
collect first hand prices of the most in 2022. This is because price rose more
range of non-grocery merchandise. than taxes.
sold brand to calculate tax rates.5 The
most sold brand is determined based

4 Or Sav = (Tav % × M*) ÷ P, if the ad valorem tax was applied only on the CIF value, not the CIF value + the import duty.
5 Due to a lack of capacity, the price is collected for cigarettes only while calculations for other smoked or smokeless tobacco products are made
using the EU tables when available, including the WAP and tax rates.

128 | WHO report on the global tobacco epidemic 2023

In the same way, there are cases where ■ Care should also be taken in relation The second assumption was made
increases (decreases) in tax as a share to countries where the most sold on the value of the CIF for countries
of price were mitigated by factors not brand changed between 2020 and that applied an import duty based on
directly related to tax rates. In the 2022. This also had an impact on the CIF value. Given the lack available
current database, this was attributable the tax proportion of the affected data on the import value of HTPs, an
to one or more of the following reasons: countries which had a specific or extrapolation was made assuming the
mixed excise structure. In some CIF value of HTPs would be higher than
■ In some instances, the price
cases, because the new brand the CIF value of cigarettes. This was
increased without a tax change,
reported was more expensive and based on the assumption that the cost
leading to a decrease in the tax
despite tax increases, the total tax of HTP production was higher than
share for a specific or mixed excise
share decreased (Turkmenistan and cigarettes production. Estimates of
structure (e.g. Andorra, Belize, Brazil,
Ukraine). In a different vein, Liberia the median CIF value as a proportion
China, Ecuador, Egypt, El Salvador,
saw its tax share go down despite no of retail price of the most sold brand
Ethiopia, Georgia, Guyana, Jamaica,
change in the statutory tax rate, this of cigarette in 2020 and 2022 ranged
Mongolia, Mozambique, Republic of
was due to the fact that the tax rate around 13-16%. As a consequence, a
Korea, Saint Lucia, Samoa, Sao Tome
is set in US$ and the exchange rate standard CIF upward value of 20% of
and Principe, Singapore, Spain, Sri
used went down between 2020 and the retail price of the most sold brand
Lanka, Switzerland and Uganda).
2022 reducing the effective value of of HTPs was applied for countries where
■ In other cases, prices increased the tax. a CIF value was needed to calculate the
above tax increases, leading to a tax burden of HTPs.
decrease in tax share for a specific Finally, when new, improved
information was provided in terms ■ Electronic nicotine and non-nicotine
or mixed excise structure (e.g.
of taxation and prices for some delivery systems (ENDS/ENNDS)
Austria, Bolivia (Plurinational State
of), Colombia, Czechia, Gambia, countries, corrections were made in Given the heterogeneity of the ENDS/
Honduras, Hungary, Ireland, the calculations of tax rates for 2008, ENNDS market and the difficulty in
Israel, Japan, Kazakhstan, Kenya, 2010, 2012, 2014,2016, 2018 and 2020 identifying a most sold brand that is
Kyrgyzstan, Malawi, Mauritius, estimates, as needed. representative enough of the market
Montenegro, Myanmar, Netherlands in a given country, data was collected
(Kingdom of the), North Macedonia, on the price of the cheapest brand
Norway, Pakistan, Philippines, available for a nicotine or non-nicotine
Portugal, Romania, Serbia, Sweden, 6. Taxation of novel and containing e-liquid (whichever was
Tunisia, Türkiye, Turkmenistan, the emerging nicotine and the cheapest available). Data was also
United Kingdom, the United States collected for three types of e-liquids,
and Uruguay). tobacco products those used for open systems and those
for closed systems that are rechargeable
■ In the case of imported products, ■ Heated tobacco products (HTPs)
and disposable ones.7 The tax was
the CIF value is an external variable
Similar to cigarettes, the price of the calculated in the same manner as for
that also influences the calculation
most sold brand of sticks (not the cigarettes with the only difference being
of tax share. This has implications in
devices) has been collected and where the base quantity. For e-liquid, the base
countries where ad valorem is based
applicable, taxes applied. The same reported is the volume, per ml. Because
on the CIF value, when import duties
methodology used for calculating of differences in prices and packaging,
are applicable on the CIF value or
the tax of cigarettes was followed for the price was standardised per 10 ml for
when the VAT is calculated on the
HTPs. Only two notable differences open systems e-liquids and per 1 ml for
base of CIF value + excise rather
were applied: when specific excise tax closed systems e-liquids (rechargeable
than VAT exclusive retail price. For
was applied on the weight of tobacco and disposable). Similar to the case of
example, if the CIF value increases,
contained in the sticks, the assumption HTPs and where a CIF value was needed
the base for the application of the
was made that each stick contained 0.3 to calculate the tax burden on ENDS/
tax is higher, leading to a higher tax
grams of tobacco (or 6 grams per pack ENNDS e-liquids, given the lack of data,
percentage if nothing else changes.
of 20), unless indicated otherwise by a assumptions were made regarding the
Countries which have seen changes
specific country. The assumption was CIF value as a proportion of the retail
in their tax share mainly due to
made based on an average estimate price of the cheapest brand reported.
changes in CIF value include Angola,
published by the e-cigarettes market Assuming the CIF value was a proxy for
Cameroon, Ghana, Lao People’s
data provider ECigIntelligence.6 the cost of production and, based on
Democratic Republic, Mali, Marshall
information from ECigIntelligence that
Islands and Niger.
mark-ups at the wholesale and retail
levels could represent up to 100% of the
cost at each level, it was assumed that
the CIF value would be around 20% of
the final retail price. A base of 20% of the

6 ECigIntelligence.com (restricted access).

7 Open systems are devices that allow the user to buy e-liquids and fill their device with the mixtures they want (with no nicotine, different nicotine
concentrations and/or flavours). Closed systems are products that come with a prefilled container (called a cartridge, pod or tank). More
specifically, disposable cigarettes are used only once and once consumed they are thrown away.

Technical note III: Tobacco taxes in WHO Member States | 129

retail price was assigned for countries d. Whether a country applies a specific i. Price dispersion: share of cheapest
where the ad valorem excise or import excise or a mixed system relying brand price in premium brand price
duty was calculated on CIF value (except more on the specific tax component (cheapest brand price ÷ premium
for Peru where a CIF value was reported (>50% of total excise is specific): brand price × 100). The higher the
by national authorities). specific excises typically lead to proportion, the smaller the gap and
higher prices and a smaller price gap the fewer are the opportunities for
between different brands, which is substitution to cheaper brands.
better (not applicable in countries
7. Supplementary tax where only ad valorem excise is II. Tax administration
applicable or where no excise tax is
information implemented).
a. Requirement of tax stamps (or fiscal
marks) on tobacco products: tax
An important consideration highlighted e. If the excise applied is ad valorem or stamps help administrators ensure
in this report is that many aspects of if it is mixed, and whether there is a that producers and importers comply
tobacco taxation need to be taken into minimum specific tax. A minimum with tax payment requirements,
account in order to assess if a tax policy tax provides protection against help detect illicit tobacco products,
is well designed. Tax as a proportion of products being undervalued. It also and facilitate the prosecution of tax
price does not tell the whole story about forces prices up since the price will fraud cases. In addition to identifying
the effectiveness of a tax policy. To not be lower than the tax paid (this if tax stamps are implemented in
explore other dimensions of tax policy, category does not apply to countries a country, data was collected to
the report has been collecting since where only specific excise tax is determine if those stamps contained
2015 additional information in relation applicable or where no excise tax is different types of security features
to tobacco taxation and compiles it into implemented). (overt and/or covert). Data was also
data that can inform researchers and collected to identify which countries
policy-makers further on tax policy in f. Base of the ad valorem tax in
required the presence of unique
different countries. countries that apply an ad valorem
identifiers on cigarette packs and
or a mixed excise system. Ad valorem
The information is compiled and whether these identifiers were used
taxes applied to the retail price
classified in this report according to two for tracking and tracing purposes.
or the retail price excluding VAT
main themes: tax structure/level and are administratively simpler. The b. Sales of duty free cigarettes: In most
tax administration. Information was retail price is easier to determine countries tobacco products are
also collected in relation to countries than producer price or CIF value, found to be sold without excise (and
that earmark tobacco taxes to fund and therefore there is less risk of other indirect taxes such as VAT and
health programmes and/or tobacco undervaluation (not applicable in import duties) in duty-free shops in
control activities. The different sets of countries where only specific excise airports, on international transport
data/indicators reported under each is applicable, or where no excise tax vehicles and/or other tax-free shops.
of the themes were developed and are is implemented). Duty-free tobacco products are
justified based on evidence provided in usually made available to travellers
past reports. g. If the excise tax applied is specific or
going out of the country, but they
if it is mixed, and whether the specific
are now also made available for
tax component is automatically
I. Tax structure/level travellers entering a country. Banning
adjusted for inflation (or other). If
a. Excise tax proportion of price: higher the sale of duty-free cigarettes for
the specific tax is not adjusted for
tax rates and greater reliance on personal consumption reduces the
inflation (or another indicator such as
excise is better. chance that these products end up in
income) over time, its impact will be
the illicit market. Additionally, there
b. Type of excise applied: if excise tax is eroded. It is good to have it adjusted
is no justification for selling a deadly
specific, ad valorem, a mix of the two, automatically (this category does
product duty-free; those foregone
or if no excise is applied. not apply to countries where only ad
taxes are a revenue loss for the
valorem excise tax is applicable or
c. Uniform vs. tiered excise tax government. Some countries have
where no excise tax is implemented).
system: a uniform excise is easier already acted and have banned the
to administer than a tiered system h. Minimum price policy: while this is sale of duty-free tobacco products.
where variable rates apply based on not reported as a best practice, it was Those products may still be found
selected criteria within one tobacco considered important to report the in airport and other tax-free shops,
product (not applicable in countries countries that did impose minimum but they are sold with (excise) taxes
where no excise tax is implemented). prices as part of their excise tax included.
policy.

130 | WHO report on the global tobacco epidemic 2023

III. Earmarking Countries for which no relevant data
was available in the IMF WEO database 9. Estimates of inflation-
(Portion of taxes or revenues from taxes
dedicated to health and/or tobacco
or World Bank’s GDP per capita series adjusted prices
were dropped from the affordability
control)
analysis: Cook Islands, Democratic Inflation raises price levels for goods
Taxes can generate substantial People’s Republic of Korea, Niue, Syrian and services and affects people’s
revenues. Earmarking all or a part of Arab Republic and Venezuela (Bolivarian purchasing power over time. Looking
tobacco tax revenues can be a useful Republic of). For each country–year at prices from any two periods needs to
tool for improving the political economy pair, the currency reported for the account for inflation, especially in the
of tobacco tax increases. Setting most sold brand was tallied with the current environment of soaring prices in
aside portions of tax revenue to fund corresponding currency for the GDP almost all countries around the world.
tobacco control efforts or relevant series, and exchange rate conversions Consequently, for a better overview
health programmes can help convince and adjustments were performed of the change in the price of the most
the public, politicians and officials of as needed (Belarus, Latvia, Liberia, sold brand of cigarettes between 2008
the value of significant tobacco tax Lithuania, Mauritania, Sao Tome and 2022, a new table has been added
increases, which ultimate goal is to and Principe, Somalia, Zambia and to this report with inflation-adjusted
reduce tobacco use. Zimbabwe). prices. The price of the most sold brand
of cigarettes was adjusted for inflation
To assess whether affordability
using annual percentage change in the
changed on average since 2012, the
average consumer prices – year-on-year
average annual percentage change
8. Estimates of the in affordability was calculated as
changes in a country’s local currency –
from the IMF’s World Economic Outlook.
affordability of cigarettes the least squares growth rate for all
The adjustment was made from 2008 to
(see Annex 1) countries with 4 or more years of data.
2022 using 2022 as the base year. Prices
This criterion automatically excluded
in international dollars (PPP) were also
The affordability of cigarettes for each Bhutan, Brunei Darussalam, Central
inflation-adjusted from 2008 to 2022
of the years 2012, 2014, 2016, 2018, African Republic, Djibouti, Guinea, Haiti,
using annual percentages of average
2020, and 2022 was measured by the Monaco, and South Sudan, as less than
consumer prices for the United States
per capita GDP required to purchase 4 years of price data were available
and 2022 as the base year. The inflation-
2000 cigarettes of the most sold brand for analysis. Additionally, countries
adjusted prices are not provided for
reported in that year. Analysis of that did not report price data for the
Afghanistan, Argentina, Cook Islands,
affordability in this report informs the most sold brand in 2022 were excluded
Cuba, Democratic People’s Republic
following: (Afghanistan, Brunei Darussalam,
of Korea, Lebanon, Monaco, Niue,
Djibouti, Eritrea, Guinea, Haiti, Sierra
■ Affordability index (% of GDP per Somalia, South Sudan, and Syrian Arab
Leone, Somalia, Syrian Arab Republic,
capita to buy 2000 cigarettes): across Republic due to lack of information on
and Niue).
countries, a higher value indicates inflation rates in those countries, and for
cigarettes are relatively more The affordability of cigarettes was Venezuela (Bolivarian Republic of) and
expensive in relation to income. judged to have been unchanged if the Zimbabwe due to inconsistencies in the
least squares trend in the per capita GDP currencies reported to WHO.
■ Whether cigarettes have become required to purchase 2000 cigarettes
relatively more affordable between (that is, 100 packs of 20 cigarettes)
2012 and 2022 (change in the was not significant at the 5% level.
affordability index as measured Cigarettes were judged to have become
above, between 2012 and 2022): less (more) affordable on average if the
as affordability decreases, least squares trend in the per capita GDP
consumption is discouraged. required to purchase 2000 cigarettes
Estimates of GDP per capita in local was positive (negative) and significantly
currency units were sourced from the different from zero at the 5% level.
IMF’s World Economic Outlook (WEO)
database which provides a complete
series of estimates for most of the 195
countries reported on. Where GDP
per capita data were not available in
the WEO database, the World Bank’s
GDP per capita data series was used.

Technical note III: Tobacco taxes in WHO Member States | 131

© WHO/Rooftop
Annex 1

Regional summary of MPOWER

measures
Annex 1 provides an overview of is available in Annex 2 for smoke-free where subnational governments play
selected tobacco control policies environments. It is important to an active role in tobacco control. Daily
in countries. For each WHO region note that data about laws reflect the smoking prevalence for the population
an overview table is presented that status of legislation adopted by aged 15 years and over in 2021 is an
includes information on monitoring and 31 December 2022 which has a stated indicator modelled by WHO from
prevalence, smoke-free environments, date of effect and is not undergoing a tobacco use surveys published by
treatment of tobacco dependence, legal challenge that could impact the Member States. Tobacco smoking is one
health warnings and packaging, date of implementation. of the most widely reported indicators
anti-tobacco mass media campaigns, in country surveys. The calculation of
The summary measures reported for
advertising, promotion and sponsorship WHO estimates to allow international
the WHO report on the global tobacco
bans, taxation levels, and affordability comparison is described in Technical
epidemic, 2023 are the same as those
of cigarettes, based on the methodology Note II.
in the 2021 report. The methodology
outlined in Technical Notes I, II and III.
used to calculate each indicator is
Country-level data were generally but described in Technical Note I. This
not always provided with supporting review, however, does not constitute a
documents such as laws, regulations, thorough and complete legal analysis
policy documents, etc. Available of each country’s legislation. Except
documents were assessed by WHO and for smoke-free environments and bans
this Annex provides summary measures on tobacco advertising, promotion
or indicators of country achievements and sponsorship, data were collected
for each of the MPOWER measures. at the national/ federal level only
Detailed information, including detailed and therefore provide incomplete
footnotes on each of the indicators, information about Member States

133
 2022 Indicator and compliance

Table A1.1 Country

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

African (2021) Health Mass media Taxation Cigarettes

warnings less
affordable

Region
since 2012
Lines Lines
represent represent
level of level of
compliance compliance
Summary Algeria 14% III IIIIIIIII 44.2% Yes
of MPOWER Angola ... III ... 18.0% Yes

measures Benin 4% IIIIII IIIIIIIII 13.2% No

Botswana 11% — I 55.2% ↔
Burkina Faso 9% III IIII 43.5% ↔
Burundi 6% I III 37.3% ↔
Cabo Verde 6% ... ... 30.2% ↔
Cameroon 4% ... ... 38.4% ↔
Central African Republic ... — — 36.3% ...
Chad 6% IIIII IIIIIIII 54.9% ↔
Comoros 10% IIIIIIII IIIIIIIIII 73.5% ↔
Congo 11% II IIIIIIIIII 24.9% Yes
Côte d'Ivoire 7% — IIIIIIII 39.5% No
Democratic Republic
7% I IIIIIIIIII 52.1% No
of the Congo
Equatorial Guinea ... — — 33.2% Yes
Eritrea ... — ... ... ...
Eswatini 6% — ... 54.3% ↔
Ethiopia 3% IIIIII IIIIIIII 48.5% ↔
Gabon ... IIII IIIIIIII 38.7% ↔
Gambia 8% I IIIIIIIIII 47.2% Yes
Ghana 2% — IIIII 22.5% ↔
Guinea ... ... ... ... ...
Guinea-Bissau 6% — — 5.7% ↔
Kenya 7% — ... 32.9% Yes
Lesotho 15% ... — 52.7% ↔
Liberia 5% — — 35.0% Yes
Madagascar 14% IIIII IIIIIIIII 87.7% ↔
Malawi 6% — — 47.9% No
Mali 5% — IIIIIII 20.5% No
Mauritania 7% III IIIIIII 17.8% No
Mauritius 16% IIIII ✩ IIIIIIIII 78.2% Yes
Mozambique ... IIII IIIII 23.9% Yes
Namibia 9% ... ... 50.6% ↔
Niger 4% IIIIIIIIII 36.0% ↔
Nigeria 2% I IIIIII 44.0% ↔
Rwanda 8% — ... 64.3% ↔
Sao Tome and Principe 4% — ... 29.9% ↔
Senegal 5% IIII IIIII 48.6% Yes
Seychelles 16% IIIIIIIIII IIIIIIIIII 69.5% ↔
Somalia ... — — ... ...
South Africa 17% — IIIIIIII 60.1% ↔
South Sudan ... — — 63.2% ...
Togo 4% IIIIIII IIIIIIIII 24.9% ↔
Uganda 5% III IIIIIII 29.8% Yes
United Republic of Tanzania 6% — ... 30.0% No
Zambia 9% ... — 22.7% ↔
Zimbabwe 7% ... — 34.5% ↔

134 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
From 20% to 29.9% Ban on national television, radio and print
Change in POWER indicator group, up or down, since 2020
media only
From 15% to 19.9%
Ban on national television, radio and print
Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
p purpose of drawing comparisons across
advertising (or at least 90% of the population
countries and must not be used to estimate covered by subnational legislation completely
absolute number of daily tobacco smokers in a banning tobacco advertising, promotion and
country. sponsorship)
p
MONITORING: PREVALENCE DATA
p p p p TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL
PRICE OF THE MOST WIDELY SOLD BRAND OF
No known data or no recent data or data that
CIGARETTES
are not both recent and representative
Recent and representative data for either ... Data not reported
adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
≥50% and <75% of retail price is tax
q Recent, representative and periodic data for
≥75% of retail price is tax
p both adults and youth

SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON

ADVERTISING, PROMOTION AND SPONSORSHIP, AND
p
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
p q Three to five public places completely
smoke-free ||||||||
p Six to seven public places completely smoke- |||||||
free ||||||
All public places completely smoke-free (or
q at least 90% of the population covered by
||||| Moderate compliance (3/10 to 7/10)
complete subnational smoke-free legislation) ||||
|||
CESSATION PROGRAMMES: TREATMENT OF ||
TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
... Data not reported
None
NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
q
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
q one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
p p
Cigarettes more affordable - per capita GDP
q needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
p CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
q 2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
p q
National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 135

 2022 Indicator and compliance

Table A1.2 Country

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

Region of (2021) Health Mass media Taxation Cigarettes

warnings less
affordable

the Americas
since 2012

Lines Lines
represent represent
level of level of
Summary of compliance compliance

MPOWER measures Antigua and Barbuda ... IIIIII IIIIIIII 14.9% ↔

Argentina 17% IIIIIIII IIIIII 76.5% ↔
Bahamas 8% — ... 53.6% Yes
Barbados 5% IIIIIIIIII — 43.0% ↔
Belize 5% — — 33.6% ↔
Bolivia (Plurinational State of) ... 31.5% ...
Brazil 10% IIIIIII IIIIIIII 80.2% No
Canada 9% IIIIIIIIII ✩ IIIIIIIIII 63.3% Yes
Chile 18% IIIIIIII IIIIIIIII 80.3% Yes
Colombia 5% IIIIIIII IIIIII 65.2% Yes
Costa Rica 5% IIIIIIII IIIIIIII 55.1% ↔
Cuba 12% IIIII — 10.0% ↔
Dominica ... — — 26.1% Yes
Dominican Republic 8% III — 44.7% ↔
Ecuador 4% IIIII IIIIIII 64.0% Yes
El Salvador 5% IIIII IIIIIII 45.7% Yes
Grenada ... — — 44.0% No
Guatemala 5% IIIII ... 49.0% ↔
Guyana 8% III IIIII 24.9% ↔
Haiti 5% — — 27.1% ...
Honduras 6% IIIIII ... 38.3% Yes
Jamaica 7% IIIII ... 38.8% ↔
Mexico 8% IIIIIIII IIII 67.6% ↔
Nicaragua ... IIIIII ... 75.7% Yes
Panama 2% IIIIIIIIII IIIIIIIIII 56.5% ↔
Paraguay 7% IIIIIII IIIII 19.2% ↔
Peru 5% IIIIIIII ... 73.3% ↔
Saint Kitts and Nevis ... — — 19.8% ↔
Saint Lucia 9% IIIIII — 43.1% ↔
Saint Vincent and the
... — — 23.2% ↔
Grenadines
Suriname ... III IIIIIII 49.3% Yes
Trinidad and Tobago ... IIIII IIIIIIII 27.5% Yes
United States 14% ... ... 37.4% ↔
Uruguay 17% IIIIIIIIII ✩ IIIIIIIII 65.5% ↔
Venezuela
... IIIIIIII IIIIIIIII 73.4% ...
(Bolivarian Republic of)

136 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
From 20% to 29.9% Ban on national television, radio and print
Change in POWER indicator group, up or down, since 2020 media only
From 15% to 19.9%
Ban on national television, radio and print
Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
purpose of drawing comparisons across
advertising (or at least 90% of the population
p countries and must not be used to estimate covered by subnational legislation completely
absolute number of daily tobacco smokers in a banning tobacco advertising, promotion and
country. sponsorship)

p MONITORING: PREVALENCE DATA TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL

PRICE OF THE MOST WIDELY SOLD BRAND OF
No known data or no recent data or data that
CIGARETTES
are not both recent and representative
Recent and representative data for either ... Data not reported
adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
≥50% and <75% of retail price is tax
Recent, representative and periodic data for
both adults and youth ≥75% of retail price is tax
p
SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON
ADVERTISING, PROMOTION AND SPONSORSHIP, AND
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
Three to five public places completely
smoke-free ||||||||
q Six to seven public places completely smoke- |||||||
free ||||||
All public places completely smoke-free (or
||||| Moderate compliance (3/10 to 7/10)
at least 90% of the population covered by
complete subnational smoke-free legislation) ||||
p p |||
p CESSATION PROGRAMMES: TREATMENT OF ||
TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
... Data not reported
None
NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
q one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
Cigarettes more affordable - per capita GDP
needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 137

 2022 Indicator and compliance

Table A1.3 Country

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

South-East (2021) Health

warnings
Mass media Taxation Cigarettes
less
affordable

Asia Region
since 2012

Lines Lines
represent represent
level of level of
Summary of compliance compliance

Bangladesh 16% IIIII IIIII 58.4% Yes

MPOWER measures Bhutan 4% — IIIIIIIIII 12.5% —
Democratic People’s
14% IIIIIIIIII — 0.0% ...
Republic of Korea
India 6% IIII IIIII 57.6% ↔
Indonesia 31% IIII ... 72.9% ↔
Maldives 18% I IIII 29.9% Yes
Myanmar 15% IIIII ✩ IIIIII 36.0% ↔

Nepal 12% IIIIII IIIIIIII 31.4% Yes

Sri Lanka 7% IIIIII IIIIIIII 66.9% Yes
Thailand 16% IIIIII ✩ IIIIIII 81.3% ↔
Timor-Leste 24% IIIIIIII IIIIIIII 47.2% ↔

138 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans
DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
From 20% to 29.9% Ban on national television, radio and print
Change in POWER indicator group, up or down, since 2020 media only
From 15% to 19.9%
Ban on national television, radio and print
Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
purpose of drawing comparisons across
advertising (or at least 90% of the population
countries and must not be used to estimate covered by subnational legislation completely
absolute number of daily tobacco smokers in a banning tobacco advertising, promotion and
country. sponsorship)

MONITORING: PREVALENCE DATA TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL

p No known data or no recent data or data that
PRICE OF THE MOST WIDELY SOLD BRAND OF
CIGARETTES
are not both recent and representative
Recent and representative data for either ... Data not reported
q adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
p ≥50% and <75% of retail price is tax
Recent, representative and periodic data for
both adults and youth ≥75% of retail price is tax

SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON

ADVERTISING, PROMOTION AND SPONSORSHIP, AND
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
Three to five public places completely
smoke-free ||||||||
Six to seven public places completely smoke- |||||||
free ||||||
All public places completely smoke-free (or
||||| Moderate compliance (3/10 to 7/10)
at least 90% of the population covered by
complete subnational smoke-free legislation) ||||
|||
CESSATION PROGRAMMES: TREATMENT OF ||
TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
... Data not reported
None
NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
Cigarettes more affordable - per capita GDP
needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 139

 2022 Indicator and compliance

Table A1.4 Country

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

European (2021) Health Mass media Taxation Cigarettes

warnings less
affordable

Region
since 2012
Lines Lines
represent represent
level of level of
compliance compliance
Summary of Albania 18% IIIIIIIIII IIIIIIII 66.7% ↔
MPOWER measures Andorra 31% IIIIIIIIII — 78.3% ↔
Armenia 24% IIIIII IIIIIII 48.5% No
Austria 20% IIIIIIIIII IIIIIIIII 74.0% ↔
Azerbaijan 17% IIIII IIIIIIII 50.3% ↔
Belarus 23% IIIIIIII IIIIIIII 56.6% ↔
Belgium 21% IIIIIIII ✩ IIIIIIIII 79.9% Yes
Bosnia and Herzegovina 30% — — 84.0% ↔
Bulgaria 32% III IIII 85.3% No
Croatia 31% IIIII IIIIII 86.0% ↔
Cyprus 29% IIIIII IIIIIIIIII 74.4% ↔
Czechia 23% IIIIIII IIIIIIIII 75.6% Yes
Denmark 14% IIIIIIIIII ✩ IIIIIIII 81.5% ↔
Estonia 20% IIIIII IIIIIIIII 88.2% No
Finland 14% IIIIIIIIII ✩ IIIIIIIIII 89.4% Yes
France 28% IIIIII ✩ IIIIIIIII 83.8% Yes
Georgia 27% IIIIIIIIII ✩ IIIIIIII 74.5% Yes
Germany 17% — IIIIIII 64.4% Yes
Greece 26% ... ... 81.2% ↔
Hungary 28% ... ✩ ... 72.0% ↔
Iceland 7% IIIIIIIIII IIIIIIIIII 63.6% ↔
Ireland 16% IIIIIIII ✩ IIIIIIIII 76.1% No
Israel 17% IIIII ✩ IIIII 76.6% ↔
Italy 21% — IIIIIIIII 76.7% ↔
Kazakhstan 16% IIIII IIIIIII 50.4% Yes
Kyrgyzstan 21% ... ... 51.3% Yes
Latvia 26% IIIIIIII IIIIIIII 81.4% No
Lithuania 23% ... ... 76.1% ↔
Luxembourg 18% IIIIIIIIII IIIIIIIII 68.5% ↔
Malta 20% ... ... 77.6% No
Monaco ... IIIIIIIIII — ... ...
Montenegro 25% ... ... 75.9% Yes
Netherlands (Kingdom of the) 17% IIIIIIII ✩ IIIIIIII 76.9% ↔
North Macedonia ... ... ... 77.0% Yes
Norway 10% IIIIIIIIII ✩ IIIIIIIII 59.6% ↔
Poland 21% IIIIII IIIIII 78.4% No
Portugal 19% IIIIII IIIII 78.0% No
Republic of Moldova 25% IIIIIIIIII IIIIIIIII 65.4% ↔
Romania 26% IIIIIIII IIIIIIII 69.1% No
Russian Federation 28% IIIIIIIIII IIIIIIII 61.0% Yes
San Marino ... ... ... 74.2% Yes
Serbia 33% ... ... 75.1% Yes
Slovakia 24% IIIIII IIIIIIII 76.7% Yes
Slovenia 18% IIIIIIII ✩ IIIIIIIIII 79.0% ↔
Spain 26% IIIIIIII IIIIIIIII 77.6% ↔
Sweden 8% — ... 67.9% ↔
Switzerland 21% — ... 59.0% ↔
Tajikistan ... ... ... 59.0% Yes
Türkiye 26% ... ✩ ... 80.8% ↔
Turkmenistan 4% IIIIIIIIII IIIIIIIIII 31.3% Yes
Ukraine 23% — — 70.7% Yes
United Kingdom 12% IIIIIIIIII ✩ IIIIIIIII 83.7% Yes
Uzbekistan 8% III IIIIIII 56.4% Yes

140 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
Change in POWER indicator group, up or down, since 2020 From 20% to 29.9% Ban on national television, radio and print
media only
From 15% to 19.9%
Ban on national television, radio and print
Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
purpose of drawing comparisons across
advertising (or at least 90% of the population
countries and must not be used to estimate covered by subnational legislation completely
absolute number of daily tobacco smokers in a
p country.
banning tobacco advertising, promotion and
sponsorship)

MONITORING: PREVALENCE DATA TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL

PRICE OF THE MOST WIDELY SOLD BRAND OF
No known data or no recent data or data that
CIGARETTES
are not both recent and representative
Recent and representative data for either ... Data not reported
adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
≥50% and <75% of retail price is tax
Recent, representative and periodic data for
both adults and youth ≥75% of retail price is tax

SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON

ADVERTISING, PROMOTION AND SPONSORSHIP, AND
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
q Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
Three to five public places completely
smoke-free ||||||||
Six to seven public places completely smoke- |||||||
free ||||||
All public places completely smoke-free (or
||||| Moderate compliance (3/10 to 7/10)
at least 90% of the population covered by
p complete subnational smoke-free legislation) ||||
|||
CESSATION PROGRAMMES: TREATMENT OF ||
p p TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
... Data not reported
None
p NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
p p Cigarettes more affordable - per capita GDP
needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
p Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
p National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
p p q National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 141

 2022 Indicator and compliance

Table A1.5 Country or territory

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

Eastern (2021) Health Mass media Taxation Cigarettes

warnings less
affordable

Mediterranean
since 2012

Lines Lines
represent represent

Region Afghanistan
level of
compliance
level of
compliance

7% ... ... ... ...

Summary of Bahrain 12% — IIIIIIIIII 73.4% Yes

MPOWER measures Djibouti ... ... ... ... ...

Egypt 22% II IIII 74.9% ↔
Iran (Islamic Republic of) 8% IIIIIIIIII IIIIIIIIII 25.7% Yes
< “occupied Palestinian territory”
should be understood to refer to Iraq 17% III IIIIIIII 16.9% ↔
the “occupied Palestinian territory, Jordan 30% IIIII 78.0% Yes
including East Jerusalem”.
Kuwait 16% ... ... 24.0% ↔
Lebanon 22% II IIII 9.9% ↔
Libya ... I IIIIIIII 32.0% ↔
Morocco 11% IIIII IIIIIIII 76.1% ↔
occupied Palestinian territory < 26% IIIIIIII 84.6% Yes
Oman 6% — ... 66.0% Yes
Pakistan 8% ... ... 51.8% ↔
Qatar 9% ... ... 68.2% Yes
Saudi Arabia 10% ... ✩ ... 73.8% Yes
Somalia ... — — ... ...
Sudan ... — IIIIIIIIII 73.3% ↔
Syrian Arab Republic ... ... ... ... ...
Tunisia 18% — ... 69.4% ↔
United Arab Emirates 8% IIIIIIIIII IIIIIIIIII 71.7% Yes
Yemen 13% IIIIII 57.0% Yes

142 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
From 20% to 29.9% Ban on national television, radio and print
Change in POWER indicator group, up or down, since 2020 media only
From 15% to 19.9%
Ban on national television, radio and print
Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
purpose of drawing comparisons across
advertising (or at least 90% of the population
countries and must not be used to estimate
q absolute number of daily tobacco smokers in a
covered by subnational legislation completely
banning tobacco advertising, promotion and
p p country. sponsorship)

MONITORING: PREVALENCE DATA TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL

PRICE OF THE MOST WIDELY SOLD BRAND OF
No known data or no recent data or data that
CIGARETTES
are not both recent and representative
Recent and representative data for either ... Data not reported
p adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
≥50% and <75% of retail price is tax
Recent, representative and periodic data for
both adults and youth ≥75% of retail price is tax

SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON

p ADVERTISING, PROMOTION AND SPONSORSHIP, AND
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
p p Three to five public places completely
smoke-free ||||||||
Six to seven public places completely smoke- |||||||
p free ||||||
All public places completely smoke-free (or
||||| Moderate compliance (3/10 to 7/10)
at least 90% of the population covered by
q complete subnational smoke-free legislation) ||||
|||
CESSATION PROGRAMMES: TREATMENT OF ||
TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
... Data not reported
None
NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
Cigarettes more affordable - per capita GDP
needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 143

 2022 Indicator and compliance

Table A1.6 Country

Adult daily
smoking
M
Monitoring
P
Smoking
bans
O
Cessation
programmes
W E
Advertising
bans
R

prevalence

Western (2021) Health Mass media Taxation Cigarettes

warnings less
affordable

Pacific Region
since 2012

Lines Lines
represent represent
level of level of

Summary of
compliance compliance

Australia 12% ... ✩ IIIIIIIIII 77.0% Yes

MPOWER measures Brunei Darussalam 12% ... ... — —
Cambodia 14% IIIII ... 26.4% No
China 21% IIIIII IIIIIIIII 52.2% No
Cook Islands 18% ... ... 72.8% ...
Fiji 16% III IIIIIIII 38.7% Yes
Japan 17% IIIIIIIIII — 59.9% Yes
Kiribati 36% IIIII IIII 50.9% ↔
Lao People's Democratic Republic 22% IIIIII IIIIIIII 15.4% No
Malaysia 17% — IIIIIIII 51.6% ↔
Marshall Islands 19% ... ... 51.1% No
Micronesia (Federated States of) ... ... ... 45.0% Yes
Mongolia 23% IIIII IIIIII 42.1% ↔
Nauru 37% IIIII IIIIIIII 42.2% Yes
New Zealand 11% IIIIIIIIII ✩ IIIIIIIIII 82.8% Yes
Niue ... ... ... ... ...
Palau 14% IIIIIIIIII IIIIIIIIII 74.1% Yes
Papua New Guinea 34% ... ... 65.2% No
Philippines 16% IIIIII IIIIIIII 50.6% Yes
Republic of Korea 19% IIIIIIII IIII 73.8% ↔
Samoa 19% IIIIII IIIIIIII 47.2% Yes
Singapore 13% IIIIIIII ✩ IIIIIIII 66.3% No
Solomon Islands 29% ... ... 43.3% ↔
Tonga 26% IIIII IIIIIIII 67.4% Yes
Tuvalu 27% ... ... 35.5% ↔
Vanuatu ... — ... 77.5% ↔
Viet Nam 19% IIIII IIIIIII 34.3% No

144 | WHO report on the global tobacco epidemic 2023

 Change since 2020
ADULT DAILY SMOKING PREVALENCE*: AGE- ADVERTISING BANS: BANS ON ADVERTISING,
P O W E R STANDARDIZED PREVALENCE RATES FOR ADULT PROMOTION AND SPONSORSHIP
Smoking bans Cessation Health Advertising Taxation
programmes warnings bans DAILY SMOKERS OF TOBACCO (BOTH SEXES ... Data not reported
COMBINED), 2021
Complete absence of ban, or ban that does
... Estimates not available not cover national television, radio and print
30% or more media
From 20% to 29.9% Ban on national television, radio and print
Change in POWER indicator group, up or down, since 2020 media only
From 15% to 19.9%
Ban on national television, radio and print
p Less than 15% media as well as on some but not all other
forms of direct and/or indirect advertising
* The figures should be used strictly for the
Ban on all forms of direct and indirect
purpose of drawing comparisons across
advertising (or at least 90% of the population
countries and must not be used to estimate covered by subnational legislation completely
absolute number of daily tobacco smokers in a banning tobacco advertising, promotion and
country. sponsorship)

MONITORING: PREVALENCE DATA TAXATION: SHARE OF TOTAL TAXES IN THE RETAIL

PRICE OF THE MOST WIDELY SOLD BRAND OF
p No known data or no recent data or data that
CIGARETTES
are not both recent and representative
p ... Data not reported
Recent and representative data for either
adults or youth < 25% of retail price is tax
Recent and representative data for both adults ≥25% and <50% of retail price is tax
and youth
≥50% and <75% of retail price is tax
Recent, representative and periodic data for
both adults and youth ≥75% of retail price is tax

SMOKE-FREE ENVIRONMENTS: SMOKING BANS COMPLIANCE: COMPLIANCE WITH BANS ON

ADVERTISING, PROMOTION AND SPONSORSHIP, AND
... Data not reported ADHERENCE TO SMOKE-FREE LAWS
Complete absence of ban, or up to two public ||||||||||
places completely smoke-free ||||||||| Complete compliance (8/10 to 10/10)
Three to five public places completely
smoke-free ||||||||
Six to seven public places completely smoke- |||||||
free ||||||
All public places completely smoke-free (or
||||| Moderate compliance (3/10 to 7/10)
at least 90% of the population covered by
complete subnational smoke-free legislation) ||||
|||
CESSATION PROGRAMMES: TREATMENT OF ||
TOBACCO DEPENDENCE
| Minimal compliance (0/10 to 2/10)
p ... Data not reported
None
NRT and/or some cessation services (neither
cost-covered) AFFORDABILITY OF CIGARETTES
NRT and/or some cessation services (at least Cigarettes less affordable - per capita GDP
one of which is cost-covered) needed to buy 2000 cigarettes of the most sold
National quit line, and both NRT and some YES brand increased on average between 2012
cessation services cost-covered and 2022.
Cigarettes more affordable - per capita GDP
needed to buy 2000 cigarettes of the most
HEALTH WARNINGS: HEALTH WARNINGS ON NO sold brand declined on average between 2012
CIGARETTE PACKAGES
and 2022.
... Data not reported
No trend change in affordability of cigarettes
No warnings or small warnings between 2012 and 2022.
Medium size warnings missing some ... Insufficient data to conduct a trend analysis.
appropriate characteristics OR large warnings
missing many appropriate characteristics
Medium size warnings with all appropriate SYMBOLS LEGEND
characteristics OR large warnings missing
✩ Plain packaging is mandated.
some appropriate characteristics
Large warnings with all appropriate Law adopted but not implemented by 31
characteristics December 2022.
Change in POWER indicator group, up or
down, between 2020 and 2022. Some 2020
MASS MEDIA: ANTI-TOBACCO CAMPAIGNS qp data were revised in 2022.
2022 grouping rules were applied to both
... Data not reported years.
No national campaign conducted between
July 2020 and June 2022 with a duration of at
... Data not reported/not available
least three weeks – Data not required/not applicable
National campaign conducted with one to
four appropriate characteristics
National campaign conducted with five to six
appropriate characteristics
National campaign conducted with at least
seven appropriate characteristics including PLEASE REFER TO TECHNICAL NOTE I FOR
airing on television and/or radio DEFINITIONS OF CATEGORIES

Annex 1: Regional summary of MPOWER measures | 145

© World Health Organization
Annex 2

Regional summary of smoke-free

measures
Annex 2 provides detailed information The following data are reported in this
on smoke-free environments in WHO Annex:
Member States for each WHO region.
- smoking bans in general indoor
public places;

- smoking bans in selected additional

indoor and outdoor public places;

- additional characteristics of smoking

bans (enforcement, signage, penalties,
etc).

Annex 2: Regional summary of smoke-free measures | 147

Table A2.1.1 Educational
Health care
facilities except Universities
African Region Country
facilities
universities

Public places with Compliance Compliance Compliance

complete smoking bans
Ban Ban Ban
^ ^ ^

^ Based on a score of 0-10, where 0 is low Algeria Yes 5 Yes 5 Yes 3

compliance. Refer to Technical Note I for more Angola Yes 9 Yes 5 Yes 4
information.
Benin Yes 10 Yes 8 Yes 4
✩ Separate, completely enclosed smoking rooms
Botswana No — No — No —
are allowed under very strict conditions (refer to
Technical Note I for more details). Burkina Faso Yes 4 Yes 5 Yes 3
... Data not available. Burundi Yes 7 Yes 5 Yes 3
– Data not required/not applicable. Cabo Verde Yes ... Yes ... Yes ...
1 Implementation decree pending. Cameroon Yes ... Yes ... Yes ...
2 Legislation enabling a complete smoking ban but
Central African Republic No — No — No —
regulations pending.
Chad Yes 10 Yes 5 Yes 5
3 Regulations are pending.
4 Smoking is banned and the law does not allow Comoros Yes 10 Yes 9 Yes 5
designated smoking rooms, except if the health Congo Yes 10 Yes 4 Yes 10
authority allows them by administrative act. Until
Côte d'Ivoire No 2 — No 2 — No 2 —
now, no such administrative act has been taken.
5 However the Minister may allow a person to Democratic Republic of the Congo Yes 8 Yes 10 Yes 3
smoke in a non-smoking area. Equatorial Guinea No — No — No —
Eritrea No — No — No —
Ethiopia Yes 9 Yes 5 Yes 4
Eswatini No — No — No —
Gabon Yes 10 Yes 4 Yes 8
Gambia Yes 5 Yes 5 Yes 5
Ghana No✩ — No✩ — No✩ —
Guinea Yes ... Yes ... Yes ...
Guinea-Bissau No — No — No —
Kenya No — No — No —
Lesotho Yes ... No — No —
Liberia No — No — No —
Madagascar Yes 7 Yes 7 Yes 4
Malawi No — No — No —
Mali No — No — No —
Mauritania Yes 5 No 3 — No 3 —
Mauritius Yes 7 Yes 6 Yes 5
Mozambique No — No — No —
Namibia Yes ... Yes ... Yes ...
Niger Yes 5 Yes 0 Yes 0
Nigeria Yes 10 Yes 3 No✩ —
Rwanda No — No — No —
Sao Tome and Principe No — No — No —
Senegal Yes 8 Yes 4 Yes 2
Seychelles Yes 10 Yes 10 Yes 10
Sierra Leone No — No — No —
South Africa No 4 — No 4 — No 4 —
South Sudan No — No — No —
Togo Yes 10 Yes 10 Yes 10
Uganda Yes 6 Yes 8 Yes 4
United Republic of Tanzania No — No — No✩ —
Zambia Yes ... Yes ... Yes ...
Zimbabwe Yes 5 ... Yes 5 ... Yes 5 ...

148 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number of
Smoking is
places with a outdoor places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking where smoking
facilities workplaces banned in one or
ban and overall is banned either
more jurisdictions
compliance score fully or partially

Compliance Compliance Ban Compliance Compliance Compliance Compliance

Ban Ban Ban Ban Places Places Ban
^ ^ Notes ^ ^ ^ ^

No — No — No — No — No — 3 3 1 No
Yes 9 No — No — No — Yes 9 5 3 1 No
Yes 7 Yes 9 Yes 4 Yes 2 Yes 9 8 6 1 —
No — No — No — No — No — 0 — 0 No
Yes 6 Yes 10 Yes 4 Yes 3 Yes 7 8 3 2 —
Yes 3 Yes 5 Yes 3 Yes 3 Yes 5 8 2 8 —
Yes ... No — No 1 — No 1 — Yes ... 5 ... 7 No
No — No — No — No — No — 3 ... 3 No
No — No — No — No — No — 0 — 0 No
Yes 5 Yes 5 Yes 10 Yes 0 Yes 5 8 5 0 —
Yes 8 No — No — No — Yes 5 5 8 1 No
Yes 5 Yes 2 Yes 0 Yes 0 Yes 10 8 2 8 —
No 2
— No 2
— No 2
— No 2
— No 2
— 0 — 0 No
No 3 — No 3 — No 3 — No 3 — Yes 7 4 1 0 No
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
Yes 5 Yes 6 Yes 4 Yes 4 Yes 9 8 6 8 —
No — No — No — No — No — 0 — 0 —
Yes 7 Yes 8 No — No — No — 5 4 2 No
Yes 2 Yes 5 Yes 0 Yes 0 Yes 5 8 1 0 —
No✩ — No✩ — No✩ — No✩ — No✩ — 0 — 0 No
Yes ... No — No — No — Yes ... 5 ... 1 No
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 1 ... 0 No
No — No — No — No — No — 0 — 0 No
Yes 4 Yes 6 Yes 6 Yes 0 Yes 8 8 5 8 —
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
No 3 — No 3 — No 3 — No 3 — Yes 10 2 3 0 No
Yes 8 Yes 10 Yes 9 Yes 6 Yes 10 8 5 7 —
Yes 8 No — No — No — No — 1 4 0 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 8 —
No — No — No — No — Yes 5 4 0 2 No
No✩ — No✩ — No✩ — No✩ — No — 2 1 8 No
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
Yes 10 Yes 8 No✩ — Yes 3 Yes 10 7 4 0 No
Yes 10 Yes 10 Yes 10 Yes 10 Yes 10 8 10 3 —
No — No — No — No — No — 0 — 0 No
No 4 — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
Yes 10 No — No✩ — No✩ — No✩ — 4 7 6 No
Yes 5 Yes 6 Yes 4 Yes 0 Yes 2 8 3 8 —
No — No — No✩ — No✩ — No — 0 — 0 Yes
Yes ... No — Yes ... Yes ... Yes ... 7 ... 0 No
No — No — No — No — Yes 5 ... 4 ... 0 No

Annex 2: Regional summary of smoke-free measures | 149

Table A2.1.2 Educational
Health care
facilities except Universities
Region of Country
facilities
universities

the Americas
Compliance Compliance Compliance
Ban Ban Ban
Public places with ^ ^ ^

complete smoking bans Antigua and Barbuda Yes 10 Yes 10 Yes 8

Argentina Yes 8 Yes 10 Yes 5
^ Based on a score of 0-10, where 0 is low Bahamas No — No — No —
compliance. Refer to Technical Note I for more
information. Barbados Yes 10 Yes 10 Yes 10
... Data not available. Belize No — No — No —
– Data not required/not applicable. Bolivia (Plurinational State of) Yes 10 Yes 5 Yes 3
1 Ban/measure is in effect in all subnational Brazil Yes 9 Yes 8 Yes 5
jurisdictions.
Canada Yes 1 10 Yes 1 10 Yes 1 9
2 Ban/measure is in effect in most subnational
jurisdictions. Chile Yes 10 Yes 10 Yes 8
Colombia Yes 10 Yes 10 Yes 7
Costa Rica Yes 8 Yes 7 Yes 5
Cuba Yes 5 Yes 5 Yes 5
Dominica No — No — No —
Dominican Republic Yes 5 Yes 4 Yes 0
Ecuador Yes 10 Yes 8 Yes 3
El Salvador Yes 10 Yes 10 Yes 10
Grenada No — No — No —
Guatemala Yes 10 Yes 8 Yes 5
Guyana Yes 8 Yes 8 Yes 7
Haiti No — No — No —
Honduras Yes 10 Yes 10 Yes 8
Jamaica Yes 10 Yes 10 Yes 3
Mexico Yes 9 Yes 9 Yes 3
Nicaragua Yes 10 Yes 10 Yes 7
Panama Yes 10 Yes 10 Yes 8
Paraguay Yes 10 Yes ... Yes 5
Peru Yes 10 Yes 10 Yes 3
Saint Kitts and Nevis No — No — No —
Saint Lucia Yes 10 Yes 10 Yes 8
Saint Vincent and the Grenadines No — No — No —
Suriname Yes 8 Yes 8 Yes 8
Trinidad and Tobago Yes 8 Yes 10 Yes 5
United States No — No — No —
Uruguay Yes 10 Yes 10 Yes 10
Venezuela (Bolivarian Republic of) Yes 10 Yes 8 Yes 5

150 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number of
Smoking is
places with a outdoor places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking where smoking
facilities workplaces banned in one or
ban and overall is banned either
more jurisdictions
compliance score fully or partially

Ban Compliance Ban Compliance Ban Compliance Ban Compliance Compliance Compliance
Ban Places Places Ban
Notes ^ Notes ^ Notes ^ Notes ^ ^ ^

Yes 8 Yes 10 Yes 7 Yes 8 Yes 10 8 7 6 —

Yes 8 Yes 7 Yes 10 Yes 5 Yes 10 8 8 2 —
No — No — No — No — No — 0 — 0 No
Yes 10 Yes 10 Yes 10 Yes 8 Yes 8 8 10 0 —
No — No — No — No — No — 0 — 0 No
Yes 7 Yes 5 Yes 5 Yes 0 Yes 0 8 0 6 —
Yes 10 Yes 8 Yes 9 Yes 6 Yes 10 8 8 0 —
Yes 1 10 No 2 — Yes 1 10 Yes 1 10 Yes 1 9 7 10 0 Yes
Yes 8 Yes 8 Yes 10 Yes 10 Yes 10 8 8 3 —
Yes 8 Yes 10 Yes 10 Yes 7 Yes 10 8 8 0 —
Yes 7 Yes 8 Yes 10 Yes 8 Yes 10 8 8 8 —
No — No — No — No — Yes 7 4 5 0 —
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 3 4 3 No
Yes 10 Yes 10 Yes 8 Yes 5 Yes 8 8 5 3 —
Yes 10 Yes 8 Yes 3 Yes 2 Yes 8 8 5 7 —
No — No — No — No — No — 0 — 0 No
Yes 8 Yes 8 Yes 8 Yes 2 Yes 7 8 5 0 —
Yes 5 Yes 7 Yes 3 Yes 0 Yes 3 8 3 8 —
No — No — No — No — No — 0 — 0 No
Yes 8 Yes 10 Yes 5 Yes 7 Yes 8 8 7 0 —
Yes 8 Yes 10 Yes 3 Yes 0 Yes 7 8 5 8 —
Yes 8 Yes 10 Yes 6 Yes 3 Yes 9 8 8 8 —
Yes 7 Yes 3 No — No — Yes 3 6 7 6 No
Yes 10 Yes 10 Yes 8 Yes 8 Yes 10 8 10 1 —
Yes 4 Yes 8 Yes 8 Yes 4 Yes 8 8 8 2 —
Yes 8 Yes 10 Yes 8 Yes 5 Yes 8 8 8 3 —
No — No — No — No — No — 0 — 0 No
Yes 10 Yes 10 Yes 8 Yes 2 Yes 10 8 7 8 —
No — No — No — No — No — 0 — 0 No
Yes 5 Yes 10 Yes 7 Yes 5 Yes 3 8 3 3 —
Yes 5 Yes 10 Yes 7 Yes 2 Yes 10 8 5 0 —
Yes ... No — No — No — No — 1 ... 0 Yes
Yes 10 Yes 8 Yes 10 Yes 8 Yes 8 8 10 3 —
Yes 8 Yes 8 Yes 8 Yes 5 Yes 10 8 8 0 —

Annex 2: Regional summary of smoke-free measures | 151

Table A2.1.3 Educational
Health care
facilities except Universities
South-East Country
facilities
universities

Asia Region
Compliance Compliance Compliance
Ban Ban Ban
Public places with ^ ^ ^

complete smoking bans Bangladesh Yes 8 Yes 8 Yes 3

Bhutan No — No — No —
^ Based on a score of 0-10, where 0 is low Democratic People's Republic of Korea Yes 10 Yes 10 Yes 10
compliance. Refer to Technical Note I for more
information. India Yes 8 Yes 6 Yes 5
✩ Separate, completely enclosed smoking rooms Indonesia Yes 9 Yes 9 Yes 4
are allowed under very strict conditions (refer to Maldives Yes 9 Yes 5 Yes 6
Technical Note I for more details).
Myanmar Yes 8 Yes 8 Yes 5
– Data not required/not applicable.
Nepal Yes 10 Yes 8 Yes 8
1 Smoking is banned, except if the health
authority allows designated smoking rooms Sri Lanka Yes 10 Yes 10 Yes 10
by administrative act. Until now, no such
Thailand Yes 1 10 Yes 1 10 Yes 1 6
administrative act has been made.
Timor-Leste Yes 10 Yes 10 Yes 4

152 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number Of
Smoking is
places with a Outdoor Places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking Where Smoking
facilities workplaces banned in one or
ban and overall Is Banned Either
more jurisdictions
compliance score Fully Or Partially

Compliance Compliance Compliance Compliance Compliance Compliance

Ban Ban Ban Ban Ban Places Places Places
^ ^ ^ ^ ^ ^

No — No — No — No — No — 3 5 1 No
No — No — No — No — No — 0 — 1 No
No — Yes 10 Yes 8 Yes 8 Yes 10 7 10 0 No
Yes 5 Yes 8 No✩ — No✩ — Yes 9 6 4 1 Yes
No — No — No — No — Yes 3 4 4 0 Yes
Yes 6 No — No — No — Yes 7 5 1 5 No
Yes 5 No — Yes 2 No — No — 5 5 3 No
Yes 10 Yes 9 Yes 4 Yes 0 Yes 9 8 6 2 —
Yes 10 Yes 10 No — No — Yes 9 6 6 1 No
Yes 1 5 Yes 1 10 Yes 1 4 Yes 1 3 Yes 1 5 8 6 8 —
No — No — Yes 3 Yes 3 Yes 3 6 8 0 No

Annex 2: Regional summary of smoke-free measures | 153

Table A2.1.4 Educational
Health care
facilities except Universities
European Region Country
facilities
universities

Public places with Compliance Compliance Compliance

complete smoking bans
Ban Ban Ban
^ ^ ^

^ Based on a score of 0-10, where 0 is low Albania Yes 10 Yes 10 Yes 10

compliance. Refer to Technical Note I for more Andorra Yes 10 Yes 10 Yes 10
information.
Armenia Yes 10 Yes 10 Yes 10
✩ Separate, completely enclosed smoking rooms
Austria No — Yes 10 No —
are allowed under very strict conditions (refer to
Technical Note I for more details). Azerbaijan Yes 7 Yes 8 Yes 7
... Data not available. Belarus No — Yes 10 Yes 8
– Data not required/not applicable. Belgium No✩ — Yes 1 ... No✩ —
1 Ban/measure is in effect in all subnational Bosnia and Herzegovina No 2 — No 2 — No 2 —
jurisdictions.
Bulgaria Yes 4 Yes 5 Yes 5
2 The three jurisdictions in the country (Federation
of Bosnia and Herzegovina, Republika Srpska Croatia Yes 7 Yes 5 Yes 5
and Brcko District of Bosnia and Herzegovina) Cyprus Yes 10 Yes 10 Yes 10
adopted separate tobacco control legislation with
several differences. There is no tobacco control Czechia Yes 10 Yes 10 Yes 10
legislation at level of Bosnia and Herzegovina. Denmark No — Yes 8 No —
3 Smoking is banned but the ban does not apply to Estonia No — Yes 7 No —
waterpipes.
Finland No✩ — Yes 10 No✩ —
4 Smoking is banned except in cigar bars allowed
under very strict licensing conditions. France Yes 10 Yes 8 Yes 7
5 Smoking is banned except in cigar or pipe clubs Georgia Yes 8 Yes 10 Yes 9
specially set out for this purpose.
Germany No — No — No —
6 These places are not reported as completely
smoke-free because the law provides for the Greece Yes ... Yes ... Yes ...
possibility of creating designated smoking rooms Hungary Yes ... Yes ... Yes ...
under specific conditions. However in practice
Iceland No — Yes 10 No —
many of them are completely smoke-free.
7 Provision adopted but not implemented by 31 Ireland Yes 8 Yes 9 Yes 8
December 2022. Israel Yes 7 Yes 8 No —
Italy No✩ — No✩ — No✩ —
Kazakhstan Yes 8 Yes 8 Yes 8
Kyrgyzstan Yes ... Yes ... Yes ...
Latvia Yes 8 Yes 10 Yes 10
Lithuania Yes ... Yes ... Yes ...
Luxembourg No✩ — Yes 7 Yes 8
Malta Yes ... Yes ... Yes ...
Monaco No✩ — Yes 10 Yes 10
Montenegro Yes ... Yes ... Yes ...
Netherlands (Kingdom of the) Yes 8 Yes 10 Yes 10
Norway Yes 10 Yes 10 Yes 10
North Macedonia Yes ... Yes ... Yes ...
Poland Yes 9 Yes 8 No —
Portugal Yes 8 Yes 8 Yes 5
Republic of Moldova Yes 10 Yes 10 Yes 10
Romania Yes 10 Yes 8 Yes 8
Russian Federation Yes 9 Yes 7 Yes 7
San Marino Yes ... Yes ... Yes ...
Serbia Yes ... Yes ... Yes ...
Slovakia Yes 10 Yes 8 Yes 8
Slovenia Yes 10 Yes 10 Yes 10
Spain Yes 8 Yes 9 Yes 8
Sweden No — No — No —
Switzerland No 6 — No 6 — No 6 —
Tajikistan Yes ... Yes ... Yes ...
Türkiye Yes ... Yes ... Yes ...
Turkmenistan Yes 10 Yes 10 Yes 10
Ukraine Yes ... Yes ... Yes ...
United Kingdom Yes 1 10 Yes 1 10 Yes 1 9
Uzbekistan No — No — No —

154 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number of
Smoking is
places with a outdoor places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking where smoking
facilities workplaces banned in one or
ban and overall is banned either
more jurisdictions
compliance score fully or partially

Compliance Compliance Compliance Compliance Compliance Compliance

Ban Ban Ban Ban Ban Places Places Places
^ ^ ^ ^ ^ ^

Yes 10 Yes 10 Yes 8 Yes 7 Yes 8 8 10 0 —

Yes 10 No✩ — No✩ — No✩ — Yes 10 5 10 1 —
Yes 8 Yes 7 Yes 7 Yes 5 No — 7 7 6 No
No — No — Yes 10 Yes 7 Yes 10 4 10 1 No
No✩ — No✩ — No✩ — No✩ — No✩ — 3 5 4 No
No — No — No — No — No — 2 8 5 No
No✩ — No✩ — No✩ — No✩ — Yes 10 2 8 2 No
No 2 — No 2 — No 2 — No 2 — No 2 — 02 — 0 No
Yes 4 Yes 4 Yes 3 Yes 1 Yes 10 8 4 1 —
Yes 7 Yes 7 No✩ — No — Yes 10 6 5 3 No
Yes 10 Yes 7 Yes 5 Yes 3 No — 7 7 2 No
No — No — No 3 — No 3 — Yes 10 4 8 1 No
No — No — No — No — No — 1 10 0 No
No — No — No — No — No — 1 7 1 No
No✩ — No✩ — No — No✩ — No — 1 10 1 No
No✩ — No✩ — No✩ — No✩ — No✩ — 3 7 2 No
Yes 4 Yes 8 Yes 10 No 4 — Yes 8 7 10 3 No
No — No — No — No — No — 0 — 0 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 2 —
Yes ... Yes ... Yes ... Yes ... No — 7 ... 7 No
No — No — No — No — No — 1 10 2 No
Yes 10 Yes 10 Yes 10 Yes 10 Yes 10 8 9 0 —
Yes 8 No — No — No — No — 3 5 3 No
No✩ — No✩ — No✩ — No✩ — No✩ — 0 — 3 No
Yes 8 Yes 8 No — No — Yes 8 6 5 0 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 3 —
Yes 8 No — Yes 10 Yes 8 No — 6 8 4 No
No — No — Yes ... No 5 — No — 4 ... 5 No
No — No — No✩ — No✩ — Yes 10 3 10 3 —
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 1 —
No✩ — No✩ — No✩ — No✩ — No✩ — 2 10 1 —
Yes ... No — No — No — No — 4 ... 0 No
Yes 10 Yes 10 Yes 10 Yes 7 Yes 10 8 8 1 —
Yes 10 Yes 10 Yes 10 Yes 10 Yes 10 8 10 2 —
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 0 —
No — No — No — No — Yes 10 3 6 1 No
Yes 8 Yes 8 No✩ — No✩ — Yes 10 6 7 1 No
Yes 10 Yes 8 Yes 8 Yes 7 Yes 8 8 10 8 —
Yes 7 Yes 10 Yes 8 Yes 7 Yes 10 8 8 0 —
Yes 6 Yes 9 Yes 10 Yes 9 Yes 10 8 10 4 —
Yes ... No✩ — No✩ — No✩ — Yes ... 5 ... 0 —
Yes ... No — No — No — Yes ... 5 ... 3 No
No — Yes 6 No — No — No — 4 6 2 No
No✩ — No✩ — No✩ — No✩ — No✩ — 3 8 2 No
Yes 8 Yes 10 Yes 9 Yes 8 Yes 9 8 9 3 —
No — No — No — No — No — 0 — 1 No
No 6 — No 6 — No 6 — No 6 — No 6 — 0 — 0 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 4 —
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 4 —
Yes 10 Yes 10 Yes 9 Yes 9 Yes 10 8 10 4 —
Yes ... Yes 7 ... Yes ... Yes ... Yes ... 8 ... 4 —
Yes 1
10 Yes 1 10 Yes 1 10 Yes 1 10 Yes 1 10 8 10 0 —
No — No — No — No — Yes 6 1 4 0 No

Annex 2: Regional summary of smoke-free measures | 155

Table A2.1.5 Educational
Health care
facilities except Universities
Eastern Country or territory
facilities
universities

Mediterranean
Region Ban
Compliance
^
Ban
Compliance
^
Ban
Compliance
^

Public places with Afghanistan Yes ... Yes ... Yes ...
Bahrain No 1 — No 1 — No 1 —
complete smoking bans Djibouti Yes ... Yes ... Yes ...
^ Based on a score of 0-10, where 0 is low Egypt Yes 4 Yes 5 Yes 1
compliance. Refer to Technical Note I for more Iran (Islamic Republic of) Yes 10 Yes 10 Yes 6
information.
Iraq Yes 8 Yes 5 Yes 4
✩ Separate, completely enclosed smoking rooms
are allowed under very strict conditions (refer to Jordan Yes 4 Yes 5 Yes 3
Technical Note I for more details). Kuwait Yes ... Yes ... Yes ...
... Data not available. Lebanon Yes 10 Yes 8 Yes 8
– Data not required/not applicable. Libya Yes 3 Yes 3 Yes 0
< “occupied Palestinian territory” should be
Morocco Yes 10 Yes 10 Yes 5
understood to refer to the “occupied Palestinian
territory, including east Jerusalem”. occupied Palestinian territory < Yes 5 Yes 3 Yes 0
1 Data not approved by national authorities. Oman No — No — No —
Pakistan Yes ... Yes ... Yes ...
Qatar Yes ... Yes ... Yes ...
Saudi Arabia Yes ... Yes ... Yes ...
Somalia No — No — No —
Sudan No — No — No —
Syrian Arab Republic Yes ... Yes ... Yes ...
Tunisia No — No — No —
United Arab Emirates Yes 10 Yes 10 Yes 5
Yemen No — Yes 3 Yes 0

156 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number of
Smoking is
places with a outdoor places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking where smoking
facilities workplaces banned in one or
ban and overall is banned either
more jurisdictions
compliance score fully or partially

Compliance Ban Compliance Compliance Compliance Compliance Compliance

Ban Ban Ban Ban Places Places Places
^ Notes ^ ^ ^ ^ ^

Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 0 —
No 1 — No 1 — No✩ — No✩ — No 1 — 0 — 0 No
Yes ... Yes ... No — No — Yes ... 6 ... 4 No
Yes 1 Yes 1 Yes 1 Yes 0 Yes 5 8 3 0 —
Yes 10 Yes 9 Yes 8 Yes 5 Yes 10 8 10 0 —
Yes 4 Yes 5 Yes 0 Yes 0 Yes 4 8 4 7 —
Yes 0 Yes 3 Yes 0 Yes 0 Yes 5 8 0 0 —
No — No — No — No — Yes ... 4 ... 4 No
Yes 3 Yes 5 Yes 3 Yes 1 Yes 3 8 3 3 —
Yes 0 Yes 0 Yes 3 Yes 3 Yes 5 8 2 0 —
Yes 3 Yes 8 No — No — No — 5 5 0 No
Yes 0 Yes 0 Yes 0 Yes 0 Yes 0 8 0 1 —
No — No — No — No — No — 0 — 0 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 0 —
No✩ — No — No✩ — No✩ — No✩ — 3 ... 0 No
Yes ... Yes ... No✩ — No✩ — Yes ... 6 ... 8 No
No — No — No — No — No — 0 — 0 No
No — No — No — No — No — 0 — 0 No
No — No — Yes ... Yes ... Yes ... 6 ... 2 No
No — No — No — No — No — 0 — 0 No
No✩ — No✩ — No✩ — No✩ — Yes 10 4 10 4 No
Yes 0 Yes 0 No — No — Yes 0 5 0 0 No

Annex 2: Regional summary of smoke-free measures | 157

Table A2.1.6 Educational
Health care
facilities except Universities
Western Country
facilities
universities

Pacific Region
Compliance Compliance Compliance
Ban Ban Ban
Public places with ^ ^ ^

complete smoking bans Australia Yes 1 ... No 2 — No 2 —

Brunei Darussalam Yes ... Yes ... Yes ...
^ Based on a score of 0-10, where 0 is low Cambodia Yes 8 Yes 10 Yes 10
compliance. Refer to Technical Note I for more
information. China No — Yes 10 No —
... Data not available. Cook Islands Yes ... Yes ... Yes ...
– Data not required/not applicable. Fiji Yes 10 No — No —
1 Ban/measure is in effect in all subnational Japan Yes 10 Yes 10 Yes 10
jurisdictions.
Kiribati Yes 8 No — No —
2 Ban/measure is in effect in most subnational
jurisdictions. Lao People's Democratic Republic Yes 8 Yes 8 Yes 7
3 Smoking is banned and the law does not allow Malaysia No 3 — No 3 — No 3 —
designated smoking rooms, except if the health Marshall Islands Yes ... Yes ... Yes ...
authority allows them by administrative act. Until
now, no such administrative act has been taken. Micronesia (Federated States of) Yes 1 ... Yes 1 ... Yes 1 ...
4 Smoking is banned by law, with an exemption Mongolia Yes 8 Yes 9 Yes 5
for indoor or enclosed workplace accessible by Nauru Yes 8 Yes 10 Yes 10
one person only, where smoking by that person is
allowed. However, this exemption has never been New Zealand Yes 10 Yes 10 Yes 8
applied in any workplaces as of today in Vanuatu. Niue Yes ... Yes ... Yes ...
Palau Yes 10 Yes 10 Yes 8
Papua New Guinea Yes ... Yes ... Yes ...
Philippines Yes 8 Yes 10 Yes 8
Republic of Korea Yes 10 Yes 8 No —
Samoa Yes 7 Yes 5 Yes 5
Singapore Yes 10 Yes 8 Yes 8
Solomon Islands Yes ... Yes ... No —
Tonga Yes 7 Yes 7 No —
Tuvalu No — No — No —
Vanuatu No 4 — No 4 — No 4 —
Viet Nam Yes 8 Yes 8 Yes 5

158 | WHO report on the global tobacco epidemic 2023

 Number of indoor Number of
Smoking is
places with a outdoor places
Government Indoor offices and comprehensively
Restaurants Pubs and bars Public transport complete smoking where smoking
facilities workplaces banned in one or
ban and overall is banned either
more jurisdictions
compliance score fully or partially

Compliance Compliance Compliance Compliance Compliance Compliance

Ban Ban Ban Ban Ban Places Places Places
^ ^ ^ ^ ^ ^

Yes 1 ... Yes 1 ... Yes 1 ... Yes 1 ... Yes 1 ... 6 ... 2 Yes
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 8 —
Yes 5 Yes 10 Yes 5 Yes 0 Yes 10 8 5 7 —
No — No — No — No — Yes 10 2 6 1 Yes
Yes ... No — Yes ... Yes ... Yes ... 7 ... 0 No
No — No — Yes 5 No — Yes 7 3 3 0 No
Yes 10 No — No — No — No — 4 10 0 No
Yes 8 Yes 10 Yes 6 Yes 3 Yes 6 6 5 0 No
Yes 7 Yes 8 Yes 7 Yes 3 Yes 5 8 7 8 —
No — No — No 3 — No — No 3 — 0 — 7 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 0 —
Yes ... Yes 1 ... No — No — No — 5 ... 1 Yes
Yes 8 No — No — No — Yes 6 5 5 3 No
Yes 7 Yes 10 Yes 8 Yes 8 Yes 10 8 5 0 —
Yes 10 Yes 10 Yes 10 Yes 10 Yes 10 8 10 1 —
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 2 —
Yes 10 Yes 10 No — No — Yes 10 6 10 3 No
Yes ... Yes ... Yes ... Yes ... Yes ... 8 ... 0 —
Yes 7 No — No — No — Yes 5 5 7 7 No
No — No — No — No — No — 2 9 4 No
Yes 5 Yes 5 No — No — Yes 5 6 7 0 No
No — No — Yes 8 No✩ — Yes 10 5 8 4 —
No — No — No — No — Yes ... 3 ... 7 No
Yes 7 Yes 10 Yes 8 Yes 7 Yes 8 7 5 1 No
Yes ... No — Yes ... Yes ... Yes ... 4 ... 0 No
No 4 — No 4 — No 4 — No 4 — No 4 — 0 — 0 No
Yes 5 Yes 7 Yes 3 No — No — 6 5 2 No

Annex 2: Regional summary of smoke-free measures | 159

Table A2.2.1 Public transport

African Region Country Land transport

(train, taxi, bus,
Air transport
(plane)
Water transport
(boat, vessel,
metro, tram) ferry)
Additional public places
Algeria Yes Yes No
with complete smoking Angola Yes Yes Yes
bans Benin Yes Yes Yes
Botswana No No No
✩ Separate, completely enclosed smoking rooms
are allowed under very strict conditions (refer to Burkina Faso Yes Yes Yes
Technical Note I for more details). Burundi Yes Yes Yes
... Data not available. Cabo Verde Yes Yes Yes
– Data not required/not applicable.
Cameroon No No No
1 Regulations are pending.
Central African Republic No No No
2 Smoking is banned and the law does not allow
designated smoking rooms, except if the health Chad Yes Yes Yes
authority allows them by administrative act. Until Comoros Yes Yes Yes
now, no such administrative act has been taken.
Congo Yes Yes Yes
3 However the Minister may allow a person to
smoke in a non-smoking area. Côte d'Ivoire No No No
Democratic Republic of the Congo Yes Yes Yes
Equatorial Guinea No No No
Eritrea No No No
Ethiopia Yes Yes Yes
Eswatini No No No
Gabon No Yes No
Gambia Yes Yes Yes
Ghana No✩ No✩ No✩
Guinea Yes Yes Yes
Guinea-Bissau No No No
Kenya No No No
Lesotho No No No
Liberia No No No
Madagascar Yes Yes Yes
Malawi No No No
Mali No No No
Mauritania Yes Yes Yes
Mauritius Yes Yes Yes
Mozambique No Yes No
Namibia Yes Yes Yes
Niger Yes Yes Yes
Nigeria No No No
Rwanda No No No
Sao Tome and Principe No No No
Senegal Yes Yes Yes
Seychelles Yes Yes Yes
Sierra Leone No No No
South Africa No Yes No
South Sudan No No No
Togo Yes Yes No✩
Uganda Yes Yes Yes
United Republic of Tanzania No No No
Zambia Yes Yes Yes
Zimbabwe Yes Yes Yes

160 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
No Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes No No No No No No Yes No
No No No No No No No No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes Yes No
Yes Yes No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No No No No No No No No No
No 1 No 1 No 1 No 1 No 1 No 1 No 1 No No
No No No No No No No No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No No No No No No No No Yes
No No No No No No Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No✩ No✩ No✩ No✩ No✩ No✩ No✩ Yes No
No No No No No No Yes No Yes
No No No No No No No No No
No No No No No No No Yes No
No No No No No No No No No
No No No No No No No Yes No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
No No No No No No No No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes Yes Yes
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
No✩ No✩ No✩ No✩ No✩ No✩ No✩ Yes Yes
No No No No No No No No No
No No No No No No No No No
Yes No✩ No✩ No Yes Yes Yes No No
Yes Yes Yes No Yes Yes Yes No No
No No No No No No No No No
No 2 No 2 No 2 No No No 2 No 2 No No
No No No No No No No No No
No✩ No✩ No✩ No✩ Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No✩ No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No Yes 3 No No

Annex 2: Regional summary of smoke-free measures | 161

Table A2.2.2 Public transport

Region of Country Land transport

(train, taxi, bus,
Air transport
Water transport
(boat, vessel,
the Americas
(plane)
metro, tram) ferry)

Antigua and Barbuda Yes Yes Yes

Additional public places Argentina Yes Yes Yes
with complete smoking Bahamas No No No

bans Barbados Yes Yes Yes

Belize No No No
... Data not available. Bolivia (Plurinational State of) Yes Yes Yes
– Data not required/not applicable. Brazil Yes Yes Yes
1 Ban/measure is in effect in all subnational
Canada Yes Yes Yes
jurisdictions.
Chile Yes Yes Yes
Colombia Yes Yes Yes
Costa Rica Yes Yes Yes
Cuba Yes Yes Yes
Dominica No No No
Dominican Republic No No No
Ecuador Yes Yes Yes
El Salvador Yes Yes Yes
Grenada No No No
Guatemala Yes Yes Yes
Guyana Yes Yes Yes
Haiti No No No
Honduras Yes Yes Yes
Jamaica Yes Yes Yes
Mexico Yes Yes Yes
Nicaragua Yes Yes Yes
Panama Yes Yes Yes
Paraguay Yes Yes Yes
Peru Yes Yes Yes
Saint Kitts and Nevis No No No
Saint Lucia Yes Yes Yes
Saint Vincent and the Grenadines No No No
Suriname Yes Yes Yes
Trinidad and Tobago Yes Yes Yes
United States No No No
Uruguay Yes Yes Yes
Venezuela (Bolivarian Republic of) Yes Yes Yes

162 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

Yes Yes Yes Yes Yes Yes Yes No Yes

Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
No Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No Yes Yes No Yes Yes Yes No No
Yes 1
Yes 1
Yes 1
No Yes 1
Yes 1
Yes 1
No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No No No No No No No No No
No No No No No No No No No
No No No No No No No No No
Yes Yes Yes No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No No No No No No No No No
Yes Yes Yes No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes Yes Yes
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes No No No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No

Annex 2: Regional summary of smoke-free measures | 163

Table A2.2.3 Public transport

South-East Country Land transport

(train, taxi, bus,
Air transport
Water transport
(boat, vessel,
Asia Region
(plane)
metro, tram) ferry)

Bangladesh No Yes No
Additional public places Bhutan No No No
with complete smoking Democratic People's Republic of Korea Yes Yes Yes

bans India Yes Yes Yes

Indonesia Yes Yes Yes
✩ Separate, completely enclosed smoking rooms Maldives Yes Yes Yes
are allowed under very strict conditions (refer to
Myanmar No Yes No
Technical Note I for more details).
... Data not available. Nepal Yes Yes Yes
– Data not required/not applicable. Sri Lanka Yes Yes Yes
Thailand Yes Yes Yes
Timor-Leste Yes Yes Yes

164 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

No No No No No No Yes No Yes
No No No No No No No No No
Yes Yes Yes No No Yes Yes No No
Yes No✩ No✩ No✩ Yes Yes Yes No No
Yes Yes No No No No No No No
Yes No No No No Yes Yes No Yes
No No No No Yes Yes Yes No Yes
Yes No No Yes No Yes Yes No Yes
Yes No No No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes Yes Yes Yes No No Yes No No

Annex 2: Regional summary of smoke-free measures | 165

Table A2.2.4 Public transport

European Region Country Land transport

(train, taxi, bus,
Air transport
(plane)
Water transport
(boat, vessel,
metro, tram) ferry)
Additional public places
Albania Yes Yes Yes
with complete smoking Andorra Yes Yes Yes
bans Armenia No Yes No
Austria Yes Yes Yes
✩ Separate, completely enclosed smoking rooms
are allowed under very strict conditions (refer to Azerbaijan No✩ Yes No✩
Technical Note I for more details). Belarus Yes Yes No
1 The three jurisdictions in the country (Federation Belgium Yes Yes Yes
of Bosnia and Herzegovina, Republika Srpska
and Brcko District of Bosnia and Herzegovina) Bosnia and Herzegovina No 1 No 1 No 1
adopted separate tobacco control legislation with Bulgaria Yes Yes Yes
several differences. There is no tobacco control
legislation at level of Bosnia and Herzegovina. Croatia Yes Yes Yes
2 Ban/measure is in effect in all subnational Cyprus Yes No No
jurisdictions. Czechia Yes Yes Yes
Denmark Yes Yes No
Estonia No Yes No
Finland No No No
France No✩ No✩ No✩
Georgia Yes Yes Yes
Germany No No No
Greece Yes Yes Yes
Hungary No Yes Yes
Iceland Yes Yes No
Ireland Yes Yes Yes
Israel Yes No No
Italy No✩ Yes Yes
Kazakhstan Yes Yes Yes
Kyrgyzstan Yes Yes Yes
Latvia No Yes No
Lithuania No No Yes
Luxembourg Yes Yes Yes
Malta Yes Yes Yes
Monaco No✩ No✩ No✩
Montenegro No No No
Netherlands (Kingdom of the) Yes Yes Yes
Norway Yes Yes Yes
North Macedonia Yes Yes Yes
Poland Yes Yes Yes
Portugal Yes Yes Yes
Republic of Moldova Yes Yes Yes
Romania Yes Yes Yes
Russian Federation Yes Yes Yes
San Marino Yes Yes Yes
Serbia Yes Yes Yes
Slovakia Yes No No
Slovenia No✩ No✩ No✩
Spain Yes Yes Yes
Sweden No No No
Switzerland No No No
Tajikistan Yes Yes Yes
Türkiye Yes Yes Yes
Turkmenistan Yes Yes Yes
Ukraine Yes Yes Yes
United Kingdom Yes Yes Yes
Uzbekistan Yes Yes Yes

166 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

Yes Yes Yes Yes Yes Yes Yes No No

Yes NA Yes No No✩ Yes Yes No Yes
Yes No Yes Yes Yes Yes Yes Yes Yes
No No No Yes No No No Yes No
No✩ No✩ Yes Yes No✩ No✩ Yes No Yes
No No No No No No No No Yes
No✩ No✩ No✩ No No No✩ No✩ Yes No
No 1
No 1
No 1
No 1
No 1
No 1
No 1
No 1
No 1
Yes No Yes Yes Yes Yes Yes No Yes
Yes Yes No✩ No No Yes Yes No No
No No No No No Yes Yes Yes Yes
Yes No No No No No Yes No Yes
No No No No Yes No No No No
Yes Yes No No No Yes No No No
No✩ No✩ No✩ No No✩ No✩ No✩ No Yes
No✩ No✩ No✩ No✩ No✩ No✩ No✩ Yes Yes
Yes No Yes Yes No Yes Yes Yes No
No No No No No No No No No
Yes No Yes Yes Yes Yes Yes No Yes
Yes Yes Yes No No Yes Yes No Yes
Yes Yes Yes No No Yes Yes No No
Yes Yes Yes No No Yes Yes Yes No
No No No No No No No No No
Yes No✩ No✩ No✩ No✩ No✩ No✩ Yes No
No No No No No No Yes Yes Yes
Yes No Yes Yes Yes Yes Yes No Yes
Yes No Yes No No Yes Yes Yes Yes
No No No No No No No Yes No
No No No✩ No No Yes Yes No Yes
Yes Yes Yes No Yes Yes Yes No Yes
No✩ No✩ No✩ No No No✩ No✩ No No
No No No No No Yes Yes No Yes
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes No No Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No Yes Yes No Yes
No✩ No✩ No✩ No No No✩ No✩ No Yes
Yes Yes Yes Yes Yes Yes Yes Yes Yes
Yes No Yes Yes No Yes Yes No No
Yes No Yes Yes No Yes Yes No Yes
No✩ No✩ No✩ No No No✩ No✩ No No
Yes Yes No No No No Yes No No
Yes Yes No No No Yes Yes No No
No✩ No✩ No✩ No No No✩ No✩ Yes No
Yes Yes Yes No No Yes Yes No Yes
No No No No No No No No Yes
No No No No No No No No No
Yes Yes Yes Yes No Yes Yes No Yes
Yes Yes Yes No No Yes Yes No Yes
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes No Yes Yes Yes Yes Yes No Yes
Yes 2 Yes 2 Yes 2 No Yes 2 Yes 2 Yes 2 Yes 2 No
No No No No No No No No No

Annex 2: Regional summary of smoke-free measures | 167

Table A2.2.5 Public transport

Eastern Country or territory Land transport

(train, taxi, bus,
Air transport
Water transport
(boat, vessel,
Mediterranean
(plane)
metro, tram) ferry)

Region Afghanistan
Bahrain
Yes
No 1
Yes
No 1
Yes
No 1
Additional public places Djibouti Yes Yes Yes

with complete smoking Egypt Yes Yes Yes

Iran (Islamic Republic of) Yes Yes Yes
bans Iraq Yes Yes Yes
Jordan Yes Yes Yes
✩ Separate, completely enclosed smoking rooms
are allowed under very strict conditions (refer to Kuwait Yes Yes Yes
Technical Note I for more details). Lebanon Yes Yes Yes
< “occupied Palestinian territory” should be
Libya Yes Yes Yes
understood to refer to the “occupied Palestinian
territory, including east Jerusalem”. Morocco No No No
1 Data not approved by national authorities. occupied Palestinian territory < Yes Yes Yes
Oman No No No
Pakistan Yes Yes Yes
Qatar No✩ No✩ No✩
Saudi Arabia Yes Yes Yes
Somalia No No No
Sudan No No No
Syrian Arab Republic Yes Yes Yes
Tunisia No No No
United Arab Emirates Yes Yes Yes
Yemen Yes Yes Yes

168 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

Yes No Yes Yes Yes Yes Yes No No

No 1 No 1 No 1 No 1 No 1 No 1 No 1 Yes No
Yes Yes Yes Yes Yes Yes Yes No Yes
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No Yes Yes Yes Yes Yes Yes No No
No Yes Yes Yes Yes Yes Yes No Yes
Yes Yes No No No No No No No
Yes Yes Yes No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes Yes Yes No Yes Yes Yes No No
No No✩ No✩ No✩ No✩ No✩ No✩ Yes No
Yes Yes No✩ No✩ No✩ Yes No✩ No Yes
No No No No No No No No No
No No No No No No No No Yes
No No No No No No Yes No No
No No No No No No Yes No No
No✩ No✩ No✩ No✩ No✩ No✩ No✩ No No
Yes No No No Yes No No No No

Annex 2: Regional summary of smoke-free measures | 169

Table A2.2.6 Public transport

Western Country Land transport

(train, taxi, bus,
Air transport
Water transport
(boat, vessel,
Pacific Region
(plane)
metro, tram) ferry)

Australia Yes Yes Yes

Additional public places Brunei Darussalam Yes Yes Yes
with complete smoking Cambodia Yes Yes Yes

bans China Yes Yes Yes

Cook Islands Yes Yes Yes
1 Ban/measure is in effect in all subnational Fiji Yes Yes Yes
jurisdictions.
Japan No Yes No
2 Smoking is banned and the law does not allow
designated smoking rooms, except if the health Kiribati Yes Yes Yes
authority allows them by administrative act. Until Lao People's Democratic Republic Yes Yes Yes
now, no such administrative act has been taken.
Malaysia No 2 No 2 No 2
3 Ban/measure is in effect in all subnational
jurisdictions but exception for government owned Marshall Islands Yes Yes Yes
boats/ships where designated smoking areas are Micronesia (Federated States of) Yes 1 Yes 1 No 3
allowed.
Mongolia Yes Yes Yes
4 Smoking is banned by law, with an exemption
for indoor or enclosed workplace accessible by Nauru Yes Yes Yes
one person only, where smoking by that person is New Zealand Yes Yes Yes
allowed. However, this exemption has never been
applied in any workplaces as of today in Vanuatu. Niue Yes Yes Yes
Palau Yes Yes Yes
Papua New Guinea Yes Yes Yes
Philippines Yes Yes Yes
Republic of Korea Yes Yes No
Samoa Yes Yes Yes
Singapore Yes Yes Yes
Solomon Islands Yes Yes Yes
Tonga Yes Yes Yes
Tuvalu Yes Yes Yes
Vanuatu No 4 No 4 No 4
Viet Nam No Yes No

170 | WHO report on the global tobacco epidemic 2023

Indoor waiting Hotels Shops Cultural Private
areas of public Outdoor
(supermarket, facilities vehicles with
transport children
Airports Prisons shop, (museum, children
(train station, playgrounds/
Main areas Bedrooms shopping cinema, aged < 18
metro station, parks
mall) theatre, arena) years
etc.)

Yes 1 Yes 1 Yes 1 No Yes 1 Yes 1 Yes 1 No No

Yes Yes Yes No Yes Yes Yes No Yes
Yes No Yes Yes Yes Yes Yes No Yes
Yes Yes No No No No No No Yes
No Yes Yes Yes Yes Yes Yes No No
No No Yes No No Yes Yes No No
No No No No No No No No No
No Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No Yes
No 2 No 2 No 2 No 2 No 2 No 2 No 2 No Yes
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No No
Yes No Yes No No No No No Yes
Yes No Yes Yes Yes Yes Yes No No
Yes Yes Yes No Yes Yes Yes Yes No
Yes Yes Yes Yes Yes Yes Yes No No
Yes Yes Yes No Yes Yes Yes No No
Yes Yes Yes Yes Yes Yes Yes No No
No No No No No No No No Yes
Yes No No No No No No No Yes
Yes Yes No No Yes Yes Yes No No
Yes No Yes No No Yes Yes No Yes
Yes Yes No No No No No No No
No Yes Yes Yes No Yes Yes No No
No Yes Yes Yes Yes Yes Yes No No
No 4 No 4 No 4 No 4 No 4 No 4 No 4 No No
No No No No Yes Yes Yes No No

Annex 2: Regional summary of smoke-free measures | 171

Table A2.3.1 Signage Fines on the establishment

African Region Requirement

Required
signs identify
For not For not
Country a telephone
Additional characteristics to display no-
smoking signs
number or other
asking a
patron
For not
removing
posting
no-smoking
mechanisms
of smoking bans in smoke-free
places
for the public
to stop
smoking
ashtrays signs
to report
– Data not required/not applicable. violations

$ Ban applies to ENDS only. Algeria Yes No No No No

1 Regulations are pending.
Angola Yes No Yes No Yes
Benin Yes No Yes No Yes
Botswana Yes No Yes No Yes
Burkina Faso Yes No No No —
Burundi Yes No No No Yes
Cabo Verde Yes No No No Yes
Cameroon No — No No —
Central African Republic No — No No —
Chad Yes No Yes Yes Yes
Comoros Yes No No No Yes
Congo Yes No Yes Yes Yes
Côte d'Ivoire Yes No Yes No No
Democratic Republic
No — No No —
of the Congo
Equatorial Guinea No — No No —
Eritrea Yes No Yes No Yes
Ethiopia Yes No Yes Yes Yes
Eswatini Yes No No No No
Gabon Yes No Yes No Yes
Gambia Yes No Yes Yes Yes
Ghana Yes No Yes Yes Yes
Guinea Yes No No No Yes
Guinea-Bissau No — No No —
Kenya Yes No Yes Yes Yes
Lesotho Yes No No No No
Liberia Yes No No No Yes
Madagascar Yes No No No No
Malawi No — No No —
Mali No — No No —
Mauritania Yes No No No Yes
Mauritius Yes No Yes Yes Yes
Mozambique Yes No No No Yes
Namibia Yes Yes Yes No Yes
Niger No — Yes No —
Nigeria Yes No Yes Yes Yes
Rwanda Yes No No No No
Sao Tome and Principe Yes No No No Yes
Senegal Yes No Yes Yes Yes
Seychelles Yes No Yes No Yes
Sierra Leone No — No No —
South Africa Yes No Yes No Yes
South Sudan No — No No —
Togo Yes No Yes Yes Yes
Uganda Yes No Yes Yes Yes
United Republic of Tanzania Yes No Yes No Yes
Zambia Yes No No No Yes
Zimbabwe Yes No No No Yes

172 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ENDS/ENNDS in public places
smoking enforcement investigations
system

Yes No No No explicit ban on use Use is banned in some public places1 $

Yes No No Use is banned in some public places No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes Yes No Use is banned in some public places Use is banned in some public places
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use Use is banned in all public places
Yes Yes No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use Use is banned in some public places $
Yes No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use

Annex 2: Regional summary of smoke-free measures | 173

Table A2.3.2 Signage Fines on the establishment

Region of Required
signs identify

the Americas
Requirement For not For not
Country a telephone
to display non asking a For not posting
number or other
smoking signs patron removing no-smoking
mechanisms
in smoke-free to stop ashtrays signs
Additional characteristics places
for the public
to report
smoking
of smoking bans violations

– Data not required/not applicable. Antigua and Barbuda Yes No No No No

$ Ban applies to ENDS only. Argentina Yes Yes Yes No Yes
Bahamas No — No No —
Barbados Yes No Yes No Yes
Belize No — No No —
Bolivia (Plurinational State of) Yes No No No No
Brazil No — No No —
Canada No — Yes No —
Chile Yes No Yes No Yes
Colombia Yes No Yes No Yes
Costa Rica Yes No Yes No Yes
Cuba Yes No No No No
Dominica No — No No —
Dominican Republic Yes No Yes No Yes
Ecuador Yes Yes Yes Yes Yes
El Salvador Yes Yes Yes No No
Grenada No — No No —
Guatemala Yes No Yes No Yes
Guyana Yes No Yes Yes Yes
Haiti No — No No —
Honduras Yes No Yes No Yes
Jamaica Yes No No No Yes
Mexico Yes Yes Yes No No
Nicaragua Yes No Yes No Yes
Panama Yes Yes Yes No Yes
Paraguay Yes No Yes No Yes
Peru Yes No Yes No Yes
Saint Kitts and Nevis No — No No —
Saint Lucia Yes No No No Yes
Saint Vincent and the
No — No No —
Grenadines
Suriname Yes No Yes Yes Yes
Trinidad and Tobago No — Yes No —
United States No — No No —
Uruguay Yes No Yes Yes Yes
Venezuela (Bolivarian
Yes No Yes No Yes
Republic of)

174 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ENDS/ENNDS in public places
smoking enforcement investigations
system

No Yes Yes No explicit ban on use No explicit ban on use

Yes Yes Yes No explicit ban on use Use is banned in all public places
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use Use is banned in all public places $
No No No No explicit ban on use No explicit ban on use
No Yes No Use is banned in all public places Use is banned in all public places $
No No Yes Use is banned in all public places Use is banned in all public places
Yes Yes Yes No explicit ban on use Use is banned in some public places
Yes No Yes No explicit ban on use No explicit ban on use
No No Yes No explicit ban on use No explicit ban on use
Yes Yes Yes Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
No No No Use is banned in some public places Use is banned in some public places $
Yes Yes Yes No explicit ban on use Use is banned in all public places $
Yes Yes Yes No explicit ban on use Use is banned in all public places $
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use Use is banned in all public places
Yes No No Use is banned in all public places Use is banned in all public places $
Yes Yes Yes Use is banned in all public places Use is banned in all public places $
Yes Yes Yes No explicit ban on use Use is banned in all public places
Yes Yes Yes Use is banned in all public places Use is banned in all public places
Yes Yes No Use is banned in all public places Use is banned in all public places
Yes No Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No No Use is banned in all public places Use is banned in all public places $
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places No explicit ban on use
No No No Use is banned in some public places No explicit ban on use
No Yes Yes Use is banned in all public places Use is banned in all public places
Yes Yes Yes No explicit ban on use No explicit ban on use

Annex 2: Regional summary of smoke-free measures | 175

Table A2.3.3 Signage Fines on the establishment

South-East Required
signs identify

Asia Region
Requirement For not For not
Country a telephone
to display non asking a For not posting
number or other
smoking signs patron removing no-smoking
mechanisms
in smoke-free to stop ashtrays signs
Additional characteristics places
for the public
to report
smoking
of smoking bans violations

– Data not required/not applicable. Bangladesh Yes No Yes Yes Yes

Bhutan Yes No Yes No Yes
Democratic People's Republic
No — No No —
of Korea
India Yes No Yes No No
Indonesia No — No No —
Maldives Yes Yes Yes No Yes
Myanmar Yes No Yes No Yes
Nepal Yes No Yes No Yes
Sri Lanka No — Yes No —
Thailand Yes No Yes Yes Yes
Timor-Leste Yes No No No No

176 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ENDS/ENNDS in public places
smoking enforcement investigations
system

Yes No No No explicit ban on use No explicit ban on use

Yes Yes Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use Use is banned in all public places
Yes Yes No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in some public places Use is banned in some public places

Annex 2: Regional summary of smoke-free measures | 177

 Fines on the
Table A2.3.4 Signage
establishment

European Region
Required
signs identify For not
Requirement For not
Country a telephone posting
to display non asking a For not
number or other no-
Additional characteristics smoking signs
in smoke-free
mechanisms
patron removing
to stop ashtrays
smoking
for the public signs
of smoking bans places
to report
smoking
violations
– Data not required/not applicable. Albania Yes No Yes Yes Yes
$ Ban applies to ENDS only. Andorra Yes No Yes No Yes
1 The three jurisdictions in the country (Federation Armenia Yes No No No Yes
of Bosnia and Herzegovina, Republika Srpska
and Brcko District of Bosnia and Herzegovina)
Austria Yes No Yes No Yes
adopted separate tobacco control legislation with Azerbaijan Yes No Yes No Yes
several differences. There is no tobacco control
Belarus Yes No No No No
legislation at level of Bosnia and Herzegovina.
2 Ban/measure is in effect in all subnational Belgium Yes No Yes Yes Yes
jurisdictions. Bosnia and Herzegovina No 1 —1 No 1 No 1 —1
Bulgaria No — Yes No —
Croatia No — Yes No —
Cyprus Yes No Yes No Yes
Czechia Yes No Yes No Yes
Denmark No — Yes No —
Estonia No — Yes No —
Finland Yes No Yes No No
France Yes No Yes Yes Yes
Georgia Yes Yes Yes Yes Yes
Germany No — No No —
Greece Yes No Yes Yes Yes
Hungary Yes Yes Yes No Yes
Iceland No — No No —
Ireland Yes Yes Yes No Yes
Israel Yes No Yes Yes Yes
Italy Yes No No No Yes
Kazakhstan Yes No Yes No Yes
Kyrgyzstan Yes No No No No
Latvia Yes No No No Yes
Lithuania Yes No No No No
Luxembourg No — Yes No —
Malta Yes No Yes No Yes
Monaco No — Yes No —
Montenegro Yes No Yes No Yes
Netherlands (Kingdom of the) No — Yes No —
Norway Yes No Yes No Yes
North Macedonia No — No No —
Poland Yes No No No Yes
Portugal Yes No Yes No Yes
Republic of Moldova Yes No Yes No Yes
Romania Yes No No No No
Russian Federation Yes No Yes No Yes
San Marino Yes No Yes No Yes
Serbia Yes Yes Yes No Yes
Slovakia Yes Yes Yes No Yes
Slovenia No — Yes No —
Spain Yes No Yes No Yes
Sweden Yes No No No No
Switzerland No — No No —
Tajikistan Yes No Yes No Yes
Türkiye Yes Yes Yes Yes Yes
Turkmenistan No — No No —
Ukraine Yes No No Yes Yes
United Kingdom Yes 2 No Yes 2 No Yes 2
Uzbekistan No — No No —

178 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ENDS/ENNDS in public places
smoking enforcement investigations
system

Yes No Yes No explicit ban on use Use is banned in all public places
Yes No Yes No explicit ban on use Use is banned in some public places $
Yes No Yes Use is banned in some public places Use is banned in some public places $
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes Yes Yes No explicit ban on use Use is banned in some public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes Yes Yes Use is banned in some public places Use is banned in some public places
Yes 1 No 1 No 1 No explicit ban on use No explicit ban on use
Yes Yes Yes Use is banned in all public places No explicit ban on use
Yes Yes No Use is banned in some public places Use is banned in some public places $
Yes No No Use is banned in some public places Use is banned in some public places
Yes No No Use is banned in some public places Use is banned in some public places
No No No Use is banned in some public places Use is banned in some public places
Yes Yes Yes Use is banned in some public places Use is banned in some public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes No No Use is banned in some public places Use is banned in some public places
Yes No No Use is banned in some public places Use is banned in some public places $
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes Yes Yes No explicit ban on use Use is banned in some public places
Yes No Yes Use is banned in all public places No explicit ban on use
Yes No Yes Use is banned in some public places Use is banned in some public places $
Yes No Yes No explicit ban on use Use is banned in some public places $
Yes No No Use is banned in some public places Use is banned in some public places
Yes Yes No Use is banned in all public places Use is banned in all public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes No Yes Use is banned in some public places Use is banned in some public places
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes No No Use is banned in some public places Use is banned in some public places
Yes No Yes No explicit ban on use Use is banned in some public places
No No Yes Use is banned in all public places Use is banned in all public places
Yes No No Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use No explicit ban on use
Yes Yes No Use is banned in some public places Use is banned in some public places $
Yes No Yes Use is banned in some public places Use is banned in some public places $
Yes No Yes Use is banned in all public places Use is banned in all public places $
Yes No Yes No explicit ban on use Use is banned in some public places $
Yes No No Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use Use is banned in some public places
Yes Yes No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes No Use is banned in some public places Use is banned in some public places
Yes No Yes Use is banned in all public places Use is banned in some public places $
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places $
Yes Yes Yes Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use Use is banned in all public places
Yes Yes Yes Use is banned in all public places Use is banned in all public places
Yes 2 No Yes 2 No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use Use is banned in some public places

Annex 2: Regional summary of smoke-free measures | 179

Table A2.3.5 Signage Fines on the establishment

Eastern Required
signs identify

Mediterranean
Requirement For not For not
Country or territory a telephone
to display non asking a For not posting
number or other
smoking signs patron removing no-smoking
Region in smoke-free
places
mechanisms
for the public
to stop
smoking
ashtrays signs
to report
Additional characteristics violations

of smoking bans Afghanistan Yes No No No No

Bahrain Yes No Yes No Yes
– Data not required/not applicable. Djibouti Yes No No No Yes
< “occupied Palestinian territory” should be
Egypt Yes No Yes No Yes
understood to refer to the “occupied Palestinian
territory, including east Jerusalem”. Iran (Islamic Republic of) Yes No No No No
$ Ban applies to ENDS only. Iraq Yes No No No No
Jordan Yes No Yes No Yes
Kuwait Yes No Yes No No
Lebanon Yes No Yes No Yes
Libya Yes No No No No
Morocco Yes No No No No
occupied Palestinian territory < Yes No No No No
Oman No — No No —
Pakistan Yes No No No Yes
Qatar Yes No Yes No No
Saudi Arabia Yes No No No Yes
Somalia No — No No —
Sudan No — Yes No —
Syrian Arab Republic Yes No No No Yes
Tunisia Yes No No No No
United Arab Emirates Yes No No No Yes
Yemen Yes No No No No

180 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ends/ennds in public places
smoking enforcement investigations
system

Yes No No No explicit ban on use No explicit ban on use

Yes No Yes No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes Yes Yes No explicit ban on use Use is banned in some public places
Yes No Yes No explicit ban on use Use is banned in all public places $
No No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No No Use is banned in all public places No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
Yes Yes No Use is banned in some public places Use is banned in some public places
No No No No explicit ban on use No explicit ban on use
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No Use is banned in all public places Use is banned in all public places
Yes No Yes No explicit ban on use No explicit ban on use
Yes No No Use is banned in some public places No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use

Annex 2: Regional summary of smoke-free measures | 181

Table A2.3.6 Signage Fines on the establishment

Western Required
signs identify

Pacific Region
Requirement For not For not
Country a telephone
to display non asking a For not posting
number or other
smoking signs patron removing no-smoking
mechanisms
in smoke-free to stop ashtrays signs
Additional characteristics places
for the public
to report
smoking
of smoking bans violations

– Data not required/not applicable. Australia No — Yes 1 No —

$ Ban applies to ENDS only. Brunei Darussalam Yes Yes Yes No Yes
1 Ban/measure is in effect in all subnational Cambodia Yes Yes Yes Yes Yes
jurisdictions. China No — Yes No —
Cook Islands Yes No Yes No Yes
Fiji Yes No Yes No Yes
Japan No — Yes No —
Kiribati Yes No Yes No Yes
Lao People's Democratic
Yes No No No No
Republic
Malaysia Yes No Yes No Yes
Marshall Islands Yes No Yes No Yes
Micronesia (Federated
Yes 1
No No No No
States of)
Mongolia Yes Yes No No Yes
Nauru Yes No Yes No Yes
New Zealand No — Yes No —
Niue Yes No Yes No Yes
Palau Yes No Yes No Yes
Papua New Guinea Yes No Yes No Yes
Philippines Yes Yes Yes Yes Yes
Republic of Korea Yes No Yes No Yes
Samoa Yes No Yes Yes Yes
Singapore Yes No Yes No Yes
Solomon Islands Yes No Yes Yes Yes
Tonga Yes No Yes No Yes
Tuvalu Yes No Yes No Yes
Vanuatu Yes No Yes No Yes
Viet Nam Yes No Yes No Yes

182 | WHO report on the global tobacco epidemic 2023

 Citizen
Fines on the Dedicated complaints
patron for funds for and Ban on use of HTPs in public places Ban on use of ends/ennds in public places
smoking enforcement investigations
system

Yes 1 No Yes 1 No explicit ban on use Use is banned in some public places $
Yes No Yes No explicit ban on use Use is banned in all public places
Yes No Yes Use is banned in all public places Use is banned in all public places
Yes No No Use is banned in some public places No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes No No Use is banned in some public places Use is banned in some public places
Yes No No Use is banned in some public places No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
No Yes No Use is banned in all public places Use is banned in all public places
Yes No Yes No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
No No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use
Yes Yes No No explicit ban on use No explicit ban on use
No No Yes Use is banned in all public places Use is banned in all public places
Yes No No No explicit ban on use Use is banned in all public places
Yes Yes No No explicit ban on use Use is banned in some public places $
Yes No No No explicit ban on use Use is banned in all public places $
Yes Yes No Use is banned in some public places Use is banned in some public places
Yes Yes Yes Use is banned in some public places Use is banned in some public places $
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes Use is banned in all public places Use is banned in all public places
Yes Yes No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use No explicit ban on use
Yes No No No explicit ban on use Use is banned in some public places
Yes No No No explicit ban on use No explicit ban on use
Yes Yes Yes No explicit ban on use No explicit ban on use

Annex 2: Regional summary of smoke-free measures | 183

© WHO/NOOR Sebastian Liste
Annex 3

Year of highest level of achievement in

selected tobacco control measures
Annex 3 provides information on the Years of highest level achievement See Technical Note III for details on the
year in which respective countries of the MPOWER measure Raise taxes calculation of tax shares.
attained the highest level of on tobacco are not included in this
achievement for five of the MPOWER Annex. The share of taxes in product
measures. Data are shown separately price depends both on tax policy and
for each WHO region. on demand and supply factors that
affect manufacturing and retail prices.
For Monitoring tobacco use the earliest
Countries with tax increases might have
year assessed is 2007. However, it is
seen the share of tax remain unchanged
possible that while 2007 is reported
or even decline if the non-tax share of
as the year of highest achievement for
price rose at the same, or a higher rate,
some countries, they actually may have
complicating the interpretation of the
reached this level earlier.
year of highest level of achievement.

Annex 3: Year of highest level of achievement in selected tobacco control measures | 185
Table A3.1
African Region Country

Year of highest level of

Algeria
achievement in selected Angola
tobacco control measures Benin
Botswana
Note: an empty cell indicates that the population is
not covered by the measure at the highest level of Burkina Faso
achievement. Burundi
Cabo Verde
Cameroon
Central African Republic
Chad
Comoros
Congo
Côte d'Ivoire
Democratic Republic of the Congo
Equatorial Guinea
Eritrea
Eswatini
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Madagascar
Malawi
Mali
Mauritania
Mauritius
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Somalia
South Africa
South Sudan
Togo
Uganda
United Republic of Tanzania
Zambia
Zimbabwe

186 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2018

2017 2021 2017

2010 2015
2018
2022
2018

2010 2015 2010

2012 2018
2019
2018

2004

2019 2022 2019 2019

2016 2019 2016

2018 2012
2012

2007

2013 2012 2003

2020 2018
2022 2022 2022 2008 2008

2010 2013
2019 2006
2019 2015

2016 2016
2009 2012 2009

2012
2015 2015

2022

Annex 3: Year of highest level of achievement in selected tobacco control measures | 187
Table A3.2
Region of Country

the Americas
Antigua and Barbuda
Year of highest level of Argentina
achievement in selected Bahamas
Barbados
tobacco control measures Belize
Note: an empty cell indicates that the population is Bolivia (Plurinational State of)
not covered by the measure at the highest level of Brazil
achievement.
Canada
* or earlier year.
Chile
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic
Ecuador
El Salvador
Grenada
Guatemala
Guyana
Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Paraguay
Peru
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Suriname
Trinidad and Tobago
United States
Uruguay
Venezuela (Bolivarian Republic of)

188 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2018 2018
2011 2012

2010 2017

2020 2009
2015 2011 2002 2003 2011
2007* 2007 2008 2011
2007* 2013 2006
2008 2009
2008 2012 2018 2013

2014 2011 2012

2022 2015 2011

2008
2017 2018 2017

2010 2017
2013 2016 2013
2021 2014 2009 2021

2008 2005 2008

2020
2008 2010 2010

2020 2017

2013 2016 2013

2009 2013
2007* 2008
2007* 2005 2005 2014
2011 2004 2019

Annex 3: Year of highest level of achievement in selected tobacco control measures | 189
Table A3.3
South-East Country

Asia Region
Bangladesh
Year of highest level of Bhutan
achievement in selected Democratic People's Republic of Korea
India
tobacco control measures Indonesia
Note: an empty cell indicates that the population is Maldives
not covered by the measure at the highest level of Myanmar
achievement.
Nepal
Policy adopted but not implemented by 31
December 2022. Sri Lanka
* or earlier year. Thailand
Timor-Leste

190 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2015
2014

2016 2016
2015
2010
2021
2011 2011 2014
2018 2012
2007* 2010 2005
2018

Annex 3: Year of highest level of achievement in selected tobacco control measures | 191
Table A3.4
European Region Country

Year of highest level of

Albania
achievement in selected Andorra
tobacco control measures Armenia
Austria
Note: an empty cell indicates that the population is Azerbaijan
not covered by the measure at the highest level of
Belarus
achievement.
Belgium
Policy adopted but not implemented by
31 December 2022. Bosnia and Herzegovina
* or earlier year. Bulgaria
Croatia
Cyprus
Czechia
Denmark
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Israel
Italy
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
Luxembourg
Malta
Monaco
Montenegro
Netherlands (Kingdom of the)
North Macedonia
Norway
Poland
Portugal
Republic of Moldova
Romania
Russian Federation
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Tajikistan
Türkiye
Turkmenistan
Ukraine
United Kingdom
Uzbekistan

192 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2006 2020 2006

2007* 2016 2020

2007* 2020 2016
2014 2017
2021 2016
2007* 2016

2007* 2012 2016

2010 2017
2014 2017
2012 2018 2016
2007* 2011 2016
2008 2016
2012 2016 2016
2007* 2016
2012 2018
2007* 2016
2007* 2010 2016
2010 2016
2007* 2006
2007* 2004 2003 2016
2022
2007* 2016
2008 2014
2021 2014 2021
2007* 2016
2008 2016
2010 2016 2017
2007* 2010 2016

2014 2018
2007* 2021 2014 2016 2021
2008
2012 2013
2007* 2016
2007* 2015
2013 2015 2015 2015
2008 2015 2022 2016
2007* 2013 2014 2013

2010
2007* 2018 2016
2007* 2017 2017
2007* 2010 2017 2010
2007* 2018 2016
2007*
2018 2018 2018
2007* 2008 2010 2012 2012
2000 2014
2007* 2021 2009 2021
2007* 2006 2016

Annex 3: Year of highest level of achievement in selected tobacco control measures | 193
Table A3.5
Eastern Country or territory

Mediterranean
Region Afghanistan
Bahrain

Year of highest level of Djibouti

Egypt
achievement in selected Iran (Islamic Republic of)
tobacco control measures Iraq
Jordan
Note: an empty cell indicates that the population is
Kuwait
not covered by the measure at the highest level of
achievement. Lebanon
* or earlier year. Libya
< “occupied Palestinian territory” should be Morocco
understood to refer to “occupied Palestinian
occupied Palestinian territory <
territory, including East Jerusalem”.
Oman
Pakistan
Qatar
Saudi Arabia
Somalia
Sudan
Syrian Arab Republic
Tunisia
United Arab Emirates
Yemen

194 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2015 2015
2011
2008 2007
2010 2008
2007* 2007 2022 2008 2007
2014 2020
2020 2020 2020
2012 2016
2013 2011
2009 2009

2011 2011

2009 2017
2019 2016
2018 2017 2017

2021

2008 2013
2013

Annex 3: Year of highest level of achievement in selected tobacco control measures | 195
Table A3.6
Western Country

Pacific Region
Australia
Year of highest level of Brunei Darussalam
achievement in selected Cambodia
China
tobacco control measures Cook Islands
Note: an empty cell indicates that the population is Fiji
not covered by the measure at the highest level of Japan
achievement.
Kiribati
* or earlier year.
Lao People's Democratic Republic
Malaysia
Marshall Islands
Micronesia (Federated States of)
Mongolia
Nauru
New Zealand
Niue
Palau
Papua New Guinea
Philippines
Republic of Korea
Samoa
Singapore
Solomon Islands
Tonga
Tuvalu
Vanuatu
Viet Nam

196 | WHO report on the global tobacco epidemic 2023

 Year the highest level of achievement was attained

Monitor tobacco use Protect people from tobacco Offer help to quit tobacco use Warn about the dangers of Enforce bans on tobacco
smoke tobacco advertising, promotion and
sponsorship

2007* 2005 2004

2014 2012 2007
2012 2016 2016
2019
2007* 2020
2013
2007*
2013
2015 2016 2016 2021
2010 2008
2006

2009 2012 2012

2009
2007* 2003 2000 2007
2018 2018
2010
2012
2007* 2020 2014
2007* 2006
2013
2008 1999 2012
2013
2020
2008
2013 2008
2012 2013

Annex 3: Year of highest level of achievement in selected tobacco control measures | 197
© WHO/Zakarya Safari
Annex 4

Highest level of achievement in

selected tobacco control measures
in the 100 biggest cities in the world
Annex 4 provides information on Where a large “city” includes several Refer to Technical Note I for definitions
whether the populations of the world’s jurisdictions or parts of jurisdictions, it is of highest level of achievement.
100 biggest cities are covered by possible that not everyone in the entire
selected tobacco control measures at “city” is covered by the same laws. We
the highest level of achievement. therefore use the list of cities and their
populations published in the United
Cities are listed alphabetically. There
Nations Statistics Division Demographic
are many ways to define geographically
Yearbook, since these are defined
and measure the size of “a city”. For the
jurisdictionally. Please refer to https://
purposes of this report, we focused on
unstats.un.org/unsd/demographic-
the jurisdictional boundaries of cities,
social/products/dyb/dyb_2021/ for the
since subnational laws will apply to
source data.
populations within jurisdictions.

Annex 4: Highest level of achievement in selected tobacco control measures in the 100 biggest cities | 199
Table A4 Coverage at the highest level of achievement

Highest level of City Population Protect people from Offer help to quit tobacco
achievement in selected tobacco smoke use

tobacco control measures Abidjan 5 467 296

in the 100 biggest cities* Adana 2 258 718 N N
in the world Addis Ababa 3 774 000 N N
Ahmadabad 5 633 927 N
* Only cities which appear among the top 100 Aleppo 4 450 000
cities globally, sorted by population size,
according to the United Nations Statistics Division Alexandria 5 163 750 N
Demographic Yearbook 2021 (available at: Algiers 2 712 944
https://unstats.un.org/unsd/demographic-social/
products/dyb/dyb_2021/). Amman 3 999 008 N N
Policy adopted but not implemented by 31 Ankara 5 663 322 N N
December 2022. Antalya 2 548 308 N N
Baku 2 285 273
City’s population is covered by
N national legislation or policy at the Bandung 2 444 160 C
highest level of achievement. Bangkok 8 392 556 N
City’s population is covered by Beijing 18 796 000 C
S state-level legislation or policy at the Belo Horizonte 2 530 701 N N
highest level of achievement.
Bengaluru 8 495 492 N
City’s population is covered by Berlin 3 644 826
C city-level legislation or policy at the
Bogotá 7 834 167 N
highest level of achievement.
Brasília 3 094 325 N N
Note: an empty cell indicates that the population is
not covered by the measure at the highest level of Brisbane 2 560 720 S S
achievement. Buenos Aires 15 567 820 N
Bursa 3 101 833 N N
Busan 3 343 528 N
Cairo 9 539 673 N
Cali 2 264 748 N
Casablanca (Dar-el-Beida) 3 566 020
Chennai 4 646 732 N
Chicago 2 696 555 N
Chittagong 2 591 681
Daegu 2 419 246 N
Damasus Rural (Rif Dimashq) 2 529 000
Dar es Salaam 5 147 070
Delhi 11 034 555 N
Dhaka 8 906 035
Douala 3 322 170
Faisalabad 3 203 846 N
Fortaleza 2 703 391 N N
Guadalajara 5 268 642 N N
Guayaquil 2 652 684 N
Hanoi 8 246 540
Ho Chi Minh City 9 227 598
Hong Kong SAR 7 413 100 C C
Houston 2 288 250 N
Hyderabad 6 993 262 S N
Incheon 2 951 030 N
Istanbul 15 462 452 N N
Izmir 4 394 694 N N
Jaipur 3 046 163 N
Jakarta 10 562 088 C
Jiddah 3 430 697 N
Kabul 4 775 074 N
Kanpur 2 768 057 N
Karachi 14 910 352 N

200 | WHO report on the global tobacco epidemic 2023

 Coverage at the highest level of achievement

Warn about the dangers of Enforce bans on tobacco Raise taxes on tobacco Country
tobacco advertising, promotion and
sponsorship

N Côte d'Ivoire
N N N Türkiye
N N Ethiopia
N India
Syrian Arab Republic
N Egypt
N Algeria
N N Jordan
N N N Türkiye
N N N Türkiye
N Azerbaijan
Indonesia
N N Thailand
China
N N N Brazil
N India
N Germany
N Colombia
N N N Brazil
N N Australia
N N Argentina
N N N Türkiye
Republic of Korea
N Egypt
N Colombia
N Morocco
N India
United States
N Bangladesh
Republic of Korea
Syrian Arab Republic
United Republic of Tanzania
N India
N Bangladesh
N Cameroon
N Pakistan
N N N Brazil
N N Mexico
N Ecuador
N Viet Nam
N Viet Nam
C China, Hong Kong SAR
United States
N India
Republic of Korea
N N N Türkiye
N N N Türkiye
N India
Indonesia
N N Saudi Arabia
N Afghanistan
N India
N Pakistan

Annex 4: Highest level of achievement in selected tobacco control measures in the 100 biggest cities in the world | 201
Table A4 (continued) Coverage at the highest level of achievement

Highest level of City Population Protect people from Offer help to quit tobacco
achievement in selected tobacco smoke use

tobacco control measures Kolkata 4 496 694 N

in the 100 biggest cities* Kyiv 2 893 215 N
in the world Lahore 11 126 285 N
Lima 10 922 735 N
* Only cities which appear among the top 100 London 8 135 667 S C
cities globally, sorted by population size,
according to the United Nations Statistics Division Los Angeles 3 849 297 S N
Demographic Yearbook 2021 (available at: Lucknow 2 817 105 N
https://unstats.un.org/unsd/demographic-social/
products/dyb/dyb_2021/). Madrid 3 320 069 N
Policy adopted but not implemented by 31 Manaus 2 255 903 N N
December 2022. Mashhad 3 001 184 N N
Medan 2 435 252 C
City’s population is covered by
N national legislation or policy at the Medellín 2 573 220 N
highest level of achievement. Melbourne 5 159 211 S S
City’s population is covered by Mexico City 21 804 515 N N
S state-level legislation or policy at the Monterrey 5 341 177 N N
highest level of achievement.
Moscow 11 918 057 N
City’s population is covered by Mumbai 12 442 373 N
C city-level legislation or policy at the
Nagoya 2 332 176
highest level of achievement.
Nagpur 2 405 665 N
Note: an empty cell indicates that the population is
not covered by the measure at the highest level of Nairobi 4 395 749
achievement. Nakhon Ratchasima 2 477 991 N
New York 8 467 513 N
Osaka 2 752 412
Ouagadougou 2 415 266 N
Puebla-Tlaxcala 3 199 530 N N
Pune 3 124 458 N
Pyongyang 2 581 076
Quezon City 2 960 048 N
Rio De Janeiro 6 775 561 N N
Riyadh 5 188 286 N
Rome 2 789 260
Saint Petersburg 4 990 602 N
Salvador 2 900 319 N N
São Paulo 12 396 372 N N
Seoul 9 601 693 N
Singapore 5 453 566 N
Surabaya 2 874 314
Surat 4 501 610 N
Sydney 5 367 206 S S
Tashkent 2 694 378
Tehran 8 693 706 N N
Tokyo 9 733 276
Toluca 2 353 924 N N
Toronto 2 974 293 S N
Yangon 5 211 431
Yaounde 3 255 651
Yokohama 3 777 491

202 | WHO report on the global tobacco epidemic 2023

 Coverage at the highest level of achievement

Warn about the dangers of Enforce bans on tobacco Raise taxes on tobacco Country
tobacco advertising, promotion and
sponsorship

N India
N N Ukraine
N Pakistan
N Peru
N N United Kingdom
United States
N India
N N N Spain
N N N Brazil
N N Iran (Islamic Republic of)
Indonesia
N Colombia
N N Australia
N N Mexico
N N Mexico
N N Russian Federation
N India
Japan
N India
N Kenya
N N Thailand
United States
Japan
N Burkina Faso
N N Mexico
N India
Democratic People's Republic of Korea
N Philippines
N N N Brazil
N N Saudi Arabia
N N Italy
N N Russian Federation
N N N Brazil
N N N Brazil
Republic of Korea
N Singapore
Indonesia
N India
N N Australia
Uzbekistan
N N Iran (Islamic Republic of)
Japan
N N Mexico
N Canada
N Myanmar
N Cameroon
Japan

Annex 4: Highest level of achievement in selected tobacco control measures in the 100 biggest cities in the world | 203
© WHO/Panos Pictures Saiyna Bash
Annex 5

Status of the WHO Framework

Convention on Tobacco Control
and of the Protocol to Eliminate
Illicit Trade in Tobacco Products
Annex 5 shows the status of the WHO Signature of a convention indicates The Protocol to Eliminate Illicit Trade
Framework Convention on Tobacco that a country is not legally bound in Tobacco Products entered into force
Control (WHO FCTC) and of the by the treaty but is committed not to on 25 September 2018. It is subject
Protocol to Eliminate Illicit Trade in undermine its provisions. to ratification, acceptance, approval
Tobacco Products. or accession by States and to formal
The WHO FCTC entered into force on
confirmation or accession by regional
Ratification is the international act 27 February 2005. The treaty remains
economic integration organizations
by which countries that have already open for ratification, acceptance,
that are Party to the WHO Framework
signed a convention formally state their approval, formal confirmation and
Convention on Tobacco Control.
consent to be bound by it. Accession is accession indefinitely for States and
the international act by which countries eligible regional economic integration
that have not signed a treaty/convention organizations wishing to become
formally state their consent to be bound Parties to it.
by it. Acceptance and approval are the
legal equivalent to ratification.

Annex 5: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate | 205
Table A5
Status of WHO Member Country

States with regard to

the WHO Framework Afghanistan
Albania
Convention on Tobacco
Algeria
Control and the Protocol Andorra
to Eliminate Illicit Trade Angola

in Tobacco Products as Antigua and Barbuda

Argentina
at 1 June 2023 Armenia

* Ratification is the international act by which Australia

countries that have already signed a treaty or Austria
convention formally state their consent to be
Azerbaijan
bound by it.
a Accession is the international act by which Bahamas
countries that have not signed a treaty/ Bahrain
convention formally state their consent to be
Bangladesh
bound by it.
A Acceptance is the international act, similar to Barbados
ratification, by which countries that have already Belarus
signed a treaty/convention formally state their
consent to be bound by it.
Belgium

AA Approval is the international act, similar to Belize

ratification, by which countries that have already Benin
signed a treaty/convention formally state their
consent to be bound by it. Bhutan
c Formal confirmation is the international act Bolivia (Plurinational State of)
corresponding to ratification by a State, whereby Bosnia and Herzegovina
an international organization (in the case of
the WHO FCTC, competent regional economic Botswana
integration organizations) formally state their Brazil
consent to be bound by a treaty/convention.
Brunei Darussalam
d Succession is the international act, however
phrased or named, by which successor States Bulgaria
formally state their consent to be bound by Burkina Faso
treaties/conventions originally entered.
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czechia
Democratic People's Republic of Korea
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt

206 | WHO report on the global tobacco epidemic 2023

WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products

Date of signature Date of ratification* Date of signature Date of ratification*

(or legal equivalent) (or legal equivalent)

29 Jun 2004  13 Aug 2010 

29 Jun 2004  26 Apr 2006 
20 Jun 2003  30 Jun 2006 
11 May 2020 a
29 Jun 2004  20 Sept 2007 
28 Jun 2004   5 Jun 2006 
25 Sept 2003 
29 Nov 2004 a
 5 Dec 2003  27 Oct 2004 
28 Aug 2003  15 Sept 2005   9 Jan 2014 28 Oct 2014
 1 Nov 2005 a
29 Jun 2004   3 Nov 2009 
20 Mar 2007 a
16 Jun 2003  14 Jun 2004 
28 Jun 2004   3 Nov 2005 
17 Jun 2004   8 Sept 2005 
22 Jan 2004   1 Nov 2005  17 May 2013 22 Feb 2019
26 Sept 2003  15 Dec 2005 
18 Jun 2004   3 Nov 2005  24 Sept 2013  6 Jul 2018
 9 Dec 2003  23 Aug 2004 
27 Feb 2004  15 Sept 2005 
10 Jul 2009 a
16 Jun 2003  31 Jan 2005   1 Oct 2013
16 Jun 2003   3 Nov 2005  14 Jun 2018 a
 3 Jun 2004   3 Jun 2004 
22 Dec 2003   7 Nov 2005 
22 Dec 2003  31 Jul 2006   8 Mar 2013 30 Mar 2016
16 Jun 2003  22 Nov 2005 
17 Feb 2004   4 Oct 2005  16 Oct 2019 a
25 May 2004  15 Nov 2005 
13 May 2004   3 Feb 2006 
15 Jul 2003  26 Nov 2004 
29 Dec 2003   7 Nov 2005 
22 Jun 2004  30 Jan 2006  13 Jun 2018 a
25 Sept 2003  13 Jun 2005 
10 Nov 2003  11 Oct 2005  10 Jan 2013
10 Apr 2008 a 21 Feb 2013
27 Feb 2004  24 Jan 2006  14 Oct 2016 a
23 Mar 2004   6 Feb 2007  14 May 2015 a
14 May 2004  14 May 2004 
 3 Jul 2003  21 Aug 2008  21 Mar 2013  7 Mar 2017
24 Jul 2003  13 Aug 2010  24 Sept 2013 25 May 2016
 2 Jun 2004  14 Jul 2008  10 Jun 2019 a
29 Jun 2004 
24 May 2004  26 Oct 2005  23 Oct 2013 29 Aug 2017
16 Jun 2003   1 Jun 2012  12 Jul 2019 a
17 Jun 2003  27 Apr 2005 
28 Jun 2004  28 Oct 2005   9 Dec 2013
16 Jun 2003  16 Dec 2004   7 Jan 2014
13 May 2004  31 Jul 2005 
29 Jun 2004  24 Jul 2006 

22 Mar 2004  25 Jul 2006  25 Sept 2013 15 Oct 2015

17 Jun 2003  25 Feb 2005  10 Sept 2020 a

Annex 5: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate illicit trade in tobacco products | 207
Table A5 (continued)
Status of WHO Member Country

States with regard to

the WHO Framework El Salvador
Equatorial Guinea
Convention on Tobacco
Eritrea
Control and the Protocol Estonia
to Eliminate Illicit Trade Eswatini

in Tobacco Products as Ethiopia

Fiji
at 1 June 2023 Finland

* Ratification is the international act by which France

countries that have already signed a treaty or Gabon
convention formally state their consent to be
Gambia
bound by it.
a Accession is the international act by which Georgia
countries that have not signed a treaty/ Germany
convention formally state their consent to be
Ghana
bound by it.
A Acceptance is the international act, similar to Greece
ratification, by which countries that have already Grenada
signed a treaty/convention formally state their
consent to be bound by it.
Guatemala

AA Approval is the international act, similar to Guinea

ratification, by which countries that have already Guinea-Bissau
signed a treaty/convention formally state their
consent to be bound by it. Guyana
c Formal confirmation is the international act Haiti
corresponding to ratification by a State, whereby Honduras
an international organization (in the case of
the WHO FCTC, competent regional economic Hungary
integration organizations) formally state their Iceland
consent to be bound by a treaty/convention.
India
d Succession is the international act, however
phrased or named, by which successor States Indonesia
formally state their consent to be bound by Iran (Islamic Republic of)
treaties/conventions originally entered.
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands

208 | WHO report on the global tobacco epidemic 2023

WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products

Date of signature Date of ratification* Date of signature Date of ratification*

(or legal equivalent) (or legal equivalent)

18 Mar 2004  21 Jul 2014 

17 Sept 2005 a

 8 Jun 2004  27 Jul 2005 

29 Jun 2004  13 Jan 2006  21 Sept 2016 a
25 Feb 2004  25 Mar 2014 
 3 Oct 2003   3 Oct 2003  11 Jul 2013 24 Apr 2019
16 Jun 2003  24 Jan 2005  25 Sept 2013
16 Jun 2003  19 Oct 2004 AA 10 Jan 2013 30 Nov 2015
22 Aug 2003  20 Feb 2009  10 Jan 2013  1 Oct 2014 A
16 Jun 2003  18 Sept 2007  26 Sept 2016 a
20 Feb 2004  14 Feb 2006 
24 Oct 2003  16 Dec 2004   1 Oct 2013 31 Oct 2017
20 Jun 2003  29 Nov 2004  24 Sept 2013 22 Oct 2021
16 Jun 2003  27 Jan 2006   9 Jul 2013 24 May 2021
29 Jun 2004  14 Aug 2007 
25 Sept 2003  16 Nov 2005 
 1 Apr 2004   7 Nov 2007   9 May 2017 a
 7 Nov 2008 a 24 Sept 2013
15 Sept 2005 a
23 Jul 2003 
18 Jun 2004  16 Feb 2005 
16 Jun 2003   7 Apr 2004  23 Jun 2020 a
16 Jun 2003  14 Jun 2004 
10 Sept 2003   5 Feb 2004   5 Jun 2018 a

16 Jun 2003   6 Nov 2005   7 Jan 2014 27 Aug 2018

29 Jun 2004  17 Mar 2008   2 Dec 2015 a
16 Sept 2003   7 Nov 2005  20 Dec 2013
20 Jun 2003  24 Aug 2005  23 Dec 2013
16 Jun 2003   2 Jul 2008 
24 Sept 2003   7 Jul 2005 
 9 Mar 2004   8 Jun 2004 A
28 May 2004  19 Aug 2004 
21 Jun 2004  22 Jan 2007 
25 Jun 2004  25 Jun 2004  29 May 2013  4 May 2020
27 Apr 2004  15 Sept 2005 
16 Jun 2003  12 May 2006  11 Nov 2013 21 Feb 2019
18 Feb 2004  25 May 2006 
29 Jun 2004   6 Sept 2006 
10 May 2004  10 Feb 2005   4 Feb 2016 a
 4 Mar 2004   7 Dec 2005 
23 Jun 2004  14 Jan 2005 
25 Jun 2004  15 Sept 2009 
18 Jun 2004   7 Jun 2005  10 Jan 2013
22 Sept 2003  16 Dec 2004   6 Sept 2013 14 Dec 2016
16 Jun 2003  30 Jun 2005  25 Jul 2019 a
24 Sept 2003  22 Sept 2004  25 Sept 2013 21 Sept 2017

23 Sept 2003  16 Sept 2005 

17 May 2004  20 May 2004 
23 Sept 2003  19 Oct 2005   8 Jan 2014 17 Jun 2016
16 Jun 2003  24 Sept 2003   2 Aug 2018 a
16 Jun 2003   8 Dec 2004 

Annex 5: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate illicit trade in tobacco products | 209
Table A5 (continued)
Status of WHO Member Country

States with regard to

the WHO Framework Mauritania
Mauritius
Convention on Tobacco
Mexico
Control and the Protocol Micronesia (Federated States of)
to Eliminate Illicit Trade Monaco

in Tobacco Products as Mongolia

Montenegro
at 1 June 2023 Morocco

* Ratification is the international act by which Mozambique

countries that have already signed a treaty or Myanmar
convention formally state their consent to be
Namibia
bound by it.
a Accession is the international act by which Nauru
countries that have not signed a treaty/ Nepal
convention formally state their consent to be
Netherlands (Kingdom of the)
bound by it.
A Acceptance is the international act, similar to New Zealand
ratification, by which countries that have already Nicaragua
signed a treaty/convention formally state their
consent to be bound by it.
Niger

AA Approval is the international act, similar to Nigeria

ratification, by which countries that have already Niue
signed a treaty/convention formally state their
consent to be bound by it. North Macedonia
c Formal confirmation is the international act Norway
corresponding to ratification by a State, whereby Oman
an international organization (in the case of
the WHO FCTC, competent regional economic Pakistan
integration organizations) formally state their Palau
consent to be bound by a treaty/convention.
Panama
d Succession is the international act, however
phrased or named, by which successor States Papua New Guinea
formally state their consent to be bound by Paraguay
treaties/conventions originally entered.
Peru
Philippines
Poland
Portugal
Qatar
Republic of Korea
Republic of Moldova
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa

210 | WHO report on the global tobacco epidemic 2023

WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products

Date of signature Date of ratification* Date of signature Date of ratification*

(or legal equivalent) (or legal equivalent)

24 Jun 2004  28 Oct 2005 

17 Jun 2003  17 May 2004  26 Jun 2018 a
12 Aug 2003  28 May 2004 
28 Jun 2004  18 Mar 2005 

16 Jun 2003  27 Jan 2004   1 Nov 2013  8 Oct 2014

23 Oct 2006 d  1 Jul 2013 11 Oct 2017
16 Apr 2004 
18 Jun 2003  14 Jul 2017
23 Oct 2003  21 Apr 2004  10 Jan 2013
29 Jan 2004   7 Nov 2005 
29 Jun 2004 a
 3 Dec 2003   7 Nov 2006 
16 Jun 2003  27 Jan 2005 A  6 Jan 2014  3 Jul 2020 A
16 Jun 2003  27 Jan 2004 
 7 Jun 2004   9 Apr 2008  10 Jan 2013 20 Dec 2013
28 Jun 2004  25 Aug 2005  12 Jul 2017 a
28 Jun 2004  20 Oct 2005   8 Mar 2019 a
18 Jun 2004   3 Jun 2005 
30 Jun 2006 a  8 Jan 2014
16 Jun 2003  16 Jun 2003 AA 16 Oct 2013 29 Jun 2018
 9 Mar 2005 a
18 May 2004   3 Nov 2004  29 Jun 2018 a
16 Jun 2003  12 Feb 2004 
26 Sept 2003  16 Aug 2004  10 Jan 2013 23 Sept 2016
22 Jun 2004  25 May 2006 
16 Jun 2003  26 Sept 2006  27 Sept 2022 a
21 Apr 2004  30 Nov 2004 
23 Sept 2003   6 Jun 2005 
14 Jun 2004  15 Sept 2006 
 9 Jan 2004   8 Nov 2005 AA  8 Jan 2014 22 Jul 2015
17 Jun 2003  23 Jul 2004  18 Jun 2013  2 Jul 2018
21 Jul 2003  16 May 2005  10 Jan 2013
29 Jun 2004   3 Feb 2009  10 May 2022 a
25 Jun 2004  27 Jan 2006 
 3 Jun 2008 a
 2 Jun 2004  19 Oct 2005  19 May 2023 a
29 Jun 2004  21 Jun 2011 
29 Jun 2004   7 Nov 2005 
14 Jun 2004  29 Oct 2010 
25 Sept 2003   3 Nov 2005  29 Jun 2018 a
26 Sept 2003   7 Jul 2004 
18 Jun 2004  12 Apr 2006 
24 Jun 2004   9 May 2005   9 Oct 2015 a
19 Jun 2003  27 Jan 2005  31 Aug 2016 a
28 Jun 2004   8 Feb 2006  30 Jun 2017 a
11 Sept 2003  12 Nov 2003   7 Jan 2020 a
22 May 2009 a
29 Dec 2003  14 May 2004 
19 Dec 2003   4 May 2004  25 Sept 2017 a
25 Sept 2003  15 Mar 2005   6 Jan 2014
18 Jun 2004  10 Aug 2004 

16 Jun 2003  19 Apr 2005  10 Jan 2013

Annex 5: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate illicit trade in tobacco products | 211
Table A5 (continued)
Status of WHO Member Country

States with regard to

the WHO Framework South Sudan
Spain
Convention on Tobacco
Sri Lanka
Control and the Protocol Sudan
to Eliminate Illicit Trade Suriname

in Tobacco Products as Sweden

Switzerland
at 1 June 2023 Syrian Arab Republic

* Ratification is the international act by which Tajikistan

countries that have already signed a treaty or Thailand
convention formally state their consent to be
Timor-Leste
bound by it.
a Accession is the international act by which Togo
countries that have not signed a treaty/ Tonga
convention formally state their consent to be
Trinidad and Tobago
bound by it.
A Acceptance is the international act, similar to Tunisia
ratification, by which countries that have already Türkiye
signed a treaty/convention formally state their
consent to be bound by it.
Turkmenistan

AA Approval is the international act, similar to Tuvalu

ratification, by which countries that have already Uganda
signed a treaty/convention formally state their
consent to be bound by it. Ukraine
c Formal confirmation is the international act United Arab Emirates
corresponding to ratification by a State, whereby United Kingdom
an international organization (in the case of
the WHO FCTC, competent regional economic United Republic of Tanzania
integration organizations) formally state their United States
consent to be bound by a treaty/convention.
Uruguay
d Succession is the international act, however
phrased or named, by which successor States Uzbekistan
formally state their consent to be bound by Vanuatu
treaties/conventions originally entered.
Venezuela (Bolivarian Republic of)
Viet Nam
Yemen
Zambia
Zimbabwe

212 | WHO report on the global tobacco epidemic 2023

WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products

Date of signature Date of ratification* Date of signature Date of ratification*

(or legal equivalent) (or legal equivalent)

16 Jun 2003  11 Jan 2005  23 Dec 2014 a

23 Sept 2003  11 Nov 2003   8 Feb 2016 a
10 Jun 2004  31 Oct 2005  30 Sept 2013
24 Jun 2004  16 Dec 2008 
16 Jun 2003   7 Jul 2005   6 Jan 2014  9 Jul 2019
25 Jun 2004 
11 Jul 2003  22 Nov 2004  10 Jan 2013
21 Jun 2013 a
20 Jun 2003   8 Nov 2004 
25 May 2004  22 Dec 2004 
12 May 2004  15 Nov 2005   9 Jan 2014 31 Jan 2018
25 Sept 2003   8 Apr 2005 
27 Aug 2003  19 Aug 2004 
22 Aug 2003   7 Jun 2010  11 Jan 2013
28 Apr 2004  31 Dec 2004  10 Jan 2013 26 Apr 2018
13 May 2011 a 30 Mar 2015 a
10 Jun 2004  26 Sept 2005 
 5 Mar 2004  20 Jun 2007 
25 Jun 2004   6 Jun 2006 
24 Jun 2004   7 Nov 2005 
16 Jun 2003  16 Dec 2004  17 Dec 2013 27 Jun 2018
27 Jan 2004  30 Apr 2007  24 Sept 2013
10 May 2004 
19 Jun 2003   9 Sept 2004  10 Jan 2013 24 Sept 2014
15 May 2012 a
22 Apr 2004  16 Sept 2005 
22 Sept 2003  27 Jun 2006 
 3 Sept 2003  17 Dec 2004 
20 Jun 2003  22 Feb 2007   7 Jan 2014
23 May 2008 a
 4 Dec 2014 a

Annex 5: Status of the WHO Framework Convention on Tobacco Control and of the Protocol to Eliminate illicit trade in tobacco products | 213
214 | WHO report on the global tobacco epidemic 2023
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was made possible by funding
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