This week the World Health Organization and Bloomberg Philanthropies issued their biennial report card on progress towards the MPOWER tobacco-control goals.
The MPOWER model was implemented by WHO and the Bloomberg Philanthropies as a way to track the global tobacco epidemic and the impact of measures intended to address it.
The first report was made public in 2008, with subsequent reports in 2009, 2011, 2013, 2015, 2017, 2019 and 2021
MPOWER focuses on core tobacco control measures that are complementary to, but a subset of, the obligations in the Framework Convention on Tobacco Control. They are:
M - MONITOR tobacco use and prevention policies
P - PROTECT people from tobacco smoke
O - OFFER help to quit tobacco
W - WARN about the dangers of tobacco (assessed for pack warnings and mass media)
E - ENFORCE bans on tobacco advertising, promotion and sponsorship
R - RAISE taxes on tobacco.
Canada has a high level of achievement in 3½ of the MPOWER measures
The World Health Organization ranks Canada among the countries with highest level of implementation for:
- M Monitoring tobacco use (along with 73 other countries)
- P Smoke-free environments (along with 73 other countries)
- O cessation programs (along with 31 other countries)
- W pack warnings (with 102 other countries).
Canada was considered to be at the second implementation level for the other objectives:
- W mass media (36 countries do better)
- E advertising bans (65 countries do better)
- R taxation (41 countries do better)
Four countries were ranked with highest level achievement in all six measures (Brazil, Turkiye, Netherlands, Mauritius). Other countries with higher overall levels of implementation than Canada are Ethiopia, Iran, Ireland, Jordan, Madagascar, Mexico, New Zealand and Spain.
This year's report also provided information on related measures. Canada was identified among the 58 countries with highest-level achievement in implementing a national level tobacco control program and among the 87 countries which have regulated electronic nicotine delivery systems (ENDS or e-cigarettes).
Canada's progress towards the MPOWER goals appears to have stalled over the past 15 years. Compiling score from all nine reports shows that Canada has increased its level of achievement in only one area (mass media) in the past decade, and has failed to implement policies on taxation or public education at the MPOWER standard. Nonetheless, age-standardized adult prevalence as measured by WHO has continued to fall.
Canada's taxes on tobacco are lower than in most other OECD countries.
The World Health Organization recommends that 75% of the purchase price of tobacco products be composed of taxes. Its assessment of tobacco taxes in Canada took note of the varying tax rates across the country, but found that overall taxes represented only 63.3% of purchase price.
Among the 38 countries with developed economies that are members of the OECD, 23 countries exceeded this target. Canada did not. Canada ranked sixth from the bottom among these countries. (see our Figure using WHO data below)
Canada's daily smoking rate is lower than in most OECD countries
To compare smoking rates across countries, the WHO team made adjustments to account for differences in age distribution and survey methods.
Traditionally, Canada measures smoking rates by considering only cigarette smoking (and not cigars, pipes, hookah or other forms of smoked tobacco. Smoking rates in Canada are usually stated as 'current smoking', meaning people who smoke on a daily or occasional basis.
The WHO team found that the age-standardized daily tobacco smoking prevalence in 2022 among people aged 15 or older for Canada was 9%. By way of comparison, Statistics Canada estimates are very similar, suggesting 8.4% of Canadians over 12 years of age smoked cigarettes daily in 2021.
Among the 38 OECD countries, Canada had the fifth lowest smoking rate - as shown below.
Canada has implemented many - but not all - of the measures WHO recommends for regulating e-cigarettes.
The World Health Organization is increasingly concerned about the marketing of electronic nicotine devices (ENDS) to children, an issue not foreseen when the MPOWER model and the FCTC were first developed.
In this year's report, for example, the WHO warns that "ENDS are addictive and harmful, particularly for young people", and that "ENDS undermine tobacco control progress and threaten smoke-free environments. The report notes that 121 countries have adopted measures to address these products, with 34 banning the sale of ENDS and 87 countries permitting a regulated market.
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| From MPOWER report 2023 Measures to Regulate ENDS 2022 |
Some of the ENDS regulations recommended by the WHO have been implemented in Canada - including bans on using them in public indoor places, workplaces and public transport, requirements for warning labels, bans on sale to minors and taxation. One WHO recommendation that has not yet been implemented across Canada is a ban on flavours.
