ENSPECTC Paris 2020 Denormalization of tobacco a reality

ENSP/ECTC Paris 2020 Denormalization of tobacco, a reality for all ? The belgian case Bizel Pierre, Berra Paul, Massot Christian, Barthe-Batsalle Helen 1

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Ranking in Tobacco control scale 2019 5 OSH -. . .

Much of the reduction in the prevalence of tobacco use can be attributed to long-term policies, most of them adopted during the last thirty years at the federal and regional levels such as: • - legal measures : smoking ban in schools, workplace, indoor public place, car when a minor is present, advertising ban, neutral packaging, gradual increase in taxation; • - support of tobacco-cessation services, systematic health care professional advice, assistance help centres, quit line, media campaign, education programmes, … 6

Fumeurs quotidiens Daily smokers Sciensano Enquêtes Santé 30 27, 6 26, 1 25 25, 5 24, 1 20 18, 8 15, 4 15 13, 4 10 Belgique Wallonie Hainaut Flandre 5 0 1997 7 2001 2004 2008 2013 OSH -. . . 2018

• A social process to denormalize tobacco use has been implemented and produced definite results. • For instance, in the region of Wallonia, smoking prevalence is currently at 19% (daily smokers) while in the northern part of the country the prevalence is even less, at 13%. 8

Fumeurs quotidiens selon revenus Smokers vs incomes Wallonie - Sciensano Enquêtes Santé 40 35 30 25 20 15 10 Low incomes 5 Bas revenus High incomes Hauts revenus 0 1997 10 2001 2004 2008 OSH -. . . 2013 2018

However, progress is not equally distributed among economic groups : • In the lowest income group (>500 -< 1380€ per month), smoking prevalence remains unchanged around 30% from 1997 to 2018, whereas it has fallen substantially from 21, 6% to 13, 4%, in the highest income group (>3800€ per month). • The prevalence gap between the lowest and the highest income groups has in fact almost doubled in twenty years, from 8% to 18%. 11 OSH -. . .

despite structural tools 12

• Despite a long process, often based on evidences, supported by politicians and public opinion, measures taken to lower tobacco smoking failed to reach low socioeconomic status group and increased health inequalities. • Studies and intervention should focus on better ways to promote health among the poorest citizens and lower tobacco consumption in this specific group. 13

Does new kid may change the trend ?

Thank you for your attention ! 17