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United Kingdom, France and Ireland top new European ranking on tobacco control, while Germany, Switzerland and Luxembourg are at the bottom. Top score (UK) is twice as high as lowest one (Germany)


20 Feb 2020


Health & Consumers

20 February 2020,

Berlin, Germany - The new Tobacco Control Scale, launched today at the 8th European Conference on Tobacco or Health (ECToH), shows United Kingdom, France and Ireland leading the ranking while three countries, Germany, Switzerland and Luxembourg continue to disappoint with extremely poor scores. The top score (UK) is twice as high as lowest one (Germany).

A new ranking report describes the results of a survey of tobacco control activity in 36 European countries in 2019. The Tobacco Control Scale quantifies the implementation of tobacco control policies at country level and is based on six policies described by the World Bank, which they say should be prioritised in a comprehensive tobacco control programme.

The new ranking is being presented today at the 8th European Conference on Tobacco or Health in Berlin by Luk Joossens of the Association of European Cancer Leagues (ECL). Countries spend less than 2 Euros per capita on tobacco control.

“The extremely poor score of Germany is not surprising for us” explains Dr. Martina Pötschke-Langer, President of ECToH and CEO of the German Smokefree Alliance (ABNR). “Now is the time to act promptly and communicate the report’s results to those who can make a change, including the Ministries of Finances, Economy, Justice, Nutrition and Agriculture and Health. Priorities should be tobacco tax increases, comprehensive advertising and marketing bans, smokefree workplaces and public areas and effective smoking cessation programmes for smokers.”

Dr Sakari Karjalainen, President of ECL, welcomes the ranking update as “an important policy tool in encouraging countries to strengthen their weak spots in tobacco control. We are very pleased that three countries with low scores in previous editions made huge progress.”

Israel, included in the survey for the first time, did very well in terms of price policies. Slovenia, Greece and Austria made spectacular progress and improved their score compared to 2016. 

“Plain packaging for cigarettes exists now in eight countries and should be the standard for all countries in the European Region” states Luk Joossens, the main author of the report.

Eight countries (UK, France, Ireland, Norway, Turkey, Slovenia, Belgium and Israel) have adopted and implemented plain packaging legislation. Hungary will implement its legislation in 2022, and the Netherlands and Denmark have agreed to introduce plain packaging very soon.

All countries assessed in the report, except for Switzerland, have ratified the WHO Framework Convention on Tobacco Control and nineteen countries have ratified the WHO FCTC Protocol to eliminate the Illicit Trade in Tobacco Products.

The full report can be downloaded at

Suggested citation: Joossens L., Feliu A., Fernandez E. The Tobacco Control Scale 2019 in Europe. Brussels: Association of European Cancer Leagues, Catalan Institute of Oncology; 2020. Copyright © 2020 ECL

About the 8th European Conference on Tobacco or Health (ECToH)



The European Conferences on Tobacco or Health (ECToH) are organised every three years under the auspices of ECL by prominent cancer leagues. The conferences attract over 600 committed scientists, policy-makers, researchers and health professionals as well as others strongly committed to fighting against tobacco. ECToH conferences are recognised internationally as the main European forum for tobacco control advocates and aim to present the most up to date advocacy trends, showcase successful tobacco control campaigns and provide a platform for experts to exchange information.

Since the first ECToH in 1996 in Finland, significant strides have been made toward effectively addressing the tobacco epidemic. But we are still not here. Tobacco remains the major cause of cancer and one of the leading causes of death and disease in Europe. European and global experts are gathering in Berlin, Germany 19-22 February 2020 on the occasion of the 8th European Conference on Tobacco or Health, hosted by the German Cancer Society, the German Cancer Aid, German Smokefree Alliance and the ECL. Our goal is to make Europe tobacco free in the next 20 years. This conference will enforce cooperation and strengthen our movement to achieve that goal.

About the Tobacco Control Scale (TCS)




In 2004, the European Network for Smoking Prevention (ENSP) provided a grant to Luk Joossens for a project to measure tobacco control activity at country level in Europe. A questionnaire was finalised with feedback from a panel of 10 international experts, researchers and specialists and sent to correspondents in 28 European countries who had agreed to fill in their country data. Although the original intention of the project was simply to describe tobacco control policies in Europe, it seemed worthwhile to quantify these policies, in order to be able to compare countries systematically. Hence, an expert panel scored the questionnaire and created a scale, assigning scores to each tobacco control policy. In 2005, Martin Raw joined the project to repeat the data collection in a more systematic manner with the intention to have the methodology published in and approved by a scientific journal. In the summer of 2005, the questionnaire survey was repeated, this time with 30 European countries. Data were collected using the 2004 questionnaire, but stricter definitions were applied in the scale for smoke free places and smoking treatment systems.

The Tobacco Control Scale (TCS) is based on 6 cost-effective policy interventions described by the World Bank which, according to the evidence, should be prioritised in comprehensive tobacco control programmes. These measures include: (i) price, (ii) public place bans, (iii) public information campaigns spending, (iv) advertising bans, (v) health warnings and (vi) treatment. The TCS was first described by Joossens and Raw in a 2006 article published in the peer-reviewed journal Tobacco Control. In 2007, the Swiss Cancer Leagues financed and published the report. In 2010, 2013, 2016 and 2020 it was published by the ECL. The research results were presented each time at the ECTOH conferences in Basel, Amsterdam, Istanbul and Porto. This year, again, the latest edition of the report is being presented at the 8th ECToH in Berlin. Joossens and Raw remained the authors of the 2007, 2010, 2013 and 2016 editions. In 2018, Ariadna Feliu and Esteve Fernandez of the Catalan Institute for Oncology joined the project. The authors of the 2019 edition were Joossens, Feliu and Fernandez.

About the Association of European Cancer Leagues (ECL)



ECL provides a unique platform as the only non-profit, pan-European umbrella organisation with the mission of uniting, at the European level, national and regional cancer leagues to achieve a cancer-free Europe. Active since 1980 and located in Brussels, ECL currently has 29 members from 24 countries in the European Region, covering 21 EU member states. ECL’s members are cancer charities operating across the whole continuum - from cancer research and awareness to patient support during and after diagnosis.

ECL’s mission is to influence and improve cancer control and cancer care in Europe. This is done by providing a forum and voice for experienced charities and supporting new entrants facilitating collaboration and knowledge sharing, primarily in the areas of cancer prevention, tobacco control, access to medicines and patient support, as well as creating opportunities to advocate for these issues at the EU level. ECL also collaborates with global and European institutions, other NGOs and research institutes.

About the German Cancer Aid



Founded in 1974 and based in Bonn, Deutsche Krebshilfe (German Cancer Aid) has been working tirelessly to improve cancer control for more than 45 years. German Cancer Aid is Germany’s leading non-governmental and non-profit organisation in the field of oncology and enjoys respect from political institutions and the health and research community. It aims to fight all manifestations of cancer by improving care for patients, promoting research and increase cancer awareness through information, education and public campaigns.

Following the motto "Helping. Researching. Informing", German Cancer Aid supports high quality research projects with potential for significant clinical impact to improve prevention, diagnosis, therapy, after-care and self-help for the benefit of cancer patients. The organisation also invests in the training of future generations of scientists and medical doctors. German Cancer Aid regularly launches campaigns, organises information events and designs brochures to inform the public about various types of cancer, early detection as well as prevention. It also offers services and assistance to patients and their families and provides support to self-help associations as well as advanced training to those who work daily with cancer patients.

About the German Cancer Society



The Deutsche Krebsgesellschaft (German Cancer Society) is the largest scientific oncology society in German-speaking countries. We are committed to ensure that cancer care is based on evidence-based medicine and interdisciplinarity. Our aim is to unlock high-quality oncological care. Therefore, our focus is on (i) the certification of centres of oncological care, (ii) the development of evidence-based treatment guidelines and patient guidelines,(iii) knowledge development and knowledge transfer in oncology and (iv) reliable patient information.

The German Cancer Society includes 16 regional cancer societies, around 8000 individual scientific members organised in 25 working groups, and 36 sponsors. We organise several scientific conferences, such as the German Cancer Congress, and symposia for the overarching professional exchange. We are also the co-founder of the German National Cancer Plan, which was launched in 2008 by the Federal Ministry of Health. During the "National Decade against Cancer", which was launched in 2019 by the Federal Ministry of Education and Research together and many stakeholders, the President of the German Cancer Society is member of the strategy group and co-chair of the working group "Generating knowledge through networking research and cancer care". We represent the Federal Republic of Germany at the EU level and in international organisations, including the Union for International Cancer Control and the Association of European Cancer Leagues.

About the German Smokefree Alliance (ABNR)

The German Smokefree Alliance (ABNR) is a coalition of 15 prominent health organisations active in tobacco prevention in Germany since 1992. ABNR’s members are:

  • German Cancer Aid
  • German Cancer Research Center
  • German Cancer Society
  • German Cardiac Society
  • German Center on Addiction Issues
  • German Dental Association
  • German Heart Foundation
  • German Lung Foundation
  • German Medical Action Group Smoking or Health
  • German Medical Association
  • German Respiratory Society
  • German academy of Children's and Youth Medicine
  • German Society of Occupational and Environmental Medicine
  • German Society for Pneumology and Respiratory Medicine
  • German Society of Social Medicine and Prevention
  • Federal Association for Prevention and Health Promotion

The ABNR is guided by three goals: to prevent the uptake of smoking, to encourage smokers to quit and to protect nonsmokers from secondhand smoke. The ABNR addresses its demands to politicians at both the federal and state level and is also active at the international level.