Tobacco endgame toolkit – protect present and future generations

Globally, over 7 million people die prematurely each year because of the diseases caused by tobacco use or exposure to tobacco smoke. In the European Union (EU), around one fourth of adult population smokes tobacco products, and around 0,7 million people die every year prematurely due to tobacco smoking. Besides people's health, and social and economic consequences, the production chain and waste disposal of tobacco and related products severely damage the environment.

The possibility of ending the tobacco epidemic, instead of only controlling it and reducing harm is gaining more and more attention. Researchers started proposing different measures towards this end as early as the 1990s. In the last 15 years, an increasing number of countries have integrated this approach into their national strategies and policies. The "tobacco endgame" approach signals a fundamental change in tobacco control. It aims for a permanent, structural transformation in public health by gradually phasing out tobacco sales and consumption to achieve minimal levels of use within a defined timeframe. This strategy sometimes extends to include recreational nicotine products.

The Europe's Beating Cancer Plan (EU Cancer Plan) exemplifies this approach. Introduced in 2021, it sets a "Tobacco-Free Generation" goal – aiming for less than 5 % tobacco use in Europe by 2040. Between 2021–2024, the EU-funded Joint Action on Tobacco Control 2 (JATC-2) project included a specific work package on tobacco endgame, and this toolkit is one of its deliverables. It provides information of tobacco endgame goals and measures in Europe, key considerations and common myths, and case studies and potential best practices. It supports identifying feasible policy options, and monitoring and evaluation. It is intended for different target groups such as regulators, policymakers, researchers and civil society organizations interested in the concept and different country approaches to it. It is developed for the European context, but its contents may be beneficial in other regions.

Goals

The specific objectives of the JATC-2 WP9 (Best practices to develop an effective and comprehensive tobacco endgame strategy):

1. To identify and assess tobacco endgame strategies and forward-looking tobacco control policies for the European region.
2. To explore best practices in developing, implementing, and evaluating tobacco endgame strategies and forward-looking tobacco control policies.
3. To promote best practices and facilitate the development of national tobacco endgame strategies in Europe.

Implementation

Tobacco endgame can be achieved in two complementary ways:

1. Measurable goals integrated into national tobacco control or health plans, with clear definitions of targeted products.
2. Forward-looking tobacco control measures, which are individual policies implemented even without a broader national goal.

Most countries should begin by rigorously implementing the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and its "best buys" (MPOWER). In the EU, regular and forward-looking revision of the directives on tobacco products, taxation, advertising, and updating the smoke-free environment recommendations are critical.

Tobacco endgame is in accordance with global tobacco control and human rights treaties. Article 2.1 of the WHO FCTC encourages its Parties to adopt and implement forward-looking measures to better protect the health of present and future generations. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being and the right of the child.

Funding

This work was supported by the European Union's Health Program (2014–2020) under grant agreement N°101035968. The content of this document represents the views of the authors only and is their sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency (HaDEA) or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.

Partners

• Belgium: Federal Public Service Health
• Cyprus: Cyprus National Addictions Authority, University of Cyprus
• Denmark: Ministry of Health
• France: Santé publique France, Ministry of health - DGS
• Greece: National Public Health Organisation
• Hungary: National Korányi Institute of Pulmonology
• Ireland: Health Service Executive (HSE)
• Italy: Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Ministry of Health, Department of Medical Epidemiology; Istituto di Ricerche Farmacologiche Mario Negri (IRCCS)
• Lithuania: Narkotiku Tabako Ir Alkoholio Kontroles Departamentas (NTAKD)
• Norway: Ministry of Health, Norwegian Institute of Public Health (NIPH)
• Portugal: Ministério da Saúde | Direção-Geral da Saúde
• Serbia: Institute of Public Health of Serbia "Dr Milan Jovanovic Batut"
• Slovenia: Nacionalni inštitut za javno zdravje (NIJZ)
• Spain: Universitat Internacional de Catalunya, Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Ministry of Health
• The Netherlands: Ministry of Health, Welfare and Sport

Updated: 28.4.2026