A new Behavioural and Cultural Insights (BCI) survey of health-care workers in the Republic of North Macedonia clarifies the drivers of tobacco use and barriers to cessation in the country. WHO, in collaboration with the Ministry of Health (MoH) of the Republic of North Macedonia, the Institute for Public Health of the Republic of North Macedonia, the BCI Unit at WHO/Europe, and the United Nations Development Programme (UNDP), presented the BCI qualitative study, along with a North Macedonia Tobacco Control Investment Case, in Skopje, North Macedonia, in the run-up to World No Tobacco Day on 31 May.
North Macedonia is among the countries in the WHO European Region with the highest prevalence of tobacco smoking. Almost half of the adult population (45.4%) are regular tobacco smokers, 70% of whom took up the habit before the age of 21, according to the BCI study. Despite its early ratification of the WHO Framework Convention on Tobacco Control (FCTC) in 2006, the country’s progress on the implementation of tobacco control measures remains inadequate.
Dr Fatmir Mexhiti, North Macedonia’s Minister of Health, noted, “The level of tobacco use and smoking in our country is worrying. The findings of the studies presented help us to direct our actions towards evidence-based measures to control the use of tobacco. At the same time, we and our partners are creating new, specific activities to support the implementation of the Framework Convention on Tobacco Control.”
Health-care worker support
The studies show that smoking is socially acceptable in North Macedonia, as only 17% of the population believe that North Macedonians disapprove of smoking. Knowledge of health risks is high, with 81% of smokers believing that smoking is harmful or very harmful. However, despite this, 53% of smokers declare that they do not plan to quit smoking.
The role of health-care workers is also clear. Seventy per cent of smokers said they were motivated to quit by a health-care worker, yet only 14% of active smokers and recent quitters said that a health professional had spoken to them about smoking in the last 12 months. Health-care workers also expressed a need for additional support for effective cessation. The BCI project, supported by the BCI Unit at WHO/Europe, is part of a wider set of activities to improve tobacco control policies and their implementation in North Macedonia.
Dr Anne Johansen, WHO Special Representative to North Macedonia, rated the studies as “an exceptionally significant activity in the direction of efficient and effective tobacco control in North Macedonia, which will help to position North Macedonia among countries with notable results in tobacco cessation and a decrease in the number of active smokers, thereby reducing pressure on the health system.” She reaffirmed WHO’s commitment to supporting the MoH and other national health-care institutions in putting forward health policies to benefit all Macedonian citizens.
Priority measures
The findings of the North Macedonia Tobacco Control Investment Case, carried out in collaboration with UNDP, were also presented, focusing on the need for implementation of the priority measures, which include:
- increasing tobacco taxation;
- strengthening enforcement of smoke-free laws;
- mandating prominent health warnings on tobacco packaging;
- promoting public awareness of tobacco control issues;
- implementing plain packaging of tobacco products;
- enforcing a comprehensive ban on all forms of tobacco advertising, promotion and sponsorship;
- promoting cessation of tobacco use and treatment for tobacco dependence;
- strengthening the ban on the sale of tobacco products to minors; and
Following the presentation, experts in the field and health-care workers discussed the findings, defined the challenges, and agreed on critical next steps regarding tobacco use and tobacco cessation in North Macedonia.