“Most smokers want to quit. As a society, we need to do more to help them.”

Suzanne Gabriels

tobacco prevention expert at Foundation against Cancer

Interview with Suzanne Gabriels

Various measures have already been taken to deter smokers, and they are effective, says Suzanne Gabriels, tobacco prevention expert at Foundation against Cancer. “The problem lies in the support for smokers. Smoking cessation assistance needs to be structurally embedded in our healthcare system.”

Suzanne, together with others you lobby for better tobacco prevention and smoking cessation support. What have you achieved so far?

“Together with "Kom op tegen Kanker" and six other organizations, we launched the Alliance for a Smoke-Free Society. We encourage policymakers to make progress in tobacco prevention and smoking cessation support. This led to the ambitious Interfederal Strategy for a Smoke-Free Generation. Some measures from this Strategy have already been implemented, others will follow. For example, the display ban in shops will come into effect in April 2025. The walls of cigarette packs you see now will disappear. Customers will have to ask for cigarettes, which will then have to be taken from a cabinet or vending machine. “Removing tobacco from view, will reduce impulse buying.”

Which measure has the most impact on smoking?

“Raising the price. Every study confirms this. But only a sudden and sharp increase leads to a significant decrease, otherwise smokers will adapt. A 10% price increase reduces consumption by 4%. And equally important, fewer young people will start smoking.

Politicians sometimes hesitate, wondering if it's appropriate to interfere in what they consider a lifestyle choice. But smoking isn't a lifestyle choice. Smokers don't choose to smoke, it is their addiction that does, because otherwise they feel horrible. Smoking gives them a false sense of happiness, until their nicotine levels drop again.”

Politicians sometimes hesitate, wondering if it's appropriate to interfere in what they consider a lifestyle choice. But smoking is not a lifestyle choice. Smokers don't choose to smoke any longer."

Who is the typical smoker today?

“Smoking has dropped significantly among higher income groups but remains almost unchanged among the 25% lowest income groups in the last 20 years. Smoking has mainly become a phenomenon among socially vulnerable individuals.”

"Our 30 tobaccoologists at Tobacco Stop hear harrowing stories every day. Sometimes they refer people to the food bank because they have no money left for food."

“Among the 25% lowest incomes, smoking has barely decreased in 20 years. Smoking has become a phenomenon among socially vulnerable individuals.”

Those who are unable to stop will feel the financial burden.

“That's why we advocate for a comprehensive approach: Increasing prices, without leaving smokers out in the cold. Our threefold approach at the Cancer Foundation is: soft on smokers, hard on tobacco industry, and aim for a smoke-free generation.”

“And price increases are one of the most effective measures to reduce health inequalities. When parents quit smoking, household funds become available for other expenses. Such as their children's leisure activities, for example.”

“Life for smokers is becoming increasingly difficult: prices are increasing, smoking is banned in more and more places – from January also in zoos, amusement parks and at sports fields. Most smokers want to quit their addiction. But that is very difficult if you have to do it alone. As a society, we need to provide them with much more support to overcome that addiction.”

What are the next steps then?

“We have tobaccologists and they are reimbursed, but in practice the system does not work well. General practitioners and hospitals do not refer enough people to smoking cessation support. About ten years ago, the regions were made responsible for smoking cessation support. Since then, the regions have been responsible for the reimbursement of tobaccologists. I still think this is odd, because it cuts off tobaccologist from the rest of the healthcare system, because hospital financing is a federal competency. Tobaccologists in Flemish hospitals have to request reimbursement themselves and cannot use their hospital's secretariat. The other healthcare providers in the hospital have nomenclature numbers that you can link to each other and to eHealth. Tobaccologists cannot do this. I am not saying that smoking cessation support should become a federal competency again, but it would be much more efficient.”

How would you better organize smoking cessation support?

“We have to turn the system around and create an opt-out system. Smoking cessation support then becomes the default, unless the smoker opts out, you obviously cannot force someone to get support. However, smokers shouldn't have to ask for support. With every additional hurdle you put up, you risk losing them. Doctors or nurses should be able to schedule an appointment with the tobaccologist directly. “We also have to advocate better reimbursement of nicotine replacements. “If you have to pay 90 euros, that's quite expensive, especially for people in a vulnerable position.”

"Make sure smoking cessation support becomes the default choice, smokers shouldn't have to ask for support."

You also want to focus on raising awareness among young people.

“If you signal to young people that these new products aren't very dangerous, why would they stay away from them? No, what we tell them is that they don't need those products to feel good. That's the narrative that's being pushed on social media. So, for mental health as well, we absolutely have to keep young people away from nicotine.”

“Young people who have never smoked won't miss it. Only we see influencers, paid by the tobacco industry, promoting smoking and vaping on Instagram and TikTok. Subtly, as part of a lifestyle. This influences young people and undermines our goal of achieving a smoke-free generation by 2040.”

“Dear young people: you don't need nicotine products to feel good.”

Another challenge in your prevention work is that you do not have recent figures to measure the effect.

“If you ask me today how many Belgians smokers there are, I will have to refer back to Sciensano data from 2018. There's only one major health survey every five years and the results of the 2023 survey are expected in 2025. So, we've been sailing blind for six years. “For Flanders, we have data from 2022, but none for Wallonia and Brussels.

“And I've already mentioned that smokers are mainly from socially vulnerable groups, while people in cabinets and administrations are often highly educated, and perhaps don't have many smokers in their circles anymore. Some believe the problem has been solved. It isn't; it's just less visible now.”