Tobacco Use and Trends
- In 2022, an estimated 2.4 million people (1.3 million males and 1.1 million females) aged 15 years and older were tobacco product users in Belgium. This positions the country as the 57th globally and the 17th in the WHO European Region in terms of number of tobacco users.1,2
For comparison, according to the Attitudes of Europeans Towards Tobacco and Electronic Cigarettes survey in 2020, 21% of respondents (21% males and 20% females) were currently smoking tobacco products (cigarettes, cigars, cigarillos or pipe). Tobacco smoking was more prevalent among 15-24 and 25-39 age groups (26%) followed by 40-54 with 19% and 55 years old and over age group with 17%.
Among those tobacco smokers, 61% were daily cigarettes and 24% were daily hand-rolled cigarettes smokers.
Demand for cigarettes reduced by 42% from 69 packs per capita in 2002 to 40 packs per capita in 2021. At the same time, the demand for fine-cut tobacco (e.g. roll your own RYO) per capita reduced by 46.7% from 40.7 packs of 20gr weight in 2002 to 21.7 packs of 20gr weight in 2021 (Figure 1).
Figure 1 Cigarette and Fine Cut Tobacco Consumption in Belgium 2002-2021
Source: European Commission, Releases for consumption of cigarettes and fine cut tobacco (2002-2022)
Nicotine Alternatives
In 2021, 10% of adults in Belgium (12% males and 8% females) aged 15 years and over were current e-cigarette users. In the same year, 3% of adults (3% males and 3% females) were daily e-cigarette users.
For comparison, in 2020, 20% respondents (21% males and 18% females) have used or at least tried e-cigarettes.
The “at least tried out” category, prevalent was the highest (33%) among 15-24 age group, followed the 25-39 age group with 31%, 40-54 age group with 14% and 55 years old and over age group with 11%.
3% of adults were current e-cigarette users.
In 2020, 8% of respondents (8% males and 7% females) have used or at least tried heated tobacco products (HTPs).
The “at least tried out” category, the rate was more prevalent (14%) in the 15-24 age group, followed by the 25-39 age group with 8%, the 40-54 and the 50 years and over age groups with 6% each.
Current HTP use prevalence was 2%.
In 2020, 75% of respondents who tried stopping and ex-smokers said they either quit or attempted to quit without assistance.
Approximately 20% utilized Nicotine Replacement Therapy (NRT), 7% sought medical support, 14% utilized e-cigarettes, a smaller percentage 1% opted for HTPs, while another 1% used oral, chewing, nasal tobacco products in their quitting journey.
Health and Economic Burden From Tobacco Use
In 2021, it was estimated that tobacco was the 1st highest risk factor driving the most deaths and disability combined in Belgium.
Tobacco was responsible for an estimated 12.5 thousand deaths, which is about 26.5% of total deaths.
Of tobacco-related deaths, 11.9 thousand or 95.2% were due to smoking, and 881.3 or 7.1% were due to secondhand smoke.
In 2021, the top 10 causes of the most deaths in Belgium included Ischemic Heart Disease (IHD) ranking 1st, Stroke ranking 4th, Lung Cancer ranking 5th and Chronic Obstructive Pulmonary Disease (COPD) ranking 6th.
Tobacco was responsible for an estimated 1.6 thousand or 17.1% of all IHD deaths, 655.5 or 10.5% of all Stroke deaths, 4.5 thousand or 79.5% of all Lung Cancer deaths, and 2.2 thousand or 67.2% of all COPD deaths.
In 2021, tobacco use caused an estimated loss of 315.3 thousand disability-adjusted life years (DALYs), which was about 26.0% of total DALYs. Tobacco accounts for 35.4 thousand DALYs for IHD, 15.6 thousand DALYs for Stroke, 99.0 thousand DALYs for Lung Cancer, and 47.4 thousand DALYs for COPD.
Regulatory Environment and Economics
Public Health Commitment
Belgium ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005 and WHO Illicit Trade Protocol in 2019.
Belgium adopted graphical health warnings (GHWs) on combustible cigarettes (CCs) in 2006, covering 65% of the front and 65% of the back of the packages. In addition, plain packaging (PP) for CCs was implemented in 2021.
Diverse Tobacco Market
HTPs and e-cigarettes are classified as “other tobacco products”. As of 2023, HTPs are not marketed.
Product restrictions for e-cigarettes include a maximum nicotine concentration to 20mg/ml, the tank capacity not exceeding 2ml, and refill containers limited to a maximum 10ml.
Text health warnings for HTPs are mandated to cover 50% of both the front and back of packages. Additionally, for e-cigarettes, text health warnings are required to cover 35% of the unit packet and any outside packaging.
Taxation Policy
In 2022, total tax rate on retail prices of a pack of cigarette was 79.9%.
There is no excise levied on e-cigarettes as of 2023. There is no tax code set for HTPs but since they are classified as smokeless tobacco, they are subject to an ad valorem excise of 31.5% of the retail selling price plus a specific excise of EUR 93.4261/kg. A minimum excise would be EUR 172.1098/kg.
A differential tax policy is applied between CCs and HTPs. The excise value for HTP is EUR 2.55/pack with its share (34.06%) of the retail selling price EUR 7.50/pack, while the excise value for CCs is EUR 5.23/pack with its share (65.41%) of the retail selling price EUR 8.00/pack in 2023.
Smoking and Advertising Bans3
- Weak smoking bans with complete level of compliance, and moderate advertising bans with complete level of compliance were enforced in Belgium in 2022.
Age Restrictions
- Tobacco products and e-cigarettes cannot be sold to individuals younger than 16 years of age.
Illicit Cigarette Trade
Estimated figures indicate that illicit cigarette trade remained slightly above or below 5% over the years with 4.6% in 2008, reaching 6.6% in 2020 and jumping to 8.8% in 2022.
Estimates from a recent study reveals that in 2021, 0.4 billion counterfeit and contraband (C&C) cigarette were consumed in Belgium, where C&Cs share in total cigarettes consumption was 4.6%. Illicit trade cost Belgium government EUR 100 million from C&Cs in 2021.
Tobacco Production and Diversification
- Detailed data is not readily available from the Food and Agriculture Organization for Belgium. (FAOSTAT [accessed January 2024])