BACKGROUND-AIM:
Despite declining smoking rates in some countries, tobacco use still accounts for 13.6% of all deaths and 7.9% of disability adjusted life years (DALY) worldwide. In Belgium, in 2023, 18% of people over 15 years smoked. E-cigarette use is rising, with a 4.1% prevalence and higher use among youth. These figures underline the need for strong evidence-based policies supported by systematic monitoring and evaluation, as recommended by international organisations. In Belgium, efforts are underway to have an integrated, flexible framework to enable the routine evaluation of prevention policy measures in Belgium.

METHODS:
As the national public health institute, we proposed a framework centred on the interconnected policy and indicator cycles, both driven by active stakeholder engagement. The policy cycle covers the key stages of policy design, implementation and evaluation, ensuring that policies are effectively developed, executed, and refined. Parallel to this, the indicator cycle is dedicated to the development of metrics used for predicting the effect of policies before implementation and monitoring their effect after implementation. We tested part of this framework in collaboration with the Belgian Federal Public Service (FPS) of Health. A Health Impact Assessment was conducted to model how policy scenarios could influence smoking behaviour and health outcomes. The scenario were based on the most recent national Interfederal Strategy for a Tobacco-Free Generation: a reduction in tobacco points of sale (POS), and a ban on the visible display of tobacco products at POS.

RESULTS:
This evaluation involved multiple stakeholders, including FPS Health, FPS Finance and FPS Economy. They provided key data for the modelling and input on barriers and facilitators for each policy scenario. Three POS reduction scenarios were assessed. The first followed current tobacco measures, banning vending machines and sales in supermarkets over 400 m², reducing smoking prevalence by 0.5 percentage points. The second extended the ban to small supermarkets and gas stations, reducing prevalence by 0.9 points. The third introduced licensing, limiting them to one per 10000 inhabitants and banning all other sales, reducing prevalence by nearly 2 points. A display ban was also modelled, with cigarettes and vapes no longer visible in stores, leading to a 7% reduction. Interviews with stakeholders highlighted additional social, economic, and fiscal impacts, including possible negative effects on retailers and equity concerns for vulnerable groups.

CONCLUSIONS:
This pilot helped advance evidence-based policymaking in Belgium. The aim is to embed this framework in public health decision-making to improve policy design. Such evaluations can forecast how policies may affect population health, supporting better prioritisation and more effective policy choices. The ambition is to test the framework also in other European countries in the Joint Action on Smoke and Aerosol Free