Background:
In Belgium, much of the reduction in the prevalence of tobacco use can be attributed to long-term policies, most of them adopted during the last thirty years at the federal and regional levels such as:
Legal measures
• smoking ban in schools (year), workplace (year), indoor public place (year), a car when a minor is present (2019)
• advertising ban, neutral packaging
• gradual increase in taxation
Support of tobacco-cessation services
• through a multifactor approach including systematic healthcare professional advice and participation of specialists through assistance centers
• adoption of health promotion policies, encouraging protective factors related to addiction, through the improvement of the skills of young people and their families.

Results:
A social process to denormalise tobacco use has been implemented and produced definite results. For instance, in the region of Wallonia, smoking prevalence is currently at 19% (daily smokers) while in the northern part of the country, the prevalence is even less at 13%.
However, progress is not equally distributed among economic groups. In the lowest income group (greater than 500 and less than 1380€ per month), smoking prevalence remains unchanged around 30% from 1997 to 2018, whereas it has fallen substantially from 21.6% to 13.4%, in the highest income group (>3800€ per month).
The prevalence gap between the lowest and the highest income groups has, in fact, almost doubled in twenty years, from 8% to 18%.

Conclusions:
Despite a long process of reflection, often based on evidence, supported by politicians and public opinion, measures taken to lower tobacco smoking failed to reach the low socioeconomic status group and increased health inequalities. Studies and intervention should focus on better ways to promote health among the poorest citizens and lower the tobacco consumption in this specific group.