The tobacco epidemic has reached Austria. The prevalence of smoking is still increasing while the habit is imposing an enormous health and economic burden on the country’s society. Tobacco consumption causes respiratory and lung diseases including chronic obstructive pulmonary disease (COPD), several cancers and cardiovascular diseases (CVD), including heart disease and stroke. The new Austrian tobacco law under preparation is a unique opportunity to raise standards of tobacco legislation, and therefore to protect the health of every Austrian citizen, including non-smokers who suffer from passive smoking. The involvement of the Austrian public health community and civil society representatives could bring an added value to the ongoing debate.
Overview of Austrian tobacco policy: successes and failures
In 1995 the government introduced the Austrian Tobacco Act (BGBl. 431/1995), which was subject to many changes. Although modifications brought many positive elements, there are identified shortcomings which hinder the fight against the tobacco epidemic.
- The first version of the Austrian Tobacco Act included provisions related to health warnings, tobacco advertising, and a smoking ban in some public places (e.g. schools and universities, public buildings and public transport facilities with the exception of rooms especially designated as smoking areas).
- However, violations of these provisions were not punished [1], so these rules were not fully respected.
- Austria amended the Austrian Tobacco Act in 2001 and introduced smoke-free workplace legislation. The law, which came into force one year later, did not affect the hospitality industry.
- However, a 2006-2007 survey highlighted that only 72% of non-smokers reported a smoke-free or nearly smoke-free workplace. [2]
- Another amendment to the Austrian Tobacco Act was passed in December 2004 which established a ban on smoking in all public places, although many exceptions to this ban existed (e.g. tobacco shops and restaurants). In 2006 schools became smoke-free. In 2008, a new amendment (BGBl No. 120/2008) established sanctions for violations of non-smoker protection. In addition, the hospitality industry was obliged to provide non-smoking rooms, except for small, single-room enterprises.
- However, many exemptions are allowed and a number of exceptions are observable on the ground. For example, in pub premises below 50 m², the landlord still can choose to allow smoking if he puts up a sign . This document provides the whole list of derogations that are applied in the Austrian legislation.
- The Austrian Tobacco Act mentions the possibility of having smoking rooms, provided that smoke is not able to penetrate the general non-smoking area.
- However, studies reported that non-smoking rooms adjacent to smoking rooms were found to be contaminated with tobacco smoke, characterised by nicotine, particulate and ultrafine particles in dangerous concentrations [3]. Austrian partial smoking bans did not prevent passive smoking exposure.
What is at stake?
When looking at the consumption of tobacco products in Austria, the data is extremely worrying and the figures speak for themselves:
Smoking is rising alarmingly in Austria; the Eurobarometer found an increase of smoking prevalence in Austria from 31% (2006) to 33% (2012).
Austria is one of the last EU countries where the minimum age for purchasing tobacco is 16 years old (in most countries it is 18 years old). In addition to this, a WHO 2009/2010 study showed that Austria had one of the highest rates of 15-year-olds who smoke at least once a week in Europe (29% of girls, 25% of boys).[4] In 2006 state revenues from cigarette consumption of minors in Austria amounted to 60.5 million Euro.[5]
In a 2013 European ranking based on tobacco price increases through taxes, smoking restrictions at work and in public places, consumer information, tobacco advertising and promotion bans, health warning labels and access to smoking cessation therapy, Austria had the poorest score, followed by Germany. [6] Youth smoking was reduced in Germany, but not in Austria.
Complete smoke-free establishments are a matter of importance. Indeed, 21% of Austrians reported in 2012 that smoking restrictions in public places in was a motivation for stopping smoking.
The 2012 Eurobarometer reveals worrying trends:
- The daily use of manufactured cigarettes by smokers is highest in Bulgaria (94%), Latvia (94%), Romania (93%), Lithuania (91%), Poland (91%) and Austria (90%)
- The average smoker in the EU smokes 14.2 cigarettes a day. The Austrian smoker smokes on average 18.3 cigarettes a day.
- Fewer than two smokers in five have tried to stop in Austria (37%), which makes the country one of the worst for smoker cessation in the EU.
- The proportion of ex-smokers remained relatively stable in 19 countries. Austria is part of the 5 countries where the proportion slightly decreased compared to 2006 (-3 points).[7]
The health burden of tobacco consumption is high. Tobacco consumption causes respiratory and lung diseases including chronic obstructive pulmonary disease (COPD), several cancers and cardiovascular diseases (CVD), including heart disease and stroke. The prevalence of lung cancer is also high in Austria. In 2012, 19% of male deaths and 10% of female deaths were due to tobacco. [8] Male lung cancer rates have declined, but have increased steadily in women over the past three decades. The primary cause of lung cancer is cigarette smoke (both active and passive inhalation).
In 2005, the percentage of undiagnosed chronic obstructive pulmonary disease (COPD) was 88,5% in Austria. For the years 2010, 2015 and 2020 GOLD stage I-IV COPD was projected to rise by 7.8%, 16.1% and 24%, respectively.
Measures to prevent COPD – such as strong anti-tobacco legislation – are absolutely necessary to forestall the projected burden of this disease in Austria. [9] [10]
Besides the health effects, economic consequences of tobacco use should not be underestimated. Smoking imposes an enormous economic burden on society. The medical costs of treating diseases caused by smoking are high, and indirect costs include loss of productivity, fire damage and environmental harm from cigarette litter and destructive farming practices. In 2004, the Federation of Austrian Social Security Institutions estimated annual direct and indirect health costs attributable to smoking to be in the order of about 2 billion Euros. This corresponds to approximately 0.8 percent of GDP in 2004.[11]
Future Opportunities
Evidence shows that Austria’s anti-smoking strategies that have been developed up till now do not work and have not reduced the burden of tobacco. The law in preparation provides a unique opportunity to establish a new policy framework that would protect the health of Austrians. However, to come up with legislation that will result in positive health outcomes, we urge members of the Austrian government to listen to public healths concerns, and work hand in hand with Austrian civil society. For example, the Austrian Council on Smoking and Health provides independent scientific expertise regarding the prevention of exposure to tobacco smoke and nicotine and on smoking cessation. Relying on health experts rather than advisers from the tobacco industry is essential.
In addition, the transposition of the recently adopted Tobacco Products Directive (TPD) provides an opportunity to strengthen standards in terms of tobacco legislation. The Austrian law currently requires that a percentage of the principal display area of the package are covered by health warnings (front and back combined). This has been 35% for cigarettes and 15% for smokeless tobacco. The country has two years to comply with the TPD, which requires that picture and text health warnings cover 65% of the front and back of cigarette packs.
Most importantly the TPD recognises the right of Member States to go beyond the set minimum standards and introduce further requirements applicable to all products placed on its market in relation to the standardisation of tobacco products packaging, where it is justified on the grounds of public health, taking into account the already high level of protection achieved through the Directive. A systematic review of evidence demonstrates that health warnings on tobacco packs are effective in discouraging young people from taking up smoking and in motivating smokers to think about stopping. [12]
The new legislation and the implementation of the Tobacco Products Directive are both opportunities to reduce health problems directly associated with smoking and with non-voluntary passive smoking. The involvement of representatives from Austrian public health civil society could bring an added value to the ongoing debate.
[1] Austria’s anti-smoking strategies, http://hpm.org/en/Surveys/IHS_-_Austria/08/Austria_s_anti-smoking_strategies.html
[2] Failure of Tobacco Control in Central Europe, Manfred Neuberger, http://images.derstandard.at/2014/04/10/TobLaw13OccMedHlthAff.pdf
[3] No Borders for Tobacco Smoke in Hospitality Venues in Vienna, H.Pletzemail – M.Neuberger, http://www.mdpi.com/2073-4433/2/2/171; Exposure to ultrafine particles in hospitality venues with partial smoking bans, M.Neuberger, H.Moshammer and A.Schietz, http://www.nature.com/jes/journal/v23/n5/full/jes201322a.html
[4] Social determinants of health and well-being among young people, http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf, p 145.
[5] Government earnings from cigarette smoking of adolescents in Austria, Neuberger M, Pock M, http://www.ncbi.nlm.nih.gov/pubmed/19787321
[6] The Tobacco Control Scale 2013 in Europe, Luk Joossens, Martin Raw, http://www.europeancancerleagues.org/images/TobaccoControl/TCS_2013_in_Europe_13-03-14_final_1.pdf
[7] Attitudes Of Europeans Towards Tobacco, http://ec.europa.eu/health/tobacco/docs/eurobaro_attitudes_towards_tobacco_2012_en.pdf
[8] The Tobacco Atlas, http://www.tobaccoatlas.org/harm/deaths/male_deaths/
[9] The prevalence of COPD in Austria—the expected change over the next decade.
[11] Austria’s anti-smoking strategies, http://hpm.org/en/Surveys/IHS_-_Austria/08/Austria_s_anti-smoking_strategies.html
[12] In 2010, Uruguay implemented health warnings covering 80% of both front and back of tobacco packages. Since then, cigarette consumption decreased by an average 4.3% per year. Other countries, like Australia and Canada, with comprehensive tobacco control strategies in place have seen significant annual decreases in youth smoking.
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