|Implemented in this survey?|
The Austrian government passed two amendments to the Austrian Tobacco Act in the last two years. In combination with various other initiatives, this adds to efforts aiming at a reduction of the number of smokers and at further protecting non-smokers.
The purpose of Austrian anti-smoking strategies is to reduce health problems directly associated with smoking and with non-voluntary passive smoking. This shall be achieved through
This required the amendment of the Austrian tobacco legislation to the latest EU regulation on tobacco marketing and product ingredients.
In accordance with the European Network for Smoking Prevention and the WHO Framework Convention on Tobacco Control, the Austrian government identified the following areas as priority areas to take action:
Smokers and non-smokers, local government, tobacco industry
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
While Austria's governance structure in the health sector often requires cooperation between social security and federal states, e.g in the hosptial sector, co-operative initiatives in the area of health promotion are rather rare. In this context we rate the establishment of an Austrian-wide telephone counselling for people wishing to quit smoking as rather innovative - it is a cooperative initiative bringing together federal states and sickness funds. However, only further developments in these areas may confirm the true degree of innovation.
Legislation as put forth in the Austrian Tobacco Act is only moderately system-dependent and reflects to a large degree EU legislation in this area and to some degree compliance with WHO recommendations.
As long as no radical smoking bans in restaurants will be put in place public visibility remains probably low. Further, it will depend on the degree to which telephone counselling will be picked up by people. This in turn would require evaluations in this area. No measures for evaluation seem to be foreseen, however.
Several possible reasons for the adjustment of anti-smoking strategies in recenct years can be identifed:
Need to comply with EU tobacco advertising directive 2003/33/EC. Non-compliance would trigger an infringement procedure by the European Commission.
Several government programs on health stated the need to promote health by preventing avoidable disease.
|Implemented in this survey?|
Until 1995 there were no statutory provisions dealing with health related aspects of smoking, although there existed private initiatives of physicians aiming at the implementation of such a law since the eighties. In addition, health promotion in the area of reducing smoking prevalence have been widely identified by scientific and conceptual work (www.univie.ac.at/lbimgs/publikat.html, e.g Duer et al 2004 and Pelikan, et.al 2004).
1995 Austrian Tobacco Act
In 1995, the Austrian government passed for the first time a law, the Austrian Tobacco Act (BGBl. 431/1995), which introduced a number of legal restrictions on advertising tobacco products, a ban on smoking in public places and the definition of thresholds on cigarette ingredients. The Tobacco Act forms an essential part of Austrian anti-smoking legislation.
This law prohibits advertising tobacco to people under the age of 30. Advertisements for tobacco products near schools had also been banned. Furthermore, the law forbids the advertisement of tobacco products on TV and radio. A more comprehensive ban on advertising was objected by the tobacco industry; hence advertising of tobacco products on billboards, in newspapers and in cinema remained permitted.
The Austrian Tobacco Act had forbidden smoking in schools and universities. The original intention of the Tobacco Law was to prohibit smoking in all school areas, but after opposition from the teachers union the ban has been restricted to areas within school buildings that are open to the public, and allowed individual regulations varying from school to school. Therefore, only small changes are observed compared to the status quo before the introduction of the ban.
The Tobacco Act provided a ban on smoking in public buildings, with the exception of rooms especially designated as smoking areas. The same applied for public transport facilities. Compliance with these regulations proved to be deficient due to a lack of sanctions.
Adaptation to EU directives
The Austrian Tobacco Act was amended in 2001 (BGBl. 98/2001) and in 2003 (BGBl. 74/2003) to keep Austrian legislation in line with EU directives (2001/37/EG) concering, among other things, the labelling of tobacco products and new thresholds on ingredients.
Tightening anti-smoking legislation
In the context of the Austrian Health Reform 2005, an important amendment to the Austrian Tobacco Act was passed in December 2004, becoming operative on January 1, 2005. This amendment stipulates a ban on smoking in all public places (although many exceptions to this ban exist), a general ban of advertisement for tobacco products with the exception of billboards and advertisment in cinemas (legal until January 1, 2007) and the obligatory signposting of places where smoking is forbidden. As of January 1, 2007, refraining from correctly signposting non-smoking-areas will be sanctioned (see above).
Ratification of WHO Framework Convention on Tobacco Control
In September 2005 the Austrian government ratified the WHO Framework Convention on Tobacco Control (FCTC). The FCTC took effect in December 2005.
Introduction of a minimum price for tobacco products and a telephone hotline
In March 2006, the Austrian government passed another amendment (BGBl. 47/2006) to the Austrian Tobacco Act, introducing a minimum price for cigarettes and other tobacco products.
Further, in May 2006 an Austrian-wide telephone counselling for people willing to quit smoking was launched. Smokers or relatives seeking advice can call at equal toll from the whole of Austria. With this initiative Austria became a member of the European Network of Quitlines, an European-wide network of now 27 countries. Founded in 2000 and funded by the European Commission's "European Network for Smoking Prevention" this network aims at exchanging management information and best practice in telephone counselling of smokers. Motivated by agreements with member states put fourth by WHO to contain smoking, the goal of the Austrian initiative is to assure easy access to counselling provided by certified psychologists every working day from 3 pm to 6 pm. The telephone service is a joint initiative of social security and most federal states. Using funds from cigarette tax revenues, investment costs are borne by sickness funds; current cost will be shared between sickness funds and federal states.
The approach of the idea is described as:
amended: Several amendments to the Austrian Tobacco Act (BGBl. 431/1995)
Although unanimity throughout the relevant stakeholders about the necessity of anti-smoking policies can be observed, opinions on the right strategies and tools differ. Especially the minimum price introduced in May 2006 is widely discussed.
|Government||very supportive||strongly opposed|
|Austrain chamber of doctors||very supportive||strongly opposed|
|Federation of Austrian Social Security Institutions||very supportive||strongly opposed|
|Private Sector or Industry|
|Tobacco Industry||very supportive||strongly opposed|
|European Union||very supportive||strongly opposed|
|WHO||very supportive||strongly opposed|
|Tobacconists||very supportive||strongly opposed|
|Austrain chamber of doctors||very strong||none|
|Federation of Austrian Social Security Institutions||very strong||none|
|Private Sector or Industry|
|Tobacco Industry||very strong||none|
|European Union||very strong||none|
Currently there is no system in place to systematically monitor the effects of the various anti-smoking policies. The Federal Ministry of Health and Women announced to evaluate the smoking ban in public buildings until 2007 and it is planned that the introduction of the 40%-rule (40% of all seats in restaurants of no less than 75 square meters have to be smoke free) will be evaluated in 2007.
As in many heath policy areas Austria has also been a late-starter with her anti-smoking strategies. However, issues of prevention and health promotion received a lot of attention in recent policy discussions. New rules for preventive health check ups (see survey (6) 2005) and current amendments to the Austrian Tobacco Act reflect this.
Legislation based on the 2005 health reform (see survey (4) 2004) stipulates that revenues from cigarette tax increases will be transferred to the Federation of Social Security Institutions. There a fund has to be created and initiatives of health promotion have to be coordinated. The establishment of the telephone counselling is the first project launched under this umbrella.
The cooperation with federal states in this matter is promising as also federal states receive cigarette tax revenues to help financing hospitals (see Hofmarcher, Rack 2006). Legislation also stipulates that the state level health platforms have tasks in health promotion and health prevention. However, it is not yet clear if the estimated amount of tax revenues that is needed to set up and to run anti-smoking programs will be sufficient as concerns have been raised that revenues fall short because of increased smuggling in this area. However, figures provided vary widely and do not seem to be very reliable.
Nevertheless institutionalised cooperation between sickness funds and federal states in matters of health promotion and prevention are promising to achieve goals as elaborated in policy statements and in the Austrian Tobacco legislation. This is the more likely as current proposals for a health reform after the October 2006 election seem to emphasise further measures in health promotion and prevention.
However, it is not expected that complete smoking bans in restaurants and bars will become mandatory in the short-run.
It is likely that minimum prices for cigarettes will be discussed and policy is probably changing toward setting minimum taxes for cigarettes and minimum margins for tobacconists.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Minimum prices for cigarettes certainly affect low-income households most. While this measure is probably effective to reduce the incidence of smoking among younger people it may equally aggravate social inequalities unless health promotion is able to target disadvantaged groups and to reduce smoking prevalence in vulnerable groups. To date no studies about the impact of health promotion strategies on the health behaviour of socio-economic groups are available in Austria.
In the short-term the impact on cost-efficiency may be low. This probably will change when the smoking prevalence and incidence is visibly reduced. However, increased life spans may well raise health expenditure at the end of life regardless of the impact of health behaviour earlier in life.
Maria M. Hofmarcher, Gerald Sirlinger, proof reading: Univ. Prof. Dr. Juergen Pelikan, Institut für Soziologie der Universität Wien