Austria’s Reversal of Smoking Ban in World Spotlight

Tobacco harms the health, the treasury, and the collective spirit of Austria. In May 2018, a smoking ban was scheduled to begin in all bars and restaurants in Austria; however, the ban was recently overturned by lawmakers from a new ruling coalition in the government, the People’s Party and the Freedom Party.

In its discussions regarding the ban, the far-right Freedom Party argued that it was an example of too much interference from the government and that it restricted the people’s freedom of choice. During the election campaign, party leader Heinz-Christian Strache, an avid smoker, promised a reversal of the ban.1 After the election, Strache made this a non-negotiable condition for entering a coalition government with the conservative People’s Party. People’s Party leader Chancellor Kurz, a nonsmoker who supported tobacco control prior to the election, accepted this demand to form a functioning government.

The move has horrified Austria’s medical establishment. Manfred Neuberger, MD, professor emeritus of environmental health at the Medical University of Vienna, told BBC News that it is “a public health disaster.” 2

“The decision is irresponsible,” he said in the BBC interview. It was a victory for the tobacco industry. The new government made Austria into the ashtray of Europe.”

Since then, and in just 3 weeks, half a million Austrians have signed a petition to ban smoking in bars and restaurants. If the petition acquires at least 900,000 signatures, the coalition has agreed to call a referendum on the topic, but not before 2022.2

In 2005, Austria became a party of the WHO Framework Convention on Tobacco Control (WHO FCTC), a legally binding public health treaty that contains provisions to reduce the health economic burden caused by tobacco use. According to Article 8 of the WHO FCTC, all treaty parties will provide protection from exposure to tobacco smoke. Guidelines regarding implementation of Article 8 came into existence in 2007; these guidelines established that each WHO FCTC member should provide universal tobacco exposure protection within 5 years of entry into the treaty. In a written statement from the WHO FCTC Convention Secretariat Vera Luiza da Costae Silva regarding the reversal of the ban, it was noted that the guidelines reaffirm “that there is no safe level of exposure to tobacco smoke and that approaches other than 100% smoke free environments, including ventilation, air filtration, and the use of designated smoking areas (whether with separate ventilation systems or not), have repeatedly been shown to be ineffective; and there is conclusive evidence, scientific and otherwise, that engineering approaches do not protect against exposure to tobacco smoke.”

Austria’s Smoking Habit

As of 2014, rates for adults (aged 15 or older) who smoked daily were comparable with rates in 1997 (24%) and increased slightly since 2006 (23%). These rates can be contrasted with the marked decline seen in 93% of Organisation for Economic Cooperation and Development countries during the same time period; on average, smoking rates decreased from 26% in 2000 to 19% in 2014.3

Outside of Austria, nearly all countries in Western and Northern Europe have complete smoking bans in the hospitality industry, according to Dr. Neuberger. In addition, a representative survey recently showed that 70% of the population of Austria is in favor of the ban,4 which would protect employees and customers from the effects of second-hand smoke.

According to Dr. Neuberger, this type of ban would also make “it more difficult for the tobacco industry to seduce young people to start smoking.”

“It is a shame that the government listened to lobbyists and merchants of ‘Big Tobacco’ and not to medical science,” he told the IASLC Lung Cancer News.

In June 2018, lawsuits were filed at Austria’s institutional court by innkeepers, waiters, and the government of Vienna against the cancellation of the smoke-free hospitality industry. The Ministry of Health then drafted an ordinance that limits exposure in smoking sections for underage trainees to no more than 1 hour per day. Guidance for enforcement of this ordinance was not provided, however.

Medical Societies as Catalysts for Change

The IASLC is dedicated to improving the health of patients and the community through effective tobacco control. Vienna was host city to the IASLC World Conference on Lung Cancer (WCLC) in 2016 and is scheduled to host it again in 2022. In 2016, despite the conference venue being smoke-free for WCLC, restaurants and hotels were subject to individual management policies.

Controversy exists over the role of the IASLC or other cancer organizations as to how to address conference venues in the context of local tobacco control laws. Whereas some advocate that the IASLC should intervene to guarantee smoke-free hospitality in venues in 2022, others advocate that the IASLC should continue to support development of smoke-free laws, particularly in countries faced with strong opposition from the tobacco industry. Robert Pirker, MD, program director for lung cancer at Medical University of Vienna, Austria, said that Austrians need support from the organizations such as the IASLC now more than ever. “The decision to reverse the planned ban of smoking in restaurants resulted in a huge outcry by doctors, medical societies, political parties, and even more so by the general public,” Dr. Pirker indicated. “The public pressure on politicians to enforce stricter tobacco control, including a full ban of smoking in restaurants, is ever increasing.”

The IASLC provides a rigorous evidence-based resource for clinicians and politicians to understand risks associated with lung cancer and the most effective methods for cancer treatment. Tobacco control is fundamental to the mission of the organization.

Dr. Pirker also said that doctors must “continue informing the public about the benefits of stricter tobacco control and to work with the public to achieve these goals, even in the absence of legal requirements.”

In Dr. Pirker’s opinion, complacency in the face of tobacco epidemic insulates the tobacco industry in Austria, resulting in more tobacco-related deaths each year. This is an area in which large international medical societies can potentially create change through increased efforts; Austria can still do more to make tobacco control and smoking cessation work for their citizens’ wellbeing.

The IASLC Tobacco Control and Smoking Cessation Committee has discussed this issue at length and acknowledges complexity in how best to respond. One option is to not hold large conferences, such as the WCLC, in cities with poor tobacco control—a potentially significant financial loss for the local government. However, presence of the conference, with high-profile tobacco-control sessions and prominent messages at key points during the meeting—the Opening Plenary at WCLC in 2016, for example, featured Dr. Tabaré Vázquez, who spoke about the success of tobacco control in Uruguay—could jumpstart a campaign for better tobacco control and thereby better serve the local tobacco-control community, healthcare workers, and patients. There is no clear answer, but the Committee and the IASLC as a whole remain committed to the very best in prevention, diagnosis, and treatment of lung cancer and, therefore, to the most vigorous, critical, and effective tobacco control measures possible. ✦

References:

1. Karasz P. Austria’s Far Right Wants the Freedom to Smoke. The New York Times. March 18, 2018. https://www.nytimes.com/2018/03/18/world/europe/austria-smoking-ban.html. Accessed May 5, 2018.
2. Bethany Bell. Austria’s plan to stub out smoking ban prompts health plea. BBC News, Vienna. February 15, 2018. https://www.bbc.com/news/world-europe-43057842. Accessed June 14, 2018.
3. Organisation for Economic Co-operation and Development. OECD Health Policy Overview: Healthy Policy in Austria. https://www.oecd.org/els/health-systems/Health-Policy-in-Austria-March-2017.pdf. Published March 2017. Accessed July 17, 2018.
4. Non-smoker protection: A study by GfK Austria on behalf of the Austrian Council on Smoking & Health. https://www.aerzteinitiative.at/UmfrageGfK18.pdf. Accessed July 17, 2018.