If Germany is the bad boy of western Europe, in tobacco control terms, it is high time to meet its little brother. Austria, with just a 10th of Germany’s population, possibly has an even worse record for lack of action to protect its citizens from tobacco. In the past, some of this may have been due to the malign though seemingly cosy participation in government policy of Austria Tabak, the state monopoly that dominated the Austrian tobacco industry until European Union (EU) requirements saw it part privatised in 1997, then sold off to UK-based Gallaher in 2001. Austrian citizens must be among Europe’s worst educated about tobacco, with tobacco related morbidity and mortality rates to prove it. Leaders of its medical profession seem to have been suffering from some form of collective denial or disbelief, and all those delegates from Austrian medical charities who have faithfully attended international meetings seem to have managed to sit through the tobacco control sessions in some sort of delusion that such matters just did not apply back in their comfortable, tolerant home country.
And tolerance is part of the excuse: it is a word often used by health ministry and other officials, and by the mass media, in defending the country’s hopeless position, and when responding to those who over the years had called for some real progress. We Austrians are tolerant people and don’t like to exclude anyone, they would say. Some suggest this line is hypocritical, as it seems to crop up more in discussions about the consumption of tobacco, alcohol, and unhealthy foods, mostly the products of big industries, than in connection with immigration, minorities, and other difficult issues faced by any prosperous, land locked, multi-bordered country. Nevertheless, it has often been seen as an acceptable excuse for not taking effective action.
There have been exceptions, though. In 1980, a burst of enthusiasm by a health minister who was in power for little more than a year saw the first attempt at a national anti-tobacco campaign, but cries of horror at his plans, even though they were relatively tame and included the creative use of athletes and other opinion leaders, were followed by another decade of near inaction and official complacency. Then, in 1992, Michael Ausserwinkler, a physician, became minister of health, sport and consumer protection. The following year, he presented a draft tobacco bill that included a total ban on tobacco advertising. Its potential effectiveness can be gauged by the strength of adverse reaction it generated, particularly in the form of political repercussions.
Most alarmingly, he was forced to accept that to prove the effectiveness of cigarette advertising on consumption, an advertising psychologist should be consulted—without knowing that the same expert had designed the advertising strategy of Austria Tabak. There was even a reaction from Germany, where tobacco interests were appalled at the prospect of progressive tobacco control policies being implemented so close to home. A senior figure in the German newspaper industry, was despatched to a personal meeting with Dr Ausserwinkler, warning him that if he proceeded, he would have to face "strong adverse winds" from the international press—an unpleasant threat, given that Austria imports a mass of print and other media from its much larger, German speaking neighbour.
The minister was still not deterred, but a public education campaign he initiated to prepare the ground for his bill drew even more opposition, including threats that football clubs would lose the tobacco sponsorship on which they depended—he was, after all, minister for sport, as well as health. Finally, he paid the classic price of a good health minister with tobacco in his sights, being removed from his post and sent back to serve in his home region, Carinthia.
Last year, another health minister had a go. Maria Rauch-Kallat, a teacher by profession, announced a package of measures on smoking in public places. Compared to other EU countries, not only is it modest, but it is questionable whether it is even up to minimum EU requirements. Worst of all, implementation relies in the early years on that long discredited, tobacco friendly mechanism, "voluntary agreement", though with the option for the minister to step in with legislation later. But judging by the uproar that ensued, she might as well have proposed restrictions on skiing, or eating apple strudel.
The country’s 8000 tobacconists led the revolt, distributing leaflets bearing a far from flattering picture of the minister, and proclaiming, "This woman will take away your rights. Today she will forbid where (or what) you can smoke," followed by similar, absurd claims that tomorrow she would introduce equally outrageous restrictions on what people drink, and the day after, on what they eat.
It is unclear what will happen, in the absence of any other leadership or encouragement for the lone minister. Will she be moved on, as Dr Ausserwinkler was? If so, it is hard to see what different line her successor could take, given that doing nothing will no longer be an option as EU and other international requirements begin to bite. It is not as if there is no base at all to build on: a recent Gallup poll showed that despite years of neglect, Austrians are not so very different to other Europeans: seven out of 10 smokers want to quit, a majority of all citizens would like to see smoking banned in all restaurants, and more than two thirds feel "harassed" by other people’s smoke. Perhaps most remarkably, in this tolerant land of unrestricted smoking, more than a quarter of smokers themselves said they found the smoke of their fellow smokers unbearable.
With an aspiring multi-national company in charge of the old state monopoly, and the other big players free to exploit the market, it is unlikely that any effective, comprehensive tobacco control legislation can be achieved without a long, hard, and somewhat un-Austrian fight, even if it is several decades overdue.