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Health vs. profit: Anti-smoking efforts in Germany

Country: 
Deutschland
Partner Institute: 
Bertelsmann Stiftung, Gütersloh
Survey no: 
(8)2006
Author(s): 
Kerstin Blum
Health Policy Issues: 
Public Health, Prävention
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein ja nein nein nein nein

Abstract

In recent years there have been multiple government initiatives to reduce the negative impact of smoking: Tobacco tax increases, information campaigns, initiatives and support to quit smoking, and a self-binding commitment by the German hotel and catering industry, representing 30% of business, to offer non-smoking areas. A ban on smoking in public places has only recently been put on the political agenda. All of a sudden, lawyers find constitutional hurdles for nationwide regulation.

Purpose of health policy or idea

The objectives of German anti-smoking strategies are to reduce negative effects of smoking and passive smoking on public health. This is supposed to be achieved by

  • Smoking ban: In November 2006, a working group of the governing coalition parties (CDU and SPD) agreed on a proposal banning smoking in public places. The outline was supposed to become the basis of a joint policy paper yet interfered with a recent, major reform of the German federalist system redistributing responsibilities between the Federal Government and the federal states. Since the passing of the federalist reform, Federal Government can only impose a ban on smoking in certains areas. At the moment, the targeted nationwide regulation seems unlikely.
  • Age limit: The same parliamentarian working group proposed to raise the age limit for buying tobacco from 16 to 18 years. This has become a cabinet decision and will be introduced to the legislative process.
  • Ban on advertisement: In accordance with the EU tobacco advertising directive, on 9 November 2006 German policy makers passed a ban on tobacco ads in newspapers, magazines, the internet, TV and radio as well as the sponsoring of sports events broadcasted via TV by tobacco industry.

Previous activities:

  • Taxation policy: The tax on tobacco products has been increased five times since 2002, adding up to 5.6 Eurocent per cigarette.  
  • Voluntary commitment by hotel and catering industry: As a result of pressure exerted by the federal government, the federal association of the German hotel and catering industry (DEHOGA) has signed a voluntary commitment in 2005. It states that by 2008, 90% of restaurants have to offer at least 50% of their space as non-smoking areas. Helas, only about 1/3 of all businesses in the hotel and catering industry are organized within this federal association.
  • Age check at vending machines: Age limits have been ineffective todate as  cigarette vending machines do not prevent young people of all ages from buying cigarettes. From January 2007, however, machines will no longer accept Euro coins. Instead, they need to be equipped with a reading device for cash cards, which allow a check for the owners age. Raising the age limit to 18 will make another update of these vending machines necessary.
  •  Information campaigns, especially deterring the young from getting started, and/or from preventing young people from developing a smoking habit.
  • Help for smokers who wish to quit via telefone hotlines and subsidized courses.

Main points

Main objectives

German anti-smoking strategies are to reduce the negative effects of smoking and passive smoking on public health. Former strategies based on voluntary commitments and information campaigns have not been effective in obtaining this goal. Now a more rigorous approach including a smoking ban in public places, and raising the age limit to 18 years is expected to reduce the number of smokers and protect non-smokers.

Type of incentives

Financial incentive to quit or reduce smoking: Tax raises on tobacco products. About four out of ten Germans support these tax raises, acceptance within the population has been increasing over the last years. 6.1% of German smokers have already quit smoking because of tax raises, 16.6% have reduced the amount of tobacco products they consume.

Other initiatives have been based on voluntary action: information campaigns, initiatives offering help for smokers wishing to quit, and a voluntary commitment by the German hotel and catering industry to transform at least half the seats in at least 90% of restaurants into non-smoking areas.

However, attempts to reduce the negative effects of smoking by voluntary arrangements did not produce the desired results. The current Federal Government is therefore in favor of a nationwide smoking ban including sanctions.

Groups affected

Smokers and non-smokers, People working in public places with a high exposure to smoke, Tobacco industry

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell traditionell innovativ
Kontroversität unumstritten recht kontrovers kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering sehr hoch sehr hoch
Übertragbarkeit sehr systemabhängig systemneutral systemneutral

German strategies to reduce tobacco consumption are traditional and have started rather late and slowly. Other countries have taken similar and often more rigorous measures to obtain this goal.

Public opinion is in favor of some of the initiatives, like raising the age limit and a smoking ban in hospitals, airports or train stations. However, the intended smoking ban in restaurants and bars causes much controversy.

A complete smoking ban in public places would have a rather strong systemic impact. Experiences in other countries indicate, that such a ban leads to an observable reduction in the consumption of tobacco products. A positive effect on public health were to be expected.

Political and economic background

Political background of smoking ban:

In September 2006, 144 members of the Bundestag signed a legislative initiative for effective protection of non-smokers. It called for a smoking ban in all public spaces including restaurants and bars. The initiative was signed by 113 members of the SPD, 5 members of the CDU and 26 Socialists (PDS/DIe Linke). The Green parliamentary group presented a similar initiative of their own. As a result, the governing coalition appointed a working group which in November agreed on a proposal. A smoking ban was to be part of a government policy paper.

However, the recent reform of the German federal system redefined competencies between the Federal Government and the federal states. As a result, the Federal Government can only impose a ban on smoking in certain public areas such as federal court rooms, offices of civil service in federal authority, public trains, train stations or airports. Other important spaces like schools, hospitals and restaurants or bars fall under the authority of federal states.

Federal state leaders are now supposed to come up with a concerted solution.  A first meeting in December has shown that ideas among regional prime ministers on the details of a smoking ban differ considerably. While some leaders still vote for voluntary commitments, Bavaria's Edmund Stoiber (CSU) is considering a complete smoking ban for all public spaces in Bavaria including restaurants - a position he shares with his colleague Jürgen Rüttgers (CDU) who has similar plans for the state of North Rhine-Westphalia. 

Meanwhile, Federal Minister of Health Ulla Schmidt (SPD), Federal Minister of Consumer Protection Horst Seehofer (CSU), protest against the prospect of regionally varying regulation on smoking in each federal state. 

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein ja nein nein nein nein

Origins of health policy idea

Now and then there have been discussions about more rigorous strategies against smoking in  Germany. However, policy papers that entered the stage of parliamentary debate over the years have so far never found majority support.

Most recent reseach findings on the effects of smoking and passive smoking indicate a greater hazard to public health than was formerly known. As a result, many European countries have passed more rigorous laws concerning smoking in public, others are planning to follow.  Combined with activities of the European Commission (like the EU tobacco advertising directive), this has re-ignited the German debate.

Initiators of idea/main actors

  • Regierung: The following description refers to actors' positions towards a complete smoking ban in public places including gastronomy.
  • Leistungserbringer
  • Wissenschaft
  • Privatwirtschaft, privater Sektor

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

Most members of the Government on federal and state level are in favor of some kind of smoking ban in public places which people have to visit, like hospitals or train stations. But there are different opinions on a smoking ban in places like restaurants or bars.

Political parties are divided on this matter. Unequivocal positions are adopted by the Liberal Democrats (FDP) and the Christian-Social Union of Bavaria (CSU). The Liberals oppose a smoking ban in restaurants and bars, voting for voluntary commitmends. Perhaps unexpectedly, the Bavarin wing of the conservatists is in favor of a smoking ban in restaurants, yet bars and beer tents should be excluded. CDU, SPD, the Greens party and the Socialists (PDS/Die Linke) all state their intention to better protect non-smokers from the dangers of passive smoking. However, altogether they did not present a coherent position on a smoking ban in public places.

Associations representing the hotel and catering industry are opposed to a smoking ban and portray their voluntary commitment as sufficient. The Bavarian association of the hotel and catering industry, however, has been the first to support a ban on smoking in all restaurants, bars and pubs, since more and more guests call for such a  ban.

Physician associations and most notably the renowned German Cancer Research Center (DKFZ) in Heidelberg have been calling for a complete smoking ban in public places for some time, pointing to the ubiquous evidence of the risk of smoking and passive smoking. For years, DKFZ director for cancer prevention Martina Pötschke-Langer has been disseminating information on the health risks of smoking and promoting a better protection for non-smokers.

The association of the German tobacco industry (VDC) is another important player acting in the background, whose influence on all levels of politics is said to be immense. Evidence suggests that this might well be true: the smoking ban proposal for public areas which the above mentioned working group of CDU and SPD agreed upon in November was almost identical with an earlier VDC position paper. The VDC maintains excellent contacts to members of all political parties. In Dezember 2006, Joachim Poss, deputy chairman of the SPD parliamentary group, was nominated "Pipe Smoker of the Year" by the VDC. What is more: He received the reward from an earlier nominee, Peter Struck, managing director of the same parlamentarian group. 

Actors and positions

Description of actors and their positions
Regierung
Federal Minister of Healthsehr unterstützendsehr unterstützend stark dagegen
Federal Minister of Consumer Protectionsehr unterstützendsehr unterstützend stark dagegen
leaders of federal statessehr unterstützendunterstützend stark dagegen
Leistungserbringer
Physician associationssehr unterstützendsehr unterstützend stark dagegen
Wissenschaft
German Cancer Research Centersehr unterstützendsehr unterstützend stark dagegen
Privatwirtschaft, privater Sektor
federal association of the German hotel and catering industry (DEHOGA)sehr unterstützendstark dagegen stark dagegen
Bavarian association of the hotel and catering industrysehr unterstützendunterstützend stark dagegen
Association of the German tobacco industry(VDC)sehr unterstützendstark dagegen stark dagegen

Influences in policy making and legislation

The Federal Government will start the legislative process to raise the age limit for the comsumption of tobacco products to 18 years and for a ban on smoking in public places under federal authority (trains, train stations, airports, offices of civil service, etc.).

The leaders of the federal states have now appointed a new working group to find out if common ground for a smoking ban in public places under state authority can be found. The result is expected in March 2007.

Actors and influence

Description of actors and their influence

Regierung
Federal Minister of Healthsehr großsehr groß kein
Federal Minister of Consumer Protectionsehr großsehr groß kein
leaders of federal statessehr großsehr groß kein
Leistungserbringer
Physician associationssehr großgering kein
Wissenschaft
German Cancer Research Centersehr großgroß kein
Privatwirtschaft, privater Sektor
federal association of the German hotel and catering industry (DEHOGA)sehr großneutral kein
Bavarian association of the hotel and catering industrysehr großgering kein
Association of the German tobacco industry(VDC)sehr großgroß kein
Physician associationsGerman Cancer Research CenterFederal Minister of Health, Federal Minister of Consumer ProtectionBavarian association of the hotel and catering industryleaders of federal statesfederal association of the German hotel and catering industry (DEHOGA)Association of the German tobacco industry(VDC)

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Expected outcome

A smoking ban in places under federal authority is likely to come into place. A large majority of the population is in favor of such a ban in offices of civil service, trains, train stations and airports.

About half of the population is in favor of a ban on smoking in restaurants and bars - the outcome concerning this point is therefore not as predictable. Distinctly differing views voiced by the leaders of the federal states imply that the intended nationwide solution is rather unlikely.

Impact of this policy

Qualität kaum Einfluss kaum Einfluss starker Einfluss
Gerechtigkeit System weniger gerecht neutral System gerechter
Kosteneffizienz sehr gering high sehr hoch

No effects on the quality of health care services or the level of equity.

High cost efficiency if there is a reduction in the consuming of tobacco products and a resulting improvement in public health. (Starting in 2007, tax revenues from tobacco products are no longer used in health care financing. The reduction of tax revenues is therefore not relevant when considering cost efficiency of anti-smoking strategies.)

References

Sources of Information

Author/s and/or contributors to this survey

Kerstin Blum

reviewer: Sophia Schlette

Empfohlene Zitierweise für diesen Online-Artikel:

Kerstin Blum. "Health vs. profit: Anti-smoking efforts in Germany". Health Policy Monitor, November 2006. Available at http://www.hpm.org/survey/ger/a8/1