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Smoking cigarettes and other tobacco products is one of the most important risk factors for developing noncommunicable diseases, such as lung cancer, chronic obstructive pulmonary disease, cardiovascular diseases and type 2 diabetes (National Center for Chronic Disease Prevention and Health Promotion Office on Smoking Health, 2014; Wannamethee et al., 2001; Zeiher et al., 2017; Zeiher et al., 2018). Measures for lowering the proportion of smokers within the population can make a significant contribution to reducing the burden of disease (Gredner et al., 2020; Levy et al., 2013; Tönnies et al., 2021). Smoking is also a risk factor for secondary diseases of diabetes, such as retinopathy and cardiovascular diseases. The tobacco control scale (Tobacco Control Scale, 2021) evaluates the measures for curbing tobacco consumption and passive smoking of a country, and thus makes it possible to make statements about the so-called tobacco control policy compared to other European countries (WHO, 2003).
Country | Total (100) | Price (30) | Public place bans (22) | Budget (10) | Ad bans (13) | Health warning (10) | Treatment (10) | Illicit trade (3) | Influence tobacco industry (2) |
---|---|---|---|---|---|---|---|---|---|
United Kingdom | 82 | 27 | 22 | - | 12 | 9 | 9 | 2 | 1 |
Ireland | 82 | 27 | 22 | 1 | 13 | 9 | 8 | 1 | 1 |
France | 71 | 21 | 18 | 3 | 11 | 9 | 6 | 2 | 1 |
Netherlands | 67 | 15 | 21 | 3 | 10 | 9 | 6 | 2 | 1 |
Hungary | 65 | 16 | 21 | 0 | 11 | 9 | 6 | 2 | - |
Norway | 63 | 20 | 17 | 1 | 13 | 8 | 3 | 1 | 0 |
Finland | 62 | 17 | 18 | 2 | 13 | 5 | 6 | 1 | 0 |
Iceland | 61 | 15 | 17 | 8 | 13 | 4 | 4 | 0 | 0 |
Romania | 61 | 18 | 21 | 0 | 8 | 5 | 8 | 1 | 0 |
Belgium | 59 | 14 | 16 | 1 | 10 | 9 | 7 | 2 | 0 |
Spain | 58 | 12 | 21 | 1 | 9 | 5 | 8 | 2 | 0 |
Turkey | 58 | 15 | 16 | 0 | 8 | 10 | 7 | 2 | 0 |
Denmark | 56 | 13 | 11 | - | 13 | 9 | 8 | 1 | 1 |
Israel | 55 | 16 | 15 | 0 | 10 | 6 | 8 | 0 | 0 |
Greece | 55 | 13 | 22 | - | 7 | 5 | 6 | 2 | 0 |
Malta | 55 | 16 | 16 | 0 | 11 | 5 | 5 | 2 | - |
Slovenia | 54 | 9 | 16 | - | 13 | 9 | 6 | 1 | 0 |
Italy | 52 | 13 | 18 | 0 | 9 | 5 | 6 | 1 | 0 |
Russian Federation | 52 | 9 | 19 | 0 | 13 | 4 | 6 | 1 | - |
Lithuania | 52 | 14 | 15 | 1 | 10 | 5 | 5 | 2 | 0 |
Czechia | 49 | 13 | 15 | 0 | 8 | 5 | 6 | 2 | 0 |
Estonia | 49 | 13 | 15 | - | 11 | 5 | 3 | 2 | 0 |
Poland | 49 | 14 | 11 | 0 | 11 | 5 | 7 | 1 | 0 |
Sweden | 49 | 11 | 15 | 0 | 9 | 5 | 7 | 2 | 0 |
Croatia | 49 | 14 | 11 | 0 | 12 | 5 | 5 | 2 | - |
Latvia | 48 | 12 | 13 | - | 11 | 5 | 5 | 2 | 0 |
Austria | 48 | 11 | 18 | 0 | 7 | 5 | 5 | 2 | 0 |
Cypus | 47 | 12 | 12 | 0 | 11 | 5 | 5 | 2 | - |
Luxembourg | 47 | 9 | 16 | 0 | 9 | 5 | 6 | 2 | 0 |
Portugal | 46 | 14 | 11 | - | 10 | 5 | 4 | 2 | 0 |
Slovakia | 46 | 11 | 13 | - | 9 | 5 | 6 | 2 | 0 |
Ukraine | 46 | 12 | 15 | - | 11 | 4 | 4 | 0 | 0 |
Bulgaria | 44 | 13 | 11 | - | 9 | 5 | 5 | 1 | 0 |
Germany | 43 | 14 | 11 | 0 | 6 | 5 | 5 | 2 | 0 |
Serbia | 38 | 13 | 11 | 0 | 9 | 1 | 3 | 1 | 0 |
Switzerland a) | 35 | 12 | 11 | 1 | 2 | 5 | 5 | 0 | 0 |
Bosnia & Herzegovina | 25 | 14 | 4 | 0 | 5 | 0 | 2 | 0 | 0 |
Compared internationally, Germany has dropped back steadily from 22nd place (out of 30 countries) in 2005 and is in 34th place (out of 37 countries) in 2021. The total number of points for Germany rose from 36 points in 2005 to 43 points in 2021 (of 100 possible points each). However, a strengthening of the measures and thus an increase from 2 points to 11 points (out of 22 possible points) and from 2 points to 6 points respectively, can be observed in this time period only for the components ‘public place bans’ and ‘advertising bans’. In contrast, there are hardly any changes in the components ‘treatment and smoking cessation’, and ‘health warnings’ between 2005 and 2021. The component ‘price’ decreased from 20 points to 14 points (out of 30 possible points). Currently, there are no noteworthy ‘public info campaign spending’ in Germany to control tobacco (0 of 15 possible points since 2013 or 10 possible points since 2019, respectively). While steps for ‘combatting illicit trade’ were taken in Germany (2 of 3 possible points), no measures for ‘limiting the influence of the tobacco industry’ are currently reported (0 of 2 possible points). Interactive graphics are available under the following link.
In 2021, in the tobacco control, Germany is in one of the last places in Europe and has implemented only few measures in the last 20 years. There is need for improvement in Germany in all areas of the tobacco control. To lower the risk factor smoking and thus the risk for type 2 diabetes and other noncommunicable diseases, the strengthening of political measures for the tobacco control appears to be expedient as these can reduce the proportion of smokers ( Levy et al., 2013; Levy et al., 2004).