From Iceland — Up In The Air

Up In The Air

Published June 22, 2011

Up In The Air

Imagine if cigarettes were sold exclusively at pharmacies as a prescription drug. If Alþingi approves a proposal for a ten-year plan on tobacco control, Iceland could become the first country to take this anti-tobacco measure.
Spearheading the proposal is Progressive Party MP Siv Friðleifsdóttir, the former Minister of Welfare who successfully worked to ban smoking in restaurants and bars three years ago. “It was very controversial when that step was taken in 2007”, Siv recalls, “but today people think it’s simply natural that employees are not be subject to second-hand smoke at their workplace”.
Now she is working with MPs from every political party to protect young adults, two of whom become addicted to tobacco every day, according to the proposal. Furthermore, half of the 700+ young adults who become addicted to tobacco every year will die from a tobacco-related disease. This is 30 times the number of traffic accident deaths.
“I want to emphasise that the proposal’s objective is to protect kids and young adults”, Siv says. “It’s not a proposal against smokers—not at all—those who smoke can continue to do so, but they will have to go to pharmacies instead of general stores to buy their tobacco. There are greater interests at stake”.
As many begin smoking before they are considered capable of making an informed decision, the idea is to decrease access to and visibility of tobacco products to reduce the number of new smokers and tobacco-related deaths. Furthermore, it will benefit the economy, which according to the proposal takes a 27 billion ISK hit every year due to smoking.
The Proposed Anti-Tobacco Measures
While Iceland was considered progressive on the tobacco front in 2007, Siv says little has been done since then, and many countries have taken far more revolutionary steps in the meantime. If the proposal is approved, not only will tobacco products be sold exclusively at pharmacies as a prescription drug, but Iceland will also adopt a number of anti-tobacco measures that have already been taken by other countries.
For instance, New York City Mayor Michael Bloomberg, who is a smoker himself, banned smoking in public parks, plazas, and beaches last month. The proposal would have Iceland follow suit and go even further by banning smoking on public sidewalks. This would mean fines for the hordes of smokers huddled up just outside bars on weekend nights.
Similar to California legislation, the proposal would also ban smoking in cars when children under the age of 18 are present. Additionally, smoking in the presence of pregnant women and children would be banned altogether.
In addition to limiting tobacco consumption, the proposal also focuses on reducing visibility of tobacco products. As Australia is slated to do in 2012, the proposal would like all tobacco products to be packaged in nondescript brown paper with a health-warning label.
Citing study results showing that smoking in films normalises the behaviour, the proposal would ban state subsidies to films wherein smoking is depicted. This part of the proposal has been heavily criticised by filmmakers who view the measure as censorship of the arts. “It would be more intelligent to spew smoke than this nonsense”, film director Friðrik Þór Friðriksson (‘Angels of the Universe’, ‘Children of Nature’) told Fréttablaðið. “’Angels of the Universe’ would not have been the same if smoking had not been allowed in the film”. Whether or not banning state subsidies to films amounts to censorship will likely be debated in parliament when the time comes to approve the proposal.
In terms of changing economic incentives to smoke, the proposal would like the price of tobacco to increase by 10% every year, which according to the World Health Organisation (WHO) will result in a 4–8% decrease in consumption. However, when cigarettes are finally sold exclusively at pharmacies, the price will be lowered to near cost value.
Lastly, the proposal would like to increase anti-tobacco education. Given that most young people start smoking between 16–20 years old, special emphasis will be on educating this group. This will include working with schools and launching traditional and social media initiatives.
While Siv says that people have criticised the proposal, suggesting that it simply focus on education, she believes that education alone is not enough.     
Should Smokers Flee The Country Now?
By no means will cigarettes disappear from stores tomorrow, nor will authorities begin fining hordes of smokers huddled outside of bars next weekend. Not only will these proposed measures be implemented gradually over a ten-year period, but also the proposal itself has a few hoops to jump through before anything happens at all.
When parliament reconvenes in October, Siv will reintroduce the proposal, which will then be open for discussion. If it is approved, likely with some changes, it will then be sent to parliament’s standing Health Committee. The Committee will then send it to a long list of consultants and make changes based on feedback. Finally, parliament will send it to the Ministry of Welfare, which will then work on implementing it.
Nonetheless, Siv is optimistic that they will take many of the proposed measures. “It’s just a question of time”. Though some of the ideas perhaps seem radical, she notes that banning smoking in airplanes, movie theatres, restaurants and bars were also radical ideas of the time.
Should smokers decide to flee the country in any case, they should avoid Finland, which has made it an official policy to eliminate smoking altogether.
The Breakdown: Societal Costs of Smoking in billions
The proposal states that smokers cost the economy roughly 30 billion ISK per year. Here’s a breakdown of that cost based on 2007 calculations that were presented at an Icelandic Physician’s Association conference in 2009.

Direct Costs:    
Direct Health Costs:    
Time spent at hospital: 5.750
Ambulance transportation: 46
Medication: 1.637
Nurse visits: 46
Time spent at nursing home: 2.020
Future health care savings: 750

Other Direct Costs:    
Property loss due to fire: 47
Tobacco control: 74

Indirect Costs:    
Productivity Loss Due To:    
Premature deaths: 5.707
Disability: 1.828
Second-hand smoke: 647
Sick days: 1.801
Smoking breaks: 6.424

Intangible Costs:    
Suffering and distress: 9.392

State Revenue From Tobacco Sales:    
Taxes: 350
Total markup: 3.739
VAT (value added tax): 1.555

Net Societal Costs: 29.024 billion ISK

The largest single cost, 9.392 billion ISK, comes from ‘suffering and distress’. Though we’re not sure how this was calculated, some smokers in the office think it should at least be counterbalanced by the ‘happiness and joy’ that also allegedly results from smoking. What do you think?

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