SWITZERLAND Country Studies: A brief, comprehensive study of Switzerland

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The Swiss population voted on the initiative on 23 September The health impact of second-hand smoke is well documented. The impact of smoking bans in cantons where stricter tobacco bans are in place show the health benefits of such measures. A study from the canton of Vaud reported an improvement in lung function, physical well-being and respiratory symptoms among hospitality workers after a similar ban [8]. The current federal smoking ban is lax but allows cantons to implement stricter regulations.

At the time of the vote, 15 of the 26 cantons already had stricter regulations in place, 8 of which are very similar to the demands of the initiative. Workers in various cantons do not have the same rights as some are not protected from second-hand smoke and must even give written consent to work in a smoking environment. Other environmental pollutants as well as radiation are regulated at the federal level with the same maximal tolerated doses throughout the country and no one would call this into question.

The negative economical aspect of second-hand smoke bans on the hospitality business is often referred to by tobacco proponents but a large body of evidence shows that such bans have no impact or even a positive impact on the economy [10], and this argument was even verified locally after a ban in the Swiss canton of Ticino [11] which was published a few weeks prior to the ballot and thus received some attention from the press as well.

Comprehensive country-wide smoking bans do not affect the economy but patchy ones where neighbouring regions allow smoking may. Moreover, the health costs related to second-hand smoke in a small country such as Switzerland, with a population of 8 million, have been estimated at million CHF a year [12]. Their campaign used the following arguments table 1 :. The opponents claimed that the current law was the result of a good compromise from all parties and that the new initiative did not introduce any substantial improvements.

They specifically asserted that the population was already well protected from second-hand smoke. They stated that many businesses had made important investments after the entry into force of the current law, for example to equip their establishment with a dedicated smoking room and said that a new change would compromise legal security. A ban was also claimed as useless since the numbers of smokers was steadily decreasing. They argue that many cantons had already adopted stricter rules regarding passive smoking.


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Moreover, they stated that many businesses already underwent costly renovations in order to comply with the current law and that these investments would be lost if the law were to change again as stipulated in the initiative. The argument that hotels would not be able to have smoking rooms was promoted as well. They also alerted the public about the detrimental impact on other sectors of the economy, notably suppliers, advertisement and communication companies. Finally they claimed that the initiative would lead to job losses and a drop in the quality of services. Furthermore, they claimed that if the initiative was accepted, the state would soon regulate every area of our privacy.

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Finally, they claimed that the real intentions of the instigators of the initiative were for a society where smoking is completely prohibited. They referred to another initiative which was still at the stage of collecting signatures, but was stricter than the initiative at vote, as it would even extend the ban to exclude dedicated smoking rooms without service and would ban smoking outdoors in certain settings, despite it coming from an individual uninvolved with the present campaign. This other initiative was labelled completely extremist, while in fact it proposed nothing other than a strict implementation of the best practices indicated in the WHO Framework Convention on Tobacco Control FCTC guidelines on the application of Article 8.

With two thirds of the voters rejecting the initiative, which furthermore was opposed by all cantons except one, including those where a similar ban was already in place due to successful cantonal initiatives, the proponents of the initiative were justifiably very disappointed by the result of the ballot box. Although they knew that there was no certainty that the initiative would be adopted by Swiss citizens, they did not expect such an overwhelming defeat.

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Was this result predictable and have the supporters of the initiative been victims of some kind of delusion? Or did something happen that radically changed the outcome in the last few weeks before the vote? Did the proponents of the initiative make some strategic or tactical mistakes in their campaign that offered crucial opportunities to their opponents to defeat them?

Most likely, the true answer is a qualified yes to each of these questions.


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  5. It is thus important to consider the plausible reasons for this failed public health initiative, in order to draw the necessary lessons and transform this setback into an experience which will help develop more effective public health policies in the future table 2. The initiative for the ban of second-hand smoke was initiated by the Swiss Lung Association and placed under the steering of a group of health specialists. This alliance raised 1.

    The opponents consisted of an ad-hoc committee of politicians and were backed by private donations; they refused to disclose their funding including the fact as to whether they received contributions from the tobacco industry. Switzerland is home to three major tobacco firms, British American Tobacco, Philip Morris International and JT International, having headquarters, large operation centres and factories in the country.

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    Regardless of direct contributions, their presence is always felt with regard to decisions in tobacco regulation. However, opponents managed to reframe the purpose of the initiative in such a way that the decision was, for many voters when they cast their ballot, no longer a smoking ban in hospitality establishments and in work places but a proposal to ban smoking altogether.

    According to the government sponsored election survey [13], smokers largely rejected the initiative; their main cited reasons for doing so were a fear of restriction of personal freedom and a rejection of excessive bans. Interestingly, even the cantons with similar laws to the initiative in place, with the exception of Geneva, voted against the current initiative. One could at first imagine that these stricter measures are not popular in the cantons where they were introduced; this is not the case. A survey undertaken by M.

    A study undertaken by GfK in the canton of St. Finally, a similar study, also by M. Geneva accepted the initiative by a small margin of Overall, the level of rejection of the initiative by the cantons was inversely correlated with the current level of protection against passive smoking they currently had fig. A major argument of the opponents was that by imposing a federal law, the cantons would lose their autonomy, which they value as very important. Federalism has been of central importance in the governance of Switzerland since the founding of the modern state in This federalist state structure affects many aspects of public policy, such as schooling, health care and the tax system, which are different from one canton to the other.

    Health in many respects is still largely a cantonal responsibility. It should be noted, however, that the federalist argument had surprisingly little weight in the motivation of voters, whether they accepted or refused the initiative, and played virtually no role in the outcome of the vote. According to an election survey [13], only one quarter of the voters who were in favour of the initiative invoked the need for a federal harmonisation of the smoking ban, while smokers, who overwhelmingly rejected it, paradoxically invoked this argument in much greater proportion.

    During , the Federal Council the Swiss government and the parliament both refused to support the initiative or offer an alternative proposal.

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    Two months before the vote, every Swiss citizen was sent a booklet containing the recommendations of the Federal Council [14] with the arguments both in favour of and against the initiative. They also mentioned that the current law had only been introduced in , that it was a good compromise obtained after much deliberation by the two chambers of parliament, and that many positive achievements could already be observed; they argued that it would be premature to change a new law so soon after it had been put in place and that people should wait to see if the situation continues to evolve positively.

    Their other claims were that the current law respects the principle of federalism important for Swiss tradition, that the initiative would force the Federal Council to establish an ordinance within six months that would remain in place until the parliament adjusted the current federal law, observing that such a practice of changing the law frequently would be unnecessarily burdensome, and finally that the initiative went too far and was not flexible enough — citing the example of an employee who smokes in his personal office without exposing anyone else who would not be allowed to do it anymore.

    This last example was actually misleading, since the proponents of the initiative had since the beginning of the campaign repeated that their only demand was the protection of the population from exposure to second-hand smoke and that employees who smoked in personal offices without anybody else being exposed to their smoke would not be subjected to the ban. In Switzerland, citizens can demand, by an initiative, that a modification of the Swiss Constitution be put to a vote. In order for the initiative to pass, it must first gather , Swiss petitioners within 18 months.

    Switzerland

    However, of the initiatives submitted to the vote of Swiss citizens since , only 19 passed the double requirement of being accepted by the majority of the population and by the majority of the cantons. The difficulties in applying these initiatives had been discussed in the media quite extensively in the time leading up to the September vote. The current initiative for the smoking ban was criticised by the opposition and the government because it implied that the Federal Council would have to establish a transitional ordinance within six months that would remain in force until the parliament would modify the law on the protection against second-hand smoke.

    They claimed that this procedure was unusual and that it would lead to a great deal of unnecessary complexity, both in the elaboration of the law and in its implementation, making the initiative yet another difficult one to apply, should it pass. On 16 May the Federal Council set the date for the vote to 23 September The campaign for the initiative was launched on 13 August leaving it just over a month to convince Swiss citizens of the importance of the health issue at stake.

    Unfortunately, this was insufficient time for a full-fledged campaign; an election survey revealed that the health issues at stake were not well understood by the population [13]. Since Switzerland has forbidden advertisements for tobacco products on television and the radio; however, all other forms are permitted, with regional exceptions. Swiss citizens even voted against a constitutional initiative to ban advertising of all tobacco products in November [15]. As a result, tobacco advertisement remains one of the main sources of revenue for the written press in Switzerland.

    It has been demonstrated that cigarette advertising in magazines is associated with diminished coverage of the hazards of smoking [16]; this was clearly the case in the time leading up to the vote. The Swiss Association for Smoking prevention analysed the written press during the four months following the collection of signatures for the initiative and found that out of contributions regarding the smoking ban, only 91 were in its favour whereas articles were against it [17].

    Direct advertisements during this short period were insufficient to change the opinion of the reader base. The current federal law for the protection against second-hand smoke allows dedicated smoking rooms with service in hospitality venues and also smoking establishments of a surface area equal to or under 80 square meters, provided the employees accept to work in these conditions and that this is stated in their employment contract. According to the government, this law was reached as the result of a compromise which followed extensive discussions for many years in the Federal Chambers.

    Another point of interest is that the population is aware of the limits imposed by the current legislation. New legislation, as demanded by the initiative, carries uncertainties in its limits as exposed by the campaign and the many, arguable false, claims used by the opposition as arguments. The main points of uncertainty that were brought up in the debates were if an employee would be allowed to smoke in his individual workplace if no one else is exposed and if unstaffed smoking rooms would still be allowed.

    On the same day, 23 September , the Swiss population was also asked to vote for other political issues. Despite the tobacco initiative having raised a vivid discussion, it was judged by the population to be the least important issue [13]. Studies show that even in high income countries such as Canada, the UK and Australia, almost half of smokers do not recognise that their smoking can cause cardiovascular disease in those who breathe their smoke [19].

    The initiative was launched by the Swiss Lung Association with the support of the Swiss Cardiology Foundation, the Swiss Cancer League and the Swiss Medical Association among others and a call for physicians to be vocal lobbyists was made [20]. Interestingly, the vaccination coverage map by canton is similar to that of the proportion of people who voted for the initiative, although this could be attributed to the fact that traditionally the French and Italian speaking cantons are more open to initiatives addressing public health issues.

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    A survey showed that people who accepted the initiative were politically more inclined to the left, had higher confidence in federal authority, were younger, had higher educational status and were French speaking [13], although this last point is probably because the majority of French speaking cantons had already accepted stricter local regulations.

    The campaign for the initiative was mostly framed positively in terms of the gains that its adoption would bring better protection against passive smoking, equity among hospitality workers, national legislative coherence , while the campaign of the opponents was framed negatively, putting forward losses loss of freedom, loss of revenue, loss of cantonal independence. Prospect theory [23] has shown that when people evaluate gains and losses, at equal objective values, losses take a much greater subjective importance than gains: people have an aversion for losses and a substantially larger gain is needed to compensate for a loss.

    This offers another highly plausible reason for the failure of the initiative. For most voters, at the individual level, the gains resulting from the initiative were small, if not insignificant. In the French speaking cantons, current local laws were already providing the same level of protection.

    For cantons which had not adopted local laws, the federal law had represented large gains, which provided what most citizens considered an acceptable degree of protection. Although the motivations of its promoters were legitimate both on health and equity ground, the initiative only filled gaps. This was probably perceived by most voters not to be enough to compensate for the scary losses announced by the other side, even assuming that these were just hypothetical. The predicted losses were of course highly exaggerated and resulted from distorting the initiative beyond recognition, a typical straw man argument.

    However, as the stake was not high in the mind of voters, who were called to the polls to decide also on other matters perceived as more important, it is likely that a large part of them based their decision simply by making theirs the campaign slogans and followed the voting directives issued by political parties, without trying to form their own independent opinion. The above explanation seems contradicted by the fact that the initiative received greater support in the cantons which already had stricter passive smoking regulations in place, i.

    Not only were the gains brought by the initiative relatively small, these gains were also not well communicated to the public perhaps because they were not easy to communicate simply. This rather unfortunate graphic design decision further weakened the positive impact of the message. The Swiss initiative for a comprehensive ban on smoking failed for many reasons. The dangers of second-hand smoke are now well documented and even the tobacco industry recognises them. We believe the public health conclusions on second-hand smoke are sufficient to support smoking restrictions in public places.

    Powerful interest groups oppose science based prevention and also exert a considerable influence on the population as exemplified in the campaign. The debate got shifted to the very existence of smokers and away from the important health issues. One can wonder if it is better not to accept anything but a comprehensive ban which could take longer to implement or a partial one that can be accepted more rapidly with the risk of greatly postponing — or pre-empting, as the tobacco industry says — a comprehensive ban.

    It seems inevitable that one day Switzerland will be graced with such a ban. Another point that can be criticised with the present initiative is the lack of precision in the demanded ban. This allowed a shift in the debate on many topics that were not supposed to be an issue, such as smoking in individual offices, and wasted much needed time and energy which should have been used to explain to the population the health benefits of a comprehensive ban.

    When decisions related to public health issues are put to popular vote — or put to debate by a legislative body — they should be carefully framed. Its tax take of At Neighbouring nations such France The gap was even greater on government spending. France 2. Unsurprisingly Greece scored zero on this front. Regulations can make it difficult for entrepreneurs to succeed. Switzerland ranked well on these regulations that often impinge on business. The degree to which government hinders the free flow of foreign commerce and finance has a direct impact on the ability of individuals to pursue their economic goals.

    On trade freedom Switzerland ranked 1st equal with a score of Foreign investors suffered little discrimination investment freedom — 10th and sources of financing were plentiful financial freedom — 3rd. Despite its reputation for launching impressive and innovative companies such as Google and Apple, the US performed quite poorly. With an overall score of Despite taxing less than Switzerland This is digging a fiscal hole for future generations of Americans that will limit their economic freedom.

    At the bottom were the usual suspects. North Korea was last with a score of 2. This man is one of five now missing from Hong Kong. For more stories like this on Switzerland follow us on Facebook and Twitter.