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The feeling on the ground in Germany is eerily reminiscent of the early days in the USA or the UK: the enemy seems all powerful, the press appears to believe nearly every word they say, and the general public does not seem concerned either way. At best, people think the health side is exaggerating, at worse that they are some sort of control freaks, unpleasantly reminiscent of a part of Germany’s history that everyone would like to forget. In tobacco control terms, Germany is not just the bad boy of Western Europe, but also a country that disobeys all the usual rules when comparing current smoking rates, including those among health professionals, with levels of education, traditions of intelligent social administration, and the pragmatic application of science.
While it is too simplistic to focus all the blame on Adolf Hitler, his hatred of smoking put a lasting stain on what was to become Germany’s most serious public health issue, and the unfortunate shadow of history hung over the nation’s public health for many years. For tobacco control, it was probably a major factor in preventing Germany from becoming a pioneer and leader in this field of health policy. For example, in the years immediately after the second world war, cancer researchers who suggested that an investigation should focus on tobacco may have found themselves given a rather wide berth. Similarly, sensible people, aware of the abuse of public health policy for extreme political purposes, would have been unlikely to advocate that the government should implement action on smoking.
When Doll and Hill published their retrospective study of smoking and lung cancer in 1950, one might have expected German doctors to be among the first to sit up and take notice. After all, German scientists had been pioneers in this area of research, with one producing convincing evidence of the link more than 50 years earlier. When the two British scientists followed with their pioneering prospective study of British doctors in the mid 1950s, would not their German colleagues have been the most likely to follow the fortuitous model of using doctors as the subjects in further research, which had so boosted compliance in the British doctors’ study? But many German doctors would have seen this whole area of research as a poisoned chalice. The distrust of government action on what could be seen as personal behaviour lasted well into our own times, and explains why public health has only become a recognised speciality within German medicine within the last decade.
In addition, after the second world war, the newly created West Germany was a sitting target for a huge invasion from American tobacco companies, whose cigarettes became a form of currency as the country got back on its feet. Today, the tobacco industry in Germany, both local and international, represents one of the largest concentrations of “Big Tobacco” in any European country, with the biggest local firm aspiring to join the big boys in the international club. German politicians do not oppose action on tobacco just because of lack of education about the topic; at important times of decision, such as over the European Union directive on tobacco advertising, the industry has had up to 10 people lobbying full time. It takes two to be influenced by tobacco money, of course. Most of the political parties and individual politicians who take tobacco money see absolutely nothing wrong with it. Even the Green Party, once the brightest hope of environmentalists in Europe, has turned a brownish shade, impermeably tainted by tobacco funding.
The news media, too, appear unconcerned by what goes on to keep smoking the norm in Germany. With honourable exceptions, such as certain freelance journalists whose investigative articles have been spiked by those who bought them, the press and broadcast media generally ignore the most important output of tobacco control advocates; and there is widespread suspicion that television soap operas are tobacco funded.
The results of such long term lack of attention to the tobacco problem are not hard to see. The average age of starting smoking among German children is 13.6 years. Some schools even have smoking areas, to enable pupils aged 16 or more to smoke if they want to. Revealingly, efforts to curb street vending machines, a popular source of cigarettes for young people, were strongly challenged by the industry. Eventually a compromise was reached, with the machines being upgraded—this is high tech Germany—with microchips that respond to identity cards to restrict sales to adults. Sales are therefore down, but it does at least preserve the 800 000 machines on Germany’s street corners; and it may not be unknown for young people to borrow their older siblings’ or friends’ ID card to make a purchase. Magazine ads often refer readers to websites leading to tobacco promotion pages where attractive prizes can be won, ideal for attracting young people, with their superior web navigation skills.
The students’ magazine Unicum, distributed free in universities and colleges throughout Germany, not only carries regular tobacco ads, but appears to plug other tobacco promotions relentlessly. For example, Polo-Cigaretten-Fabrik (Polo GmbH), recently acquired by the UK’s Imperial Tobacco group, runs special promotions for its Polo cigarette brand in association with Unicum, using a series of quirky ads centred on flirting and other aspects of young people’s relationships. One ad shows a young couple in an intimate embrace, describing in mock serious detail what good exercise kissing can be, with between 29 and 34 muscles involved. Readers are invited to send in their suggestions of the best places to flirt, with the lucky winners of a draw being sent a voucher entitling themselves and a partner to Sunday brunch on the sun terrace of the best restaurant in their town. Enjoy Sunday morning, they are told; and don’t forget your sunglasses.
Needless to say, Philip Morris is in on the student act, too. Each year, readers of Unicum can rely on a regular dose of plugs for “Marlboro Summer Jobbing”—kids are told that, “In Marlboro country, where freedom and adventure are at home”, everyone aged 18 and over can feel like a cowboy or cowgirl. With flights to the south west of the USA and accommodation paid by Marlboro, they can work as a ranger assistant, farmhand or location scout.
Ironically, travellers visiting Germany in the 1930s reported on the country’s admirable tradition of encouraging young people, especially students, to travel, with even the smallest town providing a night’s free dinner, bed and breakfast for backpackers at the local hostelry. Unfortunately, that aspect of history seems to have been forgotten, too, and the intentions of the tobacco companies in promoting the idea, or more accurately, the image of travel to students today are far removed from those of the small town burghers of the early 20th century.
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