Gaining health : analysis of policy development in European ...

of the present ten-year strategy. Representative sample
surveys of 4000 children and adolescents and 8000 adults
aged 18–65 years throughout the country are to be carried
out by academic centres in collaboration with the Ministry
and the Health Regions. For the children and youth survey,
the Achenbach questionnaire is to be used, while the survey
of the adult sample will be carried out by household visits.
In addition, there is to be a study of the existing utilization
of mental health services. Consequently, it is expected to
obtain a greatly improved picture of the real prevalence of
mental illness and of mental health care and other services
available, such as sheltered housing. By securing this muchneeded
information, it is hoped to secure the evidence base
necessary for defining emerging challenges and promoting
mental health.
2.6. Policies related to risk factors
2.6.1. Tobacco control
Tobacco is still an important crop in some parts of the
country and Greece is the world’s seventh largest tobacco
producer. The tobacco lobby is therefore quite strong.
The rate of smoking in Greece is above the European
average. Disregard for the comfort of non-smokers is not
uncommon, particularly in bars and restaurants (where, according
to existing legislation, space for non-smokers should
be provided), in the work environment and in many public
services. Smoking is still socially quite acceptable, reinforced
by a culture where free will and tolerance play an important
role and where many consider that restrictions on smoking
are invasive (21). This may be slowly changing as the rights
of non-smokers begin to be recognized.
There are apparently considerable differences in the rates
of smoking in different parts of the country (22). Rates are
higher in Athens (where 51% of men and 39% of women
smoke) compared to rural areas, where cultural traditions
that frown on women smoking tend to keep rates down.
Contrary to many countries, however, it appears that
“those of higher socioeconomic position are more likely to
smoke than the less educated or those of lower income”
(23). The most serious challenge is the high rate of smoking
among young people.
Greece complied with the 2001 EU Directive 2001/37/
EC introducing large warning labels on packages of tobacco
products. A decision of the Ministry of Health and Welfare
in 2002 prohibited smoking in all buildings housing public
services, private workplaces, and places where the public
is obliged to wait for long periods of time (such as airports
and railway stations), all health services and educational
institutions, where smoking rooms were to be provided. A
supplementary decision in 2003 indicated that, by agreement
between employers and employees, smoking and
non-smoking zones were to be provided. Implementation
of these decisions was left to those “in charge” of the
said institutions with the result that, even where smoking
restrictions are in place, there is a tendency to break the
rules, particularly in leisure-oriented places in general and in
railway stations and taxis (24).
Although the MHSS has intermittently organized committees
to discuss the problem of tobacco and health, and laws
regarding the sale of tobacco products have been passed,
this has not yet led to a comprehensive smoking control
policy. 10 There is no related training for health professionals
and, equally importantly, as yet almost no effective restrictions
on the sale of tobacco to minors.
The WHO FCTC was signed in 2003 and ratified in Greece
in 2005. A joint ministerial decision (25) was taken to
bring Greek legislation in line with an EU Directive of 2003
regarding the banning of tobacco advertising in the mass
media and the sponsorship of cultural events by tobacco
10
Since the completion of this case study, a National Action Plan for
Smoking 2008–2012 has been formulated (in Greek only) by the Ministry
of Health and Social Solidarity and is available at http://www.mohaw.gr.
As from 1 July 2009, smoking is prohibited in all public places.
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Case studies: policy development in countries for tackling noncommunicable diseases