SHARE
COPY LINK

HEALTH

How Spain could stamp out smoking

A fifth of Spain's population smokes on a daily basis. With such high numbers, here's how the country's pulmonologists propose to get smokers to quit.

Spain plans to get people to quit smoking
How Spain plans to get people to stop smoking. Photo: Khalil MAZRAAWI / AFP

For many outsiders, Spain is a nation of smokers. 

The stats from Spain’s Ministry of Health show that 23.3 percent of men smoke every day in Spain, compared with 16.4 percent of women.

For both males and females, the highest number of smokers are aged between 25 and 34, meaning that it’s the younger population who are smoking slightly more than the older generations. 

Spain’s pulmonologists are now pushing for the country’s tobacco laws to be tightened, claiming that reform is needed after the last legislation was approved a decade ago.

READ ALSO: Spain warns against smoking and vaping in public to avoid Covid infections

Why is smoking such a problem in Spain and what is being done about it?

The latest stats from the Spanish Ministry of Health show that lung cancer, often caused by smoking, is the third most frequently diagnosed cancer in Spain, with 29,549 cases diagnosed so far in 2021.

Given these high figures Spain’s Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has proposed five measures to help get people to stop smoking.

SEPAR points out that every time anti-smoking legislation is reformed and things for smokers made more difficult, the prevalence of smoking decreases.  

Smoking on terraces was banned in some regions during the pandemic. Photo: CRISTINA QUICLER / AFP
  • Price of tobacco to rise in 2022

The first point on their list is to raise the price of tobacco, which must cover all forms, from cigarettes to cigars, through to rolling tobacco, and electronic cigarettes.  

This first measure may soon become a reality as the Spanish government has already predicted that the price of tobacco will rise in 2022, after several years of stagnation.  

It is expected that tobacco will be responsible for almost a third of all special taxes received in 2022, equating to €21.8 billion.

According to the World Health Organization (WHO), “cheap tobacco” in Spain guarantees “a percentage of smokers above 30 percent”.

In Spain, the price of a pack of tobacco is around €5, which is much cheaper than in other countries. In Australia for example, a pack of tobacco costs around €22, and in the United Kingdom and France, each pack of tobacco costs around €12.4 and €10.5, respectively.

According to Dr. Carlos A. Jiménez Ruiz, pulmonologist and president of the society, the current anti-smoking law has “some deficiencies” that need to be addressed in order to develop legislation that is more effective and efficient, especially with regard to the prevention of tobacco consumption in young people, but also in helping smokers to stop smoking and in protecting the health of non-smokers. 

READ ALSO – Maps: Which beaches in Spain have banned smoking?

Besides increasing the cost of tobacco SEPAR proposes four other measures to get Spain to quit smoking. These include:

  • Banning the consumption of tobacco in public spaces, even outdoors
    During the pandemic, several regions approved a regulation to prohibit smoking on terraces. SEPAR proposes that smoking be prohibited not only in spaces such as terraces but also in sports stadiums, beaches, parks and bullrings, and that fines should be imposed for those who do not comply.

  • Establish generic packaging
    SEPAR also wants Spain to introduce generic packaging, which means no logos and images of the tobacco companies. This measure has also proven to lower the sales of tobacco in countries where it has been implemented, such as Australia and New Zealand. According to the latest statistics from the Australian National Drug Strategy Household Survey around 11.6 percent of adults in Australia smoke daily. 

  • The regulation of other smoking devices
    Despite the fact that all products that burn tobacco such as cigarettes are already regulated, SEPAR believes that it is also necessary to regulate the sale, consumption and advertising of electronic cigarettes. This is because e-cigarettes have become particularly popular among young people. 

  • Promote help for those seeking to quit smoking
    The last proposal is the creation and development of special units in public health departments to help people to stop smoking and to put more funds towards these programmes. 

How does Spain compare with other European countries when it comes to smoking?

According to the Organisation for Economic Cooperation and Development (OECD), while Spain does have a high number of smokers there are still several European countries that have more. The European countries with the highest number of smokers are Greece, Bulgaria and Hungary.

The latest European survey from 2020 shows that 42 percent of Greeks claim to be smokers, which is only slightly above Spain. 

On the other side, the European countries with the lowest number of smokers are mainly Nordic countries, such as Sweden, Finland, Iceland and Norway.

Member comments

  1. Not sure if your stats are quite right. If 23.3 percent of men smoke, compared to 16.4 percent of women, isn’t the overall percentage closer to 20? Not 39.7%?

Log in here to leave a comment.
Become a Member to leave a comment.
For members

HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

SHOW COMMENTS