knowledge transfer

Topic: Federal Office of Public Health CH-3003 Berne, www.bag.admin.ch April 2006/No. 55 The three-franc binge taxation law. Beer is very popular with adolescents and a common binge drink – not least because the beer sold through retail outlets in Switzerland is very cheap. Three francs is all it takes to drink yourself into near oblivion. Against this background, health and prevention experts are calling for a massive increase in the tax on beer, because higher prices have been shown to affect consumption, particu- larly among young people. Michel Graf, Director of the SFA, also hopes that the National Council as the second chamber of parliament will be more receptive to the con- cerns of the prevention experts. He feels that at «the absolute minimum» the Federal Council should be em- powered to raise the tax on beer for health reasons. The fact that preven- tion has deliberately been excluded from the beer taxation law is just as «unacceptable» as the tax itself, which is far too low and «can in no way have a regulating effect on adolescent alcohol consumption, which would enable it to exert a preventive effect.» Simonetta Sommaruga, State Coun- cillor for Berne, feels that «a beer tax- ation law with no element of health protection is not a pure tax law but simply a bad tax law». Sommaruga believes that beer consumption is undergoing a «frightening develop- ment», and sees a clear need to rein- force prevention.

Binge drinking by young people is unfortunately on the rise in Switzerland – not least owing to very low beer prices. Problematic drinking habits The average per capita consump- arliament is currently discussing a has joined with the Addiction Asso- tion of beer in Switzerland has de- new law on beer taxation. On 6 ciation and the Study Group on Al- creased slightly in recent years, but in

Prevention and Health Promotion P March, the Council of States unani- coholism and Addictions in French- terms of public health it is not total or mously approved a slight amend- Speaking Switzerland (GREAT) in average consumption that is the ment to the existing law: the current calling for a sharp increase in the beer problem, but drinking habits. Apart taxation rate is CHF 24.75 per hec- tax. Research findings and experi- from alcohol dependence and chron- tolitre for all types of beer; the new ence in other countries have shown ic alcohol abuse, there are other pat- proposal is for a rate of CHF 16.88 that high prices have a preventive ef- terns of behaviour that have a con- spectra for low-alcohol , CHF 25.32 for fect, specifically among young peo- siderable negative impact on public regular and special beers, and CHF ple. The recent case of alcopops (see health, namely binge drinking and 33.76 for high-alcohol beers. The box on page 4) shows how effective inappropriate drinking (e.g. in con- Council rejected by 22 votes to 18 the this type of structural prevention is in junction with driving or during preg- proposal put forward by the Eco- Switzerland. As This Jenny, SVP nancy). nomic Affairs and Taxation Commit- State Councillor for Glarus, com- tee to reduce the tax on beer. «At mented in the debate on 6 March, «A Alarming increase least this version is the lesser of all low taxation rate boosts consump- Recent findings are alarming. Four the evils,» commented Michel Graf, tion, a high rate throttles it. Con- out of five 13-year-olds have drunk Director of the Swiss Office for Alco- sumption of alcopops plummeted alcohol at least once in their lives. hol and Other Drug-Related Prob- after the tax on them was increased Prevention experts are concerned at lems (SFA). But the health and pre- from CHF 0.45 to 1.80. So taxation is the enormous increase in binge vention experts are by no means clearly linked to consumption.» happy with this situation. The SFA Markus Theunert, Secretary Gen- Continued on page 4 eral of the Addiction Association, be- lieves that part of the problem is that Taxes affect prevention is viewed as a completely Interview consumption one-dimensional activity. «Many politicians don't think further than The prevention experts rejoiced poster campaigns and activities in when the federal government im- schools. They simply don't realize posed a special tax on alcopops in that behavioural prevention, or in April 2004: imports of these prod- other words regulating the market, is ucts dropped from 4.3 million litres the simplest form of prevention.» in 2003 to 1.3 million litres in 2004. Theunert mentioned efforts to pre- The tax on imported spirits, how- vent smoking, an area in which re- ever, was reduced massively cent developments have clearly (50% on whisky and cognac) as shown that structural prevention is long ago as 1999 from CHF 34.50 starting to have an effect. per litre of pure alcohol to a flat rate of CHF 29. A survey of 4,000 Beer is cheaper than bread people carried out by the federal Beer is more popular than ever Hans Gammeter is a general practitioner government showed that con- among adolescents as a low-cost entry- in Wattwil (Toggenburg). He is familiar sumption in general jumped im- level drink. Against the background with the questions and problems facing mediately by 15 to 20%, with a of a massive increase in alcohol con- doctors who have to treat substance- massive increase of 75% among sumption by adolescents, health ex- young men aged 16 to 30 and perts urgently warn against sacrificing dependent patients, particular those in 50% among women in the same the beer tax to economic interests, a methadone programme. To facilitate age group. There has been no tax thereby completely ignoring the as- and professionalize such work, Hans Gammeter and other like-minded pro- P. P. on and must in Switzerland pect of addiction prevention. «Beer is since 1937, when pressure from cheaper than bread, so a drunken fessionals set up FOSMUS, the Forum

3052 Zollikofen vintners and farmers forced the stupor costs less than a full stomach,» for Addiction Medicine in Eastern government to revoke the «gener- says Markus Theunert. «Politics has Switzerland, which he has been coordi- al beverage tax» introduced in 1934. failed here, and if parliament is not nateing for the last two years. The tax on beer remained in place. prepared to correct this awful situa- >> Pages 2/3 tion, then it is acting irresponsibly.» spectra No. 55 • April 2006 Topic: knowledge transfer Page 2 Addiction work in general practice: «You can't e Forum for Addiction Medicine in Eastern Switzerland. One in three adults smokes, one in five has an alcohol problem, one in every hundred u fy and professionalize the work done by doctors who provide primary care to patients with dependence problems? This was the topic of a discussion with cine in eastern Switzerland; its goals are to expand collaboration between addiction experts and achieve better results through interdisciplinary cooperati spectra: How did you get in- Are the drug addicts you treat in noticed that they were not working volved in addiction medicine? your practice different to addicts in such isolation; thanks to CORO- Hans Gammeter: I realized while in urban areas? MA they had structures in which I was at medical school that I wanted I've never worked in a health cen- they could discuss their cases. Travel- to go into primary care, but I was also tre in a city, but I would imagine that ling home with another GP after the keen to practise medicine in the third the clients are much the same. But conference, we developed the idea of world. I organized my studies and my there is no heroin-prescribing pro- doing something similar for us. postgraduate training so that I could gramme in Toggenburg, which spend part of the time in Switzerland means that we don't see patients So how did the self-help organi- and part abroad. I spent a total of six who are in such a poor state that pre- zation get started? years or so in third-world countries, scribed heroin is the only option for Two people played a vital role in and that's how I qualified in tropical them. But apart from that we have the initial phase: René Stamm from and travel medicine and in general the whole spectrum of patients, from the Federal Office of Public Health, medicine. With hindsight I think it those who are pretty well integrated whose response was immediate and was logical that I developed an inter- to those who live on the margins of positive; he saw parallels to CORO- est in addiction medicine because society. We also have women with MA and brought us together with the medicine in the third world is social children, and I have seen several people from COROMA. Also Felix medicine more than anything else, pregnancies involving women who Jungi, the cantonal medical officer in where the emphasis is often on trans- were dependent on drugs. Some St. Gallen, who also recognized at ferring knowledge, working out what come into conflict with the law. We once that a structure like this could you can do to keep people as healthy are often confronted with unique be useful to him in his work. During as possible in a disease-ridden envi- cases – and then it is important for us the annual continuing education ses- ronment. Most of my work in the to be able to ask someone who has sion on methadone in St. Gallen I third world was in grassroots medi- experience of such situations. was able to talk about what I had cine, teaching local colleagues. That's learnt at the national addiction con- where I learnt to work in teams and Do problems arise if your addic- ference. A coordinating group was with different types of professionals. tion patients encounter your formed and we set ourselves up as a I learnt to listen to others and to «normal» patients in the practice? network. The Canton of St. Gallen understand the way different profes- We haven't had any problems of and the FOPH agreed to fund the sional groups communicate. Back in that kind in our ten years here. We project in its first year. The next Switzerland, my last job before I be- have never had a break-in, there has major step was to involve all the can- Hans Gammeter came self-employed was in psychi- never been any violence in the prac- tons in eastern Switzerland. I visited atric medicine, and that's where I tice, and I have never heard any crit- all the cantonal medical officers and of the St. Gallen/Appenzell pharma- came into contact with addiction icism from other patients. It probably was welcomed with open arms cists' association is a member of our medicine. depends to a large extent on how you everywhere I went. It took no time at advisory board. There are not yet I went into practice in 1993, and in organize things. From what I hear in all to convince them because the enough pharmacists involved in FO- the same year the Canton of St. the scene, addicts consider me to be FOPH and Canton of St. Gallen were SUMOS, considering the number of Gallen introduced a system which as- a strict drug doctor. I never prescribe already supporting the project. Most methadone programmes run by this signed a medical officer to the social benzodiazepines, and I'm very strict of the cantonal medical officers real- profession, and this is a situation that welfare offices. This meant that I was about doses of methadone that get ized at once that the network would we are keen to remedy. surrounded by social work from the «lost». I try and keep the tension make things easier for them and also start, and I became familiar with and often found on the street out of my improve the quality of their work. What benefits can FOSUMOS learnt to appreciate this field and the practice as far as possible. I insist that offer general practitioners? work it does. my patients adhere to a relatively So that was the background to What should a GP do if a new pa- strict structure, and I sign a contract FOSUMOS. Can you briefly de- tient comes to see him and wants What’s the proportion of patients with each of them that we stick to as scribe how the project works? methadone, how should he handle with addiction problems visiting much as possible. We view ourselves as a network patients who have an alcohol prob- your general practice? At the same time, I try to treat and want to avoid a structure that is lem or who want to give up smoking, I currently have around 20 patients these patients on the same interper- too rigid. The network is run by an what advice should he give to parents in substitution programmes, and I see sonal level as I would other patients. interdisciplinary coordinating group who want to know how to deal with one or two of them during my con- I don't get too familiar with them, whose representatives cover all the a child who smokes pot? We feel that sultation hours every day – in addi- but they know that I will have time geographical regions. This group there is too little readily available ev- tion to between 20 and 25 other pa- for them when they need it. The crux comprises three GPs who are also idence-based information in these tients. In other words, about ten is to establish mutual respect. We – medical officers attached to social areas. And that's why we offer a percent of my patients, but in terms my practice nurses, who almost have welfare offices, one practising psy- handbook on our website. The chap- of the time I spend with them, more, more contact with the patients than I chiatrist, two hospital-based psychia- ters covering opiate substitution, because I tend to spend more time do, and myself – have succeeded in trists, two psychologists and four cannabis and cocaine are already on- talking to patients with addiction achieving this respect, and that is people involved in social work. The line, and we are currently working problems. In addition I have ten or so probably one of the reasons why we coordinating group meets four times on alcohol, which is a really big sub- patients whose primary problem is have so few problems with this group a year, plans the network’s activities ject. Our objective is for GPs to be alcohol dependence. Two or three of patients. You can also organize pa- and implements them. There are a able to access up-to-date information years ago, I started programmes to tients in the practice so that they number of working groups; the most at any time in a form that is as im- help people stop smoking and I gen- don't have too much contact with intensive work is currently being mediately usable as possible. Forms erally have one or two patients who each other, and there's no reason done by the group that is writing our and the texts of laws can be down- want to give it up. why methadone has to be dispensed handbook, an Internet-based refer- loaded, as can algorithms for manag- in the reception area; it's far better to ence work that is the central feature ing patients, recommendations for So on average you need more do it in one of the examination of our website. Another working laboratory tests and the addresses of time to treat patients with addic- rooms. group looks after the regional discus- counselling centres. The online tion problems. sion groups, which are our second handbook is more than a learning re- Treating them is like treating pa- Your everyday experience with main activity. source; it is a tool that should be as tients with other serious, chronic these patients encouraged you to An advisory board brings together useful as possible in the doctor's health problems. I take time to get get in touch with colleagues in leading individuals from various bod- practice. to know these patients and to es- the same position. You set the ies: all the cantonal medical officers, The second thing that we organize tablish how good their physical networking ball rolling at the na- the cantonal doctors' association, is regional discussion groups which health is, using all the recommend- tional addiction conference in forensic medicine, pharmacies, an in- function as quality circles and have ed examinations and lab tests. I al- 2001… fection specialist, Zurich University been operating for about two years. ways treat patients on substitution That's right. I increasingly felt as if Psychiatric Hospital, the association We have four groups which meet five programmes in conjunction with a I was fighting the battle on my own. that represents patients’ families, and times a year, one in each of the re- social worker from the welfare of- I was often in touch with colleagues the FOPH. The purpose of this advi- gions Wil, St. Gallen Rheintal/Ap- fice. The social worker joins us for who had more experience or who sory board is to help exploit synergies penzell, Sargans/ and Glarner- consultations at the start of thera- could help me with a particular ques- and to facilitate direct, easy contact. land. A fifth group will be set up in py, at regular intervals or every tion. I talked to French-speaking col- We also work closely with the Thurgau in the course of the year. time, depending on the patient's leagues during the breaks at the na- pharmacists. We approached them Between 12 and 20 people usually needs. tional addition conference, and I right at the start, and the chairperson attend these group meetings. The dis- spectra No. 55 • April 2006 Topic: knowledge transfer Page 3 expect to cope on your own» At first hand ses cocaine or heroin. These are the everyday problems encountered in general practice. What can be done to simpli- Hans Gammeter, a GP in Wattwil and coordinator of FOSUMOS. This organization is a forum for addiction medi- ion. something provided by doctors for completed. Will FOSUMOS be doctors; the interdisciplinary aspect is well enough established by the extremely important to us. Our ac- time the FOPH stops financing it? tivities are open not just to doctors The FOPH is currently bearing half but also to other professions involved of the costs. We are still dependent in addiction work, although in many on this money to establish the pro- cases – and social work is a good ex- ject. The FOPH wants as many prac- ample here – the other professions tising doctors as possible to take part. «Knowledge is power», or so the saying are already backed by a very good That also means that they must not goes. Democratic societies are well ad- structure. Our key message is better lose out financially because of their vised to keep the power gap between results through interdisciplinary co- involvement, so they need reim- those who have knowledge and those operation. A doctor is naturally more bursement to cover their usual who don’t as narrow as possible – hence inclined to believe things that he hourly rate. We should manage fine the importance of knowledge transfer. hears from other doctors. during the three years in which CHF In the context of our healthcare system, 80,000 per year will be provided. it is therefore our duty to increase peo- How do you interact with other Once everything has been set up as ple’s knowledge of health issues so that groups, and with the French- planned, we should be able to man- they are capable of making a critical as- speaking part of the country in age with the cantonal contributions sessment of the supply side (e.g. health particular? and to do without federal money. insurers, doctors, pharmaceutical indus- We are in very close contact with However, this level of funding will try, catering sector, etc.). The creation of the COROMA project. I meet up once not really be sufficient to achieve a health awareness has been and will re- or twice a year with Barbara Broers, greater degree of professionalization, main an important task of the Federal from whose experience we have ben- e.g. by appointing a business manag- Office of Public Health, the aim of efited enormously. COROMA is de- er. We also have to ask ourselves which is to empower individuals to take signed primarily to facilitate the ex- whether the cantonal funding will responsibility for their own health. change between doctors, and is now continue once the federal govern- keen to move in the same direction ment has stopped contributing. It has Knowledge generated in our own de- as FOSUMOS by improving collabo- to be said that funding from the partmental research is utilized primari- ration with other disciplines. FOPH certainly opens doors. ly to support and legitimize the Confed- eration’s policy on substance abuse. We Do you feel you are benefiting FOSUMOS has been in its [one- rightly call it an evidence-based policy, enough from new findings from year] pilot phase for two years meaning that it is predicated on scien- cussion groups are also run on an in- the universities in your relatively now. What steps are planned for tific criteria and is therefore «objective». terdisciplinary basis, bringing togeth- far-flung corner of the country? the next two years? We all know of course that there is no er social workers, people working in That is certainly one major differ- In 2006 we will be working on al- such thing as an «objective» policy or community and in-patient psychia- ence between FOSUMOS and cohol, which is a big chapter in our «objective» science. Yet the «scientifica- try, and primary care providers. Dur- COROMA, which developed out of handbook. In 2007 we'll be moving tion» of policy – and hence, to many, a ing meetings, cases are presented and contacts between Geneva University on to nicotine and party drugs. At the fictitious «objectification» as well – is discussed or input presentations on and the FOPH. There is no faculty of same time, the existing chapters will a fact that is celebrated (in a sometimes various subjects are given. medicine anywhere in the region be revised and updated. The regional problematic manner) in the mass Our third activity is a service that covered by FOSUMOS. We draw to a working groups will be supported media. provides answers within 24 hours to large extent on regional knowledge, and expanded. We want to produce a specific questions relating to addic- as the psychiatric clinics here have leaflet for distribution to general Conversely, science has been «politicized» tion medicine that are posted on the been active in addiction medicine for practitioners and addiction centres so and is now underpinned by value sys- Internet. many years. At the same time we that more people can be made aware tems that lack transparency. As a result, would like to have more direct con- of the work we are doing. in knowledge transfer nowadays it is al- How many doctors are treating tact with university-level addiction most impossible to separate insights (of addiction problems in eastern medicine, so we are very pleased to science) from interests (of the commis- Switzerland? be in touch with the Swiss Society for sioning organization, and from science’s About 45% of the doctors in Addiction Medicine (SSAM), with FOSUMOS own particular interests). It is important Switzerland are running substitution whom we have a lively exchange of The Forum for Addiction Medicine that we always bear in mind that programmes, but many of them have opinions, and to have a representa- in Eastern Switzerland was set up whenever we transfer knowledge we are only a few patients, so these doctors tive of Zurich University Psychiatric in 2003 by doctors, psychiatrists, walking along a very narrow line be- are particularly in need of up-to-date Hospital on our advisory board. Prob- psychologists and social workers tween quite disparate interests: those of information and an exchange of lems tend to reach us in eastern specializing in addiction. the Administration/Confederation (i.e. opinions. Switzerland slightly later than the Fosumos is a project supported our own) in relation to substance-abuse rest of the country. The cocaine by the Federal Office of Public policy, the interests of researchers, the What target group are FOS- problem is a very good example – it Health (FOPH) in conjunction with needs of the public and the concerns of UMOS's activities aimed at? doesn't yet have the urgency here the departments of health in the business. FOSUMOS is deliberately not that it does in Zurich. So we don't Cantons of St. Gallen, Appenzell, need the expertise until later, and Glarus, Thurgau and Graubünden, The problem is getting the right knowl- that means we can wait until a glos- and the Principality of Liechten- edge to the right recipients at the right Our interview sary or a handbook has been pro- stein. time. This presupposes that we are em- partner duced in Zurich and can then benefit The forum's objective is to im- powered to (accurately) analyse the from this experience. The chapter on prove professional skills and net- knowledge we receive and translate it Dr Hans Gammeter was born in cocaine on our homepage draws working in addiction work. into a language that is understood by 1953 in Basel. He studied medi- heavily on the experience gained in The interdisciplinary coordinating all our clients. We are also expected to cine at Zurich University and then Zurich and Winterthur. group plans the project and pur- know exactly what is currently topical held various posts in Africa (Chad) sues the objectives set out in the and important and which target groups and Asia (India, Bhutan and Thai- What is your impression of work- performance mandate issued by need which information from us. At the land) before spending several ing with the FOPH? the Canton of St. Gallen. same time, the knowledge recipients years in practical training in hospi- I have always found this coopera- The project is funded by the par- must not feel that they are being manip- tals in the eastern part of Switzer- tion very constructive. I used to think ticipating cantons, the Principality ulated or patronized: we have to ensure land. He is qualified in general of the FOPH as an office that distrib- of Liechtenstein and the FOPH. that our actions are transparent and medicine and in tropical and travel utes paper. Now I have got to know a The current contract runs to the understood and we must make no secret medicine. He opened a group few people through my work for end of 2007. An advisory board of our interests. Only then will we practice in Wattwil (St. Gallen) on FOSUMOS and I am really impressed has the function of intensifying in- achieve our aims in the long term. 1 September 1993 and is also the by their dedication and their profes- terdisciplinary networking. It is medical officer assigned to the ad- sional attitude. also hoped that the activities and diction counselling centre in ideals of FOSUMOS will generate Martin Büechi Toggenburg and coordinator of The FOPH provides start-up fund- a wide-ranging positive response. Head, Scientific Foundations FOSUMOS. Hans Gammeter is ing for innovative projects and and Legal Basis Section married and has four children. then withdraws its support when www.fosumos.ch Federal Office of Public Health the founding phase has been spectra No. 55 • April 2006 Topic: knowledge transfer Page 4 What's being done about cocaine and designer drugs? The national conference in retrospect. In early June 2004 Switzerland's Federal Office of Public Health staged the first National Confer- ence on Designer Drugs and Cocaine. A full report on the proceedings is now available. It contains a detailed account of the conference discussions, reviews recent developments in Switzerland in relation to cocaine and designer-drug use and outlines the Federal Office of Public Health's measures for the coming years. he National Conference on De- growing use of cocaine among young Relatively speaking, the use of de- operation between all the players in- Tsigner Drugs and Cocaine held in people, indicated a pressing need for signer drugs was felt to be less of a volved at the federal, cantonal, mu- Berne on 3–4 June 2004 was the action targeting risk groups. Design- public health problem in Switzerland nicipal and expert levels. While the Federal Office of Public Health's re- er drugs were currently less of a than that of cocaine, though it could cantons, municipalities and specialist sponse to the proposal of the Nation- problem in Switzerland than cocaine. become a serious problem in specific services are responsible primarily for al Drugs Commission that a platform The treatment of dependent co- risk groups. Too little was known implementation of the measures, the be created to address the growing caine users was considered to be a about the long-term effects of de- Confederation's main tasks are and extremely complex problem of particularly great challenge. Though signer-drug use and therefore more cocaine and designer-drug use. a large number of highly promising research was needed in this area as • coordination and networking, treatment approaches existed, the well. • development of a knowledge base, Not a top priority tenor of the conference was that they The speakers and the other partic- • promotion of innovation, The 300-plus experts, administra- needed to be networked, system- ipants basically welcomed the rec- • further training and tors and politicians attending the atized and integrated in order to ben- ommendations published by the • quality assurance conference agreed that cocaine and efit from synergies and be able to re- FOPH in its brochure on cocaine and designer drug consumption was cur- spond to developments in the designer drugs in the run-up to the Many concerns were aired in this rently not an ultra-urgent public problems associated with drugs and conference. These recommendations context, but there was never any health issue when compared with substance abuse. Shortcomings in re- will continue to serve the FOPH as a doubt that, given the scarcity of re- the problems caused by alcohol and search were also identified, particu- basis for any measures it plans to take sources, clearly defined priorities tobacco use. Nevertheless, the slight larly in epidemiology and the evalu- or has already instituted. would have to be set. upward trend in the consumption of ation of current therapeutic these substances, particularly the approaches. Capacity to respond flexibly There was general consensus at the Contact: conference that a large-scale pro- Manuela Schmundt Results of basic research into migration and public health. gramme of measures to address de- FOPH, CH-3003 Berne signer drugs or cocaine was not re- tel. +41 31 322 58 00, The Federal «Migration and Public Some of these projects have now quired. What was, however, needed [email protected] Health Strategy 2002–2007» de- reached their conclusion, and the was targeted action that would en- fined certain key areas of basic re- final reports can be viewed on the able existing services and structures «Nationale Designerdrogen- und search in this field. Researchers website of the FOPH's Equal Op- to gear themselves to new develop- Kokainkonferenz, Tagungsbericht» were invited to submit project pro- portunities and Health Section by ments, making them more flexible [report in German on the National posals relating to these key areas in clicking first on Research and then and rapid in their response to new Conference on Designer Drugs and 2003. The FOPH made a selection on Projects. www.bag.admin.ch user patterns and changes in user be- Cocaine], published February 2006 and commissioned nine research (Topics, Migration and Health, Re- haviour. There was also agreement projects. search). that sustainable improvement could www.bag.admin.ch/themen/ be obtained only by coordinating co- drogen/00042/

Continued from page 1 16% of school-age adolescents drank considerably cheaper than a half-litre on the beer taxation law which calls beer at least once a week; by 2002 the bottle of beer. This is not the case in for a higher tax on beer in the inter- drinking among adolescents. Over figure had risen to 33%. Hans Lauri, Swiss shops. Coop sells a half-litre ests of health. A higher level of taxa- 40% of boys aged 15 – 16 and around SVP State Councillor for Berne, quot- bottle of cola for CHF 1.25, consider- tion would also have a preventive ef- 25% of girls in the same age group ed the Association of Swiss Teachers ably more than the CHF 0.75 that the fect, particularly with respect to the have experienced alcoholic stupor during the parliamentary debate: cheapest half-litre can of beer costs. sweetened mixed drinks that are so twice. Studies show that, among ado- drunkenness in the classroom is still State Councillor This Jenny also feels popular with young people. The im- lescents, drinking beer and spirits a rare occurrence, but over-tired and that «the great disparity in price be- position of a special tax on alcopops correlates particularly strongly with hungover teenagers are becoming a tween mineral water and beer is to- showed that higher prices lead to drunkenness. Beer is the preferred growing problem in schools. tally objectionable. We now know lower sales (see box). The SKS is call- alcoholic drink among school-age that Coca-Cola is 66 percent more ing for a correspondingly high tax to teenagers, and plays a correspond- Beer is too cheap expensive than beer. Is that what we be imposed on beerpops and all other ingly major role in the increased al- The tax on beer is CHF 5.30 per really want?» sweetened mixed drinks containing cohol consumption among adoles- litre of pure alcohol, and as such is GREAT, SFA and the Addiction As- alcohol, including those based on cents. The most recent survey of extremely low compared with the sociation are calling for a «substantial regular, fruit or sparkling wine. schoolchildren in 2002 showed a tax on spirits (CHF 29). This creates increase in the tax on beer to CHF drastic increase in weekly alcohol the absurd situation in retail outlets 168 per hectolitre». This would in- consumption compared with previ- of beer often being cheaper than crease the tax component of a glass of Contact: ous years, with 40.5% of boys aged non-alcoholic beverages. beer from 10 to around 50 centimes. Anne Lévy 15 – 16 and 28.5% of girls in the The World Health Organization Head, Alcohol Section, FOPH same age group drinking alcohol (WHO) believes that the beer tax Alcopops and beerpops CH-3003 Bern every week. Most of the increase in should be high enough to make a The Consumer Protection Associa- tel. +41 31 325 12 66 this age group is due to beer: in 1996 half-litre bottle of non-alcoholic soda tion (SKS) has issued a position paper [email protected]

Infograph Credits No. 55, April 2006 Cigarette prices: «spectra – Prevention and Health Promotion» Translation: is a newsletter of the Federal Office of Public BMP Translations AG, Basel Duty and manufacturers'/dealers' margins in 2006 Health published six times a year in German, Photos: French and English. Some of the views ex- 9.00 Christoph Hoigné pressed in it may diverge from the official 8.00 stance of the Federal Office of Public Health. Graphic design: Lebrecht typ-o-grafik, 3018 Bern 7.00 Published by: Federal Office of Public Health Printed by: 6.00 CH-3003 Berne Büetiger AG, 4562 Biberist 5.00 Tel. +41 31 323 87 79 Print-run: Fax +41 31 324 90 33 4.00 German: 7 000, French: 4 000, English: 1500 Produced by: 3.00 Individual issues and free subscriptions Pressebüro Christoph Hoigné to «spectra» can be ordered from: 2.00 Allmendstrasse 24 Federal Office of Public Health CH-3014 Berne 1.00 Campaigns Section, CH-3003 Berne Head of Editorial Board: Tel. +41 31 323 87 79 0.00 Markus Allemann Fax +41 31 324 90 33 Italy Switzerland Austria [email protected] www.bag.admin.ch Price in CHF of a packet of 20 of the best-selling cigarettes in Switzerland (as at 17 Jan. 06) [email protected] Contributors: In short, although Swiss cigarette duty is modest, manufacturers'/dealers' margins are not. FOPH staff, Ch. Hoigné and others Next issue: May 2006 Total duty Manufacturers/dealers