Sweden knows the smokefree way
A chart published last month by the European Union as part of a survey about attitudes toward tobacco in Europe lists the percentage of daily smokers in 28 countries. At the top is Bulgaria, where 36 per cent of the population smokes daily. Greece and France are close behind, with 35 and 33 per cent respectively.
Further down the list are Spain (26 per cent), Italy (24 per cent) and Germany (23 per cent). Near the bottom are Britain, the Netherlands and Denmark, all at 16 per cent.
Finally, represented by a conspicuously short red line at the bottom, is Sweden, where only 5 per cent smoke daily.
Let me repeat that: The smoking rate in Sweden is 5 per cent.
Do you know how astonishing that is? A few years ago, the medical journal The Lancet launched a campaign for ‘‘a tobacco-free world by 2040’’. Its definition of ‘‘tobacco-free’’ was a smoking rate of less than 5 per cent. Sweden is basically there.
Why have Swedes stopped smoking? Because Sweden has adopted a ‘‘harm reduction’’ strategy. It has largely replaced deadly cigarettes with a product that supplies users with both nicotine and tobacco yet doesn’t increase the odds of dying the way smoking does. That product is called snus – rhymes with goose.
A modern iteration of snuff, snus are little pouches of moist tobacco placed under the upper lip. Scandinavians have been ingesting nicotine via smokeless tobacco since the early 18th Century, a habit that changed only during World War II, when cigarettes became popular. Smoking peaked in 1980 in Sweden at 34 per cent of the population. Since then, the growing awareness of the dangers of smoking has brought about a steady, year-overyear reduction in the smoking rate, just as it has in much of the Western world.
Unlike most of the world, however, Swedish smokers already had a traditional way to stop smoking without having to overcome an addiction to nicotine, which of course is what makes quitting so difficult.
And that’s what they did. In the 1990s, cigarette sales declined while sales of snus rocketed upward. By about 1996, more snus cans were being sold than cigarette packs, a gap that has widened in the ensuing years. Today, 15 per cent of Swedes use snus.
You might assume it took a major government marketing campaign to persuade people to move from cigarettes to snus, but that’s not what happened.
The health consequences of Sweden’s move to snus are nothing short of amazing. As Kenneth Warner and Harold Pollack pointed out in a 2014 article in the Atlantic: ’’Sweden boasts Europe’s lowest male lung-cancer death rate – as well as the lowest male death rate from smoking-related cardiovascular diseases, and the lowest male death rate from other cancers that are attributable to tobacco.’’ Even the risk you’d most likely suspect, oral cancer, is only slightly higher than for non-users.
In effect, Sweden has been conducting an important experiment for 30-plus years, one that tobacco-control advocates have long claimed they wanted to see. What happens when, instead of relying solely on societal persuasion to get people to quit smoking, you offer them a nicotine fix without the carcinogens that come with smoking?
The answer is that smokers will embrace that solution. And as they do, smoking-related deaths will drop dramatically.
What is truly maddening is that, despite the powerful evidence provided by Sweden, most countries refuse to acknowledge it.
Most tobacco-control advocates in the West continue to push the idea that quitting all forms of tobacco and nicotine is the safest policy – true, but a classic example of the perfect being the enemy of the good.
The difference between the Swedish smoking rate and that of the next-lowest countries is enormous.
If the West really hopes to achieve a tobacco-free world by 2040, Sweden has pointed the way.