Sweden’s Gift to Global Public Health

With a smoking rate of only 5.6%, Sweden is set to become a smoke-free country in 2023 – a world first in public health. A country is considered officially smoke-free when less than 5% of the adult population smokes tobacco, according to the European Network for Smoking and Tobacco Prevention (ENSP) and the World Health Organisation (WHO).

So how did Sweden manage to cut smoking rates from 15% in 2008? In short, they separated nicotine use and cigarette smoking. Inhaling toxic smoke from combustible cigarettes causes the bulk of tobacco-related illnesses and death. Nicotine is addictive but does not cause tobacco smoking-related diseases, such as lung cancer, stroke and chronic obstructive pulmonary disease (COPD). 

Killing more than 8 million people in 2019, smoking cigarettes or other combustible tobacco products causes the majority of global non-communicable deaths. Although the health risks of smoking are widely known, there are presently more than a billion smokers in the world. 

To address this public health issue, governments introduced tobacco control, which the WHO defines as a “range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.”

Although good on paper, tobacco control policies have struggled to significantly reduce persistently high smoking rates. Governments thus need to consider other policies to make further progress toward a smoke-free society – which is exactly what Sweden did.

Sweden achieved tobacco control success by shifting the focus from tobacco control to embracing harm reduction strategies. Their proactive implementation of tobacco control as defined by the WHO Framework Convention on Tobacco Control (FCTC), Article 1(d), means that they not only employed supply and demand strategies but also harm reduction strategies that regulate less harmful non-combustible forms of tobacco and nicotine and make them affordable and their use acceptable.

The Swedish approach is two-pronged: On the one hand, strict tobacco control measures make the consumption of combustible tobacco products less attractive to adult smokers. On the other hand, the use of less harmful non-combustible forms of tobacco and nicotine is facilitated.

The Swedes’ systematic, long-term approach has made smokeless, less harmful alternatives to cigarette smoking accessible, affordable and acceptable to the population. These alternatives include snus, oral nicotine pouches, and e-cigarettes or vaping products.