Snus is a smokeless tobacco product that is placed under the upper lip. — AFP
THE Swedish experience in reducing the country’s daily tobacco smoking rate may initially seem similar to the experiences of many other countries’ fight against smoking tobacco.
But unlike others, Sweden appears to have been rather successful in this endeavour – it is now on track to become the first country in the world to be smoke-free with only 5.8% of its adult population still smoking daily, a stark difference from just 18 years ago when that figure stood at 16.5%.
Many experts, including the World Health Organisation, attribute Sweden’s low smoking rate to awareness education and tobacco control in the form of anti-smoking campaigns and legislation.
The 2024 Effective Anti-Smoking Policies Global Index from global innovation network We Are Innovation ranked Sweden as the second-best performing country in its overall assessment. The United Kingdom took the top spot.
The index scrutinises aspects such as regulatory frame-works, prohibitions, taxation, and governmental measures for switching from traditional smoking.
But the Quit Like Sweden (QLS) platform believes that they have cracked the code: the one approach that sets Sweden apart from other countries is allowing its population to access alternatives to tobacco smoking, which is a form of tobacco harm reduction (THR).
The United States’ National Academy of Medicine defines THR as “minimising harms and decreasing total mortality and morbidity, without completely eliminating tobacco and nicotine use”.
The THR approach "recognises that tobacco abstinence or never using tobacco is the ideal outcome but accepts alternative ways to reduce harm among tobacco users". Harm reduction has been considered a human rights issue, where all smokers – whether or not they want to, or are able to quit tobacco use – are provided a means to reduce tobacco-related harms.
Like other countries, Sweden has implemented restrictions on tobacco smoking in public places, such as in bus stations, train platforms, outside hospital entrances, restaurants and outdoor cafés, etc.
They have also have a high tobacco tax and has implemented strict restrictions on marketing tobacco products. Many Swedish smokers have also made a switch to alternative smokeless tobacco products such as nicotine pouches.
Sounds familiar, yes?
But what may not sound familiar to most Malaysians is an over 200-year-old Swedish tobacco product called snus.
Snus is the Swedish word for snuff, which was reportedly fashionable to inhale in the West before cigarettes superseded it. As the British American Tobacco company describes it, snus is “a finely ground moist tobacco, either loose or in tiny sachets – a bit like tiny teabags – that are placed under the upper lip and typically held in the mouth for about 30 minutes before being discarded.”
But while proponents of the THR approach tout the effectiveness of this method in reducing tobacco smoking rates, tobacco control advocates point out that despite the low 5.8% daily smoking rate, Sweden’s general tobacco use remains at around 20%, similar to global rates.
Tobacco control advocates in Sweden have also highlighted that nicotine – even as smokeless alternatives – has been linked to cognitive issues.
Meanwhile, Swedish health experts say snus is also addictive and still increases the risk of cancer, even if it is safer than conventional cigarettes.
QLS, nevertheless, believes it is the smoking that is the problem, not necessarily tobacco or nicotine itself.
QLS also believes it is this awareness among Swedes who have switched to smokeless alternatives that has not only reduced the daily smoking rate in the country, but also led to Sweden having the lowest percentage of tobacco-related diseases in the European Union, and a 41% lower incidence of cancer than other European countries.
“The Swedish government has done what all the governments have done. They have made it impossible to smoke in restaurants, outside of restau-rants where the tables are.
“In this, the Swedish government has the same approach as any government in Europe. So it is not a question of the government.
“It is a question of people understanding that smoking kills you and snus, which you put in your mouth, does not.
“You do not get cancer from nicotine, but from the tar.
“You smoke for the nicotine, but you die from the tar,” says Dr Anders Milton, former president of the World Medical Association and current chair of the Snus Commission in Sweden.
Regardless of what the main driver behind the 5.8% statistic is, data from the Public Health Agency of Sweden shows that something is working: daily tobacco smoking has steadily decreased in the country since the early 1980s.
