European Union

Sweden as a model for EU health policy

May 29, 2024

Today, a panel debate in Brussels hosted by The Parliament Magazine and the Tholos Foundation explored the challenge of how to achieve a smoke-free future, ahead of “World No Tobacco Day” this Friday.

Despite the progress made in reducing tobacco harm, the European Union is still running behind others, like the UK or New Zealand, where smoking prevalence has reduced a lot more, while within the EU, one specific member state, Sweden, is very close to achieving a smoke-free society, which means that not more than 5 percent of the population is a smoker.

Tim Andrews of the Tholos Foundation explained how “flavours [in vaping or other alternatives to smoking tobacco] are really a key driver for harm reduction. If you fight it, you get as a consequence that people either return to cigarettes or go to the black market. Only 30 percent of people opt for tobacco flavours. Vaping is really only effective as a smoking cessation tool if there are flavours. Without flavours, you take away the effect.”

Also speaking at the event was Peter Beckett of Clearing the Air. He noted that “the European institutions are paying lip service to the importance of innovation, until the market actually comes up with it. Then, the EU is suddenly not so keen any more. This is the case with AI, given the EU’s new regulation, but also with Uber and Bolt”.

He also stressed that “we need to look at public health effects, and accept that unfortunately, teenagers tend to make terrible life choices. Let’s focus on trying to limit the consequences of those [by tolerating less damaging alternatives than smoking tobacco].”

Furthermore, he also remarked that there were a lot of informational challenges, stating that “even many medical professionals still believe that nicotine is the cause of smoking-related diseases.”

Pieter Cleppe, editor of BrusselsReport.eu and also an international research fellow at the Tholos Foundation, presented his new Tholos paper, analysing the European Commission’s 2023 public consultation on the evaluation of the legislative framework for tobacco control.

There, he takes a closer look at how Sweden is the only EU member state that has not been forced to outlaw snus, a popular alternative to smoking tobacco, since the 1990s already. After three decades, the health effects are hard to deny. He writes:

“Like many other EU member states, Sweden has implemented regulations and education programs focused on smoking cessation and prevention. However, Sweden also provides smokers with access to a diverse range of alternative products. Essential elements such as flavours make these products acceptable and realistic options for smokers to switch and stay away from cigarettes, and these products are also affordable. It’s worth noting that Sweden has even negotiated a derogation from the EU’s ban on products like snus when it joined the EU in the 1990s.”

https://x.com/pietercleppe/status/1663817150010646528

Furthermore, he highlighted how the EU Commission’s consultation actually reveals a sentiment in support of alternative products as a means to smoking cessation, both among citizens and among research institutions. Despite this, the European Commission is less than open to this approach.

According to the paper, these are the key takeaways from the consultation:

“1 – The vast majority of citizens, academic and research institutions are in agreement that alternative products can effectively assist in smoking cessation.

2 – Flavors play a crucial role in alternative products for adult smokers, aiding in their decision to transition away from cigarettes and maintain abstinence.

3 – Existing regulations on these emerging products are, in many instances, deemed to be more than adequate by various stakeholders.

4 – Alternative products have not demonstrated to pose a significant public health risk. Instead, available evidence indicates they offer an opportunity to combat high smoking rates in the region.”

Of particular importance is the comparison between Australia, on the one hand, with its repressive approach, and alternative policy approaches in Sweden, Japan, the UK and New Zealand. In a nutshell, smoking prevalence is reducing much less quickly than in the four other countries mentioned:

In Sweden, where alternative products are integrated into a comprehensive strategy to combat smoking, the prevalence of daily smoking among individuals over the age of 16 decreased significantly from 11.4% in 2011 to just 5.6% in 2022. This remarkable decline brought the country closer to achieving smoke-free status, surpassing the EU’s target by nearly two decades. [i][ii]
In New Zealand, the Ministry of Health’s smoke-free plan explicitly encourages smokers to transition to less harmful alternatives. Consequently, the current smoking rates among individuals aged 15 and over decreased from 18.4% in 2011 to 8.3% in 2022. The Ministry has also developed resources, such as the “Quit Strong” website, aimed at supporting smokers in switching to vaping, with a particular emphasis on assisting ethnic minorities, who historically have higher smoking rates. [iii]
In the United Kingdom, where government policy aims to maximize the public health benefits of vaping in reducing smoking, initiatives like the Swap to Stop program have contributed to a notable decrease in current adult smoking rates. These rates declined from 20.2% in 2011 (when comparable records began) to 12.9% in 2022. [iv][v]
In Japan, health authorities have not actively promoted alternative products to displace smoking, and nicotine-containing vaping has been effectively prohibited since 2010. However, the introduction of THP in 2016 has led to a significant reduction in cigarette sales. In 2016, 168 billion cigarettes were sold compared to only 5.2 billion THP consumables. By 2022, cigarette sales had decreased to 92 billion, while THP sales increased to 52 billion consumables. [vi]
On the contrary, Australia’s restrictive approach to alternative products has impeded progress in reducing smoking rates. Australia is the only country mandating prescription-only access to vaping, de facto prohibiting their use. Similar restrictions apply to nicotine pouches, while tobacco heating products are outright banned. Coupled with ongoing negative messaging about alternative products, this has resulted in a stagnation in the decline of smoking rates, with only a marginal decrease from 2011 to 11.8% in 2023. [vii]