Ground-breaking success in the fight to reduce the toll of cigarettes in Sweden could provide major benefits for the rest of the world – and save the lives of millions of smokers here in Africa. Dr. Michael Kariuki of the Harm Reduction Society notes.
“Sweden has begun celebrating its imminent status as the first developed nation in the world to become officially ‘smoke-free.”
This is under guidelines that classify countries as smoke-free when the proportion of their population that smokes is less than 5%.
Every country in the European Union has been working towards reaching this milestone by 2040. Most are on track to miss the target, but Sweden will smash it by a staggering 17 years.
The Swedes have secured this historic achievement by developing a specific policy formula towards modern alternative nicotine products such as vapes and oral pouches for smokers. They have made these products as accessible, acceptable, and affordable as possible to adult smokers.
The results are remarkable, Fifty years ago, 49% of Swedish men were smoking regularly. In the last decade, smoking rates in Sweden halved and reached a record low of 5.6% in 2022. Soon, that figure will fall below the totemic 5%
How was this achieved?
For many years, Sweden was able to reduce its smoking rate slowly through education, tobacco control measures, and the use of snus – smoke-free, oral tobacco.
https://www.euro.who.int/data/assets/pdf_file/0008/343376/20170428WHOTobaccoFreeGeneration-DRAFT09.pdf Library of Congress, Sweden: New Rules on Smoking in Public Places and Sale of Tobacco Enter into Force, 2019. Statistics Sweden, Use of tobacco and nicotine products (self–reported) by age, gender and year, National Public Health Survey, 2022.
It was the introduction of modern tobacco-free alternatives – vaping in 2015, and next-generation oral nicotine pouches which followed in 2018 – that turbocharged their smoking decline. In the last decade, smoking rates in Sweden have fallen by an astonishing 55%.
The impact on public health in that country is evident.
Compared to the rest of the European Union, Sweden has 44% fewer tobacco-related deaths, a cancer rate that is 41% lower, and 38% fewer deaths attributable to any cancer.
Last month, global experts in tobacco harm reduction published a report showing that, if every other country in the EU followed Sweden’s example in its approach to tobacco harm reduction, up to 3.5 million early deaths in Europe would be prevented in just one decade.
So how can we achieve similar success in reducing Kenya’s smoking rates and enjoy the subsequent reduction in the burden on public health?
Here in Kenya, we are on course to miss our Health Ministry’s target of 9.7% smoking prevalence by 2025.
Smoking rates remain stubbornly high at 13%( MoH 2022) overall – despite strict restrictions, which include the prohibition of smoking in public places and mandatory health warnings on packaging.
We must acknowledge that it is immensely difficult for smokers to quit their habit, even when they are desperate to do so.
The Swedes recognized this and set about increasing the ability of adult smokers to switch to less harmful products.
Here, our policymakers maintain a ‘quit or die’ approach to tobacco control which is patently failing as it ignores the fact that alternative nicotine products are much less harmful than traditional tobacco products.
As part of this approach, the Kenyan Government classifies vapes and pouches as tobacco products and subjects them to the same high taxes and marketing restrictions that apply to far more harmful cigarettes.
Ramström, L. (2020) “Institute for Tobacco Studies. Death rates per 100,000 attributable to tobacco – Sweden and the rest of the EU in 2019. Compiled from The Global Burden of Disease Study”
Snus Commission, Snus saves lives. A study of snus and tobacco-related mortality in the EU, 2017
https://www.health.go.ke/wp-content/uploads/2021/07/Kenya-Non-Communicable-Disease-NCDStrategic-Plan-2021-2025.pdf
This flies in the face of scientific evidence. Vapes and pouches do not burn tobacco, thereby dramatically reducing exposure to disease-causing chemicals. Global research shows that tobacco-free nicotine products are about 95% less harmful than cigarettes.
For this reason, we believe that alternative nicotine products should be regulated uniquely within a framework that recognizes their potential to reduce the health burden associated with traditional tobacco products.
The ‘Swedish Model’ is an example of tobacco harm reduction being used to drive down smoking rates and dramatically reduce smoking-related diseases.
To beat smoking like Sweden, we urge our politicians to support harm reduction strategies and make smoke-free alternatives more affordable than cigarettes, thereby removing barriers to switching. Similarly, health professionals and smokers should be educated in the science involved, so that they can make informed choices.
Kenya can – and should – benefit from Sweden’s successful switch to smoke-free status. Our policymakers must simply apply the same evidence-based solutions that have already started to save millions of lives.
Public Health England, https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-thantobacco-estimates-landmark-review
