Health and Healthcare Systems

Sweden has fewer smokers than any other European country. This is why

Cigarettes are seen in this illustration photo taken May 24, 2017. Picture taken May 24, 2017.  REUTERS/Thomas White/Illustration - RTS17013

Sweden has a remarkably low percentage of smokers - and for a specific reason Image: REUTERS/Thomas White

Chris Weller
Ideas Reporter, Business Insider
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In the United States, about 15% of people smoke. Over the next three years, the Centers for Disease Control hopes to get that rate down to just 12%.

Sweden, meanwhile, has been living in the single-digits for years. Its national smoking rate is just 5%. According to recent data, the next-lowest rate in Europe is Denmark's, at just over 15%.

The world has a lot to learn from Sweden's success in cutting the national smoking rate — the biggest lesson being that so-called "harm reduction," not death prevention, could make for the greatest leaps forward in public health.

Harm reduction is the philosophy that certain addictions can be rerouted toward less-harmful, non-lethal behaviors. In the case of smoking, it has meant a federal push in Sweden since the 1980s to wean smokers off their cigarettes by getting them to switch to a moist tobacco powder known as snus.

Roughly 19% of Swedish men use snus on a daily basis, while 4% of Swedish women do, according to 2013 data.

"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," professors and public health experts Kenneth Warner and Harold Pollack wrote in The Atlantic in 2014.

Warner and Pollack believe the low cancer rates can be traced directly to the early days of the snus experiment more than 30 years ago. Although snus users still contract oral cancer at higher rates than the non-using population, the rates are lower than among those who smoke.

Harm reduction is a controversial approach to improving public health in many Western countries, because governing bodies and medical organizations feel obligated to advocate for nothing less than total cessation. The mindset is, recommending any product that could cause harm — no matter the potential upside to save lives — ultimately harms public health.

As a result, the US Food and Drug Administration refuses to advertise snus as a healthier alternative to combustible tobacco products. In many EU countries, businesses aren't even allowed to sell it.

Harm reduction advocacy groups claim approaches like Sweden's are more effective in getting people healthier because they meet them "where they're at." They don't ask people to kick their habit all at once; they provide a smoother off-ramp, in the form of nicotine patches, e-cigarettes, and other products.

And, importantly, they help people ditch the actual culprit leading to life-threatening disease: smoke.

"The enemy is not nicotine per se," Johns Hopkins University public health professor David Abrams wrote in 2014. "It's burning tobacco."

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Health and Healthcare SystemsGeographies in DepthSocial Innovation
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