Sweden's Successful Harm Reduction Strategy: A Blueprint for South Africa's Fight Against Smoking

Sweden's remarkable milestone as the world's inaugural smoke-free nation has captivated the global public health community. This achievement is credited to Sweden's consumer-centric tobacco harm reduction (THR) policies, widely embraced by both the government and its citizens.

Sweden is poised to achieve a historic milestone this year by becoming the world's first smoke-free nation. With a daily smokers rate of just 5.6% in 2022, the lowest in the EU, Sweden is on track to reach a smoking prevalence rate below 5% - a remarkable accomplishment set 17 years ahead of the EU's target. This extraordinary success can be attributed to Sweden's full embrace of tobacco harm reduction strategies.

Key Facts about Sweden:

• Boasting the lowest smoking rate in the EU, Sweden is the sole country progressing towards the EU's smoke-free objective.
• Over the past decade, Sweden has witnessed a 55% decline in smoking rates.
• In contrast, the average smoking rate across the rest of the EU remains more than 3.5 times higher.
• Smoking-related deaths in Sweden are 22% lower than the EU average.
• Despite similar overall nicotine consumption compared to other EU countries, Sweden reports a 41% lower incidence of cancer and 38% fewer total cancer deaths than the rest of Europe.

Comparative data between Sweden and other developed nations reveal that Swedes have achieved a far more rapid reduction in smoking rates compared to any other country globally. The disparity is striking when comparing Sweden's progress with countries that have implemented stricter policies on tobacco harm reduction products.

Since the 1980s, Sweden has experienced a significant reduction in smoking rates, plummeting from approximately 35% to below 6% today. Official statistics from Sweden's Public Health Authorities underscore this remarkable decline in smoking prevalence over the past two decades

Currently, no other European Union member comes close to matching Sweden's achievement, with none projected to reach the EU's smoke-free target by 2040. Meanwhile, South Africa grapples with a smoking rate approximately five times higher than Sweden's, underscoring the urgent need for transformative strategies.

Between 2012 and 2022, Sweden witnessed a decline in adult smoking rates almost twice as rapid as Spain's and nearly 6 times faster than Australia's, a country with stringent regulations on tobacco harm reduction products. How did Sweden achieve such remarkable progress while other nations struggled?

The answer lies in tobacco harm reduction.

Sweden's success underscores the effectiveness of regulating tobacco harm reduction products and encouraging smokers to transition to less harmful alternatives. It's the only European country where snus, an oral smokeless tobacco product less harmful than cigarettes, is legal. The availability of snus has prompted hundreds of thousands of smokers to switch to this safer option and quit smoking. Moreover, Sweden implemented consumer-friendly regulations for vaping and nicotine products, further expediting the decline in smoking rates.

Official data illustrates how the reduction in smoking rates over the past decade correlates with a rise in the consumption of alternative nicotine products.

Sweden's outstanding outcomes speak volumes: a 41% lower cancer incidence and a 39% lower mortality rate from smoking-related diseases than the European average. These milestones underscore the efficacy of Sweden's smoke-free strategy and emphasize the potential benefits of replicating such approaches in South Africa, where smoking prevalence remains high at 18.5%.

At the heart of Sweden's success lies its acceptance of less harmful alternatives like vaping products, coupled with measures to ensure their accessibility and affordability to the general populace. These alternatives offer tobacco smokers a viable pathway away from combustible cigarettes, significantly reducing exposure to harmful chemicals associated with combustion.

Recognizing the cultural context, oral nicotine products align closely with traditional practices in some African cultures, potentially enhancing acceptance among the population. Unlike electronic cigarettes, these products require no specialized equipment, making them more accessible and affordable, particularly in regions where e-cigarette costs pose a barrier to cessation efforts.

Emulating Sweden's approach, implementing differentiated tax rates to incentivize smokers to switch to less harmful alternatives could yield significant benefits for the continent. However, tailoring these strategies to fit Africa's cultural context, ensuring affordability and accessibility of safer nicotine products, and addressing socioeconomic factors influencing smoking habits are paramount.

Moreover, fostering collaboration with international health organizations and sharing best practices from countries like Sweden can enrich Africa's efforts, paving the way for a comprehensive approach tailored to its unique needs. By leveraging these insights and adopting evidence-based strategies, Africa can take significant strides towards combating smoking-related illnesses and promoting public health across the continent.

Sweden's thoughtful regulation of vaping products is facilitating the transition of thousands of smokers to this 95% less harmful alternative. In Sweden, e-cigarettes are legal for use and sale, obtainable without a prescription. A diverse range of vaping flavors, crucial for aiding smokers in quitting cigarettes, is readily accessible. Thanks to their inclusive approach, the switch from smoking to vaping has seen a significant uptick over the past five years, particularly among women, occasional users, and individuals aged 16 to 29. Additionally, heated tobacco products and nicotine pouches are widely available and utilized in the country. With substantially lower taxes compared to traditional cigarettes, these products offer further incentive for smokers to make the switch.

Despite the widespread use of alternative products and a nicotine intake similar to that of other EU countries, Sweden boasts a 41% lower incidence of cancer, resulting in 38% fewer cancer-related deaths. Moreover, tobacco-related deaths are nearly 40% lower. The Swedish example underscores the potential of smokeless nicotine products to substantially enhance public health, challenging the notion that nicotine itself is the primary carcinogen in cigarettes.

Sweden's approach demonstrates that uniform solutions are inadequate, and smokers require a multitude of options when seeking to quit. The availability of snus, vaping—twice as effective for smoking cessation as nicotine replacement therapies—heated tobacco, and other alternatives has proven successful in reducing smoking prevalence in Sweden.

In conclusion, Sweden stands as a beacon in the battle against smoking, offering a blueprint that, if embraced by other nations, could potentially save millions of lives. Their dedication to tobacco harm reduction products has yielded tangible success, and widespread adoption of this approach worldwide could profoundly impact public health. The takeaway is evident: to effectively combat smoking, we should draw inspiration from Sweden and implement their strategies.