Sweden’s transition to smokeless tobacco products has brought down its smoking rate to the lowest in Europe, leading to a dramatic decline in tobacco-related deaths and diseases, according to a new report.
The report, titled “No Smoke Less Harm,” underscores Sweden’s success in tobacco harm reduction (THR) and urges other countries to consider similar strategies.
“The Swedish experience demonstrates the importance of understanding public misperceptions about nicotine to develop health policies that better protect and inform consumers,” said Dr. Karl Fagerström, a public health expert who contributed to the report.
While nearly one in four Swedish adults still use nicotine daily, in line with European averages, Sweden boasts far lower rates of tobacco-related deaths (44 percent lower), cancer rates (41 percent lower) and cancer deaths (38 percent lower) compared to the rest of the European Union.
The report, released by global health advocacy group Smoke Free Sweden, argues that combustible cigarettes, not nicotine itself, are the primary culprit behind smoking-related health problems. It emphasizes the existence of significantly less risky forms of nicotine consumption.
Smoke Free Sweden is a movement that advocates for other countries to follow Sweden’s lead in tobacco harm reduction. Its report appeals for the World Health Organization (WHO) and global public health communities to acknowledge that combustible products, not nicotine itself, cause harm to smokers.
It asks policymakers to recognize the potential of tobacco harm reduction (THR) in reducing harm, regulate nicotine products based on their relative risk profile, encourage healthcare professionals to embrace THR as a harm reduction strategy, and empower THR users to advocate for supportive policies.
Sweden is poised to become the first country to achieve smoke-free status, with a smoking rate below 5 percent. The report attributed this achievement to Sweden’s openness to alternative nicotine products.
The report credited the low rate of smoking-related diseases to Swedes’ preference for alternative smokeless tobacco products like snus, oral nicotine pouches, heated tobacco products, and vapes. This shift, the report says, has led to a “smoke-free generation.” ZYN, the most popular oral nicotine pouch in the US, originated from Sweden.
The report concluded that high nicotine use does not lead to high rates of health problems, presenting compelling evidence that despite similar levels of nicotine consumption.
Dr. Fagerström said the distinction between smoking and smokeless products is crucial. “While nicotine is addictive, it does not cause the serious diseases associated with smoking,” he said. “Our findings support a shift in focus from cessation to substitution with less harmful alternatives for those unable to quit completely.”
Comparisons using 2020 data for men only show even starker differences. Sweden has 52 percent fewer tobacco-related male deaths than Poland and 57 percent fewer than Romania. For male lung cancer, Sweden has significantly fewer deaths than France, Germany, Italy and Poland.
Sweden’s public health agency reported that only 5.6 percent of Swedish adults smoked cigarettes in 2022, down from 49 percent of men in 1960.
Dr. Scott Gottlieb, a former commissioner of the US FDA, earlier recognized the benefits of smoke-free products. He said in a recent interview over CNBC that, “If we can convert more currently addicted adult smokers onto these modified risk products (ZYN nicotine pouches) that don’t have all the harms associated with combustion, we can achieve a substantial net public health benefit.”
The Swedish report argues that the method of nicotine consumption has a significant impact on health outcomes. While smoking is linked to high rates of death and disease, the report finds smokeless alternatives, like snus and oral nicotine pouches, don’t pose a similar health risk.