While the U.S. is busy issuing denial orders to thousands of flavored e-cigarette products and finalizing new rules that would remove menthol cigarettes and all flavored cigars from the U.S. marketplace, the small Scandinavian nation of Sweden is taking a far different approach to tobacco enforcement. This approach embraces tobacco harm reduction (THR) to reduce smoking rates among its citizens and promote consumer-friendly policies that encourage smokers to switch to less harmful tobacco alternatives like snus, vaping, and nicotine pouches. U.S. leaders should take note.
At the end of last year, Swedish authorities officially announced that the percentage of smokers in Sweden had fallen to an all-time low of just 5.6 percent of the population in 2022. That puts Sweden on a clear path to becoming Europe’s first smoke-free country, far in advance of the EU’s official target date of 2040. To put things in perspective, Sweden’s average smoking rate is 3.5 times lower than the rest of Europe. As a result, the incidences of cancer in Sweden are 41 percent lower than in Europe, and total cancer deaths are 38 percent lower.
These statistics are nothing short of miraculous, with some observers dubbing the phenomenon the “Swedish experience.” But this experience didn’t happen in a vacuum. Sweden took proactive steps to ensure smokers had the resources to transition to another less harmful tobacco alternative. These steps included adopting a pro-THR model that makes clear distinctions between tobacco products according to risk.
Sweden recognizes that not all tobacco products are equally harmful. For instance, some products, like smokeless tobacco, are considerably less dangerous than cigars and cigarettes. This is because they contain fewer harmful chemicals and carcinogens, while only requiring the user to inhale the flavored vapor, not smoke. Therefore, these types of products should not be regulated as harshly as traditional tobacco.
Sadly, in the U.S., they frequently are. For instance, many U.S. state and local governments have passed regressive new laws like vape bans that specifically target alternative tobacco products. The result has been a variety of unintended consequences ranging from deterring smokers from switching to safer nicotine products, unintentionally creating black markets, reducing state revenue, and in some cases, driving teens to start smoking cigarettes.
Sweden has taken a far more balanced approach to tobacco enforcement that recognizes the need to reduce tobacco consumption in the country while also making alternative tobacco products like smokeless tobacco, nicotine pouches, and heat sticks more “accessible, affordable, and acceptable” to the Swedish population. These products are readily available both online and in stores, while also being taxed at lower rates than traditional cigarettes.
A good example is Sweden’s steadfast support for snus – a moist oral tobacco product popular in the country. While the EU banned the sale of snus in 1992, Sweden negotiated an exemption for itself when it joined the block in 1995. That decision appears to have encouraged Swedish smokers, particularly men, to transition to snus as an alternative to cigarettes. Unsurprisingly, smoking rates have collapsed in the country, as have rates of lung cancer and myocardial infarction.
The Swedes have also extended this attitude of acceptance to other alternative tobacco products, like e-cigarettes and oral nicotine pouches, with similarly desirable results. Sweden has experienced an uptick in vaping even as overall smoking rates have declined. This suggests that like with snus, e-cigarettes have played an important role in encouraging Swedish smokers to abandon traditional tobacco products.
There is no reason that such successes can’t be replicated on a larger scale in the U.S. Other populous countries like Britain have successfully embraced limited forms of THR in the form of e-cigarette use in cessation treatments. The U.S. can and should do the same for all alternative tobacco products by establishing a comprehensive public health strategy that embraces THR policies rather than top-down prohibitions that are bound to fail. This would not only provide America’s nearly 30 million smokers an off-ramp in which to quit but it would also be supported by the vast majority of the country, two-thirds of which think the FDA should prioritize THR policies over blanket prohibitions.
Sweden serves as a useful case study for how to make that a reality.
Nate Scherer is a policy analyst with the American Consumer Institute, a nonprofit education and research organization. For more information about the Institute, visit us at www.TheAmericanConsumer.Org or follow us on Twitter @ConsumerPal.