Smoke Free Sweden through Tobacco Harm Reduction

LEADING international public health experts have urged South African lawmakers to follow the pioneering example of ‘Smoke Free Sweden’ to save the lives of millions of smokers.

The experts convened a seminar in Johannesburg to report how Sweden is on course to drop below a 5% tobacco smoking prevalence rate in the next few months. This is the level at which a country is considered officially smoke-free.

No other member of the European Union is close to matching this achievement and none is even on track to do so by the EU’s target of 2040, in 17 years’ time.

Speakers told the seminar on Friday that South Africa lags even further behind with a smoking rate approximately five times higher than Sweden’s.

“We should celebrate Sweden’s success story as a public health revolution,” said Dr Delon Human, secretary-general of the African Harm Reduction Alliance (AHRA). “We should all be on the mountaintop shouting ‘Victory!’, and looking at Sweden as the best-case practice.

“It’s all about saving lives and about the quality of life for smokers who’ve been unable to quit. Harm reduction is their way out, it’s their fire escape.”

The Swedish Experience

A new report entitled The Swedish Experience: A roadmap for a smoke-free society was co-authored by Dr Human and presented at the seminar. The report details Sweden’s innovative strategy to minimise the harmful effects of tobacco smoking and save lives.

According to the report, Sweden’s approach, which combines tobacco control methods with harm minimization strategies, could save 3.5 million lives in the next decade if other EU countries adopt similar measures.

However, delegates heard that the tobacco control bill currently before Parliament in South Africa could jeopardise hopes of the country becoming similarly smoke-free any time soon.

Dr Derek Yach, a global health consultant who was president and founder of the Foundation for a Smoke-Free World, warned against proposals in the bill. He stated that these would regulate harm-reduction products, such as e-cigarettes and nicotine pouches, the same as combustible cigarettes.

“Standing back and going along with equalisation of the harm reduction category versus the combustible category will set us back,” he said. “A review in a few years’ time will show that we’ve actually forgone the opportunity to save many, many lives.

“But if we were able to accelerate action on harm reduction, we could prevent up to 500,000 tobacco-related deaths in South Africa before 2060.”

Combination of tobacco control with harm minimization

The Swedish model combines recommendations in the WHO Framework Convention for Tobacco Control (FCTC). These include reducing the supply and demand of tobacco and banning smoking in certain places. Still, it adds an important element: accepting that smoke-free products – such as vapes and oral pouches – are less harmful than traditional cigarettes.

“For adult smokers, switching to non-combustible alternatives is highly recommended,” said AHRA president Dr Kgosi Letlape. “The use of combustibles has come down, and health benefits have been derived where governments have allowed these alternatives into their environment.”

“What should not be allowed is for people to continue lying that non-combustibles have no health benefits for adult smokers.”

Public health benefits for individual and society

The benefits of Sweden’s strategy are remarkable. The country’s smoking rates just 15 years ago were more than 150% higher than they are today. It now has the lowest percentage of tobacco-related diseases in the EU and a 41% lower incidence of cancer than other European countries.

“We need to be spreading the truths that are evident from these statistics,” said Dr Anders Milton, who also authored the report.

“Some people do need the kick that nicotine gives. Harm reduction products are giving that without the danger to their health.”

About the report

Health Diplomats commissioned the report. They are an international organization working to improve access to healthcare and encourage innovation and the use of harm reduction to minimize the negative impact of alcohol, food, nicotine and drugs.

The full report is available here.

Some of the report’s conclusions and suggestions for implementation in other countries.

Recognize smoke-free products as significantly less harmful than smoking. Encourage smokers to switch from cigarettes to less harmful alternatives.
Provide fact-based information. It is clear that there are no risk-free tobacco products. But, for example, e-cigarettes are 95% less harmful than cigarettes. Of course, it is better for a smoker to switch from regular cigarettes to e-cigarettes, although it is not without risk.
Develop policies that make smoke-free alternatives more accessible than cigarettes. For example, differentiated taxes that give smokers financial incentives to switch from cigarettes to less harmful alternatives.

About the report’s authors:

Dr Anders Milton, formerly chairman of the Swedish Medical Association, the Swedish Red Cross and the World Medical Association.
Dr Delon Human, a physician specializing in global public health issues. Former advisor on public health issues to, among others, three WHO directors-general and the UN secretary-general.
Prof Karl Fagerström, docent and internationally recognized expert in addiction research and smoking cessation.