Summer is in the air, but the cigarette smoke isn’t in Sweden’s outdoor bars and restaurants.
With the World Health Organization marking Wednesday as “World No Tobacco Day”, Sweden, which has the lowest smoking rate in the European Union, is close to declaring itself “smoke-free” – defined as fewer than 5% of smokers per day. Population.
Many experts credit decades of anti-smoking campaigns and legislation, while others point to the prevalence of “snus,” a smokeless tobacco product banned elsewhere in the European Union but marketed in Sweden as an alternative to cigarettes.
Whatever the reason, the 5% milestone is now within reach. According to statistics agency Eurostat, only 6.4% of Swedes over 15 were daily smokers in 2019, the lowest in the EU and well below the 18.5% average across the 27-nation bloc.
Statistics from Sweden’s Public Health Agency show that smoking rates have steadily declined since then, reaching 5.6% last year.
“We like a healthy way of living, I think that’s the reason,” said Stockholm resident Karina Astorsson. Smoking never interested him, he added, because “I don’t like the smell; I want to take care of my body.”
The risks of smoking are well understood among health-conscious Swedes, including the younger generation. Twenty years ago, about 20% of the population smoked – a low rate worldwide at the time. Since then, measures to discourage smoking have reduced smoking rates across Europe, including bans on smoking in restaurants.
France had a record decline in smoking rates from 2014 to 2019 but that success hit a plateau during the height of the COVID-19 pandemic – blamed in part on pressures that made people light up. Almost one-third of 18- to 75-year-olds in France claimed to have smoked in 2021 – a slight increase from 2019. About a quarter smoke every day.
Sweden has gone further than most in phasing out cigarettes, and says it has several health benefits, including a relatively low rate of lung cancer.
“We first restricted smoking to school playgrounds and after-school centers and later to restaurants, outdoor cafes and public places such as bus stations,” said Ulrika Arehed, secretary-general of the Swedish Cancer Society. “At the same time, taxes on cigarettes and strict restrictions on the marketing of these products have played an important role.”
He added that “Sweden is not there yet,” noting that disadvantaged socioeconomic groups have a higher proportion of smokers.
In a country of 10.5 million, the sight of people turning on lights is becoming increasingly rare. Smoking is prohibited at bus stops and train platforms and outside entrances to hospitals and other public buildings. As in most of Europe, smoking is not allowed inside bars and restaurants, but since 2019 Sweden’s smoking ban also applies to their outdoor seating areas.
On Tuesday night, Stockholm’s terraces were full of people enjoying food and drinks in the late setting sun. There were no signs of cigarettes, but snus cans could be seen on some tables. Between beers, some patrons stuffed small pouches of moist tobacco under their upper lips.
Swedish snus makers have long touted their product as a less harmful alternative to smoking and claim credit for reducing the country’s smoking rate. But Swedish health authorities are reluctant to advise smokers to switch to snus, another highly addictive nicotine product.
“I see no reason to pit two harmful products against each other,” Arehed said. “It’s true that smoking is more harmful than what you can do with snus. But that said, there are a lot of health risks with snus as well.”
Some studies have linked snus use during pregnancy to an increased risk of heart disease, diabetes, and premature birth.
The Swedes love their snus, a distant cousin of smoking tobacco in the US, so much that they sought an exemption from the European Union’s smokeless tobacco ban when they joined the bloc in 1995.
“It’s part of Swedish culture, like the Swedish equivalent of Italian Parma ham or some other cultural habit,” said Patrik Hildingsson, spokesman for Sweden’s leading snus maker Swedish Match, which was acquired by tobacco giant Philip Morris last year.
He said policymakers should encourage the tobacco industry to develop less harmful alternatives to smoking, such as snus and e-cigarettes.
“I mean, there are still 1.2 billion smokers in the world. About 100 million people smoke every day in the EU. And I think we can only go so far with policy-making regulations,” he said. “You have to give smokers other, less harmful alternatives, and a range of them.”
WHO, the United Nations health agency, says that Turkmenistan, with a tobacco use rate of under 5%, is ahead of Sweden in stopping smoking, but notes that smoking is almost non-existent among women. For men, the rate is 7%.
The WHO attributes Sweden’s decline in smoking rates to a combination of tobacco control measures, including information campaigns, advertising bans and “cessation support” for those wishing to quit. However, the agency notes that tobacco use in Sweden is more than 20% of the adult population, about the same as the world average when you include snus and similar products.
“Switching from one harmful product to another is not a solution,” WHO said in an email. “Promoting so-called ‘harm reduction approaches’ to smoking is another way the tobacco industry is trying to mislead people about the inherently dangerous nature of these products.”
Sweden’s anti-smoking policy has stigmatized smoking and smokers, pushing them away from public spaces into backyards and designated smoking areas, said researcher Tove Marina Söhlberg from the Department of Public Health Sciences at Stockholm University.
“We are sending the signal to smokers that this is not accepted by society,” he said.
Paul Monza, one of Stockholm’s remaining smokers, reflects on his habit as he prepares to light up.
“It’s an addiction that I aim to stop at some point,” he said. “Maybe not today, maybe tomorrow.”
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