Sweden is close to becoming the first "smoke-free" country in Europe as the daily use of cigarettes decreases
STOCKHOLM (AP) - It's summer in the air, not cigarette smoke, in Sweden's outdoor bars and restaurants.
As the World Health Organization marks "World No Tobacco Day" on Wednesday, Sweden, which has the lowest smoking rate in the EU, is close to declaring itself "smoke-free" - defined as fewer than 5% of the population smoking daily.
Many experts give credit to decades of anti-smoking campaigns and legislation, while others point to the prevalence of "snus", a smokeless tobacco product banned elsewhere in the EU but marketed in Sweden as an alternative to cigarettes.
Whatever the reason, the 5% milestone is now within reach. Only 6.4% of Swedes over 15 were daily smokers in 2019, the lowest in the EU and well below the average of 18.5% in the 27-country bloc, according to statistics agency Eurostat.
Figures from the Public Health Agency show that smoking rates have continued to fall since then, reaching 5.6% last year.
"We like a healthy way of life, I think that's the reason," says Carina Astorsson, from Stockholm. Smoking never interested her, she added, because "I don't like the smell, I want to take care of my body."
The risks of smoking seem well understood among health-conscious Swedes, including younger generations. Twenty years ago, almost 20% of the population were smokers – which was a low percentage globally at the time. Since then, anti-smoking measures have reduced smoking rates across Europe, including bans on smoking in restaurants.
France saw record low smoking rates from 2014 to 2019, but that success hit a plateau during the height of the Covid-19 pandemic - blamed in part for causing stress that made people light up. About a third of people aged 18 to 75 in France reported smoking in 2021 – a slight increase compared to 2019. About a quarter smoke daily.
Sweden has gone further than most to stop cigarettes, and says it has resulted in a range of health benefits, including a relatively low rate of lung cancer.
- We were early in restricting smoking in public spaces, first in school playgrounds and leisure centers and later in restaurants, outdoor dining and public places such as bus stations, says Ulrika Rehed, Secretary General at the Cancer Foundation. "At the same time, taxes on cigarettes and strict restrictions on the marketing of these products have played an important role."
She added that "Sweden is not there yet", noting that the proportion of smokers is higher in disadvantaged socio-economic groups.
The sight of people lighting up is becoming increasingly rare in the country of 10.5 million. 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 dining areas.
On Tuesday evening, Stockholm's terraces were full of people enjoying food and drink in the late setting sun. There were no signs of cigarettes, but snuff tins could be seen on some tables. Between beers, some patrons tucked small bags of the moist tobacco under their upper lips.
Swedish snuffers have long promoted their product as a less harmful alternative to smoking and take credit for the country's declining 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," Rehed said. "It's true that smoking is more harmful than most things you can do, including snuff. But as I said, there are many health risks even with snuff."
Some studies have linked snus to an increased risk of heart disease, diabetes and premature babies if used during pregnancy.
Swedes are so fond of their snus, a distant cousin of smoked tobacco in the US, that they demanded an exemption from the EU's ban on smokeless tobacco when they joined the bloc in 1995.
"It's part of Swedish culture, it's like the Swedish equivalent of Italian Parma ham or some other cultural habit," says Patrik Hildingsson, spokesman for Swedish Match, Sweden's leading snuffer, which was bought by tobacco giant Philip Morris last year.
He said policymakers should encourage the tobacco industry to develop less harmful alternatives to smoking such as snuff and e-cigarettes.
"I mean, 1.2 billion smokers are still out there in the world. About 100 million people smoke daily 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 options, and a range of them."
WHO, the UN health agency, says that Turkmenistan, with tobacco use below 5%, is ahead of Sweden in phasing out smoking, but notes that this is largely due to the fact that smoking is almost non-existent among women. For men, the percentage is 7%.
The WHO attributes Sweden's declining smoking rates to a combination of tobacco control measures, including information campaigns, advertising bans and "cessation support" for those who want to quit smoking. However, the authority noted that Sweden's tobacco use is at more than 20% of the adult population, similar to the global average, when snuff and similar products are included.
"Switching from one harmful product to another is not a solution," the WHO said in an email. "Promoting a so-called 'harm reduction approach' to smoking is another way the tobacco industry tries to mislead people about the inherently dangerous nature of these products."
Tove Marina Sohlberg, researcher at Stockholm University's Department of Public Health Sciences, said Sweden's anti-smoking policy has had the effect of stigmatizing smoking and smokers, driving them away from public spaces to backyards and designated smoking areas.
"We are sending signals to smokers that this is not accepted by society," she said.
Paul Monja, one of Stockholm's few remaining smokers, reflected on his habit as he prepared to light up.
"It's an addiction, one that I aim to stop at some point," he said. "Maybe not today, maybe tomorrow."
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By KARL RITTER and CHARLENE PELE Associated Press
Associated Press writer John Leicester in Paris contributed to this report.
Source: Courthouse News Service
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