Sweden: The accidental harm-reduction champion

By the chairmen of the youth wings of the three coalition parties composing the Swedish government:   

Douglas Thor, Chairman, Swedish Moderate Youth League
Stefan Sarmes, Chairman, Young Christian Democrats Sweden
Erik Berg, Chairman, Liberal Youth of Sweden

Sweden is set to become the world’s first officially smoke-free country. This will save lives, reduce health costs, and improve quality of life for millions. But few Swedish politicians want to talk about how we arrived there. 

Sweden holds the rotating Presidency of the Council of Ministers of the EU. As young politicians, representing the youth wings of the three government parties, we would make the case that this leadership is not just a formal role, but one with political meaning. This also resonates with Swedish self-image: we like to speak of ourselves as leading and showing the way for others.

But in one area, Swedish political leaders say as little as possible, in spite of a unique, and statistically proven, leadership position. Sweden is set to become the first country in the world fulfilling the WHO criteria for being officially smoke-free. The WHO target is a smoking incidence below five percent in the population. The Swedish figure for 2022 was 5.6 percent, down from 5.9 percent from the previous year. The trend is clear: if nothing unexpected happens, Sweden will reach the five percent target within one or two years.

Becoming the first officially smoke-free country is a big win, and a milestone in public health. Furthermore, it ticks several boxes for policy goals in Europe – including the hallmark health policy project of the von der Leyen Commission, the Europe Beating Cancer Plan. But in contrast to this, in November 2022, when the figure 5.6 percent was made public, the Swedish health minister Mr. Jakob Forssmed said nothing. No press release, no public statement. This low-key approach is not what you would expect. Also, among the Swedish priorities for health policies during the Presidency, these figures are nowhere to be found – despite the big win on smoking incidence.

So why are the Swedish politicians completely silent about it? We think we know the reason: Sweden is smoke-free for the “wrong reasons”.

We’re a country where smoke-free nicotine products have a long tradition, and are popular enough to replace smoking in large parts of the population.

We’re also a country where tobacco policy for a long time has been based on morals, rather than harm reduction.

But everyday Swedes are smarter than that. Without other incentives than a reasonably overall permissive regulation, including on taxes, smoke-free tobacco and nicotine products (traditional “snus”, as well as modern nicotine pouches) enjoy market shares at the expense of cigarettes and other smoking products. We see a direct line of cause and effect from the regulatory environment, via the popularity of smoke-free products, to the low smoking incidence, and to the positive health outcomes. 

The perfect is the enemy of the good

We call this the “harm reduction effect”. This is very close to the old saying of “not allowing the perfect to be the enemy of good”. But generations of Swedish politicians before us disagree. They oppose “harm reduction” policies, both in principle and in practice. For decades, the phrase “harm reduction” was seen as being out of line in the political debate of the Riksdag.

But the times are changing. For our generation of liberal and conservative politicians, there is no taboo surrounding harm reduction. This shift is already visible in Swedish politics. Two recent events bear witness. First, there was a rebellion in Parliament two years ago, regarding the Swedish long-term strategy on combatting addiction – the so called “ANDTS” strategy for alcohol, narcotics, doping, tobacco, and gambling. A majority of the Riksdag wanted the government to provide input on the relative harm for different products, which in effect leads to a harm reduction focus. And second, just a few weeks ago, this was followed up by a landmark decision by the new government to request such input from three central government expert agencies. The deadline for reporting on this new initiative coincides with the end of the Swedish Presidency, 30th June 2023.

At the EU level, similar discussions are taking place. In February, 2022 the European Parliament adopted its resolution on the Commission’s “Europe’s beating cancer plan”. In para 12, the EP asks for evaluation of i.a. “novel tobacco products”, which includes nicotine pouches, and calls for “…the assessment of the risks of using these products compared to consuming other tobacco products”.

For Sweden, this is a big shift, and it will have major consequences. Several of the experts who are now tasked with providing harm reduction input have previously vigorously fought the very idea of such reasoning. But we are convinced this is a better, and more effective, way of fighting addiction and employing a reasonable policy.

Without seeking this position, Sweden has become a harm reduction champion, leading the way for other countries in fighting tobacco-related deaths and illnesses. It is time to embrace this, not be quiet about it. The Swedish Presidency is the right moment for us to come to terms with our own success. 


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