“Sweden has successfully reduced smoking rates by combining innovation, legislation and consumer empowerment,” Jesper Skalberg Karlsson told the audience.
Karlsson, a member of Sweden’s parliament, was speaking at an event held in London to celebrate Sweden’s dramatic lowering of its smoking rate, and to draw out lessons for the rest of the world.
In November, after rapid declines in smoking over many years, the country recorded a smoking rate of just 4.5 percent among Swedish-born adults—well below what countries have typically established as their “smoke-free” target of 5 percent. The rate among migrants living in Sweden is higher, at 7.8 percent (though still well below rates in migrants’ countries of origin), leaving the population as a whole with a smoking rate of 5.3 percent.
The December event—titled “Leading with Innovation: Sweden’s Path to Smoke-Free”—was a collaboration between Quit Like Sweden (a nonprofit founded in 2024) and We Are Innovation (a network of NGOs, think tanks and foundations). It saw a host of scientists, policymakers and other experts discussing Sweden’s tobacco harm reduction evolution.
Sweden’s success can be attributed principally to one type of product. Snus is traditional in the country, and has gained increasing traction there as a smokeless alternative to cigarettes in recent decades. Its use involves placing a small tobacco pouch under the lip, where it slowly releases nicotine.
“We wanted to show that achieving what once seemed impossible—nearly eliminating smoking—isn’t about restriction. It’s about empowering people with better choices.”
Consuming nicotine in this way avoids the harms of combustible tobacco, and scientists consider snus, along with modern nicotine pouches that don’t contain tobacco, to be among the safest nicotine products. Sweden has Europe’s lowest rate of lung cancer.
“We wanted to show that achieving what once seemed impossible—nearly eliminating smoking—isn’t about restriction,” Federico Fernandez, CEO of We Are Innovation, told Filter of the event. “It’s about empowering people with better choices and innovative solutions.”
It adds up to an approach that doesn’t involve trying to get rid of nicotine, but instead encourages people who use it to do so in a way that doesn’t threaten their lives.
Swedes still consume nicotine at similar rates to people in other European countries. But widespread availability and cultural acceptance of smokeless products means they smoke much less—with 44 percent fewer tobacco-related deaths per capita than the rest of the European Union.
Karlsson identified “innovation in alternatives, such as snus, cultural adoption of tobacco-free pouches and focus on harm reduction” as key factors behind this remarkable story.
“We have the ability to save millions of lives just by replicating a model that has already worked so well for Sweden.”
You might think that other countries would take note.
“We have the ability to save millions of lives just by replicating a model that has already worked so well for Sweden,” Suely Castro, the founder of Quit Like Sweden, told Filter.
Yet snus is banned in all EU countries except Sweden, while some member states also ban or restrict non-tobacco nicotine pouches. Further bans and restrictions on nicotine vaping products are developing, too.
I asked Karlsson, a member of Sweden’s Moderate Party who represents the island county of Gotland, about Belgium’s new ban on disposable vapes, and the likely prospect of more European clampdowns on products used for smoking cessation.
“The result of banning alternatives to smoking cigarettes will undeniably lead people to continue with the harmful use of cigarettes,” he told Filter.
While he favors appropriate regulation, he emphasized that “what sets Sweden apart is snus and nicotine pouches. Therein are lessons to be learned.”
“It’s hard to believe that in the 21st century, we’re still seeing 20th-century approaches to tobacco harm reduction,” Castro told Filter. “Just imagine what the global impact of the full Swedish experience could be.”
One other country that has been able to benefit from snus is Sweden’s neighbor, Norway. It isn’t an EU member, so not subject to the snus ban. The product is widely available and increasingly popular there.
A briefing released in January detailed how 16 percent of Norway’s population now use snus. Only 7 percent currently smoke—a rate that plummeted from 25 percent just two decades ago, as snus use correspondingly rose.
“By rethinking tobacco control and focusing on real solutions, Sweden has proven that a world with fewer smoking-related deaths and illnesses isn’t just a dream: it’s achievable,” Castro said. “Now we need the global will to match to make this a worldwide success.”
“I am not sure the cultural adoption of stuffing things under your upper lip will be smooth sailing in all of Europe. So let me say it another way: Do not ban alternatives to smoking cigarettes.”
How feasible is this? As Karlsson explained, snus is not just any safer nicotine product in Scandinavia. It’s steeped into the cultures of Sweden and Norway, having existed in that part of the world for around 200 years. This was key to how, as Sweden joined the EU in 1995, its government negotiated an exemption to the bloc’s snus ban.
“The easy answer to help reduce smoking rates would be to say that everyone should use snus instead of cigarettes to reduce cancer rates,” Karlsson told Filter, “but I am not sure the cultural adoption of stuffing things under your upper lip will be smooth sailing in all of Europe.”
“So let me say it in another way,” he continued. “Do not ban alternatives to smoking cigarettes, ensure that information about the harmfulness of products is readily available and allow people to make wise choices about their own health. Then it will, over time, go in the right direction.”
As for Sweden, the good news might well get better still, ultimately ending smoking-related deaths.
Even when the country has already achieved a historic reduction in combustible tobacco use, “smoking prevalence could accelerate downwards,” Dr. Karl Fagerström told Filter.
Fagerström, a Swedish professor and clinical psychologist who created the Fagerström Test to assess nicotine dependence among people who smoke, was another of the speakers at the London event.
Experts attribute their continuing optimism in part to recently implemented tax policies that further incentivize safer behaviors. As of January, Sweden increased taxation on cigarettes by 10 percent, while cutting snus taxation by 20 percent.
“With the recently adopted tax cuts aimed at less harmful nicotine products, Karlsson said, “I am sure we will go even further in reducing smoking rates, stay there, and steadily phase out cigarettes as a thing of the past altogether.”
Photograph via Itoldya/Public Domain
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