By going against the Framework Convention on Tobacco Control’s prohibitionism, Sweden has become the first country in Europe to become smoke-free.
In 2021, the European Commission set a target for all its member countries to become “smoke-free” by 2040, in Europe’s Beating Cancer Plan. By “smoke-free” they mean a smoking prevalence of less than 5%.
“Tobacco consumption continues to be the leading cause of preventable cancer, with 27% of all cancers attributed to tobacco use,” it says. “By eliminating tobacco use, nine out every ten cases of lung cancer could be avoided.”
It continues: “Through rigorous enforcement of the EU tobacco control framework and its adaptation to new developments and market trends, including stricter rules on novel products, Europe’s Beating Cancer Plan will put forward actions from 2021 to help create a ‘Tobacco-Free Generation’ where less than 5% of the population uses tobacco by 2040, compared to around 25% today.”
Prohibitionist playbook
It is a familiar story. The European Union (EU) is, like South Africa, following the prohibitionist playbook of the World Health Organisation’s Framework Convention on Tobacco Control (FCTC).
South Africa’s own Tobacco Products and Electronic Delivery Systems Control Bill, which still languishes in legislative limbo, follows the same lead, focusing on rising taxation of tobacco products, prohibiting tobacco advertising, prohibiting claims such as “light” or “mild” on packaging, prohibiting retail displays, requiring plain packaging, requiring graphic health warnings on packages, and aggressively expanding smoke-free areas, not only indoors in public places, but increasingly outdoors and in private homes and vehicles, too.
In addition, there is a growing trend, both worldwide and in South Africa to treat smokeless tobacco products, such as snus, as well as electronic cigarettes (vaping devices) just the same as smoking tobacco, with taxes, marketing prohibitions and bans on appealing flavours.
The problem with these measures is that they are not particularly effective. They work, but not very well. In the EU, for example, smoking prevalence fell by only one percentage point, from 25% to 24% in the three years from 2020 to 2023.
Rebellion
It is arguable that for many smokers, stricter regulations are actually counterproductive. While smokers are largely okay with not smoking around other people, they also resent being forced to adopt healthier habits when it does not affect others.
This is anecdotal, but I know a lot of smokers who made a point of not quitting during the months that tobacco products were banned in South Africa. They didn’t want to give Nkosazana Dlamini-Zuma the satisfaction. Getting cigarettes on the black market was a little act of rebellion against what many saw as cruel, arbitrary and unjust restrictions on their freedoms.
Much the same happened during the alcohol ban, with everyone and their mate brewing pineapple beer or distilling witblits.
High taxes and prohibitions universally create black markets. It is no surprise, then, that emblazoned across the front page of the FCTC website is news of a protocol to fight not tobacco use, but illicit tobacco.
Illicit market
In South Africa, too, illicit tobacco products gained massive market share during the prohibition, which legal tobacco companies never recovered. South Africa’s largest tobacco firm, British American Tobacco, lost 40% of its sales to the illicit market, and has retrenched 30% of its staff, with more on the chopping block.
In the 20 years to 2022, the South African Revenue Service lost an estimated R119 billion in taxes to the illicit cigarette market.
Driving tobacco into the black market exposes smokers to lower-quality products which are not protected by either brand reputation or regulations on toxins such as pesticides in tobacco products.
Taxes on tobacco products are also highly regressive, since smoking is more prevalent among the poor. This reduces living standards by siphoning income away from home essentials such as food.
Illicit market revenue also funds criminal syndicates, in the same way that revenue from illegal drugs or prostitution supports crime cartels.
The upshot is that the orthodox prohibitionist approach to tobacco control purchases a marginal improvement in smoking prevalence at huge social and financial costs.
Sweden
If the recent rate of smoking decline in the EU of one percentage point every three years remains constant, Europe won’t reach its 5% target until around 2080 – three times further into the future as when the 2040 target was set.
Meanwhile, one European country reached that target last week, 16 years ahead of schedule, and has become the first EU country that can officially call itself “smoke-free”.
Regular readers of my column won’t need to guess at which country this is. I’ve written about it before. Sweden’s extraordinary success is the result not of following the prohibitionist instincts of the FCTC, but of their pioneering policy to actively encourage the same safer alternatives to cigarettes that South Africa and many other countries are trying to tax and suppress.
Dr Delon Human, leader of smoke-free Sweden, said: “This outstanding achievement marks a significant moment in global public health and stands as a testament to the progressive policies that have guided Sweden’s approach to tobacco control.
“In the early 1960s, nearly half of Swedish men smoked. By embracing and encouraging the use of alternative nicotine products such as snus, oral nicotine pouches and vapes, Sweden has paved a clear path to a smoke-free society while safeguarding public health.
“They should serve as a beacon of hope for the rest of the world and as inspirational proof that a pragmatic, enlightened approach can deliver sensational public health gains and save lives.”
“Pragmatic focus”
Dr Anders Milton, a physician and former president and CEO of the Swedish Medical Association, says: “Key to Sweden’s success is its pragmatic focus on harm reduction rather than prohibition. A wide range of safer nicotine products, with a variety of strengths and flavours, is legally available both online and in stores, supported by advertising, which raises awareness and encourages uptake.
“The Swedish government also applies a proportional excise tax, keeping smoke-free products more affordable than cigarettes. This tax policy, coupled with public education campaigns, has empowered Swedish consumers to make healthier choices and contributed to the country’s leading role in tobacco harm reduction.”
The consequences are equally striking. Thanks to its low smoking rate, Sweden can also boast of a 41% lower incidence of cancer than the rest of the EU.
“Regressive measures”
Dr Human adds: “While Sweden celebrates this historic achievement, most other nations remain far from reaching their smoke-free goals. Their rigid, prohibitionist policies limit access to safer nicotine alternatives, including oral nicotine products and e-cigarettes. These regressive measures are pushing smokers away from potentially life-saving tools and stalling progress toward reducing tobacco harm.
“Rather than follow Sweden’s lead, these nations are heading in the opposite direction, with smoking prevalence stagnating or even rising. Sweden’s success is living proof that alternative nicotine products are a powerful force for positive change when supported by evidence-based policies.”
Slavish adherence to the FCTC’s failing policies, which only serve to create black markets for tobacco, threatens the health of smokers, and makes it less likely that they’ll quit.
Smokeless nicotine products, and vapes in particular, are an alternative to smoking that is at least an order of magnitude safer than smoking cigarettes, and is far less offensive to bystanders.
More importantly, unlike pharmaceutical nicotine-replacement aids, vapes are actually pleasant to use, which makes them twice as likely to lead to successful smoking cessation.
It is high time that South Africa’s Department of Health got its collective head out of the sand and adopted a proven anti-smoking strategy. The Tobacco Products and Electronic Delivery Systems Control Bill should be scrapped in its entirety, and replaced with a tobacco policy copied and pasted from Sweden.
[Image: A man blowing vape clouds outdoors. Photo by Tnarg]
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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