My complacent country: why Sweden has long way to go on tobacco reform

Sweden is ahead of many nations in anti-smoking efforts but it’s not at the head of the class. Jess Pac

In general, Swedes tend to have a good self-image. Not necessarily of ourselves as individuals but of Sweden and Swedes as a whole. The general view is that we are more democratic, liberal, rational, equal and healthier than… well, everyone else.

Part of this position is built on our history. Three hundred years of neutrality and, more recently, a progressive welfare state (or folkhem) will do that to you. The folkhem saw the introduction of innovative socially beneficial initiatives, such as cradle-to-grave health care, addressing gender inequality, maternal and paternal leave, and much more.

We are right to be proud of these positions but, every now and then, our pride blinds us to the truth about where we are in the world. In terms of smoking, the fact that only about 20% of the population use tobacco daily puts us ahead of the curve, but are we where we should be?

Tentative steps

Banning smoking indoors has led to a rise in noncombustible tobacco (snus) use. Michael Caroe Andersen

The major legislative intrusion in smoking habits was the introduction, in June 2005, of an indoor smoking ban within the hospitality business. The Swedish National Institute of Public Health points to the success of the ban, citing a range of factors such as the high adherence to the ban (less than 11 violations observed in 1163 spot checks). Exposure to passive smoke decreased by nine percentage points.

A 2006 survey reported that 93% of Swedish people felt positive about smoke-free restaurants. And the economic effects of the ban are positive with a growth in restaurant workers since 2005.

The ban has been connected with a decline in smoking – but it has also been connected with the rise in noncombustible tobacco (snus) use. Figures between 1995 and 2009 show a decrease in daily smoking. Daily smoking among men fell from 22% to 13% and women from 24% to 15%. Much of this decrease seems lost however, when we observe that 11% of the adult population use snus daily.

Keeping up

But assessing whether Sweden’s anti-tobacco initiatives are adequate requires comparison to others. We are ahead of many nations but we are not at the head of the class. Seen in the light of the Australian High Court decision to uphold legislation on plain packaging, the question we must ask ourselves is: are we fulfilling our potential?

Sweden has ratified WHO’s Framework Convention on Tobacco Control (FCTC) and is required to adapt national law accordingly.

This requires us to submit regular progress reports on the implementation of stronger tobacco control. Sweden has submitted reports in 2008, 2010 and 2012 stating that its priorities are: national support for and local initiatives on tobacco prevention, improving enforcement of the age limits and increasing support for tobacco cessation.

Think tank Tobaksfakta is critical of Sweden’s efforts, arguing that little has been done since 2005 aside from some tax increases, maintaining the age limit for purchasing tobacco products and increased funding of anti-tobacco activities. Specifically, Tobaksfakta points out that Sweden has not addressed the tobacco industry’s influence on policy.

Sweden has not addressed the tobacco industry’s influence on policy. mynameislasek

Nor has Sweden drafted guidelines in three vital areas: (1) pictorial health warnings, (2) continuous long-term action programs for education, public information and opinion formation, and (3) implementing a total ban on tobacco advertising and sponsoring. All of these are obligations stemming from FCTC.

Long road ahead

The current Swedish position was summarised by the former minister of health, Maria Larsson (now minister for children and the elderly) in an appearance on Swedish television in connection with the Australian High Court decision. Asked directly if Sweden should follow suit she argued that trademark issues, freedom of expression and the slippery slope argument made such a move difficult.

None of these arguments are about health, or particular to Sweden. If Australia can implement plain packaging for tobacco products, then so can Sweden. It seems that Sweden is content to rest on its laurels instead of attempting to fulfil its potential.