Swedish Tobacco Control Progress & Challenge – both are greater than ever 2006 CONTENTS The Minister’s View The Voice of NGOs Snus is Harmful A Focus on Youth 1 June 2005 – Smoke-free Sweden Innovative Tobacco Cessation The Cost-Effective Quitline International Challenges Margaretha – Luther Terry Award Winner Meet the Swedish Network Photo: Åsa Till Swedish Beware of the Trojan horse… MORGAN JOHANSSON, SWEDEN’S MINISTER OF PUBLIC HEALTH: “The statistics on our smoking behaviours in Sweden are looking better and better every year, and I “We will be following believe that the new smoking ban is contributing to the continued decline.” Morgan Johansson, Minister of Public Health developments closely” Photo: Pawel Flato » Public Health Goals for the year 2014 “The ban on smoking in dining and drinking establishments that went into risks of smoking are much greater,” tobacco activity in their public health effect on 1 June 2005 is probably one of our most popular reforms,” says says Mr. Johansson. “However, there programmes. Reducing tobacco use is one of the primary are also health risks with snus and it is “We will be following develop- Morgan Johansson, Sweden’s Minister of Public Health, when he summarizes goals for public health set by the Swedish » best to stop using tobacco entirely. ments closely to make sure that there Parliament. It includes the following interim the current state of tobacco prevention in Sweden. “We are also striving to bring about are no cutbacks in that regard,” says targets: a reduction in the use of snus. For that Mr. Johansson. “In addition, the state purpose, it is necessary to provide in- must also provide fairly substantial • A tobacco-free start in life, effective by He states that, after nearly one year formation in the schools and other long-term resources for the work of the year 2014. This refers, first and with the ban on smoking in cafés, settings, and to make sure that sup- prevention. We are therefore allocat- foremost, to influencing the tobacco restaurants, bars and other facilities port is available to those who want ing funds to the municipal drug coun- behaviours of pregnant women and where food and drink are served, there to quit. That is how we succeeded in cils throughout the country, for exam- parents in general, so that children can is great popular support for the new turning the smoking trend downward, ple. They work primarily with alco- grow up in a tobacco-free environment. law. That is indicated by, among other and that is how we have to work with hol- and narcotics-related issues, but • Halving, by the year 2014, the number things, the results of opinion surveys the snus problem, as well.” also with tobacco use.” of young people under age 18 who (more on that subject on p. 14-15). begin smoking or using oral smokeless During 2002–2005, Morgan Johansson believes “When my predecessor introduced the Swed- that tobacco. the idea of smoke-free pubs in 2000, ish government invested a total of 90 it is entirely possible to fulfil the sub- there was strong opposition, especial- million SEK (approx 962,000€) to goals of public health policy in the area • Halving, by the year 2014, the pro- ly from the restaurant branch and the strengthen the work of tobacco pre- of tobacco use that has been set for the portion of smokers among those who affected labour union,” notes Mr. Jo- vention. The emphasis was on increas- year 2014 (see “Public Health Goals”). currently smoke the most. Health gaps hansson. “Today, smoke-free dining ing the availability of cessation sup- “To some extent, the decline in related to social class shall be nar- and drinking facilities are regarded as port and influencing the tobacco be- smoking is a development which, I rowed. Among the unemployed and perfectly natural. There is nothing to haviours of young people. The Na- believe, is bound to continue in the poorly educated, for example, the rate indicate that the new law has resulted tional Institute of Public Health was western world,” says Mr. Johansson. of smoking is significantly higher than Morgan Johansson is pleased by the decline in smoking but wants to promote the same trend for the use of that of the general population. in problems of any kind.” oral smokeless tobacco, snus. given the task to design and imple- ”But in order to reach our objectives, ment a programme to stimulate the it is important that people can get The primary reason for the smoking that the new smoking ban is contribut- the health effects of this product in- development of tobacco prevention help to stop smoking. The work of the • No one shall be involuntarily exposed to ban was to provide service personnel ing to the continued decline,” says the dicates that the oral smokeless tobac- efforts by municipal, county and re- municipalities and county councils is environmental tobacco smoke. The ban on smoking in dining and drinking facili- with a healthier work environment. Public Health Minister. “There was a co sold in Sweden increases the risk of gional governments. very important in this regard. Anoth- ties was an important step toward the But the Public Health Minister is con- worrying increase in smoking among fatal heart disease and certain forms of Morgan Johansson believes that er important resource is the National fulfilment of this objective. But there vinced that, by influencing general at- young women a few years ago, but that cancer, among other health effects (see many useful activities have been ini- Quitline.” (see article on p. 17). are still occupations in Sweden in which titudes toward smoking, the ban has trend has now been reversed.” p. 6-7). tiated during the past three years at “We also need to work with young it is difficult to avoid passive smoking. also produced other positive effects. “The low rate of smoking among both the local and regional levels, and people, so that they don’t begin to use Among those affected are homecare However, there has “The statistics on our smoking be- been an increase men in Sweden can in no doubt be stresses that it is important for munici- tobacco. The schools, and especially providers and prison personnel. haviours in Sweden are looking bet- in the use of oral smokeless tobacco, explained in part by the use of oral palities and county councils to con- school health services, have an impor- ter and better every year, and I believe snus. A recent review of research on smokeless tobacco instead; yet the tinue placing a high priority on anti- tant role to play.” Government Bill: 2002/03:35 TIMELINE IN 1957 The Swedish tobacco 1958 The Swedish Medical 1960 the state-owned tobac- 1960 The state tobacco monopoly is dissolved and replaced by the 1963 The first major survey monopoly, in effect since 1915, Research Council evaluates the co monopoly distributes a bro- Swedish Tobacco Company (“Tobaksbolaget“). Although the new compa- of smoking behaviours is conduct- SWEDISH expresses concern after the first health effects of tobacco use and chure which warned that “heavy ny was still owned by the state during its first decades of existence, the ed. The results indicate that half of TOBACCO scientific reports on the risks of warns smokers about the risk of consumption of cigarettes can change led to a more distinct commercial profile and an increase in ad- Swedish men smoke. A delegation smoking are published. cancer. contribute to the development of vertising for tobacco products. Those trends were more apparent by the of prominent scientists visit Prime CONTROL lung cancer” based on the conclu- introduction of U.S. cigarette brands in Sweden. Minister Tage Erlander to warn sion from the 1958 report. about the risks of tobacco use, In 1963 half following which, the government of Swedish men makes the first allocation for pub- were smokers. lic information on the harmful ef- 2 Swedish Tobacco Control 2006 fects of tobacco. Swedish Tobacco Control 2006 3 “It’s true that at a first glance today’s situation looks satisfactory. Smoking in Sweden continues to decline, and the smoking ban in dining and drinking establishments is being successfully implemented. Yet it would be unfortunate if such positive developments were » to give decision-makers the impression that the work of tobacco prevention is complete.” So says Dr. Göran Boëthius, pulmonary specialist and chairman of Doctors against Tobacco, one of the non-governmental organizations in the Swedish Network for Tobacco Prevention. The battle is not over Göran Boëthius’ assessment of the to- The move will, at least in a 2-3 years’ per- a majority of county councils and their bacco situation in Sweden in the near fu- spective, result in a loss of competence in hospitals and health centres. ture differs in several respects from the the area of tobacco prevention, since few “This will prove to be an important more optimistic view of the Minister of of the Institute’s most experienced person- move, supporting many smokers’ efforts Public Health, Morgan Johansson. nel are making the move to Östersund. to get control over their smoking and “Efforts to bring about a decline in “Article 5 of the WHO Framework promote their willingness to quit. That smoking and its damaging effects in Swe- Convention on Tobacco Control (FCTC), will result also in more smoke-free role den have been successful during the past which Sweden has ratified, emphasizes the models in the community”, states Göran 10-15 years,” concedes Göran Boëthius. importance of a strategic national agen- Boëthius. “But again, it will not be done “But we cannot rest on our heels and be cy which co-ordinates the work of tobac- without continued opinion building and satisfied so long as one million people con- co prevention.