Recently released data from Norway should cause public health professionals to sit up and take note. Cigarette users in Norway are turning to snus, a safer alternative to smoking, at a such a rate that snus users now outnumber cigarette users. In 2017, 12% of Norwegians used snus daily, compared to 11% who smoked cigarettes every day (a reduction from 22% in 2007). This switch to a safer product may come as a surprise to many in the tobacco control community, but not to those with a broad perspective of tobacco control, who recognize how smoking behaviors are evolving.
The Norway example demonstrates what is possible when governments don’t allow tobacco control policy to be straightjacketed by directives, such as the European Tobacco Control Directive, which outlawed snus in most European countries. Instead, Norway (which is not a member of the European Union) implemented sensible tobacco control policies that left room for alternatives in the marketplace. Those alternatives are helping people reduce their health risk through safer nicotine products, contributing to Norway having some of the better health indicators in the region.
The story is similar in nearby Sweden, which was exempted from the European Union’s ban on snus. Men in Sweden have the lowest rate of lung cancer in Europe, partly due to the use of snus which has led to unusually low rates of smoking.
It is vital to consider how the Sweden and Norway experience can be transferred to countries with huge populations of smokers and users of unhealthy oral tobacco, such as India, Bangladesh and Pakistan. Could Scandinavian snus supplement current tobacco control efforts in these countries by providing an alternative that is not only safer, but also affordable?
Currently, each of these countries has its own version of inexpensive oral tobacco which is prepared by mixing tobacco with ingredients like slaked lime, areca nut and flavorings. Unlike snus, the resulting products are unsafe and partially banned. But the rationale used to ban these products has the potential to limit positive change by lumping nicotine together with tar and other dangerous byproducts of burning tobacco.
The experience from Sweden and Norway indicates that banning all forms of nicotine is not the way to go and discussion should be undertaken to provide safer forms of nicotine to replace dangerous tobacco products. The Foundation for Smoke-Free World will help by facilitating this discussion and funding independent research to inform evidence based policy formulation which benefits governments, smokers and the general public.
With 250 million tobacco users in India alone, use of dangerous tobacco products is a public health crisis in need of an urgent solution. Innovative ideas are needed to help speed the adaptation of snus for markets like India, Pakistan and Indonesia. The Norwegian snus experience demonstrates what is possible when market forces and sensible policy align to provide smokers with an attractive alternative to unhealthy tobacco products. It’s time to find ways to transfer that success to other cultures around the world.
