April 13. 2024. 6:45

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Snus: The tradition that’s given Sweden the fewest smokers in Europe


Tobacco that you neither smoke nor chew is “a weird Swedish cultural product”, Patrik Hildingsson cheerfully admits. And he’s a vice-president of the biggest manufacturer of snus, Swedish Match. Weird but successful. Snus consumption never stopped, although it ceased to be fashionable when Swedes embraced the global trend to smoking cigarettes. Now the snuff-like substance, placed between the upper lip and gum, has reclaimed top spot.

Ever since the link between smoking and cancer was conclusively established in the 1960s, people in Sweden who want a nicotine hit have increasingly decided that the old ways are the best. Cigarette consumption is down to 4%, the lowest in the EU, making Sweden the only European country to have passed the World Health Organisation’s ‘endgame’ target of 5%.

Sweden now also has the lowest cancer rates in the EU, including for mouth cancer. There was never an official campaign to get smokers to switch to snus, rather it was a consumer revolt as people made up their own minds. More recently the same phenomenon has been seen in Norway, although hard data has played a bigger part in spreading the way there.

In the United States, where snus first arrived with Swedish immigrants, it is also increasingly recognised as a much safer alternative to cigarettes. A study has shown that snus has the lowest cancer risk of 10 tobacco products, with 3.18% of the risk from cigarettes. (Cigars are at 41.1% and chewing tobacco at 11.18%).

Part of making snus more attractive to modern consumers has been producing it in pouches, ready to place under the lip, rather than as loose tobacco. This has also given rise to non-tobacco substitutes, where alternative fibre is treated with nicotine. The cancer risk is then 0.22% of cigarettes, slightly below that from electronic cigarettes.

The Snus Commission, a body funded by the manufacturers but without any input from them into its work, estimates that if all EU countries had made the same switch from cigarettes to snus, 355,000 fewer people would have died. The Commission’s chairman, Anders Milton, is a physician who has been both president and chair of the Swedish Medical Association.

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He’s clear that snus is not a health product and it should be avoided by pregnant women. But as with vaping, “you can live with snus, you die with smoking”. One of his colleagues on the Commission, Professor Karl Olov Fagerström has argued that nicotine, though addictive, is close to coffee in terms of harm -and much less harmful than alcohol.

“Smoking is the harm”, he explained, “it would be similar if we smoked coffee”. It’s the science that has left the Snus Commission critical of the World Health Organisation’s stance that smoking should not be banned (though strongly discouraged) but other tobacco products should be banned.

Tommaso Di Giovanni, a vice-president with Swedish Match’s owners, PMI, likened the situation to when Galileo was obliged to recant the scientific fact that the earth orbits the sun but stated “and yet it moves”. Whether Sweden’s “weird cultural product” can move Europe’s public health doctrine remains to be seen.

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