From Sweden to the UAE: A successful public health model

What can we learn from a country that has reduced daily smoking to just 3.7 per cent?

Sweden is the only country in Europe to reach smoke-free status, 16 years ahead of the EU's 2040 target. That success was the focus of Innovation in Public Health: The Swedish Experience, held by Quit Like Sweden (QLS) at Hilton Dubai Palm Jumeirah on 12 October.

QLS, an independent public health initiative founded by Suely Castro, studies the lessons behind that success. Sweden adopted the World Health Organization's (WHO) tobacco control measures and accepted that smoke-free alternatives can help adults quit. It did not choose between tobacco control and harm reduction. It used both.

Central to this approach are the Three A's. Alternatives must be accessible (easy to find and buy), acceptable (suited to people's tastes, habits and needs) and affordable (cheaper than cigarettes). Without all three, cigarettes remain the easier option.

The UAE has regulated e-cigarettes since 2019 and nicotine pouches since 2025, for adults only. Nearly nine in ten residents are expatriates, and many bring habits from home, including smokeless nasvay and betel quid. European migrants in Sweden smoke at 7.8 per cent, against 24 per cent in their home countries. Environment and choice matter.

Dr Rachel Kaminski of Saudi German Hospital described the gaps in cessation support her patients face.

“Every week I see people whose lungs are showing the damage from smoking much earlier in life than they should. Many of them want to stop, and have tried more than once. What they lack is proper support: dedicated cessation services, treatment covered by insurance, and something realistic to offer those who cannot quit. Without that, we are treating the consequences, not the cause,” said Dr Kaminski.

Consultant Pulmonologist Dr Mohammad Fawzi Katranji said misconceptions about nicotine, among the public and health professionals, make smoking harder to tackle. Many believe shisha and midwakh are cleaner than cigarettes, but all three burn tobacco. Dokha can deliver up to five times the nicotine of a cigarette and about 55 per cent more tar, and one shisha session can equal more than 40 cigarettes.

Public health professionals in the audience asked about EVALI and “popcorn lung”. The 2019 US EVALI outbreak was caused by illicit cannabis (THC) products contaminated with vitamin E acetate, not by regulated nicotine vapes. Dr McGovern explained there is no evidence that vaping causes popcorn lung, which arose from very high diacetyl exposure among popcorn factory workers. Cigarette smoke contains diacetyl at 150 to 800 times the level ever found in e-liquids, yet no case has been linked to smoking.

Others asked whether nicotine is a poison. Speakers explained that nicotine can be dependence forming, but it is not what causes smoking-related disease. Nicotine is on the WHO Model List of Essential Medicines. Vaping products are regulated in the  EU and US only after strict safety and quality review. The US FDA has also authorised some e-cigarettes as appropriate for the protection of public health.

As the late Professor Michael Russell, a UK pioneer of stop-smoking research, said 50 years ago: “People smoke for nicotine but they die from the tar.”

The second session turned to those left behind. Dr Garrett McGovern, a Dublin addiction specialist, addressed smoking among people with mental health conditions and those recovering from drug dependence.

“People living with mental health disorders are significantly more likely to smoke, often smoke more heavily and are less likely to quit successfully, contributing to disproportionately high rates of smoking-related disease and premature death,” said Dr McGovern.

Castro explained that a legal product can still be out of reach. Innovation in nicotine delivery has widened adults' options.

“Behind every smoking statistic is a person, a family and a community affected by smoking-related disease. What we heard in Dubai reinforces the importance of giving adults who smoke better choices and ensuring that lower-risk alternatives are accessible, acceptable and affordable. Sweden has shown what is possible. The challenge now is to translate those lessons into approaches that work for the UAE and the wider region,” said Castro.

Beatriz Santos, CCO at We Are Innovation, showed how innovation shaped quitting in Sweden. Snus reached men. Nicotine pouches, a tobacco-free redesign, reached women.

“Public-health policy works best when it recognises that people face different barriers and may need different routes away from smoking. Innovation means learning from what has worked elsewhere and adapting those solutions so that no one is left behind,” said Santos.

Sweden's 3.7 per cent is a story of progress. But every person who still smokes has a story too. No two people quit the same way. Public health works best when it offers more than one way out.