EU tobacco ranking rewards prohibition failures and punishes smoke-free success

Europe’s new official tobacco control rankings are “a celebration of failure” that risk entrenching the consumption of deadly cigarettes, according to international health experts.

The report, compiled by the EU-funded Smoke Free Partnership (SFP), rewards countries with strict prohibitions but sky-high smoking rates, while punishing those that are wiping out cigarettes by giving adults access to safer alternatives, such as vapes and nicotine pouches.

Dr Delon Human, leader of Smoke Free Sweden, expressed concern that the rankings focus on process rather than actual health outcomes.

“Reductions in smoking-related disease, disability and death – and gains in cessation – should carry the heaviest weight in any ranking of this kind,” he said. “Without that, it risks becoming an annual festival of policy theatre.

“If your country keeps smoking rates high but piles on restrictions, congratulations – the Tobacco Control Scale ranks you a success. But if you actually help people stop smoking, as Sweden has done, apparently that counts for nothing.”

Sweden, which is on the brink of becoming the world’s first officially smoke-free nation with smoking rates below 5%, has dropped to number 24 on the league of 37 nations. It has fallen 15 places in the rankings over the past 15 years, despite reducing smoking by 58% over the same period.

Meanwhile, the daily smoking rate in Ireland, ranked number one in Europe, has barely budged since 2019 and remains about 13% – nearly three times Sweden’s level.

Spain climbs into the top 10 despite one of Europe’s highest daily smoking rates at 22%, while France remains in the top five even though prevalence remains about 17%.

“The most absurd part is that an organisation called the ‘Smoke Free Partnership’ appears more interested in fighting smoke-free alternatives than celebrating countries that are genuinely becoming smoke-free,” Dr Human said. “Perhaps it’s time for a name change.

“When Sweden falls down the rankings while eradicating smoking, and countries with far higher smoking rates climb the table while restricting quitting tools, the whole process appears to be a celebration of failure.”

Dr Human said Sweden’s success had been achieved by making safer nicotine alternatives accessible, acceptable and affordable.

He said the ranking system risked encouraging policies that entrench cigarette smoking by making safer alternatives less attractive, less available and more expensive.

“People smoke for nicotine, but they die from the smoke,” he said. “Countries that make it harder to switch away from cigarettes are protecting the cigarette trade, whether intentionally or not.

“In Ireland, smoking remains dramatically higher than Sweden despite being Europe’s top-ranked country, while policymakers continue tightening restrictions on reduced-risk products.

“In France, which has never dropped out of the top 10, smoking remains stubbornly high and authorities have now gone so far as to ban nicotine pouches outright. Spain has climbed the rankings while maintaining smoking rates four times higher than Sweden and pursuing restrictions that would effectively wipe pouches from the market.”

Dr Human, a former secretary-general of the World Medical Association, called for European policymakers to focus on outcomes rather than ideology, using Sweden’s approach as a blueprint for reducing smoking-related disease.

“Europe should stop rewarding countries for restricting safer products and start asking a harder question,” he said. “Why are nations with smoking rates three or four times higher than Sweden being held up as models of success?

“The scoreboard that matters is not how many bans a government introduces. It’s whether fewer people are inhaling toxic smoke.”

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