Tale Of Two Nations – Vol. 16: United Arab Emirates vs Sweden
A comparative study of how the UAE and Sweden are faring in the fight against smoking
Authors: Dr Delon Human & Dr Mohammad Fawzi Katranji
A comparative study of how the United Arab Emirates and Sweden are faring in the fight against smoking
Overview
The global fight against smoking has shown that nations embracing progressive policies and harm reduction strategies are making the greatest strides in reducing smoking-related harm. This report examines the contrasting approaches of the United Arab Emirates (UAE) and Sweden, highlighting a clear divergence in policy direction and results.
While Sweden has achieved world-leading results by promoting harm reduction and safer smoke-free alternatives, the UAE has opted for a more reserved and tightly regulated approach which may limit the potential role of these innovations within its tobacco-control framework.
Different directions
Sweden’s remarkable journey from smoking to safer nicotine alternatives, such as snus, vaping and nicotine pouches, has reshaped its public health landscape. By making these products accessible, affordable and acceptable, Swedish policymakers gave smokers practical tools to quit cigarettes without quitting nicotine.
The results are historic: daily adult smoking prevalence in Sweden has plummeted to just 5.3%1, the lowest in Europe.
The UAE has also made significant progress in reducing smoking, with an overall daily smoking rate of 7%.2 However, there remains a sharp gender divide, with 15.5% of men reported as current (daily or occasional) smokers.3 These figures indicate continued potential for improvement, particularly through policies that support smokers in switching to less harmful alternatives.
Compared to Sweden, the UAE’s regulatory approach to smokeless alternatives has been more reserved as it introduces these products under tight and evolving regulations.
Snus is banned and other smokeless products often face greater scrutiny than combustible cigarettes, reflecting both precautionary intent and regulatory uncertainty.
This ongoing policy evolution offers a crucial opportunity: by recognising that smoke-free nicotine products are dramatically less harmful than smoking, the UAE could replicate Sweden’s success in reducing smoking-related harm.
Sweden’s example shows that proportional, science-based regulation, rather than prohibition, achieves the greatest public health gains.
For the UAE, adopting a similarly risk-proportionate approach could accelerate its transition toward a truly smoke-free future while strengthening its position as a regional leader in public health innovation.
Sweden’s journey to smoke-free
In the early 1960s, Sweden faced a public health crisis, with nearly half of its men smoking cigarettes. Today, the country stands as the guiding star for tobacco control, with smoking rates barely above 5% – the global benchmark for ‘smoke-free’ status.
Sweden’s success is the result of a long-running, real-world harm reduction experiment that offers undeniable, unimpeachable proof that replacing smoking with smokeless nicotine products leads to significant public health benefits. Sweden has the lowest tobacco-related disease and death rates in Europe, including a male lung cancer death rate that is 61% lower than the EU average. These impressive outcomes highlight the effectiveness of harm reduction policies grounded in science rather than prohibition.
Rather than banning or excessively restricting nicotine products, Sweden embraced safer substitutes. The transition began with traditional snus and later expanded to include vaping (2015).
After nicotine pouches were introduced in 2016, quit rates accelerated further, particularly among women who had previously found other alternatives unappealing. By ensuring these options are accessible, affordable and socially acceptable, Sweden has successfully reduced its smoking rate by 54% since 2012.
Official data reinforces this success. Among Swedish-born individuals over 16, only 4.5% smoke. Among Swedish citizens who were born elsewhere in Europe, the smoking rate is 7.8% – further evidence of Sweden’s effective harm reduction environment.
Sweden’s success comes from decades of rethinking tobacco control, integrating
smokeless nicotine products with traditional measures while others opposed nicotine outright.
Key policy actions included:
- Legal access to safer nicotine products through both online and retail markets.
- Permitted advertising to raise awareness of harm reduction options.
- Risk-proportionate taxation: In 2024, excise taxes on snus were reduced while cigarette taxes increased, reinforcing the incentive to switch from traditional smoking products.
Sweden has formally adopted tobacco harm reduction as a national policy, shifting its focus from reducing consumption to actively reducing harm. This commitment has positioned the country as a global leader in public health innovation.
The case for tobacco harm reduction is no longer theoretical. Sweden’s experience provides real-world proof that harm reduction strategies work.
Harm reduction as state policy
SWEDEN
On December 11 2024, the Swedish Parliament voted to change the overall goal of their national tobacco strategy from focusing on “reducing tobacco use” to “reducing medical and social harm caused by tobacco and nicotine products.”
The Riksdag’s Budget stated:
“…tobacco policy must consider the varying harmful effects that various tobacco and nicotine products can cause.
…cigarettes and smoking tobacco pose a greater health hazard than smokeless tobacco and nicotine products…
This approach is also reflected in the taxation of these products in Sweden and must also be reflected in the target for tobacco policy.”
Escape Route
Just as buildings have escape routes or doors in case of fire, smokers seeking to quit have multiple ‘escape routes’ from the dangers of combustible cigarettes.
Nicotine pouches, vapes and snus offer safer alternatives that can help smokers transition away from the harmful effects of combustible cigarettes. That is because the vast majority of harm caused by smoking comes from thousands of toxins released by the burning of tobacco in combustible cigarettes.
There is a growing body of evidence establishing how much safer these alternative products are.
The UK’s OHID (Office for Health Improvement & Disparities) has repeatedly affirmed that vapes are “at least 95% less harmful” than cigarettes.
The United States Food and Drug Administration has authorised a range of e-cigarettes, nicotine pouches, heated tobacco products and snus as “appropriate for the protection of public health” under its exacting population health standard.
The Oral Nicotine Commission 2020 Report gives this visualisation of the relative harm of all products available for purchase in Sweden.
Seeking a smoke-free future
In recent years, the United Arab Emirates (UAE) has made visible progress in reducing smoking. The proportion of adults who report current (daily or occasional) tobacco use has fallen from 14.7% in 2019 to 11.1% in 2024, representing around one million current smokers nationwide.
Within this, there remains a sharp gender divide: 15.5% of men and 2.6% of women are current smokers. Daily smoking rates are lower, at around 7% of adults, reflecting reduced frequency and intensity of tobacco use. Despite these encouraging trends, smoking continues to impose a substantial public health burden. According to the Institute for Health Metrics and Evaluation, smoking caused 1,693 deaths in 2021, equivalent to 8.45% of all deaths in the UAE.
Other studies indicate that 25% of deaths from serious diseases in Abu Dhabi are directly attributable to smoking. Tobacco use remains a leading risk factor for ischemic heart disease, stroke and lung cancer.
At the same time, available market data suggest a growing interest in e-cigarettes and heated tobacco products as substitutes for traditional cigarettes. However, limited data availability constrains policymakers’ ability to measure switching rates or assess the impact of these products on cessation outcomes.
The UAE’s regulatory approach to smokeless products is evolving rapidly. Nicotine pouches are permitted, although no health claims may be made about them. Snus is banned. While vapes and heated tobacco are permitted, regulators have adopted a cautious stance, focusing on product standards, marketing restrictions and taxation
similar to combustible cigarettes.
In practice, smokeless products often face stricter scrutiny than cigarettes, which may inadvertently limit smokers’ access to lower-risk alternatives.
A key challenge lies in fragmented governance. Multiple authorities manage different aspects of tobacco and nicotine control, leading to siloed decision-making.
To achieve further progress, UAE policymakers must lead the coordination of a comprehensive, evidence-based approach to tobacco harm reduction. A coordinated national framework that brings together the country’s health, standards, economic and consumer-protection regulatory bodies could ensure policies are consistent, science-driven and focused on public health outcomes.
Establishing a clear evidence base, including national data on product use, switching rates and health outcomes, will be vital.
By prioritising harm reduction within its tobacco control strategy, the UAE can ensure that policy evolves in step with science, empowering adult smokers to move away from combustible tobacco while maintaining strong safeguards against youth uptake.
Conclusions
- Slower Progress: The UAE’s daily smoking rate of around 7% is notably higher than Sweden’s 5.3%, showing slower progress toward smoke-free status despite strong public-health commitments.
- Health Gap: Smoking-related disease and mortality remain high in the UAE, while Sweden’s harm-reduction model has sharply reduced smoking-related illness and premature deaths.
- Different Approaches: Sweden’s strategy distinguishes between combustible and smoke-free products, whereas the UAE’s more cautious framework applies tighter controls that may limit adult access to safer options.
- Regulatory Contrast: While Sweden promotes switching through risk-proportionate regulation and taxation, the UAE’s equal scrutiny of smokeless and combustible products restricts such behavioural change.
- Potential for Parity: With coordinated, evidence-based policymaking and clearer harm-reduction integration, the UAE could mirror Sweden’s success and move decisively toward a smoke-free future.
Recommendations
- Integrate Harm Reduction Policy: The UAE should create a national framework recognising differing product risks and supporting safer nicotine alternatives within tobacco control.
- Enhance Policy Coordination: Strengthen collaboration among existing health and regulatory authorities to ensure consistent, science-based implementation of tobacco and nicotine policy.
- Strengthen Data Collection: Build systems to track robust and credible population-level data that enables fact-based decision-making and ensures that policies are informed by actual consumer behavioural patterns.
- Ensure Risk-Proportionate Rules: Align regulation and taxation with scientific risk, easing barriers for low-harm products while maintaining strict controls on cigarettes.
- Promote Public Awareness: Educate adult smokers on safer options while maintaining strong youth protections.
References:
- Public Health Agency Sweden – Use of tobacco and nicotine products (self-reported) by country of birth, sex and year. Proportion (percentage)
- World Health Organization – WHO report on the global tobacco epidemic, 2025: warning about the dangers of tobacco
- Global State of Tobacco Harm Reduction – Tobacco smoking in United Arab Emirates
- Pnlee.couk – International Smoking Statistics – A collection of worldwide historical data: Sweden
- IHME – GBD Results
- Public Health Agency Sweden – Use of tobacco and nicotine products (self-reported) by country of birth, sex and year. Proportion (percentage)
- Gov.uk – Nicotine vaping in England: 2022 evidence update summary
- The United States Food and Drug Administration – Searchable Tobacco Products Database
- Global State of Tobacco Harm Reduction – Tobacco Smoking in United Arab Emirates
- IHME – GBD Results
- Cleveland Clinic Abu Dhabi – Smoking and Your Health