What the EU Snus Ban Means: 290,865 Casualties Per Year

A November 12 e-cigarette summit at the Royal Society in London featured a range of views on European prospects for these new products (information here). 

Tobacco harm reduction proponents included Clive Bates, Robert West, Jacques Le Houezec, Konstantinos Farsalinos, Jean Francois Etter and Antoine Flahault.  One presenter summarized the Swedish experience with snus as population-level proof that safer smoke-free products save lives.  He used my published study (abstract here) showing that there were 172,000 deaths from lung cancer – the sentinel disease of smoking – in the European Union in 2002.  If all men in the EU had smoked like Swedes, there would have been only 80,000 lung cancer deaths.

A summit attendee asked if I could update that analysis with more recent data.  In fact, the World Health Organization and the International Agency for Research on Cancer now have 2009 lung cancer mortality information for 27 of the 28 EU countries (Cyprus is the only exception).  I have calculated the number of lung cancer deaths among men that would have occurred at Swedish smoking rates for all of these countries.

Sweden’s lung cancer rate is still the lowest in the EU by a long shot, at 68 deaths per 100,000 men age 45+ years.  Finland’s is the next lowest at 102, which is interesting because snus is still used in some parts of that country, despite its prohibition.  In contrast, Hungary and Poland have the highest rates, at 278 and 222 respectively.

For perspective, two non-EU countries are worth mentioning.  The lung cancer mortality rate in Norway, where snus has contributed to reduced smoking (discussed here and here) was 121, which would have been fourth in the EU. The rate in the U.S., where tobacco harm reduction has been trashed by prohibitionists, was 138, which would have placed it tenth, behind Sweden. 

In the EU, the 2009 Swedish lung cancer rate was 12% lower than in 2002.  This is consistent with declines in most countries’ rates, ranging from -3% in Hungary (from 287 in 2002 to 278 in 2009) to -20% in Estonia (from 227 to 181) and Malta (from 158 to 126). 

While the declines may appear modest or even impressive, the lung cancer death toll among European men of 183,423 is intolerable.  The EU continues to ban snus everywhere except Sweden.  The price for this appalling policy: 99,086 avoidable lung cancer deaths per year, plus more from other smoking-related diseases.

Considering that 91% of lung cancer deaths are attributed to smoking, and lung cancer accounts for only 31% of all smoking-attributable deaths among men in the EU, the toll from smoking among men in these EU countries is 538,435.

At the Swedish rate, the toll would be 247,570.  That makes the net cost of the EU snus ban 290,865 deaths (assuming that all EU male smokers would adopt snus as successfully as Swedish males).

Recently the European Parliament voted on a new tobacco directive; the results make smokers both losers and winners.  Parliament continued the snus ban but struck down a provision that would have suppressed e-cigarette access.  As Clive Bates noted (here), “…the snus ban tells us that evidence, analysis and even concern for human life are not always that influential in way the EU makes policy.”     

The EU snus ban is indefensible and immoral. 

Lung Cancer Mortality Rates*, Numbers of Deaths, and Numbers Expected at Swedish Rates Among Men 45+ Years in 27 European Countries, 2009
Country	Rate*	Deaths	Deaths at Swedish Rate
Austria	120.3	2,360	1,334
Belgium	176.8	4,851	1,866
Bulgaria	157.8	2,633	1,135
Croatia	213	2,153	687
Czech Republic	176.7	3,950	1,520
Denmark	129.8	1,859	974
Estonia	180.6	475	179
Finland	102	1,426	951
France	152.9	21,983	9,777
Germany	126.8	28,839	15,466
Greece	176.6	5,280	2,033
Hungary	277.8	5,605	1372
Ireland	124.4	1,055	577
Italy	139.8	25,146	12,231
Latvia	192.5	833	294
Lithuania	188.6	1,139	411
Luxembourg	145.7	154	72
Malta	126	124	67
Poland	221.8	16,250	4,982
Portugal	105.3	2,646	1,709
Romania	182.7	7,528	2,802
Slovakia	167.6	1,567	636
Slovenia	157.5	723	312
Spain	157.9	17,061	7,347
Sweden	68	1,820	1,820
The Netherlands	156.8	6,368	2,762
United Kingdom	120.9	19,595	11,021
All		183,423	84,337

*Deaths per 100,000 men per year, age-adjusted to the World Standard Population.
Note: Croatia was not an EU member in 2009.