Harm Reduction Reduction

I write my column Harm Reduction Reduction for TCS Daily on 27 December 2004.

The battle may be lost, but the war isn't over

On December 14th the European Court of Justice in Luxembourg ruled that the EU should keep its 12 year old ban the sale of moist oral smokeless tobacco, so called snus. The ban was enacted before Sweden entered the EU, and Sweden specifically negotiated an exception to this ban in order to continue the sale of snus in Sweden.

At first this seemed like a quaint left-over, intended just for Sweden, but during the last years harm reduction has become an alternative to the "quit or die" policy regarding tobacco. Swedish snus is a type of smokeless tobacco that has been found less dangerous than cigarettes by many scientific researchers. Even if the use of snus cannot be regarded as harmless, the lack of combustion in the mouth, associated with smoking, eliminates the risk for lung cancer and other pulmonary diseases, which are the main causes of tobacco-related death. Some researchers have pointed out the availability of snus, used as an alternative to cigarettes, as the factor behind the low figures for smoking in Sweden (especially for men), and as an easy step towards smoking cessation for many Swedes.

Lately, the previously compulsory cancer warning labels present on snus boxes have been removed. The studies on snus have in fact divided the scientific community, strengthening the position of the "harm reduction" approach.

The decision of the court was not a great surprise. Already in September, Advocate General Leendert Geelhoed at the European Court of Justice said the ban on selling snus in the rest of the EU should remain in place, out of public health concerns. The European Court of Justice follows the recommendations of its Advocate Generals in about 80 per cent of the cases. Still, it was a great disappointment not only from a harm reduction perspective but also from a free trade perspective.

The ban on snus is in stark contrast with the rest of the EU's tobacco policy. Forms of smokeless tobacco that are more harmful than snus are allowed to be sold in the EU. But, as mentioned above, the ban against snus was made before Sweden joined the union in 1995. Thus it seemed as the perfect progressive anti-tobacco policy, banning a product that was not used in the union, but still not antagonizing anyone.

About 300,000 tonnes of tobacco is produced in France, Italy, Spain and Greece taken together. Around 80,000 farmers, mostly in poor regions of Greece and Italy, get about €7,000 per hectare from European taxpayers to grow tobacco. That is 20 times the subsidy paid to grain farmers!

The principle of free trade also suffers under such bans, negating the EU's own principle that a good permitted in one member nation should be allowed throughout the whole union.

The European Commission has supported the continued ban of the selling of snus on a public health argument. But the Commission dismisses public health concerns, in favor of free trade, when it comes to another one of the exceptions that Sweden negotiated when entering the EU: the restrictive policy on alcohol that limits the retail to the government owned monopoly. The EU therefore risks its credibility by using the same argument to ban snus.

Sweden and snus have thus created a difficult situation in the EU when it comes to the common market with issues stemming from the mixing of the EU paternalistic public health policy with the policy of free trade. Expect the debate over these anomalies to continue as the new Commission takes office.

The verdict in the European Court of Justice only ends the legal process, now a political process will have to start to amend the tobacco directive that banned snus in first place. This will, unfortunately for the harm reduction policy, be more difficult than the legal process since this involves a value based argumentation for harm reduction. Swedish Match, the main producer of snus, will certainly have greater difficulties enlisting support in the political debate as they dominate the Swedish snus market with a market share of 90%. Their continued work beyond the legal process could easily be targeted by the opponents as just wanting to gain new profits by opening up a market for which they possess a near monopoly.

The Swedish parliament passed that the Swedish government must work for enacting a lifting of the ban of the sale of snus in the EU, but this is not the policy of the social-democratic government, and it is the reason the minister for Public Health and Social Services Morgan Johansson did such a lackluster job supporting their case.

If more smokers used snus, hundreds of thousands of lung cancer cases could be avoided every year in Europe. There would still be addiction and other health problems, but the situation would improve. But if European consumers are to be given the opportunity to decide for themselves, the harm reduction side needs to rethink its strategy for the upcoming political process.