The most recent figures by the World Health Organization (WHO) suggest that around 1 in 5 adults smoke. While this number has dramatically reduced in recent years, it still means that 1.25 billion people consume combustible tobacco, leading to devastating death and illness.

The EU's "Tobacco-Free Generation" initiative aims to reduce smoking in the member states to 5% by 2040. While progress has been made, the prevalence in the region is currently around 25%, so the odds of hitting this ambitious goal seem remote.

However, Sweden provides a clear roadmap for reaching the 5% target. Organisations like Quit Like Sweden (QLS) are here to encourage and support countries to replicate the success of the Swedish Experience.

A tranquil Swedish countryside scene with gently rolling hills beneath a bright blue sky. In the foreground, a wooden signpost reads "Welcome to Harm Reduction," positioned next to a winding path representing a journey towards a healthier lifestyle. Along the path are symbols such as a leaf for natural wellness, a lightning bolt for energy, and a heart for health, signifying alternatives to smoking. A Swedish flag is subtly incorporated into the scene, adding a touch of national identity.

Suely Castro and Dr Andres Milton are the two big names behind QLS. I recently caught up with the brilliant Suely Castro to discuss Quit Like Sweden’s plans and objectives.

The Interview

Follow Suely on X or go to the Quit Like Sweden platform to stay up to date on the events or get involved in this important project.

Q: How did you get into harm reduction?

My journey into harm reduction began with a deeply personal experience—watching my father, an 80-year-old Brazilian man, struggle with a lifelong addiction to cigarettes. Despite his desire to quit, he couldn’t find a viable alternative that worked for him.

His story is not unique; millions face the same challenge. This personal connection, combined with a passion for public health, inspired me to advocate for harm reduction strategies that can offer smokers accessible, acceptable, and affordable alternatives to cigarettes.

Q: What are the primary aims of Quit Like Sweden?

The primary aim of Quit Like Sweden is to replicate the incredible success that Sweden has had in reducing smoking rates and improving public health. Sweden’s approach has resulted in the lowest smoking prevalence in Europe, and the key to that success lies in making alternatives to smoking accessible, acceptable, and affordable.

Our goal is to encourage other countries by showing them that they can adopt effective harm reduction policies that offer realistic paths to quitting cigarettes.

Q: Why do you think that some people are not ready to learn from Sweden’s success?

I think people are hesitant because harm reduction is often misunderstood. Many people equate nicotine use with smoking, without realising that alternatives like snus, nicotine pouches, and vaping can drastically reduce the harm caused by smoking.

There’s also a fear of change, especially in countries with deeply ingrained anti-smoking policies that haven’t considered the potential of alternatives. It’s a mindset shift that requires time, education, and a willingness to adopt more nuanced approaches to public health.

Q: Many developing countries rely on WHO health guidance. Now that this organisation is captured by ideologues, how can we prevent them from doing too much damage?

It’s challenging, but I believe the key is in building a stronger case for evidence-based harm reduction strategies. We need to support local public health advocates and policy makers who understand the unique challenges of their regions. By focusing on real-world outcomes, like Sweden’s success, we can begin to shift the narrative.

It’s also important to collaborate with global experts and organisations that are willing to push back against ideology in favour of practical, life-saving solutions.

Q: Critics of harm reduction have devised very “creative” ways to refute the Swedish Experience. However, what’s happened in New Zealand over the last few years has dismantled those positions. Is there anything else that New Zealand did that we can all learn from?

New Zealand embraced the importance of harm reduction early on, particularly with vaping. One key lesson is that they didn’t just make alternatives available—they actively supported their use through public education campaigns and smart regulation.

The government worked closely with public health bodies to ensure these alternatives were not only accessible but also seen as legitimate quitting tools. All these efforts are paying off: New Zealand’s smoking rate has fallen to the lowest it’s ever been and the decline is continuing to accelerate.

Conceptual art illustrating the collaboration between the New Zealand government and public health organizations. The image features symbolic representations of regulation and education, with books and legal documents intertwined with flourishing vines and flowers. This imagery highlights the prosperous growth of a healthy society resulting from effective partnership and policy-making.

This collaborative approach between regulators and health advocates is something other countries should take note of.

Q: Who are your favourite voices in the smoking harm reduction space?

That’s like trying to pick your favourite child! There are so many wonderful people who have dedicated their lives to this space, and many of them I call friends.

While it’s hard to single anyone out, I must emphasise the incredible work that Dr Anders Milton has been doing. He has been a significant advocate for harm reduction, particularly in Sweden, where his leadership in healthcare and public health has helped shape the country’s progressive approach. His pragmatic views on smoking alternatives, coupled with a strong focus on public health outcomes, make him a powerful voice in the conversation.

Q: How do you see the next ten years for people who smoke? Do you think governments and public health bodies will take a more sensible approach toward regulating harm reduction, or will things just get worse?

I believe the next ten years hold a lot of promise. As more evidence emerges from countries like Sweden and New Zealand, it will become harder for governments and public health bodies to ignore the effectiveness of harm reduction.

That said, progress will likely be uneven. Some regions may take a more pragmatic approach, while others remain resistant. However, I’m optimistic that the tide is turning and that more sensible, life-saving policies will be adopted over time.

Q: Countering misinformation and disinformation around smoking harm reduction is a huge problem. How can we get the public the right information?

The key is to focus on transparency and collaboration. Public health campaigns need to clearly communicate the evidence around harm reduction, especially how alternatives can drastically reduce health risks. Partnering with trusted health organisations, leveraging social media platforms, and engaging local influencers can help cut through the noise.

The public needs simple, clear messages that highlight the benefits of switching to alternatives rather than just focusing on the negatives of smoking.

Q: What upcoming events can we expect from Quit Like Sweden?

We have several initiatives planned, and will announce them on our website, www.quitlikesweden.org, as they get confirmed.

Q: What is the one piece of information that you think every Health Minister should know?

The most important thing every Health Minister should know is that harm reduction saves lives. Sweden’s experience shows that by providing accessible, acceptable, and affordable alternatives to smoking, we can significantly reduce smoking-related diseases and deaths.

It’s not about supporting nicotine use, but about offering practical solutions to reduce the harms caused by smoking. Public health should focus on what works, and harm reduction is a proven path to achieving smoke-free societies.