EVERY sector speaks the language of best practices. In business, the focus is on efficiency and competitiveness, in education, on quality and innovation, in public health, on saving lives and reducing long-term costs.
Yet, even when the evidence is clear, proven solutions can take years to gain traction.
The obstacle is seldom a lack of data. More often, it is the discomfort that comes with change: new approaches require long-held assumptions to be revisited and established models to be updated.
This is where global tobacco control finds itself today. A growing body of scientific research shows that in cigarettes, it is not nicotine but the burning of tobacco that drives most smoking-related diseases such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease.
Despite this, policy in many jurisdictions still treats all tobacco and nicotine products as if they pose the same level of risk. A number of countries, however, have begun to move away from this one-size-fits-all approach, and their results suggest that a more differentiated, evidence-based strategy can deliver better outcomes.
Sweden’s smoke-free success story
Take Sweden, for example, is a country said to have become Europe’s first smoke-free nation, defined as having fewer than 5% of adults who smoke.
Unlike many nations that rely on bans or penalties, Sweden has taken a pragmatic and science-based approach, giving adult smokers access to smoke-free alternatives such as snus and nicotine pouches.
These products deliver nicotine without burning, significantly reducing exposure to the harmful chemicals found in cigarette smoke.
This strategy has paid off. Public health data show that as low as 4.5% among Swedish-born citizens smoke, far below the European average of 24%, where one in four people still smoke daily or occasionally.
From 2014 to 2023 alone, Sweden’s smoking rate dropped by 27%, compared with only 11% across the EU.
A key reason for this success is the widespread switch among Swedish men from cigarettes to snus, a smoke-free oral tobacco product placed between the lip and gums, with newer nicotine pouches further accelerating the decline.
By focusing on harm reduction and eliminating smoke and combustion rather than nicotine, Sweden has achieved one of the lowest rates of tobacco-related illness and death in Europe.
Japan, living in a smokeless future
Then there’s Japan, where innovation has quietly reshaped tobacco control. When heated tobacco products were introduced by Philip Morris International (PMI) just over a decade ago, many questioned whether they would make a real difference.
Fast forward to today, the results speak for themselves. Japan has seen one of the sharpest declines in cigarette sales in its history, outpacing nations where smoke-free alternatives remain tightly restricted or available only by prescription.
PMI reported that between 2014 and 2022, the share of adults who smoked dropped from 19.6% to 10.6%, which is a remarkable 46% decline in just eight years.
The turnaround began with the 2014 introduction of heated tobacco in two cities, followed by a national rollout in 2015.
Before that, cigarette sales had been declining at just 1.8% annually from 2011 to 2015, despite conventional tobacco control measures.
Heated tobacco products work by heating rather than burning tobacco, drastically reducing the release of harmful chemicals.
In short, Japan’s experience shows that innovation, not prohibition, can drive real change.
By offering adult smokers a less harmful alternative to cigarettes, Japan created a compelling reason for millions to switch. Thus, accelerating the decline in smoking faster than traditional cessation efforts ever could.
Closer to home, Malaysia's smoking rate still stands at 19%, far from the long-term smoke-free goal of under 5% by 2045. Beyond its impact on individuals and families, high smoking prevalence costs the Malaysian economy a staggering RM6.2bil in direct costs of treating its related diseases annually.
Reducing the prevalence of smoking in Malaysia will depend not only on effective tobacco control, but also on whether the country is open to harm reduction strategies like those seen in Sweden and Japan.
Science makes one thing clear – it is the burning of tobacco, not the nicotine that causes most smoking-related harm. These forward-thinking nations show that progress is possible when adult smokers are given access to better, science-backed alternatives alongside traditional measures such as taxation, smoking bans, youth-access restrictions, and education.
If the goal is to save more lives and reduce the healthcare cost burden, perhaps Malaysia must look at what works – replacing cigarettes with less harmful options that can accelerate the decline of smoking and its devastating impact.
