Reduction of smoking in Finland
Cigarette consumption in Finland was the highest in the world in the 1920ґs, and much higher than in the other Nordic countries until the late 1930ґs. In the 1950ґs 76% of men and 13% of women smoked, whereas in 1998 proportion of daily smokers was 30% among men and 20% among women. The current figures are among the lowest in Europe.
The health risks of smoking have not been widely questioned in medicine since the 1950ґs. The past 30 years have been a period of transition from implicit smoking policies, mainly determined by commercial and fiscal interest, to explicit health-oriented policies. Earlier smoking was considered a medical and individual problem. Nowadays it is primarily a public health problem, but also a social and political issue.
Legislative actions
In the 1960ґs the Finnish Parliament requested the Government to take immediate, strong and systematic (legislative) measures to reduce smoking. Committees, commissions, and working groups followed one another. It took 15 years before the Act on Measures for the Restriction of Tobacco-smoking was passed unanimously in the Parliament in 1976. However, the comprehensive Act was very progressive at the time. The main goal was to protect the vast majority of the people of the health risks of tobacco smoke. The Act included among other things, advertising ban, prohibition of sales of tobacco products to any person under the age of 16 years, and smoke-free public premises and smoking prohibition on most public transport.
It was not until 19 years later in 1995, when legislative measures specified certain provisions in which there had been difficulties in interpretation and implementation. It was also clear that there was a need to prevent exposure to tobacco smoke at work. Smoking was prohibited or restricted by law in such a way that no employee is exposed to tobacco smoke against his or her will. Additionally, the age limit of selling tobacco products was raised to 18 years, and also indirect tobacco advertising and sponsoring were prohibited.
Since the Act of 1995 excluded restaurants, the Finnish Parliament requested the Government to prepare a law of smoke-free areas in restaurants. These provisions, passed by the Parliament in early 1999, require restaurants to gradually increase the smoke-free area until in 2001 half of the restaurant seats should be reserved to non-smokers. Smoking areas must be ventilated so that tobacco smoke will not spread to the smoke-free area.
Further, the Finnish Parliament required that tobacco smoke should be included into the national list of carcinogenic substances.
Health initiatives
Overall, the Finnish experience is an example of a long but rewarding process from the results of scientific research to comprehensive action and public health policy. Some of the key elements in the successful smoking reduction policy have been the traditional collaboration between the health authorities and non-governmental organisations, and intensive health promotion.
Juridical actions against the tobacco companies have revealed the tactics of the tobacco industry to recruit smokers. The side product of litigation has been a major change in the public opinion. Mainly due to lively public discussion, the atmosphere is presently positive and supportive for public actions to reduce smoking. The media has uncovered many of the questionable activities of the tobacco industry.
National monitoring systems
National registers give invaluable information for the monitoring of smoking related diseases. The tobacco consumption data from Statistics Finland and annual surveys of smoking patterns in the population form an integral part of systematic evaluation of exposure.
The consumption of tobacco products began to decrease in the 1970ґs, and has been decreasing ever since. The rapid decrease in consumption recorded in the 1990ґs may reflect public health concerns about exposure to environmental tobacco smoke. The economic recession may have some explanatory value as well. Today cigarettes are responsible for about 5000 annual deaths in Finland.
The proportion of daily smokers among Finnish men has been continuously decreasing. This development is clearly mirrored in the lung cancer incidence. The incidence in males peaked in the 1970ґs and has then been dramatically decreasing. In women the incidence has doubled since the 1960ґs and is likely to increase still, unless the younger age groups reduce their smoking. Throughout the monitoring period over 80% of adult smokers indicated that they had seriously tried to stop smoking at least once.
Although adults in Finland smoke less than in many other countries, young people tend to begin smoking earlier than in most European countries. The proportion of daily smokers 14, 16 and 18 years of age clearly decreased during the 1970ґs but returned to a relatively high level in the 1980ґs. The most obvious reason for this situation may be that the social control and family coherence is tighter, for example, in southern Europe than in the Nordic countries.
Coronary disease mortality was at its highest level in Finland in the early 1970ґs and has since more than halved in people 35-64 years of age, but mostly in men. Diminished smoking has been one of the factors affecting this development.
Past, present, future
We started with information campaigns, developed public health programs, and later introduced protective legislation. Our next challenge is to reduce and prevent smoking among young people. This has been accepted by both the health authorities and the non-governmental organisations. We need to initiate interactive processes promoting knowledge about and action for non-smoking at all levels.
The Finnish experience emphasizes the need for continuity in the progress of preventive health policy. With this insight we want to contribute actively to positive development as well in the European Community and World Health Organisation as in any other international health oriented initiatives.