Smoking rates have fallen across many high-income countries over the past several decades, but the pace of that decline varies considerably. South Korea and Sweden provide a useful comparison.
Both countries have strong public-health institutions and long-standing tobacco-control policies. Both have reduced smoking substantially from historical levels. Their current positions, however, are quite different. OECD data put daily smoking in South Korea at 15.3%, while Sweden has reached one of the lowest smoking rates in Europe. The Tale of Two Nations report from Smoke Free Sweden argues that differences in the treatment of smoke-free nicotine products help explain this divergence.
The comparison deserves attention, but also some caution. Smoking prevalence is shaped by many factors, including culture, income, cessation support, taxation, social norms and the history of tobacco use. Comparing two countries cannot establish that one regulatory policy caused a particular health outcome.
For GINN, the value of the comparison lies elsewhere. It raises a wider question about what modern nicotine regulation is ultimately trying to achieve. If reducing smoking-related disease and premature mortality is the objective, regulatory frameworks should recognise meaningful differences between combustible and smoke-free products where the evidence supports doing so.
Two Countries, Different Trajectories
South Korea has made genuine progress on smoking. According to the report, daily smoking fell from 22.9% in 2010 to 15.3% in 2023. That represents a substantial public-health achievement. Yet the decline has slowed, and smoking remains particularly high among Korean men.
Sweden has travelled further. The report cites daily smoking prevalence of 5.3% in 2024 and describes a sustained decline alongside increased use of smokeless tobacco and nicotine products. The chart on page three places these trends side by side, showing smoking falling while use of smokeless products rises.
That pattern is consistent with substitution, but it does not prove that increased use of smoke-free products caused Sweden’s decline in smoking. Sweden’s experience also reflects decades of tobacco control, changing social attitudes and a long cultural history of snus use. These factors matter when drawing lessons for other countries.
Still, Sweden has increasingly made differences in product risk explicit in policy. Its tobacco-policy objective has shifted towards reducing the medical and social harms caused by tobacco and nicotine products, reflecting greater recognition that different products can present different levels of harm.
GINN sees this as an important principle. Regulation should remain capable of distinguishing between products when credible scientific evidence justifies doing so.
South Korea’s Regulatory Framework Is Changing
The Tale of Two Nations report describes South Korea as applying a largely uniform approach to combustible and smoke-free nicotine products and argues that this limits the potential role of harm reduction. It draws particular attention to restrictions affecting nicotine pouches and to taxation that can result in a substantial fiscal burden on smoke-free alternatives.
South Korea’s regulatory environment is also evolving. Changes to its tobacco legislation have expanded the scope of products captured by tobacco regulation, addressing gaps created by newer nicotine products.
Bringing these products within regulatory oversight can strengthen consumer protection. It allows governments to establish requirements covering areas such as manufacturing, labelling, marketing and sales.
Yet classification does not answer every regulatory question.
A cigarette, nicotine pouch and vaping product may all deliver nicotine, but their toxicological profiles are different. Placing them within the same legal framework therefore does not necessarily mean that every regulatory requirement should be identical.
For GINN, this distinction is central to risk-proportionate regulation. Strong oversight and product differentiation can coexist.
The Difference Between Nicotine and Smoking Matters
Much of the preventable disease associated with cigarette smoking arises from inhaling the toxic products generated when tobacco burns.
That distinction is fundamental to tobacco harm reduction. Removing combustion can substantially alter exposure to harmful constituents, although the degree of risk reduction differs between products and the long-term evidence is more developed for some categories than others.
This does not make smoke-free nicotine products harmless. Nicotine is addictive, and emerging products require continued research and surveillance.
Context also matters.
For an adult who would otherwise continue smoking, completely switching to a substantially lower-risk nicotine product may reduce exposure to many of the toxicants associated with combustion. For a young person or someone who does not currently use nicotine, avoiding initiation remains the appropriate public-health objective.
A proportionate framework has to accommodate both realities.
For GINN, acknowledging relative risk should therefore never be confused with dismissing risk. The purpose is to regulate according to the evidence while keeping smoking-related harm firmly in view.
Taxation Can Influence Consumer Choices
The South Korea-Sweden comparison becomes particularly interesting when taxation is considered.
Excise policy raises revenue, but it can also affect the relative prices consumers face. If a smoke-free alternative carries a tax burden that makes it considerably more expensive than cigarettes, adults who smoke may have less financial incentive to switch.
The report argues that South Korea’s weight-based taxation of nicotine pouches can result in a higher tax burden than that imposed on cigarettes.
This deserves careful policy consideration.
GINN supports regulatory and fiscal frameworks that are proportionate to risk. That does not mean smoke-free nicotine products should escape taxation or regulatory oversight. Governments should instead consider whether their policies create appropriate incentives for adults who smoke to move away from combustion while maintaining strong safeguards against youth uptake and initiation among people who do not currently use nicotine.
The precise tax differential is ultimately a decision for individual governments. It should reflect local evidence, market conditions and public-health priorities.
The underlying principle is broader: taxation should support the objectives of health policy rather than unintentionally work against them.
Risk Proportionality Still Requires Strong Regulation
A risk-proportionate approach should not mean a lightly regulated nicotine market.
Smoke-free products require credible standards covering manufacturing quality, ingredients, nicotine content, labelling and packaging. Marketing rules should protect young people and avoid communication likely to encourage uptake among non-users. Retailers need effective age-verification requirements, while regulators need sufficient enforcement powers and resources.
Surveillance is equally important.
If governments permit smoke-free alternatives for adults who smoke, they should examine what happens after those products enter the market. Are smokers switching completely? Is prolonged dual use occurring? Are youth-use patterns changing? Are products meeting required standards? Is new health evidence emerging?
Regulation should respond to those findings.
For GINN, this is what risk proportionality should look like in practice: differentiation supported by standards, surveillance and enforcement, with policies adjusted when real-world evidence justifies change.
Sweden Is Evidence to Examine, Not a Template to Copy
There is a tendency in nicotine-policy debates to present individual countries as proof that one regulatory philosophy has succeeded and another has failed.
That can oversimplify the evidence.
Sweden’s very low smoking prevalence deserves serious examination. Its long history of smokeless tobacco use, changing nicotine market and increasing recognition of differences between combustible and smoke-free products make it particularly relevant to harm-reduction discussions.
But Sweden cannot simply be transplanted to South Korea.
South Korea has different patterns of tobacco use, different social norms and different regulatory institutions. Its substantial gender disparity in smoking prevalence also suggests that national averages can conceal important differences between population groups.
For GINN, the lesson from this comparison is therefore not that South Korea should copy Sweden. Regulatory frameworks need to reflect national circumstances, consumer behaviour and local public-health priorities.
The more useful question is whether reducing smoking-related harm should remain the central measure of success, followed by a careful examination of how taxation, regulation, cessation support and access to alternatives contribute to that objective.
What Should Success Look Like?
One of the most important questions raised by the Tale of Two Nations report concerns how governments measure progress.
Counting nicotine users and counting smokers do not necessarily measure the same public-health outcome. Equally, falling smoking prevalence does not establish that every alternative nicotine product will produce a net population benefit.
Governments need to look at a broader evidence base.
Smoking prevalence remains crucial because combustible cigarettes continue to carry a very high burden of preventable disease. Policymakers should also examine complete switching, cessation, youth initiation, dual use, illicit markets, regulatory compliance and emerging health evidence.
Together, these measures provide a more meaningful picture of whether nicotine policy is delivering better public-health outcomes.
South Korea’s decline in smoking demonstrates that conventional tobacco-control policies have achieved significant progress. The question is how that progress can be accelerated.
For GINN, South Korea’s evolving regulatory framework creates an opportunity to examine whether strong product standards, proportionate taxation, accurate risk communication, cessation support and robust youth protections can work within the same system.
Sweden does not settle that debate. It provides evidence worth examining.
As nicotine markets evolve, good regulation will increasingly depend on distinguishing between the harms governments seek to reduce and the products through which those harms arise. If reducing smoking-related disease is the goal, combustion should remain central to that assessment.
GINN’s position is that nicotine policy should follow the evidence as it develops, recognise meaningful differences between products where those differences are scientifically supported, and remain open to adjustment when real-world outcomes show that policy could work better.
That is the purpose of risk-proportionate regulation: strong public-health protection guided by evidence, measured against outcomes, and capable of evolving when the evidence changes.
Source
https://tobaccoharmreduction.net/wp-content/uploads/2026/02/SFS-2N-SOUTH-KOREA-v-Sweden_final.pdf
