Finn Edler von Eyben

Public health in Denmark received an early Christmas present on 18 December 2019, when most political parties agreed on a new tobacco control plan for the country.  The plan contains a raft of new measures, including plain packaging of tobacco products, a ban on point of sale advertising, strengthened smoke-free public places including schools and other educational institutions, total ban on smoking by pupils during school hours, and enforced ban on sales of tobacco to persons under the age of 18. The plan will be implemented as a new tobacco act in 2020.

The new tobacco control plan followed the passing of the 2020 budget act earlier in December. It included two tax increases in the next twelve months. On 1 April 2020, the price for a pack of twenty cigarettes will rise from 41 to 55 Danish kroner (DKK), and to 60 DKK on 1 January 2021.  The overall increase is equal to a rise from approximately 6 to 9 US dollars. Danish authorities estimate the tobacco tax increase and the coming tobacco act will reduce smoking prevalence among young people (aged 25 and below) from 31% in 2018 to 15% in 2030.

While these measures are welcome, they are still modest from an international perspective. The projected Danish youth smoking prevalence in 2030 is still five times higher than current youth smoking prevalence in neighboring Norway. Similarly, the tobacco tax increases are relatively limited compared to those of other high-income countries such as Norway, Iceland, Ireland, the UK, and Australia. These countries adhere to the highest possible prices on tobacco products. In 2020 in these countries, a pack of twenty cigarettes costs the equivalent of 12 US dollars or more.

Such prices have caused a large drop in smoking prevalence, especially among young people. Other countries such as Saudi Arabia, India, Turkmenistan, Malaysia, and Ecuador also have prices above 10 US dollars for a pack of twenty cigarettes.

Nonetheless after two turbulent decades in Denmark, the new measures start a new era for tobacco control in the country. In 1998, concerned about a stagnant Danish median life expectancy compared to those of other European countries, the Danish ministry of health made a public health program for the coming decade. At the time, 13 600 Danes died each year of smoking-related causes, representing a quarter of all Danish deaths. The public health program aimed to keep the price of tobacco products in Denmark as high as possible and aimed to reduce smoking prevalence by 1% per year.

In 2001, Denmark got a new government that weakened the public health program goals, with the intended aim only to achieve a ‘marked’ reduction in smoking prevalence. In 2004, the government even reduced taxes on tobacco products. Despite this, until 2014 Danish smoking prevalence continued to fall in line with the earlier public health program. However, consumption increased gradually from 5.6 billion cigarettes in 2014 to 6.1 billion cigarettes in 2017. Annual surveys in Denmark showed a slight rise in smoking prevalence from 21.1% in 2016 to 23.1% in 2017.

During the years from 2015 to 2019, the government announced the ‘most ambitious goal for smoking in Denmark’, to achieve smoke-free youth by 2030. Despite the increase in smoking in Denmark after 2014, the government did not pass new legislation for improved tobacco control. One political party in the government, Liberal Alliance, in general opposes increased taxation. So up to the Danish election in June 2019, a central issue in mass media was whether politicians if elected would increase taxation on tobacco products.

The 2019 Danish election gave a new government of Social Democrats led by prime minister Mette Frederiksen. The Liberal Alliance lost half of its representation in the parliament. Later, the  parties supporting the new government and two parties of the opposition, Venstre and the conservatives, supported higher taxation of tobacco products and the new tobacco control plan.

For Denmark, currently the economic balance for tobacco is negative. While revenue to the state is approximately one billion US dollars per year, the health costs from smoking-related disorders are approximately two billion US dollars per year. Another estimate including both direct and indirect costs is over seven billion US dollars (50 730 million kroner). It is not surprising in the June 2019 election that many Danes voted for higher taxation to reduce the economic gap. The new Danish measures for 2020 and 2021 should stimulate a healthier country, following the role model country Norway.

Dr Finn Edler von Eyben is a specialist in oncology and internal medicine, and the chief of the Center for Tobacco Control Research, Odense, Denmark