The health risks of smoking have not been widely questioned in medicine since the 1950īs. 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 medical and individual problem. Nowadays smoking is primarily a public health, social, and political issue.

In the 1960īs 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 passed unanimously the Parliament in 1976. However, the comprehensive Act was very progressive at the time. It included among other things, advertising ban, prohibition of sales of tobacco products to persons under 16 years, and smoke free public premises and smoking prohibition on most public transport.

Not until 19 years later it was clear that there was a need to prevent exposure to tobacco smoke at work. Further, there was a need to recast some existing legislative provisions in which there had been difficulties in interpretation and implementation. In 1995 smoking was 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 the Parliament in early 1999. They require restaurants to gradually increase the smoke free area until in the year 2001 half of the restaurant seats are smoke free. Smoking areas must be ventilated so that tobacco smoke will not spread to the smoke free area.

Further, environmental tobacco smoke (ETS) is included into the national list of carcinogenic substances. According to occupational safety and health legislation ETS must primarily be removed from all work premises. If that is not possible employee must be protected from exposure to ETS.

Overall, the Finnish experience is an example of a long but rewarding process which has adapted the results of scientific research to practical measures. Among the key elements in the successful tobacco policy is the traditional collaboration between the health authorities and non-governmental organisations, and intensive health promotion.

Mainly due to lively public discussion, the atmosphere is positive and supports public actions to reduce smoking. Juridical actions against the tobacco companies have revealed the tactics of the tobacco industry to recruit smokers. The media has uncovered many of the questionable activities of the tobacco industry.

National registers give invaluable information for the monitoring of smoking related diseases. Systematic evaluation of exposure is facilitated by the tobacco consumption data from Statistics Finland and annual surveys of smoking patterns in the population.

The consumption of tobacco products began to decrease in the 1970īs, and has been decreasing ever since. The rapid decrease in consumption recorded in the 1990īs 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 1970īs and has then been dramatically decreasing. In women the incidence, still at a low level, has doubled since the 1960īs and is likely to increase, 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. 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 1970īs but returned to a relatively high level in the 1980īs. The most obvious reason for this situation may be the looser social control and family coherence than, for example, in southern Europe.

Coronary disease mortality was at its highest level in Finland in the early 1970īs 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.

The Finnish experience emphasises 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.

Helsinki, Finland, 2000

Reduction of Smoking in Finland (in Powerpoint format)