The freedom to choose cancer

Danes are the biggest smokers in the Nordics, which contributes to the nation's high cancer rates and comparatively low life expectancy. But effective policies, such as increasing the cost of tobacco, remain politically poisonous

“Danish culture has always revolved around the feeling that nobody should tell us what to do or how to live our lives. If it weren’t for this, we wouldn’t be drinking and smoking as much as we do.”

This is Betina Jacobsen’s explanation for why Danes drink and smoke as much as they do. She is an associate professor in the Department of Sociology at Aalborg University and has spent years researching the trends and effectiveness of anti-smoking campaigns in Denmark.

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She points out that the number of daily smokers in Denmark has dropped to 17 percent of the population, down from a high in the 1950s when 80 percent of men and 50 percent of women smoked cigarettes on a daily basis. But Danes still smoke much more than their Nordic neighbours – only 9.4 percent of Swedes and 14.2 percent of Norwegians smoke every day, according to the Nordic Monitoring System.

Smoking, poor diet, and high alcohol use all contribute to Denmark’s high cancer rates – the highest in the world, according to the World Caner Research Fund International. One in three Danes will suffer from cancer at some point in their life, which is among the reasons that Danes have the shortest life expectancy in Western Europe.

World’s highest cancer rates
Lifestyle choices are the main drivers of high cancer rates in Denmark, and numbers suggest that half of all cases are currently preventable. While Norway and Sweden have implemented punitive taxes and other restrictions to limit tobacco and alcohol use, Denmark has maintained a permissive approach.

“There is one big problem I often encountered in my research – Danes reject restrictions in the name of freedom. In Denmark, we obsess over feeling free from government control. While Danes like having freedom from control, Swedes believe they have freedom to enjoy good health and a long life,” Jacobsen continued.

Gerda Engholm works as a senior statistician at the Danish Cancer Society (Kræftens Bekæmpelse), which maintains a database of cancer incidence and mortality rates across Scandinavia, NORDCAN. These statistics show that not only are Danes more likely to contract cancer, the survival rate is also lower than in neighbouring countries.

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“In some cases, it is harder to understand what causes cancer. However, when trying to avoid an increase in cancer incidence, you have to look at the biggest risk factors, and tobacco is the most important one,” Engholm observed.

Lung cancer is one of the most prevalent forms of cancer among both men and women, with over 90 percent of cases resulting from smoking. Around 4,500 new cases of lung cancer are registered in Denmark every year, accounting for 12 percent of all cancers. Mortality is high, with a survival rate of only 17 percent of women and 12 percent of men five years after diagnosis.

Research conducted by the University of Southern Denmark found that lung cancer is also the most expensive to treat, accounting for 15 percent of the state’s yearly spending on health services.

Marie Kruse works as an analyst for the Centre of Health Economics Research (COHERE) at the University of Southern Denmark, and has researched the economics of cancer in Denmark.

“All Scandinavian health systems are financed in a way that makes it difficult to estimate the costs of a certain disease. However, as mortality from lung cancer is extremely high, almost all patients end up in the very costly category ‘most severe’,” Kruse explains.

One-hundred kroner packs?
Countries around the world have decided to increase taxes on tobacco products in order to reduce tobacco consumption and ease the strain on public finances from treating tobacco-related illnesses. New York City Mayor Bill de Blasio recently set the minimum price of a pack of cigarettes at USD 13 (DKK 86), while in Australia a pack will cost ASD 40 (DKK 200) by 2020.

In Denmark, tobacco remains relatively cheap – a pack costs around DKK 45 – which makes smoking a habit affordable to children. In May, the Danish Health Authority (Sundhedsstyrelsen) reported that just over 50,000 Danish teenagers aged 11 to 17 smoke every week, and that 9.3 percent of them will end up dying from smoking.

Sophie Løhde – who was health minister until the formation of the coalition government late last year – did try to implement new policies to reduce the number of deaths from smoking, which is currently around 13,600 a year. She had an ambition to create the first smoke-free generation by 2030, and proposed banning smoking in vocational and upper secondary educational institutions.

She ran into opposition in Parliament, however, with both the Liberal Alliance and the Danish People’s Party opposing new restrictions on smokers.

Restricting where people can smoke can make it less attractive, but increasing the cost is ultimately the best strategy. A poll by MEGAFON for TV2 and Politiken last year found that 12 percent of smokers would stop smoking if a pack of cigarettes were made 10 kroner more expensive, while 20 percent said they would smoke less.

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But Betina Jacobsen stresses that this policy is too unpopular to be politically viable.

“In Denmark, we have a problem with path dependency, meaning that we like to stick to what we are used to – and 100-kroner cigarette packs would be too much of a risk.”

Jes Søgaard, Head of the Documentation and Quality department of Kræftens Bekæmpelse, argues that while cancer rates have stagnated in the last few years, the numbers are still too high to be ignored.

“We have not worked on any policy related to tax increases on tobacco or alcohol, but we wouldn’t oppose them, either. The big problem with taxation is that it ends up hitting the lower-income classes, so we would rather find other alternatives to help people quit smoking or reduce their alcohol intake,” he explains. M


By Gabriele Dellisanti

Editorial intern. Media and communications student at Lund University.

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