On 4 November 2020, the UK-based public health organization Knowledge Action Change, which aims to promote health through the concept of harm reduction, issued an expert report entitled: Burning Issues: The Global State of Tobacco Harm Reduction. The organization simultaneously hosted two discussion sessions on the state of reducing tobacco harm in the world.
The first session dealt with ‘The Context and Importance of Reducing Tobacco Damage for Global Health’ and the second ‘The Current Challenges of Reducing Tobacco Damage’.
From these discussions, it appears that reducing tobacco damage is a very sensitive topic. Several studies over the years have shown that innovative smokeless tobacco products may cause less harm than traditional cigarettes. However, many voices are against these supposedly safer products (at the forefront of the World Health Organization) because they are particularly harmful and dangerous, especially to youth.
For experts who advocate for the reduction of tobacco harm, it is a critical issue on public health, and most importantly, to meet consumers where they view their addiction and offer them the best option to live longer and prevent suffering. . Most experts have noticed over the years that quitting smoking, although it remains the best option, can be an unattainable goal for many smokers. As a result, interim solutions have emerged such as e-cigarettes, heated tobacco, pasteurized tobacco. It is noteworthy that some independent scientific studies, such as those recently led by Public Health England, show that e-cigarettes are ‘95% less harmful than cigarettes’.
What are the challenges in low- and middle-income countries?
In low- and middle-income countries (LMICs), regulations, policies and information on reducing tobacco harm (THR) are particularly restrictive. Dr Mwawi Ng’oma is the program manager of St John of God College of Health Sciences. She is a professional nurse specializing in mental health in Malawi. She said that for her there is no doubt that current policies and regulations are counterproductive and lead to more confusion and misinformation: ‘Government policies and regulations are unduly influenced by flawed science and lobbying against harm reduction. Lack of public health information in many countries is also confusing and misleading for people who want to quit smoking but are not aware of the options available “.
She added: ‘Many LMICs do not have enough resources to implement and adopt tobacco harm reduction measures. The situation is further complicated in countries where the economy is dependent on income from cultivation, such as Malaw) ”.
Samrat Chowdhery is President of the International Network of Nicotine Consumer Organizations, and Director of the Association of Vapers, India. Mt Chowdhery believes that reducing harm is the best option to significantly reduce tobacco-related deaths and illnesses: “As more than 80% of tobacco users are in low- and middle-income countries, they have scarce resources to to deal with tobacco-related consequences, the focus should be steadfastly focused on maximizing harm reduction, allowing people to exercise the choice to avoid death and disease by switching to affordable and accessible risk reduction alternatives if they not willing or able to quit. ”
Clive Bates is now director of Counterfactual, an advisory and advocacy practice focused on a pragmatic approach to sustainability and public health. He is well known in the area for reducing harm as a former Director of Smoking and Health (UK) (who strives to reduce the harm caused by tobacco). According to Bates, this pragmatic approach should be the rule for tobacco because it is the most effective despite a restrictive context: ‘Good is more or less how we want the world to be. That requires a few things. First, it requires a change of understanding in the public health community and in the world of how harm reduction works. It’s not about offering smoking cessation products. This is a reliable, valuable proposal for healthier alternatives … We need to pay much more attention to the perverse consequences of blundering in clumsy excessive regulation that renders a bad service to the public.
He then stressed the importance of communication: ‘We need a new story about THR in public. The relentless negativity must stop. People need to start seeing where the benefits are. We must stop the tirade of false and misleading misconceptions of science. Third, we must move to a risk-proportional regulatory regime. This means that you have to be very hard on the most harmful products, and that you have to be more liberal and open-minded to encourage consumers to switch to the less harmful products. “
According to the WHO, smoking kills 8 million people annually and is the leading cause of preventable death.