The 5th Tobacco Harm Reduction Summit was held in Athens, Greece, and online on September 21st and 22nd 2022. On the second day of the conference, a panel addressing “Smoking disparities within low smoking prevalence countries” took place.
Prof. Solomon Tshimong Rataemane is the head of Department of Psychiatry at the University of Limpopo in Pretoria, South Africa. For him, the policies on tobacco cessation don’t take into consideration the realities of the socio-economic dynamics around tobacco. To underpin his assertion, he referred to GATS (Global Adult Tobacco Survey), a component of the Global Tobacco Surveillance System (GTSS aims to enhance country capacity to design, implement, and evaluate tobacco control interventions, and monitor key articles of the World Health Organization’s (WHO) Framework Convention on Tobacco Control).
The GATS was carried out for the first time in South Africa in 2021. It provides a global standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators in a survey on behalf of and supported by the National Department of Health. Those measures include “monitor tobacco use, and prevention policies, protect people from tobacco smoke, offer help to quit tobacco use, warn about dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, raise taxes on tobacco”. But for Dr Rataemane, these measures are not adapted to the specificities of tobacco and addiction:
“In my capacity as a psychiatrist and also trained neuro-psychiatrist I really was concerned about the drug master plan that for the past 15 years, focused on alcohol and hard drugs. Only in the past 5 to 8 years did they bring in tobacco. However, the concept of harm reduction has been an issue as some people took the stance that people who smoke cigarettes should not be assisted to continue the habit that they developed and that they now can’t control.”
The WHO is one of the fiercest opponents to tobacco novel products (new smokeless tobacco devices) that are designed to reduce harm. It is unfortunate that for the organization, these products are not part of a public health strategy that is about minimizing the negative health impact of smoking.
For Greek researcher Konstantinos Farsalinos, who has led laboratory, clinical and epidemiological research on smoking, there is a great misunderstanding of smokers, how they see their habit, and lifestyle:
“What do people want? Why do they smoke? Why don’t they go to a smoking cessation center if the cost of medication is fully subsidized by the state, they pay nothing and still they don’t want to go. Some don’t think smoking is a disease they think of smoking as bad lifestyle habit, a bad choice that they’ve made in their lives and that they need to change their lifestyles. But we, not only the healthcare community but also the policy makers, are trying to treat smoking as a disease and you know how much burden this creates in providing alternative solutions to the smokers. For example, you can’t have any products claiming to promote smoking cessation. It must first be approved as a medication. So even if an organisation wants to sell a product that helps people to quit smoking, they can’t use that claim as it is illegal”.
He then insisted: that these key questions of “Why people keep on smoking? Why they cannot quit? Why don’t they want to get medication? Why they don’t think that smoking is a disease?need to be addressed. If we don’t answer these questions, we will never be able to make policy decisions that are going to be in the best interests of the people.”
Most of African governments use prohibition as a means to fight against tobacco related diseases. In the new GSTHR (Global State of Tobacco Harm Reduction) publication issued this September 2022, social scientist and Tobacco Harm Reduction advocate from Malawi Chimwemwe Ngoma said that those countries should take advantage of “the fact that smokeless tobacco has been used in the continent for centuries”.
Adding that “the opportunities to reduce the burden of non-communicable disease, suffering and premature deaths presented by Tobacco Harm Reduction are huge. Appropriate, accessible and affordable safer nicotine products (SNP), supported by product regulation, could help create a smoke-free Africa and, unlike most tobacco control interventions, this can be achieved at minimal cost to governments.” The briefing also reports that there are already 200,000 smoking-related deaths per year in Sub-Saharan Africa.
The WHO projects the total number of tobacco users in Africa will increase to 62 million, of whom 51 million will be smoking combustible tobacco by 2025.