The emerging case of tobacco harm reduction as an effective public health strategy

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Cigarette smoking has been one of the top concerns of public health authorities around the worldfor the longest time. While different tobacco control efforts have helped deter smoking to a certain extent, the fact that there are still one billion people who continue to smoke is concerning.

To address this alarmingly high number of smokers who continue to smoke, the concept of Tobacco Harm Reduction (THR) is fast gaining popularity as an effective, scientifically-substantiated public health strategy to bring down the rate of cigarette use and reduce the harm to a smokers’ health caused by the burning of tobacco.

It is a branch of a broader concept of harm reduction which is a well-established and accepted public health approach comprising of interventions designed to lessen harmful consequences of problematic behaviours where abstinence is not immediately achievable.

Similarly, the premise of THR is based on the understanding that while absolute cessation is the best possible option and should be the first target of people who smoke, it may not always be a viable option for every smoker and there may be many who would continue to smoke.

Thus, taking a pragmatic and rational approach, THR focuses on mobilizing programs and tools that may help these adult smokers reduce the harm to their health.

Nicotine pouches, nicotine gums, snuff, e-cigarettes, and heated tobacco products are some alternatives that are used under this approach.

When you light a cigarette, tobacco is burned which produces smoke that contains harmful chemicals. Majority of these chemicals are found to be the cause of smoking-related diseases. On the other hand, these alternatives do not involve the burning of tobacco which eliminates the release of toxic smoke.

These products only deliver nicotine which, while not risk-free, is not the main culprit behind most smoking-related harm. As a result, smoke-free alternatives inflict significantly lower levels of harm to the users as compared to the harm caused by cigarettes.

Talking about how harm reduction works as a public health approach, David J Sweanor, Faculty of Law and Centre for Health Law, Policy and Ethics, University of Ottawa, Canada, said in a recent interview that global health has seen a drastic improvement in the last century that has come through by the use of science, reason, and humanism – the same attributes that form the concept of harm reduction.

He said that where we find harm, we work pragmatically to reduce them. We seek to understand the life experience of those at risk, empower them to make better health decisions, and engage with them.

Speaking on THR, he added that it presents a huge public health opportunity in terms of effective tobacco control as science has invented a number of less harmful, smoke-free alternatives that can help smokers immediately cut down risks to their health.

Many countries are already benefiting from THR in their tobacco control goals. UK is currently considered a leader in efficiently implementing THR in its anti-tobacco efforts and yielding commendable results through it.

The health agencies in the country have issued evidence-based guidance on THR, supporting the use of smoke-free alternatives to help smokers not currently able to quit to switch to a less harmful option.

According to a recent report issued by the Office of National Statistics, UK, smoking rates in Britain dropped by 1.3%, from 15.8% in 2019 to 14.5% in 2020 – attributed significantly to the use of alternatives.

Currently, UK’s National Health Service (NHS) is also considering adding e-cigarettes to its prescriptions to combat smoking.New Zealand has also been successful in bringing down the smoking prevalence from 18.2% in 2011 to 13.4% in 2019 through the incorporation of different harm reduction strategies.

Such reports from different countries and scientific findings suggesting the effectiveness of THR in bringing down the smoking rate and reducing harm to smokers’ health are coming in almost every day. It is time that all concerned policy makers and regulators probe this opportunity for the wellbeing of the entire global health.

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