Tobacco Harm Reduction: A Pathway to Achieving Public Health Goals
Writer / Sherif Samir
According to a report by the World Health Organization (WHO) and the National Cancer Institute of the United States, tobacco control policies play a crucial role in protecting public health from leading causes of death, including cancers and heart disease. Failure to address tobacco use can result in substantial economic burdens, costing over USD 1 trillion annually in healthcare expenditures and lost productivity. While the report recommends supply and demand reduction policies, it overlooks the potential of innovative alternatives to cigarettes in reducing healthcare costs. This article explores the growing movement towards tobacco harm reduction and its potential to revolutionize public health strategies worldwide.
Former WHO staff members Robert Beaglehole and Ruth Bonita recently criticized the organization’s stance on harm reduction in an article published in The Lancet. They argued that the WHO and the Framework Convention on Tobacco Control (FCTC) Conference of Parties reject harm reduction, despite the significant advancements in technology and evidence supporting it. Beaglehole and Bonita claimed that vested interests promoting nicotine abstinence excessively influence the opposition to harm reduction, favoring the continued use of cigarettes, the most harmful tobacco products.
Increasingly, numerous countries have recognized the limitations of the WHO approach and are adopting tobacco harm reduction as a key component of their tobacco control strategies. Countries such as the United States, Portugal, the United Kingdom, New Zealand, the Czech Republic, the Philippines, and Greece are forging a different path by embracing harm reduction measures. These countries acknowledge the potential of reduced-risk products as effective alternatives to traditional cigarettes.
In Japan, the introduction and growth of heated tobacco products (HTPs) have been linked to a significant decline in cigarette sales since 2016, independent of public health groups’ efforts. A study funded by the American Cancer Institute highlighted the accelerated decline in cigarette sales and attributed it to the popularity of HTPs. This evidence suggests that innovative alternatives can drive a rapid decline in cigarette use, even without extensive public health campaigns.
Prof Francesco Moscone, from Brunel Business School, is soon to publish an independent paper in the British Journal of Healthcare Management. Titled “Does Switching to Reduced Risk Products Free up Hospital Resources? A Reflection using English Regional Data,” the study estimates potential cost savings for health expenditure in England through a transition from traditional cigarettes to reduced-risk products like e-cigarettes and heat-not-burn tobacco. Prof Moscone’s research indicates that this shift could result in significant reductions in health expenditures ranging from 2.5% to 13%, depending on the conversion rate. He emphasizes that this transition could help the UK achieve its goal of eradicating smoking by 2030 while simultaneously freeing up hospital resources for other critical treatments.
Critics argue that the WHO should be at the forefront of proposing bold actions to eradicate smoking. However, they contend that the organization relies solely on the FCTC treaty mechanism and the MPOWER measures, which have not accelerated global progress in reducing cigarette consumption or tobacco-related mortality. Combining strong measures for smoked tobacco with support for less harmful alternatives, such as e-cigarettes, could hasten the goal of eradicating tobacco smoking worldwide.
The evolving landscape of tobacco control is witnessing a shift towards harm reduction strategies that leverage innovative alternatives to traditional cigarettes. While the WHO’s approach has faced criticism for its resistance to harm reduction, several countries are embracing reduced-risk products as a key component of their tobacco control policies. Research indicates that this approach can lead to significant reductions in healthcare expenditures and offer a path towards achieving public health goals. As the world grapples with the burden of tobacco-related diseases, it is essential to consider all available options to protect global health and promote effective tobacco control strategies.
