Towards A Risk Reducing Approach For Tobacco Control

In principle, a risk reduction or harm reduction method refers to public health approach aimed at reducing the risks of potentially-harmful behaviours for individuals, communities, and society as a whole.

In reality, however, if we carefully review our daily lives, we will notice how harm reduction is so broadly practiced and such an integral part of our routine that we do not even think about the fact that we practice it. Harm reduction is looking at a problem with the goal of coming up with a solution that produces the best achievable outcome with the least possible harm in situations where complete cessation of the behaviour or act is not viable. Advances in science, technology, and regulations have further enabled societies to reduce the adverse effects of potentially harmful behaviours. These risk reduction technologies can help limit the negative consequences of our actions on ourselves, others, society, and on the environment. Wearing sunscreen, putting on seatbelts, and switching to electric cars as opposed to those with combustion engine models are all instances of harm reduction from our day-to-day life.

One area of public health and social well-being that can also greatly benefit, and is already benefitting remarkably in many countries, from the application of risk reduction approach is tobacco and cigarette use. While current tobacco control efforts have been effective, given that there are currently a billion smokers in the world and a billion people will continue to smoke till 2025 – according to WHO – there seems to be a need for innovation and a pragmatic approach to tackle the problem. Tobacco Harm Reduction proposes that adult smokers who would otherwise continue to smoke should be provided with alternatives through which they can at least reduce the harms of smoking.

Today, science and technology have designed smokeless alternatives that release less harmful and potentially harmful components than those produced by cigarette smoke when tobacco is burned. E-cigarettes, heated tobacco products, nicotine pouches, and snus are some examples of these smokeless alternatives. Scientific researches have proved that while nicotine is not risk-free, it is not the primary cause of the majority of smoking-related diseases. Instead, the smoke produced by the burning of tobacco in cigarettes contains over 6000 harmful chemicals, 100 of which are directly related to smoking-related diseases. Smokeless alternatives, therefore, based on tobacco harm reduction, do not burn tobacco and only deliver nicotine, helping adult smokers to reduce harm to their health instead of continuing to smoke.

The latest UCLA-led research shows that switching to smokeless alternatives notably reduces risks of cardiovascular diseases that are otherwise increased in those who smoke cigarettes. In Japan, studies have shown that cigarette use and hospitalisation rates for smoking-related illnesses decreased shortly after the introduction of heated tobacco products in the market. England is also on its way to achieving its smoke-free vision through tobacco harm reduction strategies. Adam Afriyi, MP for Windsor, recently remarked that the uptake of e-cigarettes and heated tobacco is a vital tool to combat smoking and get England smoke-free by 2030. England could also be the first country in the world to prescribe medicinally licensed e-cigarettes to help reduce smoking rates.

Other countries struggling with the increased burden of cigarette smoking can also benefit from these smokeless alternatives by supplementing their existing smoking cessation and prevention measures with the risk-reduction approach. As evident from different scientific findings showing how smokeless alternatives are less harmful for smokers than continuing to smoke cigarettes and the progress reported by countries who incorporated risk reduction for tobacco control, regulation of scientifically-substantiated smokeless products as less harmful alternatives and providing adult smokers access to correct information can significantly help bring down cigarette use and its harmful effects.

While quitting tobacco and nicotine altogether should be the priority and existing tobacco control measures designed to discourage initiation and encourage cessation should continue, a risk reduction approach to cut down harms of cigarette smoking can serve as a practical tool to help us along the way.