Charting the History and Future of Tobacco Harm Reduction

    On November 15, Knowledge-Action-Change (KAC), a public health group in the United Kingdom, published its latest Global State of Tobacco Harm Reduction report. Titled “The Right Side of History,” it outlines both the origins of THR and the current obstacles to reducing smoking-related deaths across the globe.

    Tobacco harm reduction offers us an historic opportunity. We must not let it slip away.”

    “A failure to recognize and exploit the potential of tobacco harm reduction will mean millions more avoidable deaths each year, and contribute to an ever-growing burden of disease that disproportionately affects the most vulnerable countries and communities,” Gerry Stimson, the founder and director of KAC, said in a press statement. “Tobacco control’s lack of evolution, despite its very limited gains, means that many aspirational targets to achieve smoke-free status by 2030 or within the next generation are no more likely to be met than former aspirations for a drug-free world. Tobacco harm reduction offers us an historic opportunity. We must not let it slip away.”

    In more than 100 pages, the paper details the innovation of safer nicotine products (SNPs) over the past 20 or so years, charting how THR—in its guises of vapes, smokeless tobacco options and heated tobacco products, all of which offer nicotine in far less harmful forms than cigarettes—became a reality for millions and a potential lifesaver for many millions more. And it reflects on how many public health authorities now oppose a chance to make combustible cigarettes obsolete—in part because of entrenched disdain for the industry that creates both cigarettes and some of these safer options.

    Smoking, which the report notes “sees 8 million deaths each year, more than from HIV/AIDS, tuberculosis and malaria combined,” disproportionately affects people in the lower- and middle-income countries where prevalence is highest. The total number of people who smoke still hovers around 1.1 billion worldwide, despite the efforts of international tobacco control.

    The report estimates that 112 million people are already using safer nicotine products.

    Yet even though many governments are hostile toward THR—with exorbitant taxes, prohibitive regulations, outright prohibition and tangled, onerous bureaucracies that essentially amount to bans—the report estimates that 112 million people are already using safer nicotine products.

    This now somewhat-realized “disruptive potential,” the report highlights, has been decades in the making. Early pro-THR academics—like Michael Russell and Martin Jarvis in the United Kingdom, and Brad Rodu in the United States—began saying many years ago, for example, that forms of smokeless tobacco like snus were “less harmful to health than smoking and palatable to consumers.” The phenomenon of vaping is meanwhile owed to “a small number of individuals, motivated by their own desire to quit smoking,” who began exploring innovative ways to deliver nicotine without combustion—principally Hon Lik, a Chinese pharmacist looking to quit cigarettes after the smoking-related death of his father. Others, similarly inspired, started to tinker with open systems and share ideas on blogs in the US, as a vapor industry took root in Shenzhen in the mid-2000s.

    From there, lines were soon drawn in tobacco control between those who supported THR and those who remained skeptical of advances that could end smoking, on the basis that they still contained nicotine. Most in the latter camp, influenced by billionaire Michael Bloomberg and his heavy funding, strongly favor some form of prohibition; tobacco companies’ investments in safer nicotine products provided a convenient way to smear THR itself.

    The genie is out of the bottle—these new technologies demand the development of new policies and new thinking.”

    Technology helped smoking become one of the world’s biggest health problems,” Harry Shapiro, the author of the report, said in a press statement. “Now, technological innovations from beyond both the tobacco industry and public health have combined to produce safer nicotine products, and millions of people who smoked have already chosen to switch. Yet progress is being hampered. Although disruption is not always comfortable, the genie is out of the bottle—these new technologies demand the development of new policies and new thinking.”

     


     

    Photograph via Wikimedia Commons

    The Influence Foundation, which operates Filter, has received grants and donations from KAC. Both KAC and The Influence Foundation have received grants from the Foundation for a Smoke-Free World. Filters Editorial Independence Policy applies.

    • Alex is Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in The New York Times MagazineThe Columbia Journalism Review, The Los Angeles Times and The New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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