The entire world agrees that smoking rates need to be decreased. Whether it's the ubiquitous cigarette or local cigars and hookahs known as shisha in Nigeria, all stakeholders want to reduce smoking rates, and in fact, keep reducing them. While cigarettes have always received the most attention, people are now beginning to recognize the dangers of shisha, especially as it becomes increasingly popular among young people.
However, the means to achieve the expected decrease in smoking rates continue to cause debate among various parties. The popular African saying, "there are different paths to reach the same destination" is a subtle way our ancestors chose to remind us that the destination is the ultimate goal. Naturally, as long as the expected destination or established objective is reached, everything is fair and great, without any mistakes made along the way.
In fact, this motto has never been more important than in the process of reducing smoking rates in Africa today. While the debate about the path to this destination continues, prohibitionists – those who believe that only complete abstinence from smoking can achieve a decrease in smoking rates – continue to denigrate advocates for harm reduction, while also denying the success of harm reduction plans.
The photo, taken by Haim Charbit on Unsplash, represents a public health strategy called tobacco harm reduction (THR), which aims to reduce personal and wider societal health risks associated with combustible tobacco products. This approach is based on the understanding that most of the harm related to combustible tobacco is caused by the chemical mixture released when tobacco is burned (smoked) and then inhaled. However, if you remove the smoking/burning element, the risk of consuming tobacco is significantly reduced.
THR advocates believe that many adult smokers who wish to quit smoking often struggle or cannot quit, while others wish to continue to enjoy nicotine without harmful effects. Therefore, these smokers should switch to alternative products that release nicotine without burning tobacco. The word "switching" is an effective term for THR advocates, who prioritize the freedom to switch and the availability of alternative options. Providing information on alternative or reduced-risk products is a key driver of effective THR strategies for adult consumers to make informed choices.
Recently, advocates of tobacco harm reduction (THR) have been promoting their cause in Africa by explaining the science behind the concept and citing successful records from countries that have accepted the ideology of reducing tobacco harm. It is worth noting that THR advocates still agree that quitting smoking is the best choice and frequently emphasize this fact. However, they have chosen a pragmatic approach because they understand that both quitting smoking and switching will achieve the goal of reducing smoking rates. The position of THR advocates is supported by scientific evidence from more developed economies, which recognizes that adopting and effectively implementing tobacco harm reduction strategies can significantly reduce smoking rates. For example, the United Kingdom has recognized the effectiveness of reducing tobacco harm or substituting tobacco products in lowering smoking rates. The National Institute for Health and Care Excellence (NICE), which publishes evidence-based guidelines for the most effective methods of disease prevention, diagnosis, and treatment, has also released guidelines for tobacco harm reduction. The guidelines acknowledge that quitting smoking is always the best choice for smokers, but they support the use of licensed nicotine-containing products (NCPs) to help smokers who are currently unable to quit transition to less harmful options.
The Food and Drug Administration (FDA) of the United States of America (USA) has begun to classify alternative products as "reduced-risk tobacco products". This is a clear indication that the country is relying on scientific and verified evidence to provide guidance on reducing tobacco harm.
According to reports, Japan's smoking rate has decreased by 34% primarily due to the introduction of alternative products that give citizens the opportunity to switch to lower-risk options rather than outright quitting. This was detailed in a report by renowned consultancy firm Frost & Sullivan in December 2020, which also emphasized the importance of establishing effective regulation.
In Canada, the government has released a scientifically-supported statement through the Canadian Ministry of Health, stating that "completely replacing smoking with e-cigarettes will reduce your exposure to harmful chemicals" and "e-cigarette products and e-cigarettes release nicotine in a smaller way than smoking." Others are advising adult smokers to stay away from combustible tobacco products. The Canadian Public Health Association also recognizes the efficacy of alternative products and has released statements since 2018 acknowledging that the risks associated with alternative nicotine delivery products are lower than combustible tobacco.
New Zealand's Ministry of Health launched a website called Vaping Facts in 2019 with the aim of educating citizens about the realities of using e-cigarettes as a smoking cessation tool. The website encourages smokers to consider e-cigarettes as a means of quitting smoking and widely disseminates content indicating that the risks associated with vaping are lower than with smoking. This is another clear example of a country using a scientific and fact-based approach to reduce the harm caused by tobacco.
African countries need to conduct independent evaluations of each potential pathway towards reducing smoking rates. Their health departments and other health organizations, including academic members, must commission independent research focused not only on reducing tobacco harm but also examining the numerous public health issues affecting their citizens. This will aid in determining the best policies and regulatory frameworks to effectively promote smoking cessation and reduce tobacco harm simultaneously.
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