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Harm Reduction can complement Traditional Tobacco Control Measures

The debate over tobacco harm reduction has divided the tobacco control community into two camps, one expressing serious reservations about tobacco harm reduction whereas the other believes that reduced-risk products like e-cigarettes will disrupt the cigarette market.

Many smokers are unable — or at least unwilling — to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die.

The Framework Convention Tobacco Control treaty implementation is working in countries that adopt taxation, packaging, smoking location limits, etc. But,smoking has declined even faster in countries that embrace harm reduction products as a public health good. While smoking is on the decline in high-income countries (still not fast enough), smoking rates are actually rising globally because poor countries are becoming less poor. They can now afford cigarettes. Tobacco harm reduction is a public health strategy to lower the health risks associated with using nicotine, as an example of the concept of harm reduction, a strategy for dealing with the abuse of other drugs.

A harm reduction approach embodies basic human rights, concern for people’s welfare, an enlightened view of individual freedom and dignity, and an effort to resist egocentrism and appreciate others’ perspective and preferences. Oh, and it also involves some tools and behavior changes that can lower risk.

The public health community embraces harm reduction to prevent STD transmission and address drug addiction (e.g., condoms, needle exchanges). This is because evidence showed that prohibition and abstinence don’t work. So it’s plausible that harm reduction can complement (not replace) traditional tobacco control measures — leading to still faster smoking declines. We just want smokers to quit by any means: pharmacotherapies including NRTs, counseling, wearables, apps, alternative medicines… whatever works. If they can’t quit that way, then harm reduction reduces harm.

To date, harm reduction approaches have not been widely used in Africa in relation to tobacco smoking. The emphasis has been on population and individual health strategies focused on encouraging existing smokers to quit and preventing uptake among young people. These approaches have been effective and should continue to be encouraged,to help reach the goal of more tobacco-free people in African.

There are, however, a number of smokers who have to date proven resistant to these measures. These smokers are more likely to be the most socioeconomically disadvantaged and those otherwise excluded from conventional society. The emergence of electronic nicotine delivery systems (ENDS), which includes electronic cigarettes, and the likely arrival of more effective nicotine delivery devices may provide additional harm reduction options.

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