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World no tobacco day has been observed for decades now, intended to encourage a 24-hour period of abstinence from all forms of tobacco consumption around the globe. There are nearly 1 billion smokers worldwide, with about 7 million of them dying from smoking related diseases every year. Today, smoking kills 1 person every 4 seconds and is the leading cause of preventable deaths.

Even as smoking rates drop in high-income regions, they have risen at least 50% in Africa. A country like Lesotho for example, has seen a significant spike in smoking from 15% of its population in 2004 to 54% in 2015. Low- and middle-income countries represent over 80% of tobacco users and tobacco-related deaths, placing an increased share of tobacco-related costs on those who can least afford it.

Unfortunately, many smokers in Africa today 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. Isn’t it time that the World Health Organization considered tobacco harm reduction in the fight against smoking?

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. 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.

Happy World No tobacco day!

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