In many countries, smoking prevalence has declined over the past three decades. These declines can be attributed to a constellation of factors including some regulatory measures, increased taxes, educational levels, and societal attitudes. However, it is clear that despite these measures, many millions of adults around the world will continue to smoke.
In 2015, the WHO issued a report detailing prevalence trends and projections for many markets. The report provides prevalence and total smoker projections through 2025. For many markets, these projections show a flat to increasing smoking population. For example, projections for South Africa suggest there will be 6.8 million smokers through 2025 despite declining prevalence and increasing regulation.
There is a growing support among public health experts and regulators for the premise that encouraging smokers to switch to less harmful alternatives to cigarettes can reduce individual risk and population harm, in turn providing a major benefit to public health. This means that there is a growing consensus that adult smokers should have access to, and information about, smokefree alternatives to cigarettes.
In an article which appeared in the South African Medical Journal, Professors David Sweanor and Derek Yach argue that alternative tobacco products, such as e-cigarettes and snus, offer a sensible solution to the smoking pandemic. “We are currently presented with the very real prospect of massively reducing the individual and population risks of smoking by something in the range of two orders of magnitude. If we seize the opportunity for this new breakthrough, SA can once again be on the forefront of cutting-edge health policy”.
Many tobacco harm reduction advocates have spent their lives trying to reduce smoking and now see non-combustible alternatives as a means of doing so.
Harm reduction is a public health strategy designed to reduce the harmful consequences associated with risky activities. It was developed initially for adults with substance abuse problems for whom abstinence was not feasible. In recent years, the concept of harm reduction has been successfully applied to a number of other policy areas. The interventions aim at reducing the risks for those who choose to (continue to) engage in certain risky behaviours.
South Africa has had some remarkable success with harm reduction in health policy before. Examples include HIV education and access to free antiretroviral treatment.
Other countries have harm reduction strategies in place to provide clean needles and syringes to intravenous drug users to reduce the risk of infection.
There is no substitute for quitting, but governments can have a big impact on public health by appropriately regulating alternatives to smoking cigarettes.
The rapid growth in the use of e-cigarettes by smokers since 2007 shows many smokers want alternative products. In South Africa, some 200,000 people use e-cigarettes.
Making effective, socially acceptable, reduced risk, nicotine products available to adult smokers as an alternative to traditional cigarettes could be a tool in the fight against the effects of combustible tobacco use.
While regulations are needed, more freedoms are also important to encourage smokers who would otherwise continue using cigarettes to switch to non-combustible products.