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Reducing harm: Prevention is better than cure

When we think of harm reduction, the adage “prevention is better than cure” coined by physician Christoph Wilhelm Hufeland (1762-1836) inevitably springs to mind. For smokers, this either means quitting or opting for alternatives that are less risky to their health. 

Harm reduction strategies are applied to many areas of life. Consider how road-traffic risks have been reduced considerably over the years by safety measures such as new technologies and tightening the rules of the road. Also, when we are engaged in relatively dangerous pursuits such as driving, we adapt our behaviours to increase our safety. When skiing, for example, one of the central goals is to reduce potential negative impacts as much as possible, rather than prohibiting the activity outright.

Better choices

Such thinking can also be applied to how we seek to reduce harm and the negative health impacts related to tobacco consumption; an aspect of health policy for governments around the world. According to the World Health Organisation (WHO), government regulation and public health campaigns reduced smoking rates by 4.1% between 2005 and 2015. Nevertheless, despite these many initiatives many millions of people continue to smoke, despite them being perfectly aware of the risks involved. Indeed, according to WHO estimates, over a billion people will smoke in 2025.

The most effective step would of course be for everyone to stop smoking completely, but WHO figures show that nine out of ten smokers continue each year. This reality calls for us to find other ways to reduce negative outcomes. Harm reduction strategies include using alternatives developed through scientific and technological advances. These can be considered as one solution among many, which includes encouraging people to stop smoking or enacting prevention measures.

The combustion problem

According to the UK’s National Institute for Health and Care Excellence (NICE), “it is the toxins and carcinogens in tobacco smoke - not the nicotine - that are primarily responsible for illness and death”. Toxic substances are released when tobacco is burnt, but risks are reduced when heat-not-burn products and e-cigarettes are used.

This is why many countries have adopted innovative policies in this area. The UK, for example, recently launched a major campaign to make the country smoke-free by 2030. As part of this initiative, the British government plans to provide free electronic cigarettes to one million smokers in England. In fact, by “smoke-free”, the government is in fact targeting a smoking rate of less than 5%.

Sales in Japan began to fall five times faster after heated tobacco products came onto the market in 2017. An independent study carried out in 2019 by researchers from the American Cancer Society concluded that heated tobacco products “likely [VK1] reduced cigarette sales in Japan”.

The Swedish example

As for nicotine consumption, Sweden has shown the way forward to help people give up smoking. The availability of alternative nicotine products has been proven to help the battle against traditional cigarettes.

Over the last 20 years, the country has taken a range of systematic and progressive measures. Through the use of alternatives such as snus and oral nicotine pouches, Sweden has succeeded in reducing the potential danger faced by its citizens, by already achieving today a smoking rate of only around 5%.

According to the Institute for Studies on Tobacco, these measures are leading to a reduction in smoking-related deaths, which could save more than 3.5 million lives over the next ten years in the European Union alone.