Tobacco Harm Reduction and the right to health

Tobacco harm reduction and the right to health 15 One billion lives at stake Tobacco harm reduction is a pragmatic and compassionate response to one of the biggest health crises facing our world. It offers tens of millions of smokers who either cannot quit by other means, or who want to continue using nicotine, the opportunity to avoid premature death and disability. Many millions of nicotine users have already adopted safer nicotine products, leaving combustible tobacco behind, with negligible cost to governments and taxpayers. If integrated as part of the response to tobacco use, tobacco harm reduction could make a major contribution to ending smoking. So why is tobacco harm reduction encountering opposition from many quarters, instead of more widespread adoption and implementation? The WHO’s resistance to tobacco harm reduction World leaders and policymakers look to the WHO for guidance on how to care for the health of their populations; its role is defined “as the directing and co-ordinating authority on international health work.” 47 For low- and middle-income countries especially, with healthcare systems that may still be developing, the WHO offers an essential source of technical and policy support and practical and financial input – and its actions and leadership in many areas of health have saved hundreds of thousands of lives. However, the WHO’s relationship with harm reduction strategies is complex. The organisation and UN drug agencies resisted harm reduction in their response to the spread of HIV/AIDS and blood borne viruses among people who inject drugs. They cited unproven (and now debunked) claims that, for example, provision of clean needles was simply condoning drug use, or that harm reduction was actually a Trojan horse for the legalisation of drugs. tobacco harm reduction is a pragmatic and compassionate response to one of the biggest health crises facing our world So far, the WHO has remained implacably opposed to tobacco harm reduction through the use of safer nicotine products. The organisation continues to urge signatories to the international legislation concerned with tobacco control, the Framework Convention on Tobacco Control (FCTC), to instigate outright product bans. The alleged Trojan horse in this context is that tobacco harm reduction is a tobacco company ruse to encourage former smokers and young non-smokers through a new product gateway either to return to, or to graduate to, smoking tobacco. In the seventh WHO report on the global tobacco epidemic (2019), tobacco harm reduction is positioned as “a manipulative tobacco industry strategy”, with the potential to “misinform and mislead consumers and confuse governments” and disrupt “genuine initiatives to assist tobacco cessation”. 48 Unfortunately, this approach is then reflected in the WHO’s efforts to tackle non- communicable diseases. In December 2019, the WHO published the final report 47 WHO Constitution (1946). https://www.who.int/governance/eb/who_constitution_en.pd f 48 WHO (2019) Seventh WHO report on the global tobacco epidemic, p. 33. https://apps.who.int/iris/bitstream/handle/10665/326043/9789241516204-eng.pdf?ua=1 Image: Ryoji Iwata on Unsplash