Tobacco control strategies in South Africa could be complemented by a harm reduction approach to reduce smoking rates faster, writes Marcelo Nico, MD of Philip Morris South Africa*. To tackle the public health issue of smoking we need sensible regulation that recognises the role of less harmful nicotine products in helping smokers to quit.
According to the World Health Organization, more than seven million people die each year from diseases linked to smoking. Tobacco control strategies in most countries have focused on measures to prevent initiation and encourage cessation, and through the work of the WHO Framework Convention on Tobacco Control, smoking prevalence has declined 4.1% between 2005 and 2015 (1).
Yet despite these efforts, millions of people who understand the risks continue to smoke cigarettes. According to WHO estimates, there are over one billion smokers worldwide and this will not change materially by 2025.
There are 10 million adult smokers in South Africa according to our estimates. The University of Cape Town’s Economics of Tobacco Control Project reported that there were eight million smokers in South Africa in 2017, up from 7.36 million in 2008 (2)
When will smoking be a thing of the past in South Africa?
We agree with the standard measures of preventing initiation and encouraging cessation. However, we advocate the inclusion of a third strategy which complements these measures, namely tobacco harm reduction – that adults who would otherwise continue smoking should have access to and accurate information about less harmful alternatives. This approach considers the rights and needs of this population and is a means of reducing smoking rates faster.
In a Harm Reduction Journal paper titled “Harm reduction principles for healthcare settings”, the authors state that harm reduction refers to measures aimed at reducing the negative consequences of risk behaviors without necessarily preventing or eliminating the behaviour completely (3).
They add that while the concept is frequently applied in relation to drug use, the philosophy “can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors”.
Tobacco harm reduction
Tobacco harm reduction (THR) means replacing cigarettes, which are known to be the most harmful form of nicotine consumption, with products that are scientifically substantiated to be less harmful than continued smoking; less harmful does not mean risk-free.
The WHO Framework Convention on Tobacco Control, article 1(d), states that ““tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke” (4).
In South Africa, the authors of a position statement on harm reduction regarding psychoactive substances – published in The South African Medical Journal – mention the need for supply, demand and harm reduction stating: “Evidence-based approaches that reduce harm from continued and chronic use of alcohol, tobacco, marijuana and other substances…deserve greater attention and additional resources and harm reduction.” (5)
We encourage the South African public health community to reflect upon these statements, as well as mounting evidence from several countries where tobacco control combined with tobacco harm reduction involving less harmful nicotine products is reducing smoking rates faster.
Less harmful nicotine products
The burning of tobacco is responsible for the production and transfer of most of the toxicants that experts agree are the primary cause of smoking-related disease. Nicotine, while addictive and not risk free, is not the primary cause of smoking related disease (6).
For decades, governments and the public health community have told the tobacco industry to develop less harmful products. We have invested more than US$7 billion in science and technology to achieve that precise objective, to ensure that only smoke-free products which robust science demonstrates are a better alternative to continued smoking are brought to market.
By not burning tobacco, e-cigarettes and heated tobacco products don’t produce smoke and their aerosols contain fewer and lower levels of harmful chemicals compared to cigarette smoke.
Recognising this, the United Kingdom government’s Tobacco Control Plan for England (2017) states: “The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.” (7)
Way forward for South Africa
Tobacco control strategies based on supply and demand reduction can be complemented by including a harm reduction approach to reduce smoking rates faster.
It is time for a new conversation to reduce smoking rates, one where tobacco harm reduction is no longer a forgotten pillar of tobacco control. It’s time to grow that conversation among the public, civil society, public health experts and the government in order to reduce smoking rates in South Africa faster.
To address the public health issue of smoking we need sensible regulation which recognises the role of less harmful nicotine products in helping those adults who would otherwise continue to smoke to move away from cigarettes. Coupled with responsible commercialisation by manufacturers whereby youth and non-smokers are protected, we can together achieve a smoke-free South Africa.
We welcome any interest from public health experts, governments and civil society in examining our commitments and efforts.
Marcelo Nico is Managing Director of Philip Morris South Africa.
* This article is sponsored by Philip Morris International, PMI.
1- WHO global report on trends in prevalence of tobacco smoking 2000-2025. 2018
2- Illicit cigarette trade in South Africa: 2002–2017
3- Harm reduction principles for healthcare settings
4- WHO Framework Convention on Tobacco Control
5- Psychoactive substances: Position statement on harm reduction
6- Perspectives – Is it the nicotine or the tobacco?
7- Towards a Smokefree Generation – A Tobacco Control Plan for England
Philip Morris International: Delivering a Smoke-Free Future
Philip Morris International (PMI) is leading a transformation in the tobacco industry to create a smoke-free future and ultimately replace cigarettes with smoke-free products to the benefit of adults who would otherwise continue to smoke, society, the company and its shareholders.
PMI is a leading international tobacco company engaged in the manufacture and sale of cigarettes, smoke-free products and associated electronic devices and accessories, and other nicotine-containing products in markets outside the United States.
PMI is building a future on a new category of smoke-free products that, while not risk-free, are a much better choice than continuing to smoke. Through multidisciplinary capabilities in product development, state-of-the-art facilities and scientific substantiation, PMI aims to ensure that its smoke-free products meet adult consumer preferences and rigorous regulatory requirements. For more information, please visit http://www.pmi.com and www.pmiscience.com.