Tobacco Harm Reduction and the right to health

Tobacco harm reduction and the right to health 5 Many low and middle-income countries (LMIC) are not sufficiently resourced to implement and enforce tobacco control policies. The situation is further complicated in countries where the economy is reliant on income from tobacco cultivation. Levels of smoking in many LMIC are plateauing (and may be under-reported). Numerous LMIC have large projected population increases, suggesting the number of smokers is likely to rise. smoking-related death and disease are disproportionately high among vulnerable and marginalised groups One target of the overall UN Sustainable Development Agenda (SDA) is to reduce pre- mature deaths from non-communicable disease by one third by 2030. 5 The top three causes of NCD mortality are cardiovascular disease, cancer and respiratory disease – all of which are closely associated with cigarette smoking. It is hard to see how this goal can possibly be achieved if dramatic reductions in smoking are not achieved. “People smoke for nicotine but they die from the tar.” As pioneering tobacco researcher Professor Mike Russell identified in 1976, “Smokers cannot easily stop smoking because they are addicted to nicotine…. People smoke for nicotine but they die from the tar.” 6 People smoke tobacco because they feel they benefit from the effects of nicotine. People report that it helps concentration and can relieve anxiety or stress. Conversely, people who smoke say they crave cigarettes, feel agitated and irritable and find it hard to concentrate if they run out. From this point of view, some people are said to be dependent on nicotine. But given that nicotine as a substance is relatively benign and does not cause any of the illnesses associated with smoking, using nicotine is arguably not the physical or psychological problem usually conveyed by the public image of the word ‘addiction’. It has been clear for many years that the reason people die prematurely or develop life-threatening diseases from smoking cigarettes is exposure to the toxic chemicals released when a cigarette is lit and the fumes from burning are inhaled. The main toxins in cigarette smoke identified as potentially harmful include carbon monoxide, volatile organic compounds, carbonyls, aldehydes, tobacco-specific nitrosamines and metal particles. 7 Over 70 of the 7,000 – 8,000 chemicals released in the combustion of tobacco are carcinogenic. 5 UN Sustainable Development Goals (SDG) Knowledge Platform, SDG 3 Retrieved from: https:// sustainabledevelopment.un.org/sdg3 (select ‘Targets and indicators’ tab). 6 Russell, M. (1976) Low-tar medium-nicotine cigarettes: a new approach to safer smoking. British Medical Journal (BMJ 1: 1430-1433). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1640397/pdf/brmedj00520-0014.pdf 7 Knowledge-Action-Change (KAC) (2018). No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 , p63. https://gsthr.org/report/full-report Image: Franck V. on Unsplash Image: Obby RH on Unsplash