Tobacco Harm Reduction and the right to health

Tobacco harm reduction and the right to health 7 are unwell. For lung cancer patients, for example, this can lead to delayed diagnosis and poorer prognosis, lower quality of life, negative impacts on relationships and interactions with health workers. 10 public anti-smoking campaigns have embedded feelings of guilt and shame in people who, for whatever reason, continue to smoke Stigma creates additional suffering on an individual level. However, it can also reinforce population health disparities, impacting most significantly on those who are already the most vulnerable. Some argue it should not be used as a strategy in global health at all. 11 “People think you're dirty because you smoked. People automatically think you've brought it on yourself.” 56-year-old living with lung cancer 12 The war on tobacco becomes a war on nicotine Many advocates for tobacco control see worldwide abstinence from tobacco use and the dismantling of the tobacco industry as the only viable measure of success. Tobacco control has become a war on tobacco. In taking a total prohibitionist stance on tobacco, tobacco control advocates are also waging war on nicotine. In doing so, they may be missing the most significant public health opportunity the world has ever seen. 10 Riley, K. E., Ulrich, M. R., Hamann, H. A., and Ostroff, J. S. (2017). Decreasing Smoking but Increasing Stigma? Anti- tobacco Campaigns, Public Health, and Cancer Care. AMA journal of ethics , 19(5), 475–485. (doi:10.1001/journalofethi cs.2017.19.5.msoc1-1705). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679230/ 11 Brewis A, Wutich A. (2019) Why we should never do it: stigma as a behaviour change tool in global health. BMJ Global Health (doi:10.1136/ bmjgh-2019-001911). https://gh.bmj.com/content/4/5/e001911 12 Chapple A, Ziebland S, McPherson A. (2004) Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. British Medical Journal  (BMJ 2004; 328 :1470). https://www.bmj.com/content/328/7454/1470 Image: Patrick Hendry on Unsplash