Tobacco harm reduction (THR) is a health strategy implemented to curtail the risks associated with tobacco products to users and society at large. The concept of THR dates back to 1976 when Professor Michael Russell, also considered the father of tobacco harm reduction, stated that people smoke for nicotine but they die from the tar. Russell’s advocacy that the ratio of tar to nicotine could be the key to a less harmful smoking experience has served as a stencil for strategies implemented against tobacco harm by health organizations today.
Unfortunately, Pakistan is among the high-burden tobacco-use countries identified by the World Health Organization. According to the Journal of Pakistan Medical Association’s estimations, almost 36% of males and 9% of females in Pakistan are addicted to tobacco or tobacco-based products. In addition to that, approximately 1,200 children in Pakistan start smoking every day!
Despite innumerable studies stating tobacco smoking as the leading cause of illness and death, many countries are still struggling to control its consumption. Approximately 7 million deaths every year are the result of smoking. While around 1.2 million are of non-smokers exposed to second-hand smoke.
This is why reducing smoking has become essential to public health now more than ever. However, it is not as easy as it seems. Quitting altogether or more commonly known as going ‘cold turkey’ has a success rate of as low as 3% with a high chance of relapse. This percentage may increase between 6 – 15% with the help of nicotine replacement therapy (NRT), according to Cancer.org.
This has led to the rise in popularity of nicotine replacement therapy products such as patches, gum, lozenges, spray, and inhaler in the last decade. Moreover, electronic cigarettes, non-combustible tobacco products, and pharmaceutical nicotine have also witnessed a surge in demand. As more people get acquainted with THR, these along with niche products like snus (smokeless tobacco product originating from Sweden) are being used to quit or temporarily abstain from smoking.
Pakistan is also playing its part by being an active member of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) since 2005. With WHO’s support, Pakistan has successfully implemented MPOWER – a policy package that helps countries implement effective interventions to lower the demand for tobacco. In just a couple of years, Pakistan has a long list of achievements in its fight against tobacco harm. The achievements include:
• Ban on tobacco advertisements both in print and electronic media
• Ban on smoking in closed public places and public transport
• Ban on selling cigarettes to minors
• Ban on shisha and related substances in restaurants
• Ban on manufacturing, importing, or selling of cigarette packs that have less than 20 cigarettes
• Ban on free samples, cash rebates, discounts on tobacco products
• Increasing the size of pictorial health warning to 85% size on both sides of cigarette packs
In addition to these, Pakistan may do well from regulating and formally introducing alternative smoking products as well. Unofficially, e-cigarettes and vapes of different types and quality are already available in the market through various means. However, these products are usually brought in through grey channels and due to lack of proper sales channels and regulations, are either not reliable or too expensive. If there were proper laws in place, these alternative products could go a long way in improving the overall health statistics of Pakistan.