If we were living in an ideal world, people who smoke would have easily quit tobacco and nicotine outright, our public health would not have still been battling its decades-long fight against smoking and exhausting its resources, and over 1.1 billion people from across the world would not have been dealing with the multitude of diseases and health complications that are otherwise caused by cigarette smoking. But as we are well aware, our world is far from ideal. Despite regulations and public health campaigns about the well-known health risks associated with smoking, a number of people choose to continue to smoke. The World Health Organization (WHO) estimates there will still be over 1 billion smokers by 2025. This raises the question of whether the current measures taken to reduce tobacco use are too idealistic, sounding the alarm for the need to revisit our tobacco control efforts based on a more pragmatic approach to reducing smoking.
Idealistic policymakers solely focus on the ultimate goal of visionary ideas. Urging all smokers to quit their habit completely and rooting out smoking prevalence is, without a doubt, the best possible target but also seemingly unlikely to achieve out right. On the other hand, pragmatic policymakers take a realistic and practical approach, recognizing the challenges and roadblocks in achieving the end result. While this approach to tobacco control understands that the preferred goal is complete smoking cessation, it also acknowledges that quitting cold turkey is not a viable option for some smokers and that there will always be people who would otherwise continue to smoke.
For these adult smokers, a pragmatic solution that has proven effective globally is the adoption of tobacco harm reduction strategies. This strategy aims to reduce smoking-related diseases and mortality by encouraging smokers to switch to smoke-free alternatives, such as
e-cigarettes, heated tobacco products, nicotine pouches, and snuff, that are scientifically-proven to be less harmful.
Decades of research indicate that it is the smoke in cigarettes, not nicotine, that causes the most harm. Cigarettes, when lit on fire, burn the tobacco contained within and produce more than 6,000 chemicals, majority of which are attributed to smoking-related cardiovascular and pulmonary diseases. Smoke-free alternatives eliminate this process of tobacco burning and offer consumers nicotine without the toxic smoke.
Growing global scientific evidence suggests that innovative smoke-free alternatives have the potential to significantly reduce exposure to toxins in cigarettes by eliminating the process of burning of tobacco. Many health authorities around the world are seeing these solutions as a way to reduce the burden of smoking on public health and are opting to incorporate these alternatives into their legislation.
According to the guidance published by the National Institute for Health and Care Excellence (NICE) of the UK on Tobacco Harm Reduction and its efficacy in driving down smoking rates, quitting smoking is always the best option for smokers, but it supports the use of licensed nicotine-containing products (NCPs) to help smokers, who are currently unable to quit, switch to a less harmful option.
Japan saw a significant decline in its cigarette sales after heated tobacco products were made available for smokers. UK’s National Health Service (NHS) has also recognized e-cigarettes as an effective tool for adult smokers to reduce the harm to their health and reported how thousands of people in the UK have already stopped smoking with the help of an e-cigarette.
A similar change of approach is needed for the better health of the 22 million adult smokers in Pakistan. But for such dramatic change to occur, we need action from policymakers, consumers, and society as a whole. That’s why it’s more urgent than ever to start a rational, nuanced, science-backed conversation about ways to achieve realistic public health targets for everyone.