Menu Close

Tobacco harm reduction and the right to health

By Vita Mithi and Chimwemwe Ngoma

Combustible tobacco products inhaled into the lungs are the ultimate cause of health-related harms resulting from use of tobacco products. The damages of smoking are global in scope. Globally, tobacco cigarette production is a multi-billion-dollar industry, sponsored by more than 1.1 billion smokers worldwide.

Currently, there is shift of disease burden, which is from infectious to non-communicable diseases, and tobacco smoking plays a significant role in this. The good news is that such kind or diseases are preventable, unfortunately, people are ignorant of tobacco harm reduction information. This write-up elucidates how access to tobacco harm reduction information by smokers and access to quitting services is crucial in upholding human rights – which is right to health.

Having known the scientific consensus that tobacco cigarettes are the most deadly form of nicotine consumption, tobacco smokers have a right to clearly understand this. Where information, services and aids on cessation are present, there is a need to make them readily available to smokers so that they are able to make informed personal health choices thus, to quit or switch to safer alternatives of nicotine consumption.


Countries with heavy dependence of tobacco production like Malawi invest few resources in tobacco control and harm reduction programs. As such, public health and the right to health is compromised, positioning ourselves far from achieving the two pieces of Ottawa Charter that go hand in hand, which are; to promote and create supportive environments and strengthen community actions– in this context; towards tobacco control and harm reduction amongst smokers.

The Malawi demographic and health survey 2015-16 highlights that exposure of individuals to smoke either from cooking with solid fuels or tobacco smoking is high and has not changed since 2010. In Malawi, you cannot walk a significant distance without inhaling tobacco smoke, because the country has no smoke free laws. The group that suffers a lot from this negligence and irresponsible behaviour are children and non-smokers, a violation to their right to health.

The Universal Declaration on Human Rights (UDHR) article 25 affirms that everyone has the right to a standard of living adequate for the health and well-being of himself and of his family. In addition, the International Covenant on Economic Social and Cultural Rights (ICESCR), further expands the right to health to include “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Malawi is a signatory of all these.

Tobacco harm reduction is demarcated as a strategy that lowers total tobacco-related mortality and morbidity despite continued exposure to tobacco-related toxicants. It can also be understood as methodologies on tobacco control that are applied to empower people (smokers and non-smokers or individuals that are trying to quit) to make informed decisions on those things which determine their health, as well as understand the sense of personal identity and self-worth.

Harm reduction strategies include using behavioral methods such as-; stopping in one step, Pharmacotherapies, nicotine replacement therapies, “safer e-cigarettes” and smokeless tobacco products. All of these resources and approaches are for the community to come together to create supportive environment for the smoker and nonsmokers. People need to know that licensed tobacco harm reduction nicotine-containing products (such as e-cigs, nicotine patches, gum, or spray) make it is easier for someone to reduce the amount of tobacco they smoke with an aim to quit smoking.

Tobacco harm reduction corresponds with the Malawi Environmental Management Act, subsection 1 & 2 “right to clean and healthy environment” which affirms that every person has the right to a clean and healthy environment and has the duty to safeguard and enhance the environment. If smokers cannot hold their urge to smoke when there are in the public, they should consider switching to vaping. Vaping delivers nicotine through a vapor. Using E-cigarettes or vaping is 95% safer that smoking, promoting a safe, clean and healthy environment as well as fulfilling their responsibility of protecting non smokers and children from passive smoking.

To crown it all, in the context of smoking, it is the right of smokers to gain access to information, services and products that can decrease the harm from smoking to enable them to achieve a higher quality of health and life for themselves and the general public.

Governments should achieve their responsibilities by creating policy, regulation and legislation that enables smokers to have access to information and services about products that can reduce the harm caused from smoking. The right to information originates from the principle of respect for self-government or autonomy. The people need to have access to materials relevant to their health, so that they make the right choices that will strength and protect their health.



Benjamin Mason Meier and Donna Shelley (2006) The Fourth Pillar of the Framework Convention on Tobacco Control: Harm Reduction and the International Human Right to Health. Health Center for Health Policy, Columbia Univ., 617 W. 168th St., New York, 2006 Association of Schools of Public.

Harry Shapiro (2018) No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018. London: Knowledge-Action-Change.

Marc T. Kiviniemi and Lynn T. Kozlowski (2015) Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey: Biomedical Central New yoke; USA.

National Institute for Health and Care Excellence (2013). Smoking: harm reduction. Subject to Notice of rights (

National Institute for Health and Care Excellence (2013). Tobacco: harm-reduction approaches to smoking. NICE public health guidance 45

National Statistical Office (NSO) [Malawi] and ICF. 2017. Malawi Demographic and Health Survey 2015-16. Zomba, Malawi, and Rockville, Maryland, USA. NSO and ICF.

Ottawa Charter on Smoking (2016, Nov 04) Retrieved from

Related Articles


    • Chimwemwe Ngoma

      We advocate for smoke free spaces, we educate the public on the adverse effects of passive smoke on non-smokers and children so that those people who smoke tobacco can be responsible enough and protect these non-smokers by either not smoking in public spaces or switch to smokeless means of nicotine consumption or vaping.

  1. Daudi kammambala

    I love this article and i enjoy reading ur articles…
    In your article you mention about vaping and the use of e-cigarettes, my question is how can people living in rural areas access this e-cigarettes and can they manage the price of these e-cigarettes?

    • Vita Mithi

      For them to have them, first of all they need to know about them. E-cigarettes can be popularised by sharing information like this to smokers.

  2. Daudi kammambala

    First thing, I enjoy reading your article.
    In your article you emphasize much on using e-cigarettes or vaping, but my question is: how can aperson living in rural areas access these cigarettes and if yes……can he/she afford the price of these cigarettes?

    • Chimwemwe Ngoma

      Thank you very much Daudi.

      Vaping products are very new in Malawi and not popularly known among Malawians, accessibility and awareness of these products is a big challenge. However, I can say that one can get a vape at MK10,000 and it can be used for an extended period. For someone who is concerned about their health, he/she can trade off with a pack of tobacco cigs which is approximately MK1,000 and can be consumed in less than a week by a standard smoker.

  3. Wilfred Jekete

    THR strategies are scientifically proven that they are capable of reducing the harm being caused by combustible tobacco products, hence need to be accepted and embodied in our public health national policy.

    • Vita Mithi

      That’s true, unfortunately; Malawis’ public health law is outdated. The public health policy of Malawi was formed and adopted in 1948 and does not include the current laws that may help or that would best fit with the shift of disease burden. In other words, the Public Health Law is outdated and people are not aware of it.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.