By Vita Mithi (THR-Malawi Volunteer Ambassador)
Harm reduction refers to policies, regulations and activities that are put forward to reduce health risks or encourage less risky behaviours, by providing safer forms of hazardous products rather than concentrating on eradication of the hazardous products or risky behaviours only. So, Tobacco Harm reduction can be explained as policies, regulation and actions that are focused on reducing health risks or behaviours by providing safer forms or smokeless tobacco products to promote good health and well-being (Sustainable developmental Goal 3).
Tobacco harm reduction works through the provision of or making Safer Nicotine Products available for inveterate smokers by allowing people to be able to consume nicotine without inhaling smoke and other health risk producing chemicals found in cigarette smoke.
Most of the African leaders during conventions or summits stress that nations are going towards a “tobacco smoke free world” but do not stress much on tobacco harm reduction strategies that may as well help in achieving that, while boosting the economy. With countries like Malawi who still regard tobacco as an economic backbone; contributing 11 percent of Gross Domestic Product and 60 percent of forex earnings, have little or no time to discuss or follow World Health Organization Framework Convention on Tobacco Control (WHO FCTC), hence, making it nearly impossible or difficult for daily smokers to attain good health and well-being.
A large number of African countries have made a commitment to accomplish the SDGs, and Malawi is one of the countries that is striving to achieve the sustainable developmental goals (SDGs) by 2030. Recently, the Government has translated the SDGs into local language so that people should be able to read and understand them and be responsible. Even though the government has done this, still, little is being done for inveterate smokers and minimization of second hand smoke in public areas, for people to have tobacco smoke free environment. This clearly points out that there is need to introduce and follow WHO Framework Convention on Tobacco Control (WHO FCTC).
The WHO and partners, mark 31 May, as World No Tobacco Day (WNTD) and highlights the health and other risks associated with tobacco use, while advocating for effective policies to reduce tobacco consumption. The 2018 World No Tobacco Day, the WHO and partners derived up strategies that can be used by governments to reduce tobacco use and its products and protect people from Non-Communicable Diseases (NCDs) such as heart Diseases. The strategies include;
- Monitor tobacco use and prevention policies,
- Protect people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces and public transport;
- Offer help to quit tobacco (cost-covered, population-wide support, including brief advice by health care providers and national toll-free quit lines);
- Warn about the dangers of tobacco by implementing plain/standardized packaging, and/or large graphic health warnings on all tobacco packages, and implementing effective anti-tobacco mass media campaigns that inform the public about the harms tobacco use and second-hand smoke exposure.
- Enforce comprehensive bans on tobacco advertising, promotion and sponsorship; and
- Raise taxes on tobacco products and make them less affordable.
Malawi is one of the few countries in central Africa that neither have a regulatory body nor control legislation on tobacco use and their products. As such, little is being done to promote activities that should promote smokeless tobacco products. As a result, many smokers are unable to stop nicotine and tobacco smoking despite having knowledge on the health effects. This lives them with two unfriendly alternative which are “Quit or Die” from tobacco smoke. This might be because they either do not have access and knowledge or are unwilling to get smokeless tobacco products. Even though that is the case, tobacco harm reduction gives smokers an opportunity to “Quit or Try”.
There are different smokeless tobacco products (STP) that can be employed to reduce the consumers’ consumption of smoke and production of second hand smoke to the environment. One of the STP are E-cigarettes. These are devices that have the ability to reduce the heating of tobacco below the level of burning. Smokers consume a pack of cigarettes because they cannot store it, but E-cigarettes offer consumers’ storage of their tobacco and in the process able to spend less on buying tobacco cigarettes, which on the other hand means E-cigarettes helps in the fight against poverty – by giving an individual the chance for economic growth.
The other way is the use of Snus also known as moist snuff which are packed in containers. The consumer compress the tobacco in it and puts on the lips. There is no risk of respiratory diseases or conditions that result from smoking from using Snus.
Apart from that, there are local traditional ways such as; leaf chew tobacco, soaking tobacco or mixing raw tobacco with food and other ways that are yet to be explored to promote good health and wellbeing. There are few or close to zero situations that entails that, it is safer to smoke than to use SNP or Smokeless Tobacco Products to attain good health.
In summary, Tobacco harm reduction is more than just health and safety on tobacco use and its products. It is the coming together of public health and human rights as expressed in the WHO Ottawa Charter on Health Promotion. The WHO Ottawa Charter on Health Promotion states that, “People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health”. Malawi needs to consider and implement tobacco harm reduction towards achieving Sustainable Developmental Goal 3 in inveterate smokers and the general public.
Alison Cox, Brian Lutz, Douglas Webb, Michelle Sahal-Estime, Roy Small and Vijay Trivedi. (2014) Development Planning and Tobacco Control: Integrating the WHO Framework Convention on Tobacco Control into UN and National Development Planning Instruments; One United Nations Plaza, New York, NY, 10017, USA: United Nations Development Programme
Harry Shapiro (2018) No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018. London: Knowledge-Action-Change
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Who (2016) Conference of the Parties to the WHO Framework Convention on Tobacco Control. 7th Session. Delhi, India, 7-12 November 2016.