Why We Need Balanced Policy on Tobacco

Government Bureaucracy

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Despite what you might think, smoking rates haven’t significantly declined. Despite all the ads warning about the dangers of smoking, the decline has only been approximately 1 percent per year since 1965.

I was anticipating a large drop especially over the past 10-20 years with increased anti-smoking campaigns in schools and university (that I can remember). I remember in my high school, there were ads against smoking, and commercials like ‘truth.com’ about smoking effects. 

Cliff Douglas is the Director, University of Michigan Tobacco Research Network. During the Obama administration, he served as the consulting tobacco control policy advisor for the U.S. Assistant Secretary for Health and the U.S. Surgeon General, and served as a lead author and editor of a landmark report titled Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan for the U.S. Department of Health and Human Services, released by Secretary Kathleen Sebelius.

Cliff is also a proponent of evidence-based informed public policy on tobacco – one that is not heavy-handed and instead seeks to meet the consumer, who is currently addicted at where they are.

What is Tobacco Control?

Tobacco use is an “industrially created epidemic” that is sustained by the activities of the tobacco industry. The burden of death and disease caused by tobacco is preventable, but preventing them requires governments to honour their commitments to implement evidence-based and cost effective legal measures to regulate the tobacco industry.

More countries are implementing effective tobacco control measures, which are having the desired effect of reducing tobacco use. Tobacco control measures (such as taxes) are implemented to not only help reduce tobacco consumption and health-care costs, but also represent a rev­enue stream for financing for development in many countries.

What is a ‘Harm Reduction Approach’ to Tobacco?

Instead of ‘Tobacco Control’ policies, a harm reduction approach aims to reduce the negative consequences of cigarette smoking by recognizing the potential benefits of using less harmful alternatives.

Both sides of the debate have engaged in what Professor Douglas calls an ‘internecine warfare’ between mainstream tobacco control community, and the tobacco harm reduction (THR) community.  The THR community emphasizes the potential benefits of vaping for adult smokers who cannot or will not quit smoking otherwise.

In March, 2021 the International Network of Nicotine Consumer Organisations (INNCO) calls for ‘Sensible Policies’ on harm reduction. Specifically, the article states:

    • “The report, “10 Reasons Why Blanket Bans of E-Cigarettes and HTPs in low- and middle-income Countries (LMICs) Are Not Fit for Purpose,” sends a strong warning to organizations and governments that limiting options to reduce harm will only increase the number of people smoking tobacco, inevitably leading to illicit markets and increases in crime.”
    • Many harm reduction advocates discuss the need for governments to regulate e-cigarettes and other vaping products – otherwise, an illicit market will be the primary place tobacco users will obtain these products. As a result, the technologies will not be regulated and users may be susceptible to very dangerous products. 

The Benefits of Harm Reduction

In Cliff Douglas’ 2019 article, “The San Francisco Ban and the Future of e-Cigarettes,” he states the following:

As part of such efforts, the FDA should review the plethora of e-cigarettes on the market and implement regulations to reverse the youth epidemic, starting with a ban (like Michigan’s) on flavored products that have not undergone premarket review and received marketing authorization by the agency. Against this dynamic backdrop, the nation must also stay focused on the public health bull’s-eye: ending smoking by maximizing proven evidence-based interventions, such as coverage for FDA-approved cessation medications and counseling, taxation, clean indoor air policies, raising the minimum age of sale to 21, and countermarketing. e-Cigarette policy should ensure product safety, prevent youth initiation, and advance the overall goal of eliminating combustible tobacco use.

You can read Cliff Douglas’ March 2021 Commentary: It’s Time to Act – here.


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