Tobacco Control and Harm Reduction?

1. Tobacco Control and Harm
Reduction?
Dr Fenton Howell, Department of Health, Ireland
Colette Rogers, Public Health Agency NI
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2. Workshop
• Current Practice
• Brief outline of issues around harm reduction and
public health interventions
• Group work
– Do harm reduction strategies have a place in tobacco
control?
– If yes, what form should it take, what are the
benefits/risks?
– If no, what are the benefits/risks? what other
alternatives are there to support current supply and
demand reduction strategies in tobacco control?
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3. 3

4. NI ROI
• 20% prevalence
• 6 people per day die
in NI from Smoking
related illness
• 86% of all deaths
from lung cancer
• 85% of all deaths
from Chronic Lung
Disease
• 22% prevalence
• 16 people per day die
in ROI from Smoking
related illness
• 86% of all deaths
from lung cancer
• 85% of all deaths
from Chronic Lung
Disease
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5. What is harm reduction?
• Harm reduction is a pragmatic approach (public
health policies, interventions or programs)
designed to reduce the harmful consequences
associated with substance use and high-risk
activities.
• Harm reduction cuts across the spectrum from
safer use to managed use to abstinence.
• Primary goal of most harm reduction strategies is
to meet individuals “where they are at”
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6. Examples of harm reduction
• Illicit drugs:
– Needle syringe programmes
– Opiod substitution – e.g. Methadone
– Safe injecting facilities
– Overdose –prevention programmes- naloxone
• New national strategy: Reducing Harm,
Supporting Recovery – a health-led response
to drug and alcohol use in Ireland 2017-2025
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7. Examples of harm reduction
• HIV/AIDS/STI:
– Condoms
– Safe sex
• Unwanted Pregnancy:
– Contraception
– Emergency contraception
• Road traffic accidents
– Seatbelts, airbags, crumple zones etc
• Safe participation in sport:
– Helmets- cycling, hurling, cricket, hockey etc
– Life vests – water based activities
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8. Why harm reduction and tobacco
control and why now?
• WHO Framework Convention on Tobacco
Control (WHO FCTC) defines tobacco control
as: a range of supply, demand and harm
reduction strategies that aim to improve the
health of the population by eliminating or
reducing their consumption of tobacco
products and exposure to tobacco smoke
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9. Why harm reduction and tobacco
control and why now?
• Magnitude of the risk
– One in every two smokers will die from a tobacco
related disease
• Worldwide
– 1 Billion smokers
– Spend $700 billion annually on cigs
– 6 million dying annually
– Expected to get worse
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10. Why harm reduction and tobacco
control and why now?
• Tobacco Free Ireland Page 51:
There is a requirement for alternative, less harmful
forms of nicotine. Whilst there are smokers who are
able to quit abruptly, either alone or by using
current support mechanisms, there are others who
are unable to. These people need an alternative
measure of support to reduce the harm they
experience from tobacco use. This can involve the
use of alternative safer sources of nicotine while
they reduce their tobacco consumption in
preparation to quit.
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11. Why harm reduction and tobacco
control and why now?
Ten Year Tobacco Control Strategy for NI (pg.44)
Levels of tobacco addiction vary and some smokers,
in spite of frequent and determined efforts to quit
smoking, find it impossible to completely break the
addiction. In such cases, harm reduction schemes
can reduce the risks to health through the regular
substitution with NRT products… The Department of
Health will continue to keep this subject under
review.
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12. Why harm reduction and tobacco
control and why now?
NICE Guideline – Stop Smoking Interventions and
Services - Draft for Consultation Sept 17 (pg6)
Those who advise people on how to quit smoking
should…
• Encourage them to seek help to quit smoking
completely in the future
• Ask them to think about adopting a harm
reduction approach (see NICE guideline on
smoking: harm reduction)
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13. Why harm reduction and tobacco
control and why now?
• Changed landscape: newer and less harmful
modes of nicotine now available;
• For years – combustible products only- dirty
delivery systems: cigarettes, pipes etc
• Now there are safer alternatives (not safe):
– Medicinal nicotine therapy
– Oral smokeless tobacco (SNUS – Sweden)
– Aerosolized nicotine delivery – without tobacco
– Heat -not-burn tobacco products; aerosolised
nicotine.
– Technological disruptions suggest more alternatives to
come.
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14. Harm reduction and tobacco control
• Its controversial, not only in tobacco control
• Harm reduction v zero tolerance
• People on both sides are finding evidence that
supports what they want to believe
• Previous “harm reduction” efforts were
unsuccessful – light/low tar cigs
• Nicotine addicts:
– nothing about me, without me
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15. Public health objectives
• Control/regulation should be proportionate to
the real risks
• Manage those products with different risk
profiles differently
• Avoid unintentional consequences: protecting
the most harmful at the expense of the least
harmful
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16. Public health intervention ladder
What policy choices will leads to fewer funerals in years to come?
Eliminate choice: ban completely
Restrict choice: remove unhealthy ingredients from food
Guide choice through disincentives: tax on sugary soft drinks
Guide choice through incentives: fiscal – Bike to work scheme
Guide choice by changing the default policy: Chips as the standard or , veg as the
standard with chips as the option
Enable choice: build cycle lanes, offer help to quit, provide free fruit at schools
Provide information: inform and educate the public e.g 5 a day, 10,000 steps
Do nothing
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17. Workshop
• Group work
– Do harm reduction strategies have a place in
tobacco control?
– If yes, what form should it take, what are the
benefits/risks?
– If no, what are the benefits/risks? what other
alternatives are there to support current supply
and demand reduction strategies in tobacco
control?
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