 strategies emerge as a crucial hope, particularly for historically exploited and marginalized communities within the existing economic ecosystem.){kind=link}
Smoking continues to be the leading cause of preventable deaths worldwide. It has an alarmingly high prevalence, especially among economically disadvantaged populations in low- and middle-income countries. In this scenario, Tobacco Harm Reduction (THR) strategies emerge as a crucial hope, particularly for historically exploited and marginalized communities within the existing economic ecosystem.
Surprisingly, the World Health Organization (WHO) remains reluctant to adopt the Harm Reduction approach to smoking. This could mitigate health risks and address social inequalities exacerbated by policies that traditionally prioritized capital interests over public well-being.
As we advance into the third decade of the 21st century, the effective implementation of THR faces significant but essential challenges in a landscape where political and health authorities and private entities oscillate between cooperation, manipulation, and conflict. The situation demands an unwavering commitment from the WHO to save thousands of lives through justice and equity in public health.
Tobacco Harm Reduction (THR) emerges as a contemporary paradigm in public health. It aims to mitigate the devastating health consequences associated with tobacco use, particularly smoking. Smoking is the leading cause of preventable deaths globally, predominantly affecting the less privileged classes and marginalized communities. This reflects the depth and magnitude of its impact on society.
A researcher at the Institute for Clinical and Health Effectiveness (IECS) said, “There is an inverse and constant ‘dose-response’ relationship between smoking and the income level of smokers and their families. This means that sectors with lower economic incomes have a higher percentage of smokers. This relationship is present in all geographical areas of the world, making it a global phenomenon, seen in both sexes and all ages.” According to the WHO, around 80 percent of the 1.3 billion tobacco users worldwide live in low- and middle-income countries.
Harm Reduction can be interpreted as a health intervention strategy and a necessary response to the inherent injustices in policies regarding access to healthy habits from a social perspective. This includes access to more nutritious products, medical resources, and medications. The sectors driving this industry perpetuate social conditions that foster cycles of dependency and public health deterioration. They are motivated by profit and sustained by the oppression of the less privileged classes—who are simultaneously the productive force and disproportionately the most affected by tobacco-related diseases. This keeps millions of people marginalized from the advances of medical science and new health technologies, often under the neglect of the World Health Organization itself.
No one can doubt that the technical and scientific body of the WHO recognizes that Tobacco Harm Reduction promotes the use of safer technological alternatives for nicotine consumption, such as e-cigarettes, nicotine pouches, and heated tobacco products. They surely know that these alternatives can significantly reduce or eliminate the ingestion of carcinogens like tar and other toxic compounds that are omnipresent in tobacco smoke.
There is a widespread deduction that Tobacco Harm Reduction not only addresses the direct harms associated with tobacco use but also subtly challenges the dominance of a health and disease industry that often prioritizes its profits over the well-being of the population through the use of safer technological alternatives for nicotine consumption.
Decision-makers know this approach can subvert capitalist logic by reducing the demand for specific products. This, in turn, erodes the economic foundations that sustain the power of large corporations in the consumer products sector, which impacts health or reduces certain diseases. This awareness highlights the complex interaction between public health, economic interests, and regulatory policies that shape our society.
This can be interpreted as a reflection of the tension between capital’s interests and society’s collective needs in public health and regulation.
The World Health Organization has generally maintained a cautious, rigid, or neglectful stance regarding tobacco harm reduction strategies. This varies according to each country’s specific social, political, and economic context. Still, it often focuses more on income level and material capacity than on the public health burdens related to smoking. This underscores that economic structures and power relations influence all spheres of social life, including health.
Different Strategies, Different Results: The Global Inconsistency of the WHO in the Fight Against Tobacco
In this context of injustices, the active presence and development of humanizing policies led by the World Health Organization would be essential. The WHO could play a fundamental role by providing clear, evidence-based guidelines on the risks and benefits of various nicotine products to support public health policies that effectively promote harm reduction. However, its stance is marked by a curious imbalance: it is versatile according to the socioeconomic environment, reserved in the Global North, and resistant in the Global South.
Some places in the world have different destinies or luck. Encouraging advances in THR have been observed in New Zealand, Sweden, and the United Kingdom. In these countries, public health agencies support e-cigarettes as a safer alternative to tobacco. They encourage smokers to switch as part of comprehensive tobacco control strategies.
This support represents a recognition of the need to adopt pragmatic and evidence-based approaches to combat the risks associated with tobacco use. It marks a crucial step towards mitigating the impact of this habit on public health. Generally, they do not face criticism or strict policy defenses regarding promoting alternative tobacco products. This is due to the lack of conclusive evidence on their long-term safety and effectiveness as cessation tools.
In regions such as many former colonies in Africa, certain areas of Asia, and Latin America, where tobacco consumption rates are persistently high and public health infrastructure is often deficient or practically nonexistent, integrating Tobacco Harm Reduction into public health policies represents a significant and urgent challenge.
Given the ongoing struggle between various socioeconomic forces, there is an implicit prohibition against adopting such strategies in these places. These forces shape a social structure that often places corporate profits above public welfare, further complicating efforts to prioritize and improve public health in these regions.
In addition to material obstacles, these regions face the challenge of changing mindsets and countering the lobbying efforts of powerful economic interests in the health and disease industries. Misconceptions about the relative risks of different nicotine delivery systems hinder public understanding and obstruct any transition to safer alternatives.
These misunderstandings demand a concerted effort to educate and politically empower affected communities, as they are deeply rooted in a history of information manipulation and exploitation. Civil society generally championed this process, essential to overcoming the barriers that impede progress toward more effective and equitable public health policies.
On the other hand, the World Health Organization has adopted a cautious and critical stance towards harm reduction, operating under the Framework Convention on Tobacco Control. This attitude reflects a notable disparity in how the WHO addresses the issue in different countries, highlighting variations in its guidelines and their application depending on each nation’s socioeconomic and regulatory context.
While the WHO has expressed significant concerns about the potential of harm-reduction products, such as e-cigarettes, to serve as gateways to smoking for young people and non-smokers, their reception varies significantly between nations. For example, in countries like the United Kingdom and New Zealand, which have robust regulatory frameworks, the WHO admits and accepts the implementation of harm reduction policies. This underscores how each country’s socioeconomic context and public health policies influence the organization’s stance and recommendations.
However, the WHO’s acceptance reveals a notable inconsistency. It suggests that only countries with advanced regulatory systems and sufficient resources can adequately handle these harm reduction approaches. This situation raises severe criticisms about the equity and universality of global health policies. It highlights a bias towards wealthier nations and leaves low- and middle-income countries in a vulnerable position without the possibility of effective regulation.
This underscores the need for a more inclusive and equitable policy that ensures all nations can benefit from best practices in the fight against smoking. Regulation is a tool to mediate and sometimes resolve the contradictions between different forces (in this case, public health interests and economic capital), potentially favoring a more community-oriented approach.
Tobacco Policies and Social Justice: The Dilemma of Prioritizing Health Over Other Interests
The active presence of the public sector is fundamental to guiding and strengthening efforts to promote public health. However, it is often weakened by robust private economic interests or divergent orientations of health authorities.
The effective integration of Tobacco Harm Reduction into public health policies is a complex but indispensable challenge, especially those targeting marginalized or economically exploited populations. This process demands a careful, detailed, and nuanced approach that considers the socioeconomic and cultural realities of the different affected groups, with particular attention to their material and health conditions.
The state’s role in regulation (in the broadest sense of ‘protection’) and the rigorous oversight of private entities’ participation in health policies is fundamental. It intends to ensure that commercial interests do not overshadow public health benefits. This approach ensures that the measures implemented meet health objectives and promote equity and social justice within the community, with transparency and citizen participation.
The private sector actors’ involvement in Tobacco Harm Reduction creates a complex and often contradictory landscape, requiring effective mediation by the state to protect public interests.
On one hand, pharmaceutical companies have played a fundamental role in developing nicotine replacement therapies (NRTs), such as patches, gum, and lozenges. However, these same companies seem to strive to maintain their hegemony and commercial dominance over the available alternatives for smoking cessation, especially in low- and middle-income countries.
The tobacco industry’s involvement in harm reduction provokes justified skepticism due to its prolonged history of downplaying the risks associated with tobacco use. Paradoxically, this same industry, which is mainly responsible for the problem, also has the resources to offer solutions. This is evident in the commercial transformation of its most harmful products into lower-risk, more attractive, affordable options, posing a significant ethical and regulatory challenge.
Although the industries involved can significantly contribute to reducing smoking rates, there are significant concerns regarding their marketing strategies, especially in the case of tobacco companies, and their profit-maximization goals, which are particularly notable in the pharmaceutical industry. These approaches can undermine efforts to promote public health and call into question the genuine commitment of these companies to tobacco harm reduction.
These concerns underscore the potential of these realities to undermine broader efforts in tobacco control and public health promotion. These dilemmas highlight the need to establish a stricter and more transparent regulatory framework that ensures the actions of these industries effectively align with global public health objectives.
Prioritizing the Common Good, Dialogue, and Action
Active and transparent participation by the state, organized civil society, and other stakeholders is fundamental in guiding efforts to promote public health. This collaboration must align with the World Health Organization’s objectives and purposes, which embrace its modern health concept. This encompasses complete physical, mental, and social well-being and not merely the absence of disease.
The effective integration of Tobacco Harm Reduction into public health policies represents a complex but essential challenge, especially for vulnerable populations. This process requires a detailed and careful approach, considering the socioeconomic and cultural realities of the groups involved and developing assertive policies that promote open and ongoing dialogue with all stakeholders.
The state’s role is fundamental in regulating and promoting this inclusive dialogue and maintaining strict oversight of private entities’ participation in public policies. It is required to ensure that commercial interests do not outweigh public health benefits and guarantee that the measures adopted favor general well-being over particular interests.
Especially in the Global South, where most of the people affected by smoking are located, the expanded public sector must exert effective control to ensure that harm reduction strategies are inclusive, based on solid evidence, and meticulously adapted to meet the needs of the most vulnerable.
Adopting a collectivist approach prioritizing the common good over private benefits is necessary to promote equitable and effective public health. This approach ensures that policies address the health imperatives defined and often ignored by the WHO and contribute to social justice and progress toward a healthier and fairer society.
Tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries. https://www.who.int/news-room/fact-sheets/detail/tobacco
The WHO emphasizes strategies like smoking cessation, increasing taxes on tobacco, implementing public smoking bans, and conducting public health campaigns as the most effective means of reducing tobacco use and its associated health risks. https://www.who.int/docs/default-source/campaigns-and-initiatives/world-no-tobacco-day-2020/wntd-tobacco-fact-sheet.pdf?sfvrsn=e77859a4_2
The recurrent system in which large industries, such as pharmaceuticals and food, operate often perpetuates cycles of dependency and deterioration of public health. These practices, driven by profit motives, frequently neglect social needs and create individual barriers to achieving good levels of health. This is evident in the health disparities that primarily affect marginalized, vulnerable and socioeconomically disadvantaged communities. https://www.hhrjournal.org/2013/08/social-conditions-health-equity-and-human-rights/