What is THR?

``Existing forms of tobacco control are proving insufficient. While many people give up smoking, on their own or with medicinal products, many fail. ‘Quit or die’ is no longer the only option for those who cannot give up. Safer nicotine products offer another way. There is substantial international, independent evidence that these products are demonstrably safer than cigarettes. These potential lifesaving products could lead to a global revolution in public health.``

– Tobacco harm reduction and the right to health (2020). London: Knowledge•Action•Change. ISBN 978-1-9993579-4-8

Tobacco Harm Reduction (THR)

Harm reduction is a range of pragmatic policies, regulations and actions that either reduce health risks by providing safer forms of products or substances, or encourage less risky behaviours. Harm reduction does not focus exclusively on the eradication of products or behaviours.

Tobacco harm reduction, using safer nicotine products, offers new choices to millions of people worldwide who want to switch away from smoking, but have been unable to with the options previously available. 

There is substantial international, independent evidence that the safer nicotine products that are available today – including nicotine vaping devices (e-cigarettes), heated tobacco products and Swedish-style oral snus – are demonstrably and significantly safer than smoking tobacco. 

Until now, official responses to tackle the death and disease caused by smoking have been led by tobacco control. While it has achieved much, it has not eradicated tobacco use. Millions of people worldwide are either unable or unwilling to give up nicotine and continue smoking tobacco to consume it.

The THR Proposition

Harm reduction is based on the principle of trying to reduce the risk of using certain products or engaging in certain behaviours or activities;

It recognises the reality of aiming to reduce risk rather than believing that risk can eliminated;

There are examples of harm reduction in many areas of daily life, such as road safety;

But in the context of public health it has particular resonance, existing as it does at the crossroads between public health and human rights;

The pioneering examples operating at this intersect were the grassroots activity among the gay and drug-using communities, looking to protect their health through safer sex and drug-using strategies in the face of official marginalisation and discrimination;

In higher income countries, smoking levels remain highest among marginalised communities. In many low- and middle-income countries, smoking levels have plateaued and population increases look set to increase the number of people who smoke.

Millions of people should not be denied access to products that can help them avoid poor quality of life, disease, and premature death. Preventing access to these products denies people their right to health as enshrined in many international health conventions. 

Where safer nicotine products are accessible and well regulated, the evidence is clear. People quit combustible tobacco in huge numbers and switch to these products – making the choice to improve their own health, at almost no cost to governments and taxpayers. 

Yet bans on safer nicotine products are rising, including in those countries where the number of people who smoke is predicted to increase due to population growth. Government policies and regulation are being unduly influenced by flawed science and anti-harm reduction lobbying, leading to sensational media coverage. Flawed public health information in many countries is confusing and misleading people who want to switch away from smoking. 

Similar problems accompanied the introduction of many previous drug or sex harm reduction strategies when they were still new. With tobacco use, the number of people directly affected is vast. Will the transformative public health potential of tobacco harm reduction be realised? Or will this opportunity to save millions of lives be squandered, as a decades-long war on tobacco turns into an all-out war on nicotine? 

The above explanation of Tobacco Harm Reduction is from the publication Tobacco harm reduction and the right to health (2020). London: Knowledge•Action•Change. ISBN 978-1-9993579-4-8. The full report, detailing the state of THR across the world, as well as many other resources, can be accessed for free at GSTR.org