A the brutal culture war is raging over the role of harm reduction in accelerating the end of smoking. But as Twitterstorms rumble, evidence mounts that safer nicotine products…vapes, sachets, snus and heated tobacco—help millions of people around the world to quit flammable cigarettes and other dangerous uses of tobacco.
The cigarette is a harmful delivery mechanism for nicotine – and nicotine does not cause tobacco-related disease. Choice now available deliver nicotine at a significantly reduced risk. More Swedes consume snus than cigarettes, resulting in the lowest lung cancer rates of any EU country. In the UK, vaping is supported by health authorities as a weaning tool. About 7% of adults (six million people) vape; a year-over-year increase in vaping is accompanied by a decrease in smoking, and more than a quarter of people who tried to quit smoking in England in 2020 did so by switching to vaping. These products reduce harm at both the individual and population level.
For harm reduction advocates, great collective energy is invested in discussing scientific and regulatory issues. It is important, both to quantify and to maximize the benefits of safer nicotine options, and because there are many countries where poor regulation or outright banning prevents access. Thirty-six countries currently ban the sale of nicotine vapes, 39 selling snus and 14 the sale of heated tobacco.
A human rights-based approach offers us important and yet unexplored opportunities to challenge bad laws and policies.
In contrast, combustible cigarettes are widely available everywhere, and in 18 countries, the state is directly involved in the manufacture of deadly tobacco products and profits from it. In Los Angeles, you can buy THC gummies in flavors like sour lemon and strawberry, and cigarettes at any store around the corner. But one new ban means you can’t buy flavored vaping products, which many vapers find quitting smoking completely essential.
However, it is also important for us to examine the more fundamental basis of the argument for safer nicotine options. It can be said forcefully that international human rights law supports tobacco harm reduction. A human rights-based approach offers us important and yet unexplored opportunities to challenge bad laws and policies.
The role of health rights in harm reduction was an integral part of my work on drug use and HIV/AIDS in the UK from the 1990s. prohibitions, prevention and abstinence. In many countries around the world, this is still the case. Yet the focus on reducing drug supply and demand began to fracture with the advent of HIV/AIDS, when it became apparent that safer drug use, or the reduction harm, could limit the spread of the virus.
Beginning in the early 2000s, organizations such as Human Rights Watch and the International Harm Reduction Association, which I headed, campaigned to establish that harm reduction was about the right to health. These organizations have worked with the United Nations Special Rapporteurs on the right to health, who have advocated within the United Nations system that interventions such as the provision of safer drugs and delivery systems – substitution treatment to opiates and access to needles – were fundamental to the health rights of people who use drugs.
The parallels with tobacco harm reduction are clear. And the need is clear: There are 8 million smoking-related deaths each year. This is three times the number of deaths from HIV/AIDS, tuberculosis and malaria combined. This is 10 times more than all the deaths linked to the use of drugs banned by the state.
A difficulty in developing these tobacco arguments is that human rights repercussions have long been ignored in tobacco control. While harm reduction is referred to as the third “pillar” in the 2005 World Health Organization report Framework Convention on Tobacco Control (FCTC)besides supply and demand reduction, the FCTC is not a human rights treaty and no human rights framework has been incorporated into the text.
Human rights were hardly taken into account during the treaty negotiations. No delegate or NGO involved in the process raised the issue. Subsequent discussions of human rights in tobacco control have focused on the state’s obligation to protect people from the violation of their rights by third parties, primarily identified as the tobacco industry. These deal with the demand and supply components of tobacco control and can be referred to as a ‘free from’ position. Political philosopher Isaiah Berlin called this concept “negative freedom,” describing freedom from outside constraints and influences.
We desperately need a alternative narrative to the mainstream view on tobacco control that harm reduction can only be about protecting against tobacco.
Yet the right to health and the personal autonomy to take positive action to protect one’s own health have been neglected. This is not surprising, given the neglect and denigration of harm reduction by FCTC Parties, FCTC Secretariat and WHO.
Ironically, the preamble to the Constitution of the World Health Organization (1946) which is recognized as the first declaration of the right to health in international law. It stipulates that “the possession of the best state of health that he is capable of attaining is one of the fundamental rights of every human being without distinction of race, religion, political opinion, economic or social condition”. and “the extension to all peoples of the benefits of medical, psychological and related knowledge is essential for the attainment of full health.
In 1966, the International Covenant on Economic, Social and Cultural Rights (ICESCR) has been ratified by 171 countries. Article 12 enshrines the right of everyone to “enjoy the highest attainable standard of physical and mental health” and stipulates that everyone has the right “to benefit from scientific progress” (article 15).
The quest for the highest state of health is about enabling people to protect themselves. This can be called a position of “freedom from” or “positive freedom”. With respect to tobacco, this would include the freedom to choose safer alternatives to combustible cigarettes or risky oral tobacco products, in order to avoid smoking-related diseases and premature onset death. A rights-based approach that blends both the elements of “freedom from” and “freedom from” is central to most public health thinking. in other spheres. The exclusive invocation of negative freedom in anti-tobacco discourse is an anomaly.
This tobacco control blind spot costs lives – millions of lives – every year. The right to control one’s health and one’s body is at the heart of tobacco harm reduction. It allows people to make safer choices.
We desperately need a alternative narrative to the mainstream view on tobacco control that harm reduction can only be about protecting against tobacco. Times and technologies have changed since the FCTC came into effect. Taking the right to health as a starting point, FCTC and WHO signatories have a responsibility to take positive action to ensure that safer alternatives are available to the world’s 1.1 billion smokers. .
Those of us involved in tobacco harm reduction must build alliances with those working in human rights, explore the challenges posed by international, regional and national legislation, and make harm reduction tobacco a fundamental element of the right to health.
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Professor Gerry Stimson will discuss this topic in a panel entitled “Safer nicotine: human rights and legal challenges”, at the World Nicotine Forum 2022To take place in Warsaw and on line June 16-18. The session is one of many from #GFN22 that will be streamed live free for registered delegates. It is also the subject of a new Global State of Tobacco Harm Reduction (GSTHR) Briefing Paper, which will be launched in Warsaw on June 18 by Knowledge-Action-Change. The GSTHR, of which Stimson is the project leader, receives funding from the Foundation for a Smoke-Free World.
The World Nicotine Forum is organized by KAC Communications, the sister company of Knowledge-Action-Change. The Influence Foundation, which operates Filteredhas received grants from Knowledge-Action-Change and the Foundation for a Smoke-Free World. Filtered is an official media partner of GFN. Filteredit is Editorial Independence Policy applies.