Employing tobacco harm reduction as a public health policy to drive down smoking rates in Nigeria, Ghana, Cameroon

Tobacco use is a major global public health concern. Tobacco consumption has been linked with life-threatening conditions such as cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Also, it increases risk for tuberculosis, certain eye diseases, and some immune system conditions, including rheumatoid arthritis” (Centre for Disease Control and Prevention).

The public health challenge caused by tobacco usage has been attributed to the toxic chemicals released from combustible cigarettes. Cigarette is estimated to contain 599 additives and toxic substances combustible substance. To reduce the harm or risks posed by the increasing use of tobacco products and slow down the incidence of its health risks, public health strategies have been undertaken “to manage addictive behaviours that pose severe health risks.” This “approach recognizes that for people unable to abstain from a certain risky behavior” including cigarette smoking, “public health intervention can be used to mitigate the potential dangers and health risks” (Dewhirst, n.d).

Tobacco harm reduction (THR) is a strategy aimed at minimizing the inherent toxicity of tobacco products, and the introduction of less harmful alternatives to mitigate health risks associated with tobacco use. It recognizes that encouraging people to abstain from smoking cigarettes has been somewhat very challenging and most times is ineffective. Instead, a more feasible solution is to introduce alternatives that can minimise adverse effects on the users when compared to the harmful effects tobacco consumption has on the health of its users. Among such alternatives are oral nicotine pouches and e-cigarettes. Nicotine pouches are convenient and discreet alternatives to smoking tobacco because they are smoke-free and not combustible.

They provide a soothing satisfactory experience. Benefits of nicotine pouches include: potentially less harmful alternative to cigarette through the elimination of combustion and associated toxins; they can be used discreetly in place even where smoking is prohibited and, they come in various flavours, which offers users different experiences. E-cigarettes unlike tobacco do not produce tar or carbon monoxide, two most harmful compositions in tobacco. These products have proven to help smokers reduce their tobacco intake, thereby reducing the illnesses, harm, and diseases associated with smoking tobacco.

The World Health Organization approximates that 80% of tobacco users worldwide reside in low- and middle-income nations such as Nigeria, Ghana, and Cameroon. Despite the harm tobacco use poses to the health of its users, there is an increased rate in the number of users consuming tobacco in these three countries. According to WHO, it is estimated that by 2025, there will be 16,868,400, 1,697,800, and 7,631,000 smokers in Nigeria, Ghana, and Cameroon, respectively. The high tobacco consumption rate in Africa is attributed to the youthful population with high prevalence. Low and Middle-income countries such as Nigeria, Cameroon, and Ghana are making cogent efforts to reduce tobacco consumption and its attendant risks.

As a solution to the increasing number of tobacco smokers in Nigeria, Ghana, and Cameroon, tobacco harm reduction is presented as a viable solution. Harm reduction strategies offer a promising approach to minimizing the health risks associated with tobacco smoking. After battling with tobacco smoking for years, Sweden has become the European country with the lowest rates of tobacco smoking owing to the implementation of THR.

The methodology we employed is a desk review of related articles on tobacco harm reduction strategies across three countries, namely Cameroun, Ghana, and Nigeria. The rationale for the choice of this method afforded the researchers to examine existing literature related to tobacco harm reduction strategies to gather information on the three countries under review. A total of 165 articles were reviewed, which included journals, working papers, workshop proceedings, technical papers, and newspapers.

To mitigate the harmful effects of tobacco, some of the world’s leading tobacco manufacturers, work to create alternative reduced-risk products BASED on tobacco harm reduction principles. Strategies deployed include measures to control product distribution authorization, adoption of nicotine delivery systems, price and taxation. Other strategie public awareness and education, stringent regulation, ban on tobacco advertising, promotion and sponsorship, school interventions, warning labels and plain packaging, increasing the price of cigarettes to prevent initiation, mass media involvement in tobacco control programmes, smoke-free policies, and restricting access to cigarettes by minors

In conclusion, it is significant to note that promoting tobacco harm reduction strategies is a more practical step towards reducing the health risks associated with tobacco use. To effectively reduce smoking rate, it is important to target the uptake of smoking among the young population than the established smokers. Quitting tobacco consumption may be difficulty in established smokers.
Alternatively, switching to non-combustible products is likely to benefit the smoker and the public in tobacco risk reduction. If the recommendations outlined in this policy brief are implemented, we can improve public health outcomes and lower tobacco smoking-related diseases and deaths.

This policy brief presents key recommendations for promoting tobacco harm reduction strategies in Cameroon, Ghana, and Nigeria as follows:

1. Increase awareness and education on harm reduction strategies for the general public, policymakers, and non-health ministries.

2. Governments should be transparent in their interaction with the tobacco industry by holding policy advocacy meetings in public or making minutes/reports accessible to the public.

3. There should be a strengthened collaboration between citizens and government to improve surveillance, reporting, and enforcement mechanisms. For example, in the US, there is a Tobacco Violation Act, and citizens can report any violation by submitting a form online, calling a toll-free number, or sending an email. When there are such reports, prompt action such as investigation, monitoring, or additional surveillance should be carried out.

4. The use of non-tobacco-based alternatives such as vapes and oral nicotine have been recommended to reduce smoking rate and disease burden below the acceptable average.

5. New, more modern and less harmful tobacco-free products that have been introduced into the market in the last decade such as vapes (e-cigarettes) and oral nicotine pouches should be adopted. These products have been considered to be accessible, acceptable, affordable and effective as tobacco harm reduction strategies.

References

Dewhirst, T. (n.d). “Co-optation of harm reduction by Big Tobacco.” Retrieved from https://tobaccocontrol.bmj.com/content/30/e1/e1

The author, John Tengey, is a Primary Healthcare Physician/Medical Epidemiologist