A shift to smoking harm reduction

Dr Eric Crampton
The Post
27 January, 2024

If Guyon Espiner at Radio New Zealand is right about Associate Health Minister Casey Costello’s plans for tobacco policy, there is reason to celebrate. At least for those who care about harm reduction, proportionality, and civil liberties.

The incoming government’s coalition agreements had already signalled a substantial change in approach to tobacco policy. Rather than rely on punitive measures that make life harder for current smokers, the incoming government would make it easier for smokers to shift to far less harmful ways of getting nicotine.

Prior to losing office, the Labour government had legislated a 90% reduction in the allowed number of tobacco retailers, to start taking effect this year; a prohibition on cigarettes containing any appreciable amount of nicotine, to take effect from 2025; and, a ban on tobacco sales to anyone born after 1 January 2009, which would have begun to have an effect from 2027.

The coalition agreements promised to repeal those policies, so they will not come into effect. Instead, the agreements encouraged reduced-harm alternatives to smoking.

As Action on Smoking and Health’s Professor Robert Beaglehole and Ben Youdan pointed out earlier this month, these repeals will not jeopardise the Smokefree 2025 goal. Smoking rates halved between 2018 and 2023, with fewer than 7 per cent of Kiwis now smoking daily. Among 15- to 24-year-olds, the rate is 3 per cent. The increase in vaping over the same period does not seem coincidental. As vaping became more available, and legal, smokers shifted to that far safer alternative.

This week, Guyon Espiner reported that Associate Minister Costello had sought advice on freezing tobacco excise for the next three years, rather than increasing excise to reflect inflation. He noted the government is doing the necessary due diligence around the coalition agreement’s promise to remove tobacco excise from reduced-harm heated tobacco products. And he highlighted Costello’s preference for broadening the range of reduced harm alternatives to include snus – which had also been signalled in the coalition agreements.

Espiner also noted Otago Public Health Professor Janet Hoek’s scepticism about legalising a greater range of reduced-harm alternatives, in contrast to the government’s approach. It is the standard way that tobacco policy is reported: industry, or the current government, contrasted with Otago’s researchers’ views.

But the public health community is hardly of one view. Action on Smoking and Health’s Beaglehole and Youdan do support maintaining tobacco retail licensing with an eventual gradual sinking lid on outlet numbers, but also supported “legalising a greater variety of safer nicotine products such as snus and nicotine pouches”.

To put things most simply, there are two contrasting and conflicting approaches to tobacco harm reduction in the public health community.

One approach sees nicotine consumption as a harm in itself, because nicotine consumption can lead to nicotine dependence even if there are only trivial health consequences from that consumption. In that view, shifts to vaping or other reduced-harm alternatives are only a minor victory, because people continue to rely on nicotine.

That view leads to a more prohibitionist policy agenda. Vaping is mainly seen as a transitional step towards nicotine prohibition and is to be sharply discouraged except among current smokers. An increased range of low- to no-harm alternatives may help reduce the health costs of smoking but is seen as risky because more people will consume nicotine over a longer period.

It is the approach that has generally been favoured by the University of Otago’s public health researchers. 

The alternative approach focuses more sharply on making sure that those who enjoy nicotine, or who are dependent on it, or both, have the widest possible range of alternatives to cigarettes. Smoking’s substantial harms come from combustion, not from nicotine. Making sure that smokers are supported in finding a form of nicotine that they prefer, and whose harms will be trivial relative to cigarettes, is their highest priority.

They also weigh the harms imposed by tobacco control policies, including the burden that tobacco excise imposes on poor households that continue to smoke when an inadequate range of reduced-harm alternatives are available. They remind us of inconvenient consequences of prohibitionist approaches, including that bans on disposable vapes would have disproportionate effects on disadvantaged groups with higher smoking rates and make it harder to reduce smoking’s harms.

The change in approach with the change in government is far less about the country’s commitment to the SmokeFree goal than it is about the approach that should be followed in getting there. Heated tobacco products have helped reduce smoking in Japan. Oral tobacco products, like snus, have helped Sweden sharply reduce smoking rates. Taxing heated tobacco as though it is as harmful as cigarettes, and maintaining a ban on snus, seems inconsistent with harm-reduction.

The shift in focus from prohibition to harm reduction, and toward regulation and taxation that is proportionate to actual risk, should be welcome.

To read the full article on The Post website, click here.

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