What is the common thread between sunscreen, vaccines, condoms, seat belts, smoke-free tobacco consumption and speed limits?
Harm reduction: a public health, safety and social approach to reducing risk and creating safe spaces for users of different products that could pose damage. A concept that was discussed at length by industry experts at the fourth Harm Reduction Exchange hosted by Integra Africa in Nairobi, Kenya, last week.
It is meant as a pragmatic, compassionate approach that recognises that human behaviour can be destructive, but measures can equally be put in place to support choice. However, the group of experts at this event alleged that trying to implement this approach to smoking cigarettes and drug abuse continues to be a challenge.
Speaking about the cost of smoking and integrating harm reduction in policies, Prof Nnanyelugo Ike-Muonso from Nigeria, director-general of the Raw Materials Research and Development Council, raised concern that HR is not mainstreamed in public health discussions.
“There is a classification issue that shapes the debate on tobacco harm reduction. Are they risk-reduction products or are they medicinal products? This changes the way the government and media look at harm-reduction products.
“Many people, especially religious communities [when they] see smoke coming out of the e-cigarette, they see it as tobacco and not otherwise. It is key to consider how we incorporate this in harm-reduction policies. Vapes and e-cigarettes would be taxed less if they were viewed as something that saves lives.
We can have two types of futures: one, we talk about this for the rest of our lives, or we can ensure the future comes to life by the steps we can take today.
— Samuel Hanu from Harm Reduction Alliance
“There is a perception by professionals in public health that you should not give people a chance to use harm reduction interventions, as this will keep them in the cycle of smoking tobacco. This bias exists because they have not been exposed to enough scientific evidence to accept these alternative harm-reducing products,” Muonso said.
He emphasised that other African countries, such as Nigeria, seem to move at a slow pace in popularising HR, and the likes of Kenya and Ghana are moving in a different direction.
“Kenya has implemented a number of policies and regulations to reduce the harm of Tobacco HR use, including Tobacco Control Act 2007, which requires graphic health warnings on e-cigarette packages and bans smoking in public places.
“The Tobacco Control Policy is aligned with the constitution of Kenya and the Kenya Vision 2030.”
Delving into what HR looks like in Africa, Samuel Hanu from Harm Reduction Alliance in Ghana, said that though 108 countries include it in their national policies, often the criminalisation and punitive responses to drugs remain dominant in most places.
“These approaches undermine HR efforts, and they continue to fuel stigma and deter people who use substances from seeking vital, life-saving services. When science and policy align, the results save lives.
“We can have two types of futures: one, we talk about this for the rest of our lives, or we can ensure the future comes to life by the steps we can take today,” Hanu said during the conference.
Additionally, an investment in holistic harm reduction programmes with specific gender-sensitive services and interventions is necessary to meet the needs of women who use and inject drugs.
“Such programmes must consider creating safe spaces where women feel secure and respected, free from judgment or discrimination.
“Involving female peers in the programmes can be an effective way to foster trust and encourage participation,” he said.
Hanu remarked that the healing powers that exist within African communities should be cultivated. “Historically, we had traditional solutions to various ailments. In Africa there is a large treatment gap, hence we need to leverage the strength in our communities and contextualise the solutions to them,” he added.
In South Africa, a contentious bill, the Tobacco Products and Electronic Delivery Systems Control Bill, is with the National Economic Development and Labour Council (Nedlac) for review.
The bill seeks to control smoking habits, and introduce stringent measures on the sale and style of packaging of tobacco products and smoking devices, has been a major point of criticism, with the industry arguing it is misguided and poses unfair measures.
Part of the reason it is pushed back is that the standardised package labelling strategy will potentially lead to further illegal infiltration of the market and loss of jobs.
Martin Agwogie, executive director of the Global Initiative on Substance Abuse , said “no-one will ever achieve perfect health behaviours.
“Health behaviours and the ability to change them are influenced by social and community norms; behaviours do not occur in a vacuum. A range of supportive approaches should be provided, there should be care messages about actual harms to patients as opposed to moral or societal standards.
“Thus, abstinence is neither prioritised nor assumed to be the goal of the patient, also behavioural interventionists should be encouraged to reduce risk factors,” Agwogie said.
Harm reduction is a movement that started in the 1970s by activists as a controversial set of ideas challenging global drug policies on the total prohibition of drugs, the criminalisation of drug use and the “war on drugs”.
The other side of the coin is that Big Tobacco stands accused of being ostentatious when it comes to smoke cessation efforts, with new products such as vapes attracting a younger and new market due to its accessibility and advertising standards.
An additional allegation towards the industry is that they interfere with policy design that aims to reduce harm and encourage healthier choices.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.