Evidence that smoking cigarettes has adverse effects on the healthcare system, users and the environment has existed as far back as 1964. However, smoking cessation remains a difficult task, though policies, societal attitudes and campaigns continue to advocate for it.
Over the years, efforts have been made through the harm-reduction drive: the adoption of draconian policies and the introduction of less harmful alternatives such as e-cigarettes, vaping products and oral snuff pouches.
The habit, however, persists. A 1964 US surgeon general's report on tobacco cautioned smoking was negatively affecting people’s health. It found that on average, those who smoke less than 10 cigarettes a day had a 40% chance of dying earlier than those who did not smoke. Additionally, users who smoked up to 19 cigarettes a day had a 70% chance of dying.
There can be no doubt that smoking is detrimental to people’s health and smoking cessation, over and above harm-reduction, should be encouraged.
The Global Adult Tobacco Survey of 2021 found that of the 12.7-million adult population of South Africa, 29.4% used tobacco. The general perception is the country’s public healthcare system is, as a consequence, more strained than is necessary.
Which country has done harm-reduction right and what should we learn from them?
Sweden is one of the countries that took a decision to switch from smoking to smoke-free products and snuff was widely adopted as a safer option.
This created the Swedish Experience concept. The country has famously reduced the number of smokers in its population by 5% and thereby reduced the burden on the healthcare system.
According to the Swedish Experience 2023 report, compared with other countries in Europe, Sweden has a 36.6% low rate of tobacco-related illnesses.
“Over the past 15 years, Sweden has slashed its smoking rates from 15% in 2008 to 5.6% today. Sweden is one of three countries with the lowest number of deaths attributed to lung cancer,” said the report.
This approach was heavily influenced by the country’s history and attachment to snuff. Tobacco was reputably used to heal debilitating headaches suffered by Queen Catherine de' Medici of France in the 1560s. The Swedes also embraced cigarettes after the French Revolution but later went back to using snuff after the release of the US surgeon general's report on tobacco.
Though this experiment provides evidence that smoke-free products reduce the risk of tobacco-related diseases and are beneficial for the overall sustainability of the wellbeing of a population, is a world without cigarettes a possibility? Can the South African market embrace snuff over puffs?
The benefits of having fewer smokers will benefit smokers and non-smokers alike. A smoke-free nation is a healthier nation. All efforts should be made to achieve this
Snuff consumption also forms a part of the South African consumer market but mostly for spiritual reasons. Snuff powder is predominantly popular among older women in rural areas. A research paper investigating the perceptions of smoke-free products used in the northern provinces found snuff was not a trendy merchandise but one used for a purpose.
“Snuff was found to have important functions and to be socially acceptable in the groups studied mainly for ceremonial and medicinal use and to a lesser degree for relaxation and pleasure.
“Most participants agreed it is addictive but only a few acknowledged the negative effects in causing cancer,” the report found.
The emergence of e-cigarettes as an alternative has also complicated the harm-reduction conversation as the products have attracted a younger market as they are easily available and poorly regulated.
The government has previously considered stringent measures to curb the prevalence of smoking, control access of new products in the market and align to international standards.
In 2017, 8-million deaths globally were ascribed to tobacco, according to the World Health Organisation.
The Tobacco Control and Electronic Delivery Systems Control Bill formed part of the plans under the previous government but was not passed as it received a heavy backlash from the tobacco industry.
Under the government of national unity, the move to regulate smoking is being revisited. Two weeks ago health minister Aaron Motsoaledi announced the country was still committed to a smoke-free future vision and further consultations were to take place.
The bill seeks to restrict indoor and public use, adopt uniform packaging and labelling of nicotine boxes, but also prohibit the advertising and visibility of e-cigarettes and vapes.
While consultation with stakeholders is crucial, a perception that the government is tiptoeing around this bill because of powerful interest groups cannot be avoided. We hope the government remembers the intention — saving people’s health — is no doubt in the right place and the protection of the people, even if from themselves sometimes, should take centre stage.
The benefits of having fewer smokers will benefit smokers and non-smokers alike. A smoke-free nation is a healthier nation. All efforts should be made to achieve this.
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