Risk proportionate tobacco regulation and the science to support it
The 3rd annual Tobacco Harm Reduction Summit 2020 (largest in the world) saw global scientists and harm-reduction advocates discuss, debate and present strategies around tobacco harm reduction, regulations and the use of science to combat the current cigarette epidemic.
The first keynote speaker, David T. Sweanor J.D., talked about “Risk proportionate regulation and the science to support it” and how we can use regulation and science to get rid of the cigarette-caused epidemic.
Smoking is regarded differently than other public health issues that we dealt with historically; yet the same principles apply to smoking. Good public health practice means, when we identify a risk, we seek to reduce it-he said- using medical science to investigate what causes disease, and policy to deal with it. Policy is about changing the rules and using regulation (and litigation) to reduce health risks, he noted; to take measures against the most hazardous products. There is a vast range of examples, where industries were transformed to ensure more safety.
In the case of cigarette smoking, although we know for decades that cigarettes are deadly—cigarettes kill nearly 2/3 of their long-term users—and it is the fact that they inhale smoke that is deadly. In other words, while people smoke for the nicotine, they die from the smoke.
Based on this knowledge, there is a potential for people who seek nicotine to get it through other less hazardous products, without the smoke, and it is possible to change to non-combustible smoke; the technology already exists and there are examples—such as Norway, Iceland, Japan—where the transformation to non-combustible products has been achieved.
So far, we dealt with issues about the product, such as accessibility, prices, warnings on ingredients, information and advertising about the hazards to smokers and to others. But the product itself is the problem, in the sense that we have allowed a deathly product to stay on the market. And we have the potential to do a dramatic change, really quickly.
What the risk-proportionate regulation would look like, in the case of cigarettes?
Regarding accessibility, risk-proportionate taxation, so that the more hazardous products, such as cigarettes have a much higher taxation than the low-risk products. The bigger the differential, the more likely the people will move to alternative, lower risk products. Also, we can have different points of access, so that lower risk products are easier to buy. The information on alternative products needs to be more accurate, in order to reverse the current misinformation on the risks of these products.
But why were the changes, which could have been implemented really fast, delayed? One reason is that many of those who where involved in battling tobacco, had an “abstinence only” approach to nicotine. Unfortunately, this approach has been a gift to cigarette companies keeping competition off the market and making incredible profit for the tobacco industry, Prof. Sweanor said. And he added:
Cigarettes make a return on capital, earnings that dwarf what you see in other industries. People think Apple is an incredibly profitable company, but the profit of Apple on sales are half of Altria on cigarettes …
We need to change this so that consumers have an incentive to move to less hazardous products, the industry has an incentive to transform and open-up to competition so that new ideas and technology so that we help “get rid” of cigarettes. In conclusion:
We have this amazing opportunity: we have what is needed, and we understand the science, the market, we understand what consumers will do; we have the ability to transform the cigarette business into something entirely different in a short period of time. In doing so, we have the potential to have one of the biggest public health breakthroughs ever seen.
