Harm reduction with safer alternatives new approach to public health

Leading experts from the fields of science, technology, health, policy and consumer advocacy from Asia Pacific gathered at the third Asia Harm Reduction Forum (AHRF) held in Seoul late in August to discuss and share information about the “harm-reduction” approach, which they believe will play an important role in improving public health.

Introduced in developed countries, the harm-reduction concept is a new public health approach aimed at reducing damage from heath hazards such as alcohol, cigarettes and gambling. The concept focuses on cutting down on negative consequences rather than eliminating them.

Though the forum discussed measures to reduce harm from addictions, it mostly focused on harm from tobacco.

Konstantinos Farsalinos, a cardiologist and researcher at the Onassis Cardiac Surgery Centre in Greece, said the harm-reduction concept was necessary to tackle tobacco consumption because as of 2015, there were more than 1.1 billion smokers worldwide and up to 8 million premature deaths are caused annually from smoking.

Moreover, he said, quitting cigarettes is very difficult and the efficacy of approved methods, like nicotine replacement therapy, is very low at under 7 per cent.

Hence, he added, products like e-cigarettes, heat-not-burn and oral smokeless tobacco fit perfectly in the harm-reduction definition due to their effectiveness as smoking cessation aids and have lower toxin emissions.

Expert speakers from New Zealand, Canada and the United States also shared how state policy can intervene by taking a pragmatic approach and regulating novel tobacco products as well as providing alternatives to smokers who want to quit conventional cigarettes.

New Zealand, for instance, has launched advanced tobacco-control programmes and has committed itself to a smoke-free environment, said Marewa Glover, director of the Centre of Research Excellence: Indigenous Sovereignty and Smoking.

She said that a policy “sweet spot” is important to politicians and the important thing now is gathering and better organising vaping proponents.

New Zealand government runs a website that provides accurate information on vaping, so people can make their own decisions, she said, adding that the government has also launched a campaign encouraging people to switch to vaping.

David Sweanor, a public health advocate from Canada, said there is a global public health catastrophe with as many as 20,000 people dying from inhaling second-hand smoke, so the problem here is not nicotine but the delivery system.

He said this problem can be solved by coming up with an advanced public health policy, that reduces risk once it is found with the use of technology, policy changes and the gathering of information.

He also called on policymakers across the world to take a fundamental step by changing the products themselves.

Sweanor added that there is a tremendous opportunity to combine technology with public policy, which will help markets develop amazing alternatives.

Carrie Wade, director of harm-reduction policy at the R Street Institute in Washington, suggested that the US tobacco-control policies, such as high taxes and mandatory labels on tobacco products, have reduced the prevalence of smokers by about 15 per cent.

However, she said, smoking is still very high among lower income and less-educated segments of society.

The US Food and Drug Administration (FDA) is partly committed to allowing e-cigarettes to be made available to smokers, but they have set up a system, in which electronic device sellers need to make a Pre-Market Tobacco Application and manufacturers making “reduced risk” claims need a Modified Risk Tobacco Product Application, to ensure a robust process is in place.

Hong Kong, meanwhile, has been holding discussions about tobacco harm-reduction issues, with the government initially proposing that it will regulate e-cigarettes and tobacco heat products in the same way as traditional cigarettes, said Willy Wong, director of Hong Kong Psychiatry and Integrated Medical Centre.

However, Hong Kong eventually decided to ban e-cigarettes and tobacco heat products because these devices were seen as fashion accessories, not smoking-cessation devices, he said.

Co-organised by the Korea Harm Reduction Association (KHRA) and the Indonesian Public Health Observer Foundation, the AHRF aims to educate society on the reduction of harm through better alternatives, and to promote and advocate practical solutions that can contribute to better public health.

Its goal is to boost public awareness of the harm-reduction concept, integrate harm-reduction strategy and eventually achieve improved health and health public environment.