In Aid of World Heart Day - Thursday, 29 September. The Unrelenting Health Burden of NCDs - A Pleading Call for Tobacco Harm Reduction

Article written by Joseph Magero of CASA:

Non-communicable diseases (NCDs)—including cardiovascular diseases, chronic respiratory diseases, and cancer—account for about 60% of global deaths, mostly in low and middle-income countries. Smoking and tobacco use accounts for a sixth of these deaths.

Cigarette smoking is a major risk factor for noncommunicable diseases such as chronic respiratory diseases, cancer, heart disease and stroke, as well as a factor for some communicable diseases such as tuberculosis. Evidence obtained shows that important benefits of reducing smoking accrue quickly; a reduction in tobacco use rapidly decreases NCDs and healthcare costs.

The number of annual deaths from tobacco-related diseases now stands at eight million, according to the World Health Organization. High-level action is needed to beat NCDs. Progress on the global epidemic of non-communicable diseases will not depend on waiting for new breakthroughs but on insights gained from tried and tested solutions.

Reducing tobacco use plays a major role in global efforts to achieve the SDG target to reduce premature deaths from noncommunicable diseases by one-third by 2030. There should be little doubt that a very large portion of the proposed one-third reduction in global NCD mortality would be reached simply by eliminating the smoking of combusted tobacco.

A multi-pronged approach to tobacco harm reduction in the low-and middle-income countries, which incorporates both tobacco consumption and production, is needed. There is significant global independent evidence that safer nicotine products are significantly safer than any combustible and many types of oral tobacco products.

The WHO “best buy” framework of recommendations is limited by the options it considers. Harm reduction strategies are well established in the greater UN - WHO ecosystem and ethical frameworks in many areas, but is excluded from the area of tobacco control.

Ending communicable diseases is a moonshot goal that will be difficult to reach under the very best of circumstances, but hopefully not impossible. The difficulties in reaching the target are further compounded by higher disposable incomes globally that result in important resources being allocated toward research on largely preventable NCDs. If the International Community realistically is to find ways to finance moonshot research on NCDs and Cancer - The low hanging fruit of a 2 trillion $ smoking cost rapidly shifting at no cost to society to harm reduced alternatives with approximately zero cost to society, seems an obvious no-brainer. There should be no question that materially altering the smoking trajectories would prove the single largest addition to reaching the goal of a full third reduction in premature NCD mortality. This shift is already well underway among smokers switching to vastly harm-reduced non-combustible alternatives among those not quitting. Broadly allowing, promoting, measuring, and monitoring a global movement to “quit or switch” instead of “quit or die” is a “best buy” complement to W.H.O FCTC in reaching their goal, more so since the full cost is borne by the consumer-producer partnership.

Pragmatic approaches are absolutely essential to improve outcomes. Globally, ‘tobacco control’ has, in truth, not proven as effective as desired. Over 1.3 billion people in the world still continue to use tobacco. The shortage and lack of healthcare infrastructure in many low and middle-income countries makes the scale of the task to reduce tobacco use inherently complex and puts the onus on individuals to reduce their harm and risk. Everyone deserves to have awareness about, and access to, all options available to them, especially when their own health – and that of their families – is on the line.

Tobacco harm reduction has multiple benefits for the smoker, non-smoker, economy, and environment as well. Policymakers must implement harm reduction to reduce tobacco use and the global burden of non-communicable diseases. This approach will provide an effective method for the reduction of harm caused by the most significant NCD source – smoking.

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