By David T. Sweanor J.D., Chair of the Advisory Board, Centre for Health Law, Policy & Ethics, University of Ottawa, Canada
The Covid-19 pandemic has focused global attention on the need for rational measures to reduce risks, effectively treat those afflicted and develop vaccines. This is entirely consistent with longstanding public health goals of reducing risks wherever they are found, and the importance of empowering people to improve their health.
Yet at the same time another pandemic, one claiming over 20,000 deaths a day globally, rages on despite being something that can be easily addressed through effective public health policy. The cause is the use of toxic tobacco products as a way of obtaining nicotine, and India is well positioned to be a world leader in addressing it.
The enormous harm associated with nicotine is almost entirely due to the way people get it rather than the nicotine itself. Science has informed us for decades that while people use cigarettes, bidis and a host of other products to get nicotine, it is the toxins from inhaling smoke and the use of unnecessarily hazardous oral tobacco products that is causing the health catastrophe.
The situation is akin to people getting caffeine by smoking tea leaves or using tea contaminated with superfluous poisons. Or, indeed, like the harms caused by cooking food over an open fire with poor ventilation; a significant health issue India is now admirably addressing.
Not only is there overwhelming scientific evidence of a vast difference in risk depending on how someone gets nicotine, as documented by the prestigious Royal College of Physicians in the UK, but there is proof-of-concept from countries that have acted on the evidence. The best example is Sweden, where pragmatic efforts to reduce the harms from tobacco use coincided with similar leadership in reducing the harms from automobile use.
The result is that Sweden has, by far, the lowest rate of cigarette smoking and of tobacco related disease in the European Union.
There are well over a billion tobacco users worldwide and around 300 million in India alone. But India has hobbled the competitiveness of low risk Swedish-style oral tobacco products and banned the vaping products that can replace lethal cigarettes.
Yet, to deal with the tobacco epidemic as effectively as we are trying to do with the covid one, is amazingly straightforward. Countries need only follow established public health principles and allow informed consumers and market forces to quickly achieve a public health revolution.
The WHO Constitution (1946) envisages “…the highest attainable standard of health as a fundamental right of every human being”. This implies a clear set of legal obligations on states to ensure appropriate conditions for the enjoyment of health for all people, and this right to health is one of a set of internationally agreed human rights standards that includes both freedoms and entitlements. Those freedoms include the right to control one’s health and body.
Currently the WHO, in an apparent alignment with the unscientific views of the private funders the organisation has sought for its tobacco programme, has jettisoned public health principles. It needs to return to them, and India, which accounts for one in six global deaths from tobacco products, should demand such changes while pursuing rational and humane domestic policies.
Nothing but a continued unnecessary pandemic, foreseeable opprobrium and ultimate failure await policies that seek to undermine an individual’s freedom to protect their own health.
The way forward is to empower consumers to make better decisions through accurate information and access to a wide range of less toxic and less addictive products. Also, to use risk-proportionate regulation to change the market dynamics that currently protect the deadliest nicotine products.
We already have the policy tools, the science, and an array of far less hazardous products. Around the world people show a great interest in switching to safer alternatives. Norway reduced cigarette sales by half in just a decade as the Swedish product became available. Japan saw cigarette sales fall by more than a third in just four years as a smoke-free product came onto the market. These successes are being repeated globally, and the declines in the use of toxic products are unprecedented.
With numerous goods and services an empowered public supported by innovative science, technology and regulatory policies has led to massively improved health. We can do it again in replacing lethal nicotine products.
India, with its huge market, a plethora of different tobacco products that can be readily replaced with dramatically less harmful alternatives, and internationally recognised expertise in science, technology and manufacturing is well positioned to help lead a global public health breakthrough.
It is time to work with consumers, to adopt and refine new technologies, and to achieve the public health revolution that is within our grasp.