By Adeshina Adams
Tobacco use is a major global public health concern. The high population of youths in Africa contributes to the high rate of tobacco consumption in the continent. High and middle-income countries such as Nigeria, Cameroon and Ghana are making cogent efforts to reduce tobacco consumption and its attendant risks.
The World Health Organization (WHO) approximates that 80% of tobacco users worldwide reside in low- and middle-income nations such as Nigeria, Ghana and Cameroon. Despite the harm tobacco use poses to the health of its users, there is an increased rate in the number of users consuming tobacco in these three countries. According to WHO, it is estimated that by 2025, there will be 16,868,400, 1,697,800, and 7,631,000 smokers in Nigeria, Ghana and Cameroon, respectively.
As a solution to the increasing number of tobacco smokers in Nigeria, Ghana and Cameroon, tobacco harm reduction is presented as a viable solution. Harm reduction strategies offer a promising approach to minimizing the health risks associated with tobacco smoking. After battling with tobacco smoking for years, Sweden has become the European country with the lowest rates of tobacco smoking owing to the implementation of THR.
Tobacco consumption has been linked with life-threatening conditions such as cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Also, it increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis (Centre for Disease Control and Prevention). This public health challenge has been attributed to cigarettes combustible substance and associated toxins. To reduce the harm or risks posed by the increasing use of tobacco products and slow down the incidence of its health risks, therefore, public health strategies have undertaken “to manage addictive behaviours that pose severe health risks”. This “approach recognizes that for people unable to abstain from a certain risky behaviour” including cigarette smoking, “public health intervention can be used to mitigate the potential dangers and health risks” (Dewhirst, n.d).
Tobacco harm reduction is a strategy aimed at minimizing the inherent toxicity of tobacco products, and the introduction of less harmful alternatives to mitigate health risks associated with tobacco use. It recognizes that encouraging people to abstain from smoking cigarettes has been somewhat very challenging and most times is ineffective. Instead, a more feasible solution is to introduce alternatives that can minimise adverse effects on the users when compared to the harmful effects tobacco consumption has on the health of its users. Among such alternatives are oral nicotine pouches and e-cigarettes. Nicotine pouches are convenient and discreet alternatives to smoking tobacco because they are smoke-free and not combustible. They provide a soothing satisfactory experience. Benefits of nicotine pouches include: potentially less harmful alternative to cigarette through the elimination of combustion and associated toxins; they can be used discreetly in place even where smoking is prohibited and, they come in various flavours, which offers users different experiences. E-cigarettes unlike tobacco do not produce tar or carbon monoxide, two most harmful compositions in tobacco. These products have proven to help smokers reduce their tobacco intake, thereby reducing the illnesses, harm and diseases associated with smoking tobacco.
The methodology we employed is a desk review of related articles on tobacco harm reduction strategies across three countries, namely Cameroun, Ghana and Nigeria. The rationale for the choice of this method afforded the researchers to examine existing literature related to tobacco harm reduction strategies to gather information on the three countries under review. A total of 165 articles were reviewed, which included journals, working papers, workshop proceedings, technical papers and newspapers.
To mitigate the harmful effects of tobacco, some of the world’s leading tobacco manufacturers work to create alternative reduced-risk products BASED on tobacco harm reduction principles. Some of the strategies they have been deployed so far include measures such as controlling product distribution and authorisation; adoption of nicotine delivery systems, price and taxation, public awareness and education, stringent regulation, ban on tobacco advertising, promotion and sponsorship, school interventions, warning labels and plain packaging, increasing the price of cigarettes to prevent initiation, mass media involvement in tobacco control programmes, smoke-free policies, and restricting access to cigarettes by minors.
From the review, it is significant to note that promoting tobacco harm reduction strategies is a more practical step towards reducing the health risks associated with tobacco use. If the recommendations outlined in this policy brief are implemented, we can improve public health outcomes and lower tobacco smoking-related diseases and deaths.
This policy brief presents key recommendations for promoting tobacco harm reduction strategies in Cameroon, Ghana and Nigeria as follows:
• Increase awareness and education on harm reduction strategies for the general public, policymakers, and non-health ministries.
• Governments should be transparent in their interaction with the tobacco industry by holding policy advocacy meetings in public or making minutes/reports accessible to the public.
• There should be a strengthened collaboration between citizens and government to improve surveillance, reporting, and enforcement mechanisms. For example, in the US, there is a Tobacco Violation Act, and citizens can report any violation by submitting a form online, calling a toll-free number, or sending an email. When there are such reports, prompt action such as investigation, monitoring or additional surveillance should be carried out.
• The use of non-tobacco based alternatives such as vapes and oral nicotine have been recommended to reduce smoking rate and disease burden below the acceptable average.
• New, more modern and less harmful tobacco-free products that have been introduced into the market in the last decade such as vapes (e-cigarettes) and oral nicotine pouches should be adopted. These products have been considered to be accessible, acceptable, affordable and effective as tobacco harm reduction strategies.
* Dr. Adams, a public health expert, writes from Lagos, Nigeria
