Harm reduction overview

The Global Context

Current efforts to curb the smoking epidemic are failing to move fast enough. Despite decades of tobacco control, the number of people who smoke worldwide has remained stagnant at approximately 1.1 billion since 2000.^[1] The World Health Organization (WHO) projects that smoking will kill one billion people by the end of this century, with 8 million deaths occurring annually right now.^[2]

Traditional measures-taxes, bans, and warnings-have not significantly reduced the global population of smokers, particularly in low- and middle-income countries where 80% of smokers live. A new approach is urgently needed to prevent millions of premature deaths.

What is Tobacco Harm Reduction?

Tobacco Harm Reduction (THR) is a public health strategy that recognizes some people will continue to use nicotine. It focuses on lowering the health risks for these individuals by encouraging them to switch from combustible tobacco (cigarettes) to Safer Nicotine Products (SNP).

SNP include:

• Nicotine Vapes (e-cigarettes)
• Heated Tobacco Products (HTP)
• Nicotine Pouches and Snus

These products are non-combustible. Since it is the burning of tobacco that releases the tar and toxic gases causing cancer and heart disease, removing combustion dramatically reduces the risk. There are now at least 144 million SNP users globally, demonstrating a massive consumer demand for safer alternatives.^[1]

Evidence from Case Studies

Real-world data from countries that have embraced or allowed SNP shows a clear correlation: as the use of safer products rises, smoking rates fall.

Japan: The Heated Tobacco Revolution

Japan offers the most dramatic evidence of substitution. Since the introduction of Heated Tobacco Products (HTP) in 2014, cigarette sales have collapsed.

• 52% Decline: Between 2015 and 2023, cigarette sales dropped by 52% (from 182.3 billion to 88.1 billion units).^[1]
• Substitution: This decline coincided perfectly with the rise of HTPs, which reached sales of 72 billion units by 2023.
• Drivers: Japanese consumers switched primarily for health reasons and hygiene (lack of smoke smell/ash), proving that smokers will voluntarily move to safer products if they are available and acceptable.^[3]

Norway: The Success of Snus

Norway has achieved one of the lowest smoking rates in the world by allowing snus (a traditional oral tobacco product) to compete with cigarettes.

• Overtaking Smoking: In 2017, daily snus use overtook daily smoking for the first time.
• Generational Shift: Among young Norwegians (aged 16-24), smoking has effectively disappeared, with daily prevalence dropping to just 2-4% in 2023.^[4]
• Health Impact: Norway now has significantly lower rates of lung cancer and tobacco-related disease compared to the rest of Europe, largely attributed to the shift from smoking to snus.

New Zealand: Vaping to Smoke-Free

New Zealand legalized and regulated nicotine vaping in 2018, leading to a rapid acceleration in the decline of smoking.

• Rapid Decline: Daily smoking rates fell from 16.4% in 2011/12 to just 6.9% in 2023/24.^[5]
• Vaping Overtakes Smoking: In 2022, vaping prevalence surpassed smoking, confirming that vapes act as a substitute for cigarettes.
• Equity: Significant drops in smoking were observed among Māori and Pacific peoples, communities that have historically had high smoking rates, suggesting THR can help reduce health inequalities.^[1]

Why It Works

Tobacco harm reduction works because it works with consumer behavior rather than against it. SNP offer a viable exit route for smokers because they provide:

1. Nicotine: Preventing withdrawal.
2. Ritual: Mimicking the hand-to-mouth action (especially vapes and HTPs).
3. Cost Savings: Often cheaper than highly taxed cigarettes.
4. Social Acceptability: No "second-hand smoke" harm to others.

The evidence is clear: when safer alternatives are available, accessible, and affordable, people switch, and public health improves.