India's tobacco control policy can be bolstered with reduced risk alternatives

~Indian policy makers must look at examples from the world and adopt a tailored approach best suited to the country - experts~

MUMBAI, India, June 13, 2023 /PRNewswire/ -- On the World No Tobacco Day' 23, medical experts shared their views at an ET Edge panel discussion on how science-backed policymaking is the way to achieve public health goals.

India has been progressive with numerous specialised policies being adopted in the past. While battling the pandemic, Indian leaders devised an independent strategy customized for the population. In fact, India became a case study for the world on digital public health systems. Further, the Union Health Ministry launched a 60-day pan India campaign on the theme 'tobacco-free youth' to support young smoker quit. However, India still has 1 in every 4 adults consuming tobacco. It would need a middle path with safer alternatives to have a realistic impact towards tobacco control.

With the second largest tobacco using population in the world, India witnesses over a million tobacco related deaths every year in the country. The healthcare expenditure associated leads to a loss of productivity and costs as much as 1% of the country's GDP. Customized policies backed by science needs to come to the fore to realize a public health opportunity.

During a discussion at an ET Edge event, Dr. Kiran Melkote, an orthopedic surgeon based in Delhi, and member of AHRER (Association for Harm Reduction, Education and Research), said, "On an average it takes smokers thirty attempts to quit, and the large majority never manages to do so as the likelihood of quitting decreases with each attempt. The inclusion of Nicotine Replacement Therapies (NRT) in the National List of Essential Medicines (NLEM) is a step in the right direction, however, we need to keep progressing on such policies. Lastly, while drafting laws there must be a representation of tobacco users to understand their fears and take their aspirations into account which is lacking at the moment." 

In a lancet article by two former WHO officials, Prof. Robert Beaglehole and Prof. Ruth Bonita, conveyed that WHO Framework Convention on Tobacco Control (FCTC) does not prohibit reduced risk approaches to treating tobacco dependence, including the use of novel nicotine alternatives. The FCTC Conference of Parties has encouraged governments to regulate these alternatives as appropriate to their national laws and public health objectives.

Recently, Britain has announced that it is encouraging smokers to swap cigarettes for safer alternatives. Under the scheme, almost one in five smokers will get a starter kit along with support to help quit smoking, UK's Department of Health (DoH) said.

Sweden is emerging as a leading country on its way to achieve a smoke free status. They achieved this through a tailored approach leading to the smoking rate falling from 15% to 5.6% in just 15 years. The Swedish model combines recommendations in the WHO Framework Convention for Tobacco Control, but it also accepts safer alternatives. Similarly, Japan has seen a 25% reduction in tobacco consumption ever since the Japanese government regulated safer alternatives in 2016.

This trend is true for developing countries as well. A study under Thailand's house standing committee on public health suggests that the government should adopt a policy of Tobacco Cessation and revisit relevant laws towards safer alternatives. Egyptian experts associated with the government have voiced their opinion about novel nicotine options being a viable path for policy makers to adopt.

Sharing his perspective on the benefits of switching to less harmful alternatives, Prof Dr. Nimesh G Desai, Senior Consultant in Psychiatry, and former Director IHBAS, said, "In the last 30-40 years, there have been progressive policies and programs for tobacco control by the Government. Habits related to alcohol and tobacco can be defined as bio-behavioural disorders which unfortunately also bring significant social and moral dimensions. For solutions where we have equivocal evidence, regulation is a much better approach than an outright ban."

Since tobacco cannot be taken out of the population mix, it becomes pivotal to explore and adopt non-combustible safer alternatives that remove tar from tobacco. Adult smokers of varied degree need a diversified approach to help them quit. A good and progressive public policy must allow customers to obtain innovative solutions based on informed choices. To help the Indian adult smokers, policy makers could explore tobacco risk reduction as a national health intervention. Science & evidence of cessation, nicotine replacement therapies & introduction of reduced harm, safer alternatives are innovative means that could help.

Countries across the globe are adopting progressive policies. In order not to miss this opportunity, India needs to revisit present regulations and embrace science-backed policymaking for public health. Studies have established how prohibition on reduced-risk products has the ill-effect of increased tobacco usage. Hence, a middle path involving a reduced risk approach will benefit millions of legal age smokers who struggle to quit and help reduce the public health burden of the Government.

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