Pragmatic paradigm needed in tackling tobacco harm

 

From Benedict Weerasena

Every 20 minutes, one Malaysian dies from a disease related to smoking, such as cancer, stroke or heart disease. This results in over 27,200 smoking-related deaths annually, according to the National Health and Morbidity Survey (NHMS) 2019.

Despite this alarming news, tobacco prevalence remains high in which slightly over one in five Malaysians aged 15 and above smoke tobacco.

Nonetheless, tobacco prevalence is on a slight downward trend with a compound annual growth rate (CAGR) of -1.0%. At the current rate of reduction, Malaysia will only achieve its 2025 target of 15% in 2042.

This failure beckons the question on whether the measures taken to reduce tobacco use have been overly idealistic. Have the tobacco control and regulation efforts in addition to multiple preventive measures been effective enough? Otherwise, should we employ a more pragmatic approach to reduce tobacco prevalence?

Idealism versus pragmatism has been a long ongoing debate when it comes to policy-making. Idealist policy-makers focus on the end goal of visionary ideas. For example, Malaysia’s ideal goal of reducing tobacco prevalence to 15% by 2025 and finally an endgame target of less than 5% in 2045. This goal is certainly commendable, yet seemingly impossible to achieve.

On the other hand, pragmatic policy-makers focus on the practical including the roadblocks and challenges faced in getting to the end-result. It is a realistic recognition that while the preferred goal is complete cessation of harmful habits, this goal is not always achievable.

Take, for instance, those who understand that quitting smoking is incredibly difficult due to biopsychosocial reasons, in addition to the highly addictive nicotine. What about those who choose to continue smoking to cope with the monotony of working long hours or are in high stress jobs? How can we as policy-makers offer practical and realistic solutions to reduce the harmful effects of smoking?

One pragmatic solution that is proven effective on the global stage is employing a strategy of tobacco harm reduction. This strategy seeks to reduce smoking-related disease and death by encouraging smokers to switch to better alternatives.

Reputable institutions and independent researchers have highlighted the less harmful effects of electronic nicotine delivery systems (ENDS) such as e-cigarettes and vaping devices and also heated tobacco products (HTP), which have been highly effective in empowering cessation efforts.

For instance, New Zealand amended the Smokefree Environments and Regulated Products Act in 2020 to include ENDS and HTP to allow smokers to switch to less harmful alternatives.

In addition, it recently introduced the “QuitStrong” campaign to encourage vaping as a way to quit smoking, in line with its Smokefree 2025 goal launched in 2011.

This long-term goal, which incorporates numerous harm reduction strategies, has been successful, bringing down smoking prevalence from 18.2% in 2011 to 13.4% in 2019 with a CAGR of -3.8%.

Another example is Japan, which allows the substitution of combustible cigarettes with lower risk HTPs in the market, in line with the harm reduction concept. Moreover, HTPs are taxed differently than cigarettes and exempted from indoor or outdoor smoking bans in certain cities, receiving less stringent regulatory settings than conventional cigarettes. These policies have been associated with the success of reducing smoking prevalence with a CAGR of -5.2%.

It is time for Malaysia to emulate these leading nations who have successfully demonstrated the effectiveness of pragmatism in tobacco control policies. We need a paradigm shift away from the idealistic notion of banning or applying cigarette-like restrictions on less harmful alternatives such as HTPs and ENDS.

Instead, we need science-backed and well-thought-through regulation grounded on tobacco harm reduction strategies towards better overall public health. - FMT

Benedict Weerasena is an economist with Bait Al-Amanah.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.