My opinion: Harm reduction is the path to a smoke-free future
Since the start of 2020, the world has been living under varying degrees of lockdown measures due to the coronavirus pandemic. I have personally found this period to be one of the most difficult times I have faced. But I have also found moments of personal enrichment by spending more time introspecting, planning, strategizing, and luckily a lot of invaluable companionship with my family.
Without a doubt, this pandemic has been a trying and stressful experience, even for the best of us. I know the extended lockdown and various demands caused by the pandemic are straining people’s mental health, which has resulted in a host of other health risks.
This must be addressed immediately to avoid long-term risks and health repercussions, as the World Health Organization (WHO) claims in its Big Event for Mental Health survey. Grief, isolation, loss of income, and fear trigger mental health problems or make existing ones worse.
A study conducted by researchers in Malaysia between May and September 2020 to assess the overall mental health of adult Malaysians found that there was an increase in cases of depression, anxiety and stress throughout the pandemic period. , with depression rates showing the largest increase compared to the pre-pandemic period. The study also found that there was a higher percentage of depressive symptoms (59.2%) and anxiety (55.1%) reported compared to symptoms of stress (30.6%).
Deteriorating mental health has been reported to lead to increased levels of harmful alcohol use, drug addiction, tobacco use, insomnia, anxiety, unhealthy eating, and increased cases of violence. domesticated. Naturally, people find solace in these vices and unhealthy behaviors when dealing with their daily stress, even more so during a pandemic.
As we are social beings, the prolonged blockages that have essentially restricted our movements to socialize and, to some extent, to earn a living have put immense pressure on our well-being. The solace we find in binge drinking, eating, smoking, and other unhealthy habits will unfortunately lead to bigger long term impacts that need to be addressed now.
Among the harmful behaviors that can lead to long-term health risks, smoking has been one of the hot topics. International research has shown that adult smokers reported 25% to 45% higher tobacco consumption during the lockdown period compared to before the pandemic. There has also been a substantial drop from 27% to 39% in the number of people calling to stop line operators and smoking cessation services during the lockdown.
Experts believe many have turned to smoking in response to psychosocial stress, noting that people from low-income backgrounds and young adults are among those who have been disproportionately affected by the pandemic and are more prone to tobacco use.
Malaysia has set key targets to reduce our smoking prevalence to 15% by 2025 and 5% by 2045, in line with our commitment to the WHO Framework Convention on Tobacco Control (FCTC ). Unfortunately, we have not really been successful in striving for this goal, as our smoking prevalence has hovered around 21% to 25% since 1986. Essentially, we have not sustainably reduced our smoking prevalence since 35 year !
With the pandemic and restrictions on movement, it has been even more difficult to reduce the prevalence of smoking, especially when there is relatively easy access to illicit cigarettes that have flooded the market. According to the Nielsen’s Illicit Cigarettes study, commissioned by the Confederation of Tobacco Manufacturers of Malaysia, the country’s illegal cigarette trade hit a monthly record of 64.5% in August 2020.
This means that 6 out of 10 cigarettes sold in Malaysia are fundamentally illegal, meaning that they do not properly contribute to the duties and taxes collected by the government. In addition to the danger of consuming products that do not meet government standards, Oxford Economics has estimated that the illicit cigarette trade costs the Malaysian government around RM 5 billion per year in evaded taxes.
A smoke-free future
WHO’s vision of creating a smoke-free generation is certainly a noble goal towards which we should all be working. In fact, tobacco companies have already committed to this vision, where a major tobacco company recently announced that it plans to stop producing combustible cigarettes by 2030. Ultimately, the goal is to get people to quit and eliminate smoking.
However, we all know how difficult it is to quit smoking. Research shows that the annual success rate for quitting smoking remains low at 7%, which means that there are less than one in 10 adult smokers who successfully quit each year. It’s a painful journey that many are used to taking as a resolution, but struggled to accomplish.
I myself was a die-hard smoker when I was younger, when I smoked two packs of cigarettes a day. I never thought about quitting, until one day during a medical examination, a growth was found in my throat. Fortunately, the growth was diagnosed as benign. However, I vowed to never touch another cigarette in my life and have kept my word for 24 years.
So my motto is simple: don’t start smoking. And if you’ve started, quit. But the question is, what if you are not able to quit smoking?
Innovation in consumer products
In my day, the only withdrawal aid I had was the nicotine patch and gum. But today’s innovation has given us a line of less harmful alternative products such as electronic nicotine delivery systems (ENDS), heated tobacco products (HTP) and snus.
These alternative and innovative products that use non-combustion technology have been the subject of scientific studies and evaluations, which have shown that these non-combustible products are over 90% safer than combustible cigarettes. Studies have also shown that the rate of smoking cessation is over 60% higher in those who use a combination of authorized drugs and non-combustible nicotine products.
Do the less harmful alternatives really help reduce the prevalence of smoking?
Japan, a good example of a progressive country, has a concept called a Harm Reduction Product (HRP), which basically encourages households to choose HRP for at least 20% of their household product consumption. This HRP concept aims to increase the general well-being and life expectancy of the Japanese public while trying to maintain the same lifestyle and minimize the unnecessary stress of a sudden change in behavior.
By understanding the needs of the public, Japanese policymakers incorporated policy measures that were successful in reducing harmful behavior. For example, the incorporation of HRP into tobacco policy and regulation has resulted in a 34% drop in conventional cigarette sales as people turn to the healthier and cheaper option of alternative products, instead. to continue to smoke cigarettes. The introduction of alternative non-combustible products such as HTP in Japan since 2016, has also accelerated the decline in cigarette sales, supporting the HRP concept implemented there.
Other countries like New Zealand and the United Kingdom have recognized the benefits of harm reduction in tobacco control and, therefore, have incorporated harm reduction from tobacco into their respective policies and regulations. The advantage of such a progressive policy is evident in the contrast between the rate of reduction in the prevalence of smoking in New Zealand (CAGR: -3.8%), in the United Kingdom (CAGR: -4.4% ) and Japan (CAGR: -5.2%), compared to that of Malaysia (CAGR: -1.0%) during the same period.
As these progressive countries focus on the concept of harm reduction which is more pragmatic to achieve their long-term goal of reducing the prevalence of smoking, it is high time that Malaysia adopted a similar approach and action for the collective good. Malaysians.
Pragmatic policies and regulations that drive innovation and behavior
I think competition and innovation should be the foundation of policy making. It is about putting in place a policy that encourages innovation, not only from the industry side but also from the consumers’ point of view. These could take the simple form of a risk-proportional tax approach by applying taxes and excises on harmful products that could alter consumer demand, or by offering tax breaks to innovative companies with new inventions marketable in markets. less harmful products or services that would influence the offer.
These pragmatic policies and regulations that stimulate innovation are important, not only to enable better choices for consumers, but also to encourage and change the behavior of the masses. Ultimately, with the right measures and implementation of tobacco control, this pragmatic approach to policies and regulations would bring medium- and long-term benefits to the health system and to the population in general.
The status quo will not be enough to make a difference in our approach to tobacco control. If we were to continue this way, the current trajectory shows that we would not reach our goal of smoking prevalence of 15% until 2042, off target within 17 years. Essentially, Malaysia should embrace gradual policy changes if we are to realize and enjoy the vision of a smoke-free future.
Datuk Seri Idris Jala is President and CEO of Pemandu Associates