One Million Years of Life: How Harm Reduction in Tobacco Policy Can Save Lives

Summary of Study

Bottom Line: By taking a comparatively liberal approach to reduced-risk e-cigarettes, the United Kingdom has thus far followed the right path in tobacco harm reduction, setting a positive example on the international stage. To improve public health further, the UK should take an even more laissez-faire attitude toward e-cigarettes. 

International experiences of harm reduction strategies demonstrate the effectiveness of empowering individual smokers who want to quit by making reduced-risk products more attractive cessation options. The available evidence from the UK shows that e-cigarettes have contributed to tens of thousands of additional quits every year, and it is vital to ensure this trend continues.

To its credit, the United Kingdom has in many ways adopted a successful, pragmatic approach to smoking cessation. Its smoking rate is the second lowest in Europe (only behind Sweden), which is partially due to the rapid market penetration of e-cigarettes. Its public health establishment has been broadly consistent in supporting this harm reduction approach.

The basic premise of harm reduction is simple: Make it as easy as possible for smokers to switch to nicotine products that cause them significantly less harm. This must involve:

  1. Educating smokers on the relative risk levels of different reduced-risk products.
  2. Ensuring that smokers know these reduced-risk products are available as a smoking cessation aid.
  3. Expanding the range of reduced-risk products available by encouraging innovation, in order to cater to different smokers’ preferences.
  4. Setting taxation levels to accurately reflect the relative risk levels of different reduced-risk products, rather than to maximize revenue.
  5. Designing smart regulations that ensure a consumer-friendly experience of reduced-risk products.

The February 2018 evidence review from Public Health England concluded that e-cigarettes are at least 95% safer than conventional cigarettes. Moreover, the latest data available from the Office of National Statistics show that nearly three million people use e-cigarettes in Great Britain: that’s around one e-cigarette user per three smokers.

Public health bodies and advocates have repeatedly affirmed their positive impact on smoking cessation, and they are more than 10 times as popular as NHS Stop Smoking services. There are now more ex-smokers who use e-cigarettes than current smokers.

Sensible reforms to advertising restrictions could set the record straight on the relative risk of e-cigarettes among UK smokers and extend the vaping revolution to the young female smokers who it has largely failed to reach. Stop Smoking Service practitioners ought to feel confident in recommending e-cigarettes as a viable component of quit attempts. Politicians should use Brexit as an opportunity to change elements of regulation that hamper consumer choice and rail against restrictive policies on indoor vaping in hospitals, train stations, and beyond.

Read the full report here.