Tobacco harm reduction: Promises and pitfalls of “product performance” and “product transition” strategies

Introduction

Tobacco control regulation in most countries makes no attempt to regulate the manufacturing process or constituents of tobacco products.  Tobacco product regulation, however, has become an important topic of debate, driven by the hope of reducing harm by improving product performance.  “Tobacco harm reduction” also refers to regulatory policies designed to encourage smokers to migrate to less harmful forms of tobacco use, as distinct from quitting altogether.

There is scope for tension between tobacco harm reduction policies that focus on “product performance”, and those that focus on “product transition”.

Methods

This paper considers the conditions for success of product performance, and product transition strategies, both from a public health perspective, and from the tobacco industry’s perspective.

It draws on recommendations made by the World Health Organisation’s TobReg Study Group, legislative proposals currently before the United States Congress, and proposals from the public health literature to assess the contribution that harm reduction could make to reducing the burden of disease from tobacco use.

Tobacco harm reduction is sometimes presented by the tobacco industry in terms of a “happy alignment” between its own commercial goals, and public health goals.  Drawing on proposals for harm reduction prepared by tobacco companies, and interviews with senior industry leaders, this paper will paint a more accurate picture of the depth of industry commitment to harm reduction strategies.

Conclusions and recommendations

Harm reduction offers both pitfalls and possible benefits for public health.  The industry’s commitment to harm reduction should not be overstated.  It falls well short of those product performance and product transition strategies that could maximize reductions in tobacco-related disease.

Governments should regulate to reduce the harm caused by existing tobacco products.  A Nicotine and Tobacco Regulation Authority provides one model for implementing tobacco product regulation, monitoring its impact, and responding to emerging evidence.