Integrating Tobacco Harm Reduction into Public Health Policy and Global Governance Frameworks

Despite existing global tobacco control policies, combustible tobacco use continues to burden health systems worldwide, particularly in low- and middle-income countries (LMICS). This can be changed through adopting Tobacco Harm Reduction (THR) policies that prioritize a risk-proportionate approach.

This research critically examines the potential of THR within global health policies and governance frameworks, arguing that integrating risk-proportionate regulations into public health policies provide a necessary and realistic solution. In countries like Sweden, the United Kingdom and New Zealand, tobacco control policies are already complemented by tobacco harm reduction frameworks that position reduced harm products as acceptable adult alternatives. Working together, these public health initiatives tackle the tobacco epidemic through proportionality, evidence-based regulation and pragmatism. Their success is seen in reduced smoking rates as well as reduced tobacco-related morbidity and mortality.

Expanding beyond these nations, this research showcases how differential regulation based on product risk could be incorporated into national and international tobacco control strategies as a necessary evolution in global health policy. As an example, acknowledging that non-combustible tobacco or nicotine products are substantially less harmful than combustible cigarettes and taxing them as such, while still maintaining high product standards as well as awareness campaigns educating and encouraging smokers to switch, is an effective risk-proportionate policy. This is particularly crucial for LMICs, where access to cessation services is limited and smoking-related disease burdens are high. Effective risk-proportionate policies offer scalable, cost-effective harm reduction options while maintaining quality and protections against youth uptake. They also help accommodate social stigmas, gender sensitivities and other factors that influence choice.

Rather than a prohibitionist approach to tobacco control, this research pursues the benefits of operationalizing risk-proportionate policies globally without undermining existing public health protections. Reduction through risk-proportionate policies does not weaken tobacco control; rather, it strengthens it by prioritizing the reduction of preventable harm, aligning regulation with evidence, and offering realistic pathways to improved population health outcomes. A more inclusive global policy framework has the potential to save millions of lives otherwise lost to preventable smoking-related harm.

Dr Delon Human is a French and South African dual citizen and physician qualified in family medicine and child health. He is a health care consultant specializing in global health strategy, harm reduction and health communication. He has been active in tobacco control for decades, including advocacy for taxes on combustible tobacco to drive down consumer demand. He has acted as adviser to WHO Director-Generals and UN Secretary-General Ban Ki Moon. Formerly, he was Secretary General of the World Medical Association (WMA), the global representative body for physicians and thereafter Secretary General of the International Food and Beverage Alliance (IFBA).