One shoe doesn’t fit all: Evaluating proposed graphic warnings for tobacco products through a harm reduction lens.

  • 9 May 2024
  • 3 Mins Read
  • 〜 by Brian Otieno

Kenya appears to be making a significant stride in public health by introducing graphic health warnings on tobacco products. This initiative has the potential to significantly reduce smoking rates, save lives and hasten Kenya’s path to achieving its smokeless target.

However, a crucial element seems to be missing: the appreciation of harm reduction strategies as an enabler to the smokeless aim. It is safe to say that the Ministry of Health’s current “one-shoe-fits-all” approach to graphic warnings ignores the existence of safer alternatives, potentially hindering progress and discouraging smokers from exploring less harmful options.

The flawed “one-size-fits-all” approach

The World Health Organization (WHO) recognises the potential of harm reduction. The Framework Convention on Tobacco Control (FCTC) acknowledges that “effective tobacco control requires a comprehensive and integrated approach to address the demand for and supply of tobacco products.” This includes encouraging smokers who are unable or unwilling to quit completely to switch to less risky alternatives.

However, the current proposal for graphic health warnings lumps all tobacco products together, regardless of their risk profile. Imagine plastering the same gruesome image on a pack of nicotine pouches, which contain only nicotine and not the burning process that creates harmful carcinogens, as on a pack of cigarettes. This approach not only dilutes the impact of the warnings for cigarettes but also discourages smokers from exploring potentially life-saving alternatives.

Science affirms “less harm” as a reality

Extensive research highlights the significant risk reduction associated with switching from cigarettes to harm-reduction products like nicotine pouches. These pouches deliver nicotine without combustion, the primary culprit behind the deadly cocktail of chemicals found in cigarette smoke.

In fact, nicotine, the addictive component in tobacco, is not the primary health concern. It’s the burning process that generates a plethora of carcinogens. Public Health England, a leading public health body in the UK, concluded that e-cigarettes, another harm reduction tool, are “at least 95% less harmful than smoking”. Similar findings extend to nicotine pouches, offering a clear path for smokers who struggle to quit completely.

Sweden: A smoke-free success story

Look no further than Sweden for a real-world example of harm reduction success.  Sweden has one of the lowest smoking rates in the world, at a staggering 6.4%. This remarkable achievement wasn’t driven by simply demonising all nicotine products. Instead, Sweden embraced harm reduction.

The country saw a dramatic decline in smoking rates when snus, a smokeless tobacco product like pouches, became widely available. While not risk-free, snus demonstrably carries significantly fewer health risks compared to cigarettes.  Sweden’s experience highlights the effectiveness of offering smokers a less harmful alternative, paving the way for a smoke-free future.

Tailored warnings: A smarter approach

Kenya can learn from these success stories.  Graphic health warnings on cigarettes are undeniably crucial. However, these warnings should be distinct from those placed on harm-reduction products.  Nicotine pouches, for example, could have clear warnings about addiction while emphasising the significantly reduced risk compared to cigarettes.

This approach achieves two key goals:

  • Deterring new users: Gruesome images on cigarette packs serve as a powerful deterrent for non-smokers, especially young people.
  • Encouraging smokers to switch: Clear, informative warnings on harm reduction products highlight the risk reduction potential, nudging smokers towards a healthier path.

Opportunity for a progressive public health approach

Kenya has a golden opportunity to become a leader in tobacco harm reduction within Africa. Updating the current proposal to acknowledge the varying risk profiles of tobacco products is a critical step.  By adopting a nuanced approach with tailored graphic warnings, the Ministry of Health can create a win-win situation: discourage new smokers and empower existing smokers to make informed choices about potentially life-saving alternatives.

It is critical to note that the success of a harm reduction strategy hinges on robust scientific evidence and transparent communication. To this end, the Ministry should consider the following:

  1. Support and engage in independent research through partnerships with local and international institutions. This research will form the basis of an evaluation of the risk profile of harm-reduction products available in Kenya.
  2. Public education fostered through open and informed communication about the varying risk levels of tobacco products and the role of harm reduction in achieving a smoke-free future.
  3. Collaborate with stakeholders, particularly open itself to engagements with public health experts, consumer groups, and the harm reduction industry to develop a comprehensive and evidence-based tobacco control strategy.
  4. Review the Tobacco Control Act 2007 and the attendant regulations to ensure they capture the industry’s current nuances, including harm reduction products and other safer alternatives.

In conclusion, by acknowledging the science behind harm reduction and adopting a tailored approach to graphic health warnings, Kenya can chart a course towards a healthier future for its citizens. Kenya must not miss this opportunity to embrace innovation and empower smokers to make informed choices for their well-being.