David Sweanor has worked with numerous companies and organisations, including the International Union Against Cancer, World Health Organization, World Bank and the Pan American Health Organization, on the issue of tobacco harm reduction. He has received both international recognition and prestigious prizes for his work.
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How did you get interested in the issue of Tobacco Harm Reduction?
I have been actively involved in tobacco and health policy issues since the beginning of the 1980s. During that time I have tried to apply the lessons from other successful public health campaigns. Any effort to reduce death, injury or disease entails some combination of four broad strategies:
1) Measures to prevent people from ever engaging in a risky behaviour
2) measures to get those engaging in the behaviour to cease engaging in it
3) efforts to prevent injury to third parties as a result of the behaviour
4) efforts to reduce the risks to those who will continue the behaviour.
By the early 1990s there was no doubt that the vast majority of the harm caused by smoking was from the method of nicotine delivery rather than from the nicotine itself. There would be a parallel problem if people got caffeine from smoking tea leaves rather than making an infusion of these leaves in hot water. At the same time the projections of future smoking rates was for increasing consumption despite global anti-tobacco policies, and there was increasing scientific understanding of the reasons people use nicotine. An ‘abstinence-only’ policy aimed at a nicotine-free world was simply unrealistic.
So certainly by the 1990’s, and much earlier in the case of far-sighted researchers such as Michael Russell, it was clear that there were huge gains to be made from dealing with the delivery system. Oddly, though there had by that time been much focus on issues such as where the product could be used, how it was taxed, limits on advertising, controls on places of sale, packaging requirements, etc., there was little to nothing being done about the product itself.
What progress has been made since you got involved?
Short answer: Not enough.
Longer answer: There is now a much greater awareness that there is a very pronounced continuum of risk depending upon how nicotine is delivered. We are also seeing greater (though still poor) availability of medicinal forms of nicotine and a proliferation of new nicotine products. There is also no longer any scientific doubt that combustion-based products are massively more hazardous than non-combustion products such as Swedish snus. My experience is that as soon as someone grasps the concept of the continuum of risk and recognizes that all nicotine use is not going to end anytime soon, the pieces start coming together. This comes at a time that many countries are moving toward regulating tobacco products and discussing the need for some form of comprehensive regulatory oversight of the full range of nicotine products. Clearly, any rational health-focused regulation will demand that we deal with issues of differential risks.
I know that you don't necessarily agree with our theory that there is a conspiracy against alternative forms of smoking. Yet you have said Snus is a far safer alternative to smoking than cigarettes. How do you explain the reasons for illogical bans against alternative forms of tobacco such as in the European Union, where Snus has been banned but both cigarettes and more dangerous forms of chewing tobacco remain legal?
I think cigarettes have dominated the marketplace of most countries for so long that people have trouble even thinking of alternatives. Many of those who seek restrictions on non-combustion products, and certainly some of the companies selling them, see them as a way to perpetuate rather than replace cigarette smoking. When snus was positioned as a potential additional problem, rather than as a potential partial solution to a much bigger health problem, efforts to keep it off the market seemed logical.
We also have an issue with the tendency of our species to do something ‘because we can’ rather than to look at issues in a more comprehensive way that will better meet long term goals. It was possible to get laws banning a tobacco product that was not yet on the market, just as today it is possible to enforce existing drug laws to ban new recreational nicotine products. Had there been greater awareness of relative risks and a less risk-averse mentality snus could have been seen the way auto safety advocates saw Volvos – an agent of change for the marketplace.
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