Sunday, October 7, 2018

Harm Reduction: The Canada way

Harm reduction is gaining popularity as a public health strategy to reduce the potential risks associated with health behaviors. We’ll be coming out with a series of articles and viewpoints on harm reduction in the future. Here is the first one.

A seminar on “Harm Reduction” was organized on September 27th at IIC, New Delhi to discuss how alternates to nicotine and tobacco products can potentially reduce harm caused by smoking and oral tobacco use.

I spoke to Prof David Sweanor on the side-lines of the seminar about what Canada and the medical community in Canada thinks about e-cigarettes given that the Health Ministry in India recently issued an advisory to states/UTs to ensure that ENDS are not sold, manufactured, distributed, traded, imported and advertised in any manner.

Prof David Sweanor is Chair of Advisory Board, Centre for Health Law, Policy and Ethics, University of Ottawa in Canada.

This is what he had to say.

“The Canadian government years ago thought the way to deal with things like vaping was to ban the products. What we have ended up with is recognizing that these products are massively less hazardous than cigarettes and that we need to encourage smokers to move to these products. So, now Health Canada is actually talking about how do you give more information to people and how do you move more smokers to products like vaping.

More and more of the medical community in Canada is moving the way we have seen in the UK. In the UK, the Royal College of Physicians, British Medical Association, Action on Smoking and Health, Cancer Research UK ...all the major health and medical organizations have now come on board saying that this is what we need to do; we need to try to encourage people to move to less hazardous products and vaping is less hazardous than smoking cigarettes. We should encourage it.

It’s very hard for us to have the number of those who have switched from cigarettes to e-cigarettes in Canada now. The surveys are not done yet. In the UK, 3 million people are vaping. In the US, there are several million who are vaping; there are about five and half million exclusive vapers i.e. they don’t smoke cigarettes any more.

Estimates from very prestigious bodies like Royal College of Physicians saying based on all the science and everything that we know, vaping is likely to be at least 95% less hazardous than smoking cigarettes. So, we can never say anything is risk-free, but we know that some things are less risky than others.

The history of public health has been very pragmatic to say that we may not be able to eliminate risk, but what we can do is to make it less risky. For example, we can make automobiles such that they are less likely to injure or kill people that are inside them.

When phasing out, give people some alternatives – something else to use instead. So, the idea is that if we are trying to ban something that people are using, particularly if it is something that they are addicted to, or acculturated to, we need to change the behavior and that is why we have moved to things like people wearing seat belts in cars. This is not saying don’t use a car, but when in a car, use seat belt. There are rules about not drinking and driving in many countries. This is not to say that driving isn’t safe, drinking and driving is not safe.”

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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