Global forum in Warsaw tackles tobacco use, countermeasures

KUCHING (July 15): In the heart of Warsaw, where historic streets meet modern skyscrapers, the 11th Global Forum on Nicotine (GFN) served as a melting pot for individuals from around the world to exchange ideas.

Visiting the city for the first time, my initial view from the hotel was the Palace of Culture and Science, symbolising Warsaw’s post-war reconstruction and ongoing development.

Combining rich history with modern life seamlessly, Warsaw’s Old Town, a 40-minute walk away, features restored buildings and narrow streets that recount tales of resilience following wartime devastation.

This lively setting provided an ideal backdrop for the GFN that is held in the city for the ninth time with the theme ‘Economics, Health, and Tobacco Harm Reduction’.

Organised by Knowledge Action Change (KAC), a UK-based public interest company, the focus this year was on the topics of nicotine use, tobacco harm reduction, and the economic impacts of global government policies.

The conference from June 13 to 15 saw the participation of researchers, public health experts, industry leaders, and advocates to advance the understanding and strategies for harm reduction in tobacco use.

Toll of tobacco use

One of the keynote speakers on the first day of the conference was Prof Dr Andrzej Fal, who is president of the Polish Society of Public Health.

He said tobacco smoking continues to be a leading cause of numerous health issues, including cancer, cardiovascular diseases and respiratory conditions.

“Each year, it accounts for 8.2 million deaths, including from the effects of exposure to second-hand smoke, and is projected to increase markedly over the coming years,” he said.

Dr Fal is also Head of the Department of Allergy, Pulmonary Diseases and Internal Medicine at the National Institute of Medicine in Warsaw.

“I do not remember in the history of homo sapiens, any culture that wasn’t smoking things and drinking [alcohol]. I’m not quite sure that we can stop doing that, so that’s why harm reduction are the words that will go with us forever,” he said.

Dr Fal also pointed out that while the addictive substance in tobacco – namely nicotine – was not the one that causes the biggest health threats, nicotine addiction complicates efforts to combat tobacco use.

“The direct costs of smoking include healthcare spending. But there are also the indirect costs such as those people who drop out of the workforce because they get sick as a result of smoking and can no longer work.”

According to him, about 250 million people are trying to quit smoking cigarettes at any given time and the main goal should be to support them.

“But I am afraid that is not the case and over 60 per cent of them return to smoking cigarettes in a short time.”

Safer alternatives?

From bustling coffee breaks to formal presentations, the conference buzzed with energy and enthusiasm as the delegates gathered to tackle one of the world’s most challenging public health issues.

Central to the discussions was the fundamental distinction between nicotine and the harmful chemicals found in tobacco smoke.

Throughout panel discussions, workshops and presentations, one key point reiterated was that while nicotine is addictive, it is the tar, carbon monoxide and other toxins in cigarette smoke that causes the most harm.

This difference is crucial for harm reduction strategies, which aim to offer smokers safer alternatives.

One of the highlights of the conference was the exploration of innovative harm reduction products and approaches which claim that tobacco heating system devices, e-cigarettes, nicotine replacement therapies, and smokeless tobacco products as the safer options for smokers looking to reduce or quit their tobacco use.

These discussions by the various panels also underscored the importance of fostering innovation in the development of products that can mitigate the health risks associated with smoking.

Policy and regulation

Policy and regulation were also among the key topics at the GFN as delegates emphasised the need for balanced regulatory frameworks and the necessity for evidence-based policies to guide regulatory decisions concerning nicotine and tobacco products.

Dr Fal stated that as part of their tobacco harm reduction efforts in Poland, a proposal to the Polish parliament were to impose duties and increase the price of cigarettes based on ‘harm’.

“On a less-harm-less-tax basis, the less harmful the product is, the lower the excise we impose on it. This doesn’t mean there is no excise as all these products are harmful, but less harmful products should have lower excise, while more harmful products should have higher excise,” he explained.

Various discussions during the conference also highlighted successful strategies like taxation, product standards, and public education campaigns, as a means to promote safer alternatives.

“Too many healthcare providers and the consumers they serve believe that their only options for quitting are either going cold turkey or using a medicinal nicotine replacement product such as nicotine gum or the patch,” said Global Action to End Smoking president and chief executive officer Cliff Douglas.

Douglas also said there are many individuals who either cannot or will not quit smoking using cessation medicines and it is a moral imperative that they not be forced to choose between those limited, and too often ineffective, options or nothing at all.

“Requiring people who smoke, in effect, to simply ‘quit or die’ is inhumane, and it’s unacceptable,” he said.

Malaysian Society of Harm Reduction chairman Prof Dr Sharifa Ezat Wan Puteh, who was one of the panellists, said there are restrictions in Malaysia to talk and share about alternatives.

She added that these restrictions have sparked a debate on tobacco harm reduction, as they limit public awareness of safer alternatives to traditional cigarettes.

“What we see now is that because of the lack of regulations, we see an increment of the black market and most come from certain nearby countries, and we have a huge black market not only for illicit tobacco but also illicit vaping products,” said Dr Sharifa Ezat.

Swedish success

The forum’s global reach was evident in the diversity of perspectives shared as delegates from countries with progressive tobacco control policies presented success stories and best practices, illustrating how robust regulatory frameworks can promote public health.

Among the highlight of the conference was Sweden’s remarkable success in reducing smoking prevalence to less than five per cent through a combination of innovative public health policies and culturally specific approaches.

Central to Sweden’s strategy is the promotion of ‘snus’, a smokeless tobacco product that has gained widespread acceptance and usage among the population.

Unlike traditional tobacco products, ‘snus’ is placed under the upper lip, delivering nicotine without the harmful effects of combustion and secondhand smoke.

This approach has been pivotal in Sweden’s efforts to transition smokers away from more harmful forms of tobacco.

In addition to promoting ‘snus’, Sweden has implemented comprehensive tobacco control policies that discourage smoking and support harm reduction.

These policies include high taxes on cigarettes, strict regulations on tobacco advertising and extensive public education campaigns about the risks of smoking.

By creating a supportive environment for quitting smoking and promoting safer alternatives like ‘snus’, Sweden has effectively reduced the appeal and prevalence of smoking across the country.

Finding the balance

Sweden’s success can be attributed to its strong cultural acceptance of harm reduction principles and evidence-based policymaking.

The Swedish government and public health authorities have actively supported harm reduction strategies that prioritise the reduction of the overall health impact of tobacco use while respecting individual choices.

This approach has fostered a society where smokers are encouraged to switch to less harmful alternatives which has led to significant reductions in smoking-related diseases and healthcare costs – evident in the country’s low rates of smoking-related diseases compared to many other countries.

By embracing harm reduction and providing smokers with viable alternatives, Sweden has not only improved public health outcomes but also set a positive example for tobacco control efforts globally.

The success of Sweden’s approach underscores the importance of tailored strategies that consider cultural preferences and prioritise harm reduction as a central pillar of tobacco control policy.

As the conference drew to a close, delegates managed to exchange ideas and forged collaborations to reaffirm their commitment to promote public health through evidence-based strategies.

As discussions evolve and new challenges arise, the forum managed to highlight the critical role of international cooperation and informed policymaking in promoting safer alternatives and minimising the global health impact of tobacco use.