GSTHR Press Release

Friday 20 May 2022

What is Tobacco Harm Reduction? – the latest GSTHR Briefing Paper explains how this public health strategy could save millions of lives

  • Tobacco harm reduction is a potentially life-saving intervention for millions of people across the world who currently use high-risk tobacco products
  • Building on the success of earlier harm reduction initiatives, tobacco harm reduction offers smokers the chance to switch to a range of safer nicotine products that pose fewer risks to their health
  • Embracing tobacco harm reduction is the key to England achieving smoke-free status by 2030

In anticipation of the imminent release of the government’s independent review into tobacco control led by Javed Khan OBE, UK-based public health agency Knowledge·Action·Change (K·A·C) is today launching the latest in a series of Briefing Papers as part of its Global State of Tobacco Harm Reduction project.

Titled What is Tobacco Harm Reduction?, the publication provides a detailed introduction to the principles, history and evidence for this vital public health strategy – elements of which have successfully been adopted into the UK approach to tobacco harm for a number of years, most visibly with the uptake of nicotine vaping among smokers looking to quit and switch to a safer alternative.

For the 1.1 billion people across the world who smoke combustible cigarettes, tobacco harm reduction is a potentially life-saving approach. Like other forms of harm reduction, it recognises that simply quitting isn’t possible for all smokers. People smoke for the nicotine, but nicotine itself does not cause smoking-related death and disease - it’s the chemicals inhaled in tobacco smoke. Removing combustion reduces the risk. For those people who can’t or don’t want to quit nicotine, tobacco harm reduction offers a chance to switch to safer nicotine products including nicotine vapes (e-cigarettes), tobacco-free nicotine pouches, Swedish-style snus (an oral tobacco), many US smokeless (chewing) tobaccos and heated tobacco products.

Many of these products have only been developed in the last 10-15 years, but they are proving increasingly popular. Research published in March by the GSTHR estimates there were 82 million vapers worldwide in 2021. This represents a 20% increase on the figure for 2020 (68 million), meaning safer nicotine products are now being used by 112 million people worldwide. A striking example of tobacco harm reduction’s potential can be found in Scandinavia. Sweden now has the lowest rate of tobacco-related disease in Europe,[i] thanks to Swedish men switching from smoking to snus, and in Norway, 12% of women aged 16-24 use snus daily while only 1% smoke.[ii]

In England, tobacco harm reduction can play a key role in the government’s bold ambition to make the country smoke-free (defined as a prevalence rate of under 5 per cent of the population) by 2030. The uptake of vaping has been accompanied by a rapid decline in smoking. Vapes are the most popular way to stop smoking,[iii] with 3.6 million people vaping in Great Britain, of whom 2.4 million have completely quit combustible cigarettes.[iv] But tobacco is still the single largest cause of preventable mortality in England with nearly 75,000 smokers dying from smoking in 2019[v] and figures show nearly one in 10 pregnant women are smoking at the time of delivery.[vi]

Continuing to drive down smoking rates is crucial if the Government is to tackle the health disparities caused by smoking that currently see a disproportionate burden falling on the most disadvantaged families and communities. Smoking rates vary significantly across the country – for example in Blackpool about one in five people smoke (19.8%), compared to about one in twenty in Richmond upon Thames (6%).[vii] Rates are also very high among people who experience drug and alcohol problems (56% of those entering treatment smoke),[viii] people who are homeless (of whom 77% in England smoke)[ix] and people who live with mental health problems (of whom 26.8% in England smoke).[x]

Adopting tobacco harm reduction will not just help the UK counter the impacts of smoking, it has huge potential as a global public health solution. Smoking is responsible for 7.7 million deaths a year[xi] and current tobacco control measures are failing to reduce the death and disease caused by smoking fast enough. Translated into Spanish, Russian, Mandarin, French, Portuguese, Indonesian, Swahili, Japanese, German, Polish, Hindi and Arabic, this GSTHR Briefing Paper is intended to start conversations in countries across the world where harm reduction has yet to be recognised.

Expressing the hope that tobacco harm reduction will be central to the Khan review’s recommendations,[xii] Professor Gerry Stimson, Director of K•A•C and Emeritus Professor at Imperial College London, said: "By embracing tobacco harm reduction, England can help bring about an end to smoking. Every possible effort should be put towards making use of the widest range of harm reduction products, from nicotine vapes and heated tobacco products to non-tobacco nicotine pouches and Swedish-style snus. Strong government support is also needed to ensure access for marginal and vulnerable groups. The gains will be evident in the lives saved and the communities protected. Crucially, tobacco harm reduction is an extremely low cost yet effective strategy - a rare example of a health intervention that doesn't require significant government expenditure, as consumers bear the cost. If England is to achieve smoke-free status by 2030, tobacco harm reduction is the key.”


Notes to editors

Read the Briefing Paper in English, Japanese, Chinese (Mandarin), Arabic, Russian, Polish, Spanish, Portuguese, German, Indonesian, French and Hindi at

Read the full K•A•C submission to the Khan review:

Contact: For further information, please contact either Oliver Porritt at [email protected] or on +44 79 30 27 99 16 or Ruth Goldsmith at [email protected] or on +44 78 01 84 51 92.

About us: Knowledge·Action·Change (K·A·C) promotes harm reduction as a key public health strategy grounded in human rights. The team has over forty years of experience of harm reduction work in drug use, HIV, smoking, sexual health, and prisons. K·A·C runs the Global State of Tobacco Harm Reduction (GSTHR) which maps the development of tobacco harm reduction and the use, availability and regulatory responses to safer nicotine products, as well as smoking prevalence and related mortality, in over 200 countries and regions around the world. For all publications and live data, visit

Our funding: The GSTHR project is produced with the help of a grant from the Foundation for a Smoke-Free World, a US non profit 501(c)(3), independent global organisation. The project and its outputs are, under the terms of the grant agreement, editorially independent of the Foundation.


[i] Institute for Health Metrics and Evaluation. (2019). Global Burden of Disease (GBD).

[ii] Statistics Norway. (2022). Tobacco, alcohol and other drugs.

[iii] Public Health England. (2021). Vaping better than nicotine replacement therapy for stopping smoking, evidence suggests.

[iv] Action on Smoking and Health. (2021). Use of e-cigarettes (vapes) among adults in Great Britain.

[v] Office for Health Improvement & Disparities. (2022). Smoking and tobacco: applying All Our Health.

[vi] Department of Health and Social Care. (2022). Government launches landmark reviews to tackle health disparities.

[vii] Office for Health Improvement & Disparities. (2021). Local Tobacco Control Profiles.

[viii] Office for Health Improvement & Disparities. (2021). Adult substance misuse treatment statistics 2020 to 2021: report.

[ix] Homeless Link. Homelessness and health campaign.

[x] Public Health England. (2020. Health matters: smoking and mental health.

[xi] Our World in Data. (2022). Smoking.

[xii] The full Knowledge·Action·Change submission to the Khan Review can be accessed here: