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Tobacco harm reduction and the right to health

Tobacco harm reduction and the right to health (2020) is published by Knowledge•Action•Change, a UK-based agency promoting health through harm reduction (

8 Northumberland Avenue
London WC2N 5BY, UK

Written by: Ruth Goldsmith
Edited by: Harry Shapiro

Publication management by: Grzegorz Król
Design by: WEDA sc; Urszula Biskupska
Project team: Gerry Stimson, Paddy Costall, Grzegorz Król, Kevin Molloy, Harry
Shapiro, Jess Harding and Tomasz Jerzyński
Cover image: Patrick Hendry on Unsplash

This briefing forms part of a broader project to produce a biennial report on the Global State of Tobacco Harm Reduction (GSTHR). The GSTHR is supported by a grant from the Foundation for a Smoke-Free World. The Foundation played no part in determining the content, analysis, or conclusions of this briefing, which remain those of the publisher.

To access this briefing, the GSTHR biennial report and up-to-date information on tobacco harm reduction around the world, visit

Warm thanks to Will Godfrey (USA), Chimwemwe Ngoma (Malawi), Alex Wodak (Australia), Clive Bates (UK), Dave Cross (UK) and Marewa Glover (New Zealand) for their feedback; any errors remain those of the author.

Copyright (c) Knowledge•Action•Change 2020. Under a Creative Commons licence (BY+NC) you are free to copy and redistribute the material for non-commercial use, using the citation below to recognise Knowledge•Action•Change as the content creator.

Citation: Tobacco harm reduction and the right to health (2020). London:

ISBN 978-1-9993579-4-8

Tobacco harm reduction and the right to health

Key messages

Harm reduction is a range of pragmatic policies, regulations and actions that either reduce health risks by providing safer forms of products or substances, or encourage less risky behaviours. Harm reduction does not focus exclusively on the eradication of products or behaviours.

Tobacco harm reduction, using safer nicotine products, offers new choices to millions of people worldwide who want to switch away from smoking, but have been unable to with the options previously available.

There is substantial international, independent evidence that the safer nicotine products that are available today – including nicotine vaping devices (e-cigarettes), heated tobacco products and Swedish-style oral snus – are demonstrably and significantly safer than smoking tobacco.

Until now, official responses to tackle the death and disease caused by smoking have been led by tobacco control. While it has achieved much, it has not eradicated tobacco use. Millions of people worldwide are either unable or unwilling to give up nicotine and continue smoking tobacco to consume it.

In higher income countries, smoking levels remain highest among marginalised communities. In many low- and middle-income countries, smoking levels have plateaued and population increases look set to increase the number of people who smoke.

Millions of people should not be denied access to products that can help them avoid poor quality of life, disease, and premature death. Preventing access to these products denies people their right to health as enshrined in many international health conventions.

Where safer nicotine products are accessible and well regulated, the evidence is clear. People quit combustible tobacco in huge numbers and switch to these products – making the choice to improve their own health, at almost no cost to governments and taxpayers.

Yet bans on safer nicotine products are rising, including in those countries where the number of people who smoke is predicted to increase due to population growth. Government policies and regulation are being unduly influenced by flawed science and anti-harm reduction lobbying, leading to sensational media coverage. Flawed public health information in many countries is confusing and misleading people who want to switch away from smoking.

Similar problems accompanied the introduction of many previous drug or sex harm reduction strategies when they were still new. With tobacco use, the number of people directly affected is vast. Will the transformative public health potential of tobacco harm reduction be realised? Or will this opportunity to save millions of lives be squandered, as a decades-long war on tobacco turns into an all-out war on nicotine?