Aligning Harm Reduction in Tobacco Control Strategies in Pakistan

Tobacco remains a significant threat to global public health, irrespective of the ongoing tobacco epidemic, which is increasingly dangerous in countries with developing economies like Pakistan. This article therefore demonstrates that, while evaluating the integration of harm reduction measures coupled with conventional measures for the management of tobacco use, it is apparent that there is a need for community interventions and dispel the myths about harm reduction products. Currently approaches to tobacco control are focused on abstinence or Prohibition. (
For Example, the existing law of the country is known as the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance, 2002). While harm reduction is based on understanding that there are various levels of nicotine addiction and aims at the reduction of potential adverse health effects of tobacco consumption. In this article through discussion of e-cigarettes, vaping, and Nicotine pouches, this article will describe how the implementation of harm reduction into Pakistan’s tobacco control strategies will be beneficial for public health. In doing so the intention is to offer a holistic analysis of the nature and environment within which health-tobacco-related, health initiatives can thrive while acknowledging the barriers to their improvement in the region.

The burden of tobacco use in Pakistan presents a significant public health challenge, characterized by high prevalence rates and limited awareness about its associated health risks. The country has more than twenty-four million adults who use tobacco products; thus, it has high statistics of smoking-related illnesses affecting young individuals. In support of these, researchers define noncommunicable diseases, and the continued prevalence of these diseases in developing countries such as Pakistan requires immediate intervention. However, the incidence of smokeless tobacco varieties usage has not ceased which makes the problem even more challenging for public health practitioners. So, the approach to the current situation and Pakistan’s tobacco control plans must focus on the principles of harm reduction to reduce tobacco-related diseases and deaths for the betterment of overall population health.

However, there has been an increasing drive towards reducing the use of tobacco products in Pakistan, despite the many challenges. Currently, some policies comply with the World Health Organization’s Framework Convention on Tobacco Control including taxation and restriction to advertising and smoking in the public. However, the foregoing measures are offset by the relentless marketing strategies employed by the industry, particularly among the youth and the poor. Innovative studies stress that complex policy interventions, such as school-based campaigns, lectures, and media campaigns, decrease use, with declines in smoking. However, these accomplishments are threatened by the interference and manipulation of the industry in local economies for promoting the use of tobacco products, especially in low and middle-income countries such as Pakistan. If these crucial issues are effectively managed and effective measures to curb cigarette harms are reinforced, Pakistan can frame a better strategy to tackle the menace, thus reducing the expensive health impact. But there are almost no cessation services, or guidelines available for the numbers of smokers who want to quit smoking. While there are products available in the market to help smokers quit there needs to be some regulatory mechanism for these products. Pakistani market has been flooded with these products, there is almost no way to determine the safety, and quality of these products. This has boosted the need for the government to speed up its thought process and develop relevant policies that should be replicated in firm regulatory mechanisms.

The existing tobacco control policies in Pakistan put into perspective warrant an assessment to assess the extent of their impact on various tobacco products such as smokeless and waterpipe tobacco (Sheesha). Crucially, a cross-sectional study conducted on selected countries discovered that while most of them do not have specific legislation regarding WTP, the generic regulation of tobacco products definition fails to address the waterpipe smoking nature. Collectively, the smokeless tobacco policies in Pakistan extend beyond the WHO FCTC and are patchy; although, its usage is seen among a cross-section of people. Overall, a systematic review suggested that policy measures including taxation and multipronged strategies reduced the use of smokeless tobacco in other countries, potentially in Pakistan. Still, issues like cross-border smuggling and other practices that do not adhere to existing regulations are prevalent. Therefore, it is important to integrate the harm reduction strategies in the context of the existing framework to improve the efficiency of these policies in Pakistan.

The strategies of harm reduction in tobacco control offer a critical platform for dealing with the rampant problems of smokeless tobacco, especially in the context of Pakistan. The compiled data, therefore, suggests that taxation and comprehensive policies have a positive correlation with the decrease in the prevalence of smokeless tobacco, ranging significantly. While there is an urgent need to implement evidence-based cessation interventions and policies for those who choose to use tobacco or its bye products, the WHO Framework Convention on Tobacco Control still requires the development of culturally appropriate strategies to reduce tobacco use as well as cessation support among users. Such strategies can include educational campaigns aimed at increasing public health knowledge on the risks involved with the use of smokeless tobacco, which has been said to significantly increase quit rates. In the historical account of global tobacco control activities, the focus of the pursuits on the reduction of untimely deaths and illnesses resulting from tobacco use provides a befitting illustration of the significance of integrated harm reduction interventions in creating healthier societies within Pakistan.

A look at the practices in the other countries and findings out the ways to improve the anti-tobacco campaign in Pakistan seems fascinating. In developed economies, organization’s strong CSR practices proved to enhance the health of the public thus implying that similar structures could practice in Pakistan’s tobacco control environment. This suggests that there is a need to involve all the key stakeholders and be transparent, especially in the process of issuing and preparing CSR, especially in health-related issues. Along with that, the identification of risks and management of supply chain risks in terrorism-affected regions shows that there is a need to establish supply chain risk management strategies for the protection of the public health agenda against disrupting factors. Thus, Pakistan may produce specific policies that will address the issue of complex regulation by focusing efforts on the global practices associated with the reduction of the use of tobacco products and the promulgation of a healthier environment. The integration of these practices shall therefore provide a proper way of ensuring that the reduction of harm is in line with the current anti-tobacco campaign in the country.

Consequently, integrating harm reduction strategies within the framework of tobacco control in the context of Pakistan is vital for tackling the rising threat of diseases associated with tobacco consumption. This means that any force affecting an environment is likely to affect the health of an individual or a community thus the need to use policies, and community engagement as researchers have argued that researchers need to engage key stakeholders in decision making. In addition, identifying a rising trend in environmental health risks, other areas such as Southeast Asia and the Western Pacific similarly imply the importance of tobacco control measures aiming at the health and safety of children. Thus, the Pakistani government and relevant health authorities should learn best practices from other countries in this sphere and implement them in local conditions to promote healthier settings to decrease the negative effects of tobacco consumption. In this sense, this collective effort results in major decreases in morbidity and mortality related to tobacco while at the same time maintaining sustainable public health benefits.

Adopting a harm reduction strategy in national tobacco control requires comprehensive policies that go beyond the abstinence approach towards tobacco use. It calls for the development of other evidence-based protocols that call for reduced-risk exposure products such as e-cigarettes and nicotine replacement therapeutic products (pouches) which act as interim help to those who cannot quit or do not wish to quit completely. Based on these findings, policymakers should consider supporting public awareness initiatives meant to eliminate myths about these alternatives thus preventing consumer self-deception.

Besides, there is a need to establish a regulatory structure that keeps the product from posing risks to the people while at the same time promoting the development of other products with minimal risks involved. This sort of regulation should therefore involve consultation with public health bodies to make sure that the harm reduction measures applied are culturally sensitive to the specific socioeconomic status of the population being tried to be targeted. If these recommendations are to be implemented, then Pakistan can have a progressive tobacco control policy one that is comprehensive and realistic as to the issues of tobacco consumption and dependency.

Dr. Ziauddin Islam

Public Health Professional

Former Focal Person of the Government of Pakistan to FCTC and ITP of WHO's FCTC

Ziauddin.islam@gmail.com