10.2. SR 09-08-2015 - Laserfiche WebLink

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4 2 The public health case – tobacco harm reduction 2.1 Challenging the burden of smoking In 2013, 19% of British adults aged 16 and older, roughly 9.9 million people, smoked 4. Worldwide about 1 billion people smoke daily, about 6 trillion cigarettes are consumed annually (about 3 per adult person per day) and these numbers are still rising 5. The current annual premature death tolls attributed to smoking are 100,000 in the UK and six million world-wide. WHO estimates smoking caused 100 million deaths in the 20th century. If current trends continue, it may cause one billion deaths in the 21st century 6. The public health value of e-cigarettes could reduce this toll of death and disease by hundreds of millions if the promise is fulfilled. The public health proposition is that: (1) E-cigarettes provide a satisfactory alternative to smoking (nicotine, sensory and ritual aspects) and will displace cigarette use in the consumer market for recreational nicotine. (2) E-cigarettes dramatically reduce risks to health, likely by 95-100%, among those who switch with negligible impacts on bystanders, at lower cost, and with lower social stigma. The vast majority of harm in smoking comes from tar and hot gases – products of combustion, rather than nicotine. These are almost entirely absent in e-cigarette vapour. (3) E-cigarettes are a market-based public health phenomenon that ‘meets people where they are’. The public health benefit does not rely on public spending, coercion, prohibition, punitive taxes, fear, stigma or treating smokers as though they are ill. (4) The risks of harmful unintended consequences, like gateways to smoking, are low, remain hypothetical and are so far unsupported by any evidence. The alternative public health approach is to insist that smokers quit smoking and nicotine altogether, sometimes offering a variety of pharmaceutical aids and behavioural support. But this strategy simply does not work for many people because they cannot or do not want to quit smoking, or don’t think the benefits justify the losses and efforts required. The public health case for e-cigarettes involves a major technological disruption of the continuing market for recreational nicotine. Global tobacco sales are variously estimated at $700-800 billion (Bloomberg), mainly cigarettes, whereas sales of vapour products are no more than $5 billion in 2014 (Euromonitor). There is scope for a major structural change in the market for recreational nicotine that could make substantial inroads into the billion deaths projected by WHO. 2.2 Benefits of vaping to a smoker From the smoker’s perspective, e-cigarettes create a new ‘value proposition’. They offer many of the experiences of smoking (a nicotine hit, something to hold and gesture with, sensory experience etc) with few of the harms (long term risk is much lower, less social disapproval, minimal odour nuisance) and at a lower cost, with beneficial knock-on effects to the family budget – which can be especially important in poor families. Prior to the emergence of e-cigarettes, the alternatives were broadly 4 ONS, Opinions and Lifestyle Survey, Adult Smoking Habits in Great Britain, 2013, 25 November 2014 [link] 5 Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014; 311: 183–92 [link]. See full analysis at Counterfactual: Are we in the endgame for smoking? Jan 2015 [link] 6 WHO Factsheet Tobacco, May 2014 [link]