No, I’m not proposing one, but referring to the outcome of the recent WHO Global Conference on Primary Health Care in Astana, Kazakhstan which produced the Astana Declaration. Of itself it isn’t a charter for tobacco harm reduction (THR), but if the WHO is seriously committed to delivering on its vision and not just cherry-picking the areas of health care that suit the organisation and its funders, then it is certainly a template for THR.
As readers of the Global State of THR might recall, this Declaration repeats many past global public health ‘health for all with nobody left behind’ aspirations that wither on the vine. But any excuses for failing to protect the entrenched smoker are seriously undermined now we are in an age of truly disruptive new technologies that can assist smokers to move away from killer cigarettes.
There are many quotes to choose from, but here is a selection - bold type is emphasis added:
“We strongly affirm our commitment to the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind”.
“We will continue to address the growing burden of noncommunicable diseases, which lead to poor health and premature deaths due to tobacco use, the harmful use of alcohol, unhealthy lifestyles and behaviours, and insufficient physical activity and unhealthy diets”.
“We can no longer underemphasize the crucial importance of health promotion and disease prevention…”.
“We will involve more stakeholders in the achievement of Health for All, leaving no one behind…”.
“Through digital and other technologies, we will enable individuals and communities to identify their health needs, participate in the planning and delivery of services and play an active role in maintaining their own health and well-being”.
“We will promote health literacy and work to satisfy the expectations of individuals and communities for reliable information about health”.
“In implementing this Declaration, countries and stakeholders will work together in a spirit of partnership and effective development cooperation, sharing knowledge and good practices while fully respecting national sovereignty and human rights”.
And finally, the Declaration encourages Member States to “Make bold political choices for health across all sectors”.
Maybe the boldest political choice would be for Member States to start putting pressure on the WHO to look seriously at the evidence in favour of safer nicotine products (SNP) and reverse its ‘encouragement’ of States to introduce prohibitive legislation, and actually do some public health good with the added ‘cost-free’ bonus of SNP to the public purse.
On September 12, 2018, and in light of all the fuss about JUUL, the FDA wrote to the five leading manufacturers of e-vapour products in the States and outlined the Agency’s concerns about underage access to and use of e-vapour products. Altria replied to the FDA saying they were going to immediately remove two of their pod products from the market and sell only tobacco, menthol and mint flavours for use with cig-a-likes – in other words acting in support of FDA proposals for flavour bans. No doubt the company are hoping that somehow they will be seen as the good guys in the ongoing row over teen vaping. Cynics (meaning just about everybody else) see this as simply a business ploy to put pressure on rivals, essentially JUUL whose only product is an e-cigarette, who are undermining the sales revenues of the major companies. And this from the company that sells around half the cigarettes in the USA and is on the cusp of investing in the Canadian cannabis business through a minority interest stake in Aphria, who are now quoted on the New York Stock Exchange.
It is possible that Altria are just playing dog in the manger in that it might not see a huge financial future for the company in SNP, but wants to sabotage the success of others. Or more likely the harder life is for SNP producers, and easier life for traditional cigarette companies. This contrasts to the totally uninformed view of anti-tobacco harm reductionists who persist in the claim that SNP are just another way of boosting the profits of Big Tobacco. Really? Not according to most informed market analysts.
Shane De La Haye, assistant fund manager at Ashburton Investments, wrote that “Growth in vaping will benefit global tobacco companies such as British American Tobacco (BAT) and Philip Morris, as they own many of the largest vape brands”. But he also believes BAT’s vaping business is “Loss making currently”. He wrote, “The rapid growth of the vaping industry has been a double-edged sword for large tobacco companies. On one hand, the popularity of vaping has provided much needed growth within the industry, but at a cost, given the margin dilution”. With “Cannibalisation” of demand for cigarettes, he concludes, “We do not expect the rising demand for vaping to arrest the long-term decline in the global tobacco industry”.
I’m reminded of the Stonecutters song from an episode of The Simpsons where Mr Burns and his secret cabal of industry bigwigs celebrate their self-interested global influence. Listen out for the line about the electric car.
On the subject of the FDA and the so-called teen vaping epidemic, it seems that a government agency which should be setting the standard for openness and transparency is proposing to act on the data which is supposed to reveal its justification for the use of term ‘epidemic’, while at the same time failing to reveal that same full data set. I wonder if they are worried that the data really won’t stand up to scrutiny?
An almost inevitable consequence of increasing global prohibition of e-cigarettes will be an explosion (quite literally I suspect) in fakes and clones, not just of the devices, but also the liquids which could easily contain a whole panoply of potentially dangerous substances as regulation and control safety standards give way to the Wild West. This from The Conversation: