Anti-smoking policies

Moon Ok-ryun
The author is an emeritus professor at the Graduate School of Public Health, Seoul National University, and president of Korea Harm Reduction Association.

The U.S. Federal Drug Administration (FDA) recently authorized the marketing of an international tobacco company’s heated tobacco products (HTPs) as “modified risk tobacco products [MRTPs].” The decision is very surprising given the common notion that all tobacco products are harmful. What led one of the world’s most stringent food and drug agencies to come to this conclusion? With the limits of current anti-smoking policies being reached, there is a need to develop new policies that can help supplement former policies.

Anti-smoking policies exist in various forms throughout the world in regard to tobacco. Increase in taxes, restrictions of sales and advertisements, the inclusion of warning labels and images, restrictions on smoking areas, restriction of sales to minors are just a few examples. Following this trend, our country has also been implementing strong anti-smoking policies over the years. As a result, our country successfully reduced the smoking prevalence of adults from 35.1 percent in 1998, to 22.4 percent in 2018.

However, despite stronger anti-smoking policies and a drastic price increase over the past 5 years, the rate of smoking is no longer on a decline. What could be the reason for this? It’s very unlikely that it is because smokers are unaware of the risks involved with smoking and that there aren’t enough public anti-smoking campaigns to educate smokers, or that there is a general lack of social interest in anti-smoking.

What we do have to take note of is that current anti-smoking policies are geared towards putting strong social pressure and regulations on smokers and trying to force them to quit through criticism and discipline. Modern science dictates that smoking causes nicotine addiction. It does not factor in the individual’s urge and circumstances for being addicted to nicotine and for failing to quit smoking. Good policies are aimed at providing a wide range of options for consumers. Having the option of choosing products that can help reduce smoking in steps or reduce the risks are the stages of such policies that should be implemented, which will ultimately aid smokers to quit.

This type of approach follows the foundations of harm reduction, a concept devised to treat alcohol, cigarette and drug addictions. Having the chemical contents of cigarettes available so that smokers can assess the risks themselves and implementing differentiated regulations based on levels of risks, conventional cigarettes, which have the highest risk, will eventually fade out. The FDA’s authorization of MRTP supports the harm reduction theory and demonstrates that the agency acknowledges that there is a reduced level of risk when compared to conventional cigarettes.

However, our authorities are holding on to the former anti-smoking policies of “unconditional anti-smoking.” As a result, despite HTPs and e-cigarettes having the potential to reduce risk compared to conventional cigarettes, regulations have remained the same or are facing even stricter regulations, like policies being pushed forth by the 21st National Assembly.

Within the bills to National Health Promotion Act proposed by the current National Assembly, there are no revisions that ban the use of flavored additives, which can help prevent teen smoking, and regulate conventional cigarettes, which are found to be more harmful, have not been tightened. According to a survey conducted by a polling organization, 62.7 percent of teen smokers started smoking with flavored cigarettes (conventional cigarettes that use capsules, flavored filters, etc.), and of them, 89.6 percent said that flavored capsule cigarettes influenced their decision to start smoking. Rather than revising more urgent issues like these, the bills are focused on regulating the sales, inclusion of warning messages and images on lower risk HTPs and e-cigarettes. The result of these policies may lead smokers who have trouble quitting to continue smoking higher risk conventional cigarettes rather than quitting. There is a need to prioritize the implementation of policies.

Smoking does not only harm the health of the smoker, but it is also a leading cause of the public health crisis. Smoking is not something that should be encouraged. However, in order to achieve the goal of an anti-smoking policy, a new practical approach which could lead smokers to quit smoking is needed instead of solely pushing an “unconditional anti-smoking” manner to cover the limitation of the current policy. A new policy that is centered on harm reduction by allowing smokers the option of choosing products with lower risks and creating an environment that aids quitting is required. Policies that open up more options will help grow the self-determination of smokers.

Though the goal of a policy can be close to a value judgment, to truly achieve the original goals of a policy, it must be carefully catered to the needs of the target. It is worried that current policy that equally regulates or even more strictly regulates lower risk tobacco products compared to high risk conventional cigarettes, might cause more harm than good.