Reducing Tobacco harm: Public health policy in Nigeria, Ghana, Cameroon.

By Olasunkanmi Ekundayo

Tobacco use is a major global public health concern. The high population of youths in Africa contributes to the high rate of tobacco consumption on the continent. High- and middle-income countries such as Nigeria, Cameroon, and Ghana are making cogent efforts to reduce tobacco consumption and its attendant risks.

The World Health Organisation estimates that 80 percent of tobacco users worldwide reside in low- and middle-income nations such as Nigeria, Ghana, and Cameroon. Despite the harm tobacco use poses to the health of its users, there is an increase in the number of users consuming tobacco in these three countries. According to the WHO, it is estimated that by 2025, there will be 16,868,400, 1,697,800, and 7,631,000 smokers in Nigeria, Ghana, and Cameroon, respectively.

As a solution to the increasing number of tobacco smokers in Nigeria, Ghana, and Cameroon, tobacco harm reduction is presented as a viable solution. Harm reduction strategies offer a promising approach to minimising the health risks associated with tobacco smoking. After battling with tobacco smoking for years, Sweden has become the European country with the lowest rates of tobacco smoking owing to the implementation of THR.

Read also: Tobacco harm reduction: Nnanyelugo, others push Sweden model for smoke-free future Nigeria

Tobacco consumption has been linked with life-threatening conditions such as cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Also, it increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis” (Centre for Disease Control and Prevention). This public health challenge has been attributed to cigarettes, which contain combustible substances and associated toxins. To reduce the harm or risks posed by the increasing use of tobacco products and slow down the incidence of its health risks, therefore, public health strategies have been undertaken “to manage addictive behaviours that pose severe health risks.” This “approach recognises that for people unable to abstain from certain risky behaviours, including cigarette smoking, “public health intervention can be used to mitigate the potential dangers and health risks” (Dewhirst, n.d.).

Tobacco harm reduction aims to reduce the toxicity of tobacco products and introduce less harmful alternatives to mitigate health risks associated with tobacco use. Nicotine pouches and e-cigarettes are two options that can minimise adverse effects on users. Nicotine pouches are smoke-free, discreet, and offer a soothing experience, while e-cigarettes do not produce harmful tar or carbon monoxide. These products have proven to help smokers reduce their tobacco intake, reducing illnesses, harm, and diseases associated with smoking tobacco. Despite the challenges in encouraging people to quit smoking, these alternatives offer a more feasible solution to reducing tobacco use.

The methodology we employed is a desk review of related articles on tobacco harm reduction strategies across three countries, namely Cameroun, Ghana, and Nigeria. The rationale for the choice of this method afforded the researchers the opportunity to examine existing literature related to tobacco harm reduction strategies to gather information on the three countries under review. A total of 165 articles were reviewed, which included journals, working papers, workshop proceedings, technical papers, and newspapers.

The World Health Organisation estimates that 80 percent of tobacco users worldwide reside in low- and middle-income nations such as Nigeria, Ghana, and Cameroon. Despite the harm tobacco usage poses to the health of the users, there is an increase in the number of users consuming tobacco in these three countries. According to the WHO, it is estimated that by 2025, there will be 16,868,400, 1,697,800, and 7,631,000 smokers in Nigeria, Ghana, and Cameroon, respectively.

Read also: The science of tobacco harm reduction

To mitigate the harmful effects of tobacco, some of the world’s leading tobacco manufacturers work to create alternative, reduced-risk products based on tobacco harm reduction principles. Some of the strategies they have deployed so far include measures such as controlling product distribution and authorisation; adopting nicotine delivery systems, price and taxation; raising public awareness and education; stringent regulation; a ban on tobacco advertising, promotion, and sponsorship; school interventions; warning labels and plain packaging; increasing the price of cigarettes to prevent initiation; mass media involvement in tobacco control programmes; implementing smoke-free policies; and restricting access to cigarettes by minors.

From the review, it is significant to note that promoting tobacco harm reduction strategies is a more practical step towards reducing the health risks associated with tobacco use. If the recommendations outlined in this policy brief are implemented, we can improve public health outcomes and lower tobacco smoking-related diseases and deaths.

This policy brief presents key recommendations for promoting tobacco harm reduction strategies in Cameroon, Ghana, and Nigeria, as follows:

-Increase awareness and education on harm reduction strategies for the general public, policymakers, and non-health ministries.

-Governments should be transparent in their interactions with the tobacco industry by holding policy advocacy meetings in public or making minutes and reports accessible to the public.

-There should be strengthened collaboration between citizens and the government to improve surveillance, reporting, and enforcement mechanisms. For example, in the US, there is a Tobacco Violation Act, and citizens can report any violation by submitting a form online, calling a toll-free number, or sending an email. When there are such reports, prompt action such as investigation, monitoring, or additional surveillance should be carried out.

-The use of non-tobacco-based alternatives such as vapes and oral nicotine has been recommended to reduce the smoking rate and disease burden below the acceptable average.

New, more modern, and less harmful tobacco-free products that have been introduced into the market in the last decade, such as vapes (e-cigarettes) and oral nicotine pouches, should be adopted. These products have been considered to be accessible, acceptable, affordable, and effective as tobacco harm reduction strategies.

Ekundayo, a community health worker based in Lagos.