Session 5: Tobacco control and regulation Seminars

Professor Levy will discuss the vaping and smoking regulatory regimes and smoking prevalence trends in Australia, England, Canada and the US.  Applying the SimSmoke tobacco control simulation model, he will present estimates of the effects of vaping on smoking prevalence for each of the countries, and discuss how these results depend on the regulations in effect.

On November 27, 2001, Dr Cheryl Healton, president and CEO of the American Legacy Foundation, addressed the National Conference on Tobacco or Health on the subject, “Tobacco as a Social Justice Issue.” Dr Healton described the excess burden that tobacco places on society’s poor and underserved populations and recommended ways to expand access to cessation services. She called upon the federal government to hold the tobacco industry accountable for decades of deceptive business practices. And she urged the states to fulfill their moral obligation to use Master Settlement Agreement funds to protect their citizens from future harm from tobacco. 20 years on, Dr Healton will consider what has been achieved and what has changed.

New Zealand has taken a progressive approach to tobacco harm reduction with the Government actively promoting the role of vaping as a harm reduction tool. In particular for populations experiencing health inequities. Currently, an estimated 5% of NZ adults vape regularly, increasing to 8% for the most deprived.

Legislation to control and regulate reduced harm tobacco products and e-cigarettes was passed in mid 2020.  The intent being to balance the benefits of vaping and smokeless tobacco products (as compared to smoking) with concerns about children’s and young people’s access to these products. The legislation favours a more flexible regulatory to vaping controls and will bring some clarity to what has been a totally unregulated e-cigarette market up until now.

However, proposed regulations risk undermining the governments objectives, and tip the balance back in favour of smoked tobacco. This presentation will summarise the major changes to the vaping market as a result of recent legislation, and explore whether it will enhance or hinder the goal to reduce tobacco harms and inequities.

Australia was an early and vigorous adopter of what is now conventional international tobacco control policy. Cigarette taxes were increased 9 times in the last 10 years and Australian cigarette prices are now the highest in the world. Harm minimisation, defined as comprising supply, demand and harm reduction, has been the official national drug policy since 1985. Harm reduction is explicitly supported in the National Tobacco Strategy and the 2003 Framework Convention on Tobacco Control (which Australia has signed). Yet of all High Income Countries (HIC), Australia has been the most hostile in response to tobacco harm reduction, including vaping. It is the only HIC to require a doctor’s prescription for nicotine liquid for vaping. Almost all major Australian health organisations strongly support this approach. Further restrictions, not yet announced in detail, will be introduced on 1 October. Twenty eight government backbenchers, representing 25% of all government members of parliament, publicly criticised proposed new restrictions in June 2020 and December 2020, forcing the Health Minister to retreat. Australian smoking rates have missed official targets twice in recent years and have been almost flat since 2013. New drug harm reduction interventions such as methadone treatment, needle syringe programs and drug consumption rooms were also bitterly resisted for many years before being accepted and acknowledged as effective, safe and cost effective. Like tobacco harm reduction products, they were also strongly supported by compelling and increasing evidence. The significant decline in share price of major tobacco companies in recent years with the impressive growth in companies committed only to tobacco harm reduction products suggests that economic factors will also powerfully influence government policy in Australia and other countries. There is good reason to anticipate a political correction although this will probably take some time and involve many incremental steps.

At the beginning of April 2021, the UK Government set out its plans for the transformation of public health after the abolition of Public Health England. The vision is ambitious stating that “Health will no longer only be the business of the DHSC, but a core priority for the whole of government. “The vision will be delivered by rolling the national functions of Public Health England back into the Ministry of Health within an Office of Health Promotion (OHP), due to be up and running by October 2021.   The OHP will have a broad remit to drive “action across government on prevention and the wider determinants of health”. The reorganisation is taking place as a new Tobacco Control Plan is under development. Public Health England has played a leading role in establishing the UK’s considered and evidence-based policy position on e-cigarettes. This presentation examines what the impact of its abolition and the reorganisation of public health are likely to be on the UK’s e-cigarette policy going forward.

• Is smoking a social justice issue – are we supporting those that need it the most
• Does tobacco harm reduction compromise core tobacco control principles?
  

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