Infectious diseases account for the greatest burden of mortality and morbidity in SSA, however, the incidence and prevalence of non-communicable diseases (NCDs) in the region is also on a steady rise. Smoking is an important and a leading cause of preventable mortality due to NCDs as it contributes to a significant number of non-communicable diseases in human. The United Nation ‘Sustainable Development Goal 3.4 states that “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”. It could be said that high income countries are well on their way to achieving this as the number of smokers in the developed world is on a steady decline. Unfortunately, same cannot be said for the developing world as the population of smokers in the region continues to increase. Of the over one billion global smokers, over 80% reside in low-and-middle-income countries including a substantial number in sub-Saharan Africa. Out of this, about 7 million deaths yearly could be attributed to cigarette smoking. It is even more worrisome that the numbers of smokers in sub-Saharan Africa is expected to increase in the coming years.
In order to achieve the SDG 3.4 Goal in the African region, it is imperative that great attention be paid to the tobacco control policies in the region. The 2003 Framework Convention for Tobacco Control (FCTC) and the 2008 M-Power Package represent the bulk of the guide used in sub-Saharan Africa for Tobacco control. Although the FCTC and the M-Power package have played significant role in reducing global smoking rate, it continues to prove inadequate in the African region. This has necessitated the need for Tobacco Harm reduction as a smoking cessation strategy in the region. Tobacco Harm reduction aims to reduce the harm associated with smoking for smokers who are unable to or unwilling to quit Nicotine. As Michel Russel aptly stated that “People smoke for the nicotine but they die from the tar”, it is the nicotine in cigarette that causes addiction and it is the tar and the other components that are responsible for the debilitating effects of smoking. Therefore, Tobacco Harm Reduction, although, still in its early stages of operation in SSA, holds promises of reducing the harms associated with tobacco smoking.
Tobacco Harm Reduction offers safer nicotine products (SNPs) such as the electronic cigarettes, a vaping device, smokeless tobacco such as snus and heat not burn products. There is a need for widespread adoption of Tobacco harm reduction in the region. Many tobacco harm reduction advocacy groups in the region continue to do incredible work of preaching and advocating for SNPs in the region. Campaign for Safer Alternatives, Tobacco Harm Reduction Nigeria, Tobacco Harm Reduction Malawi, Tobacco Harm Reduction Uganda and many others continue to bring THR closer to the people particularly the smoking population in the region.
While THR is very promising for the region, it has perpetually been faced with myriad of challenges. Prominent among these are huge cost of adoption of THR and its products, existence of tobacco control policies which are ineffectual, lack of adequate government support, lack of awareness about and access to THR products and inability to afford relatively expensive alternatives to smoking. These challenges heavily contribute to obscurity of THR in sub-Saharan Africa and thus confers heavy burden to smoking prevalence among its titanic population.
A need to proffer solution becomes imperative. Fore mostly, there is need for re-examination and revamp of existing tobacco control policies in the region to accommodate THR. Government at all level should adopt policies that encourage THR and provide needed support to smokers including rehabilitation and provision of THR products to aid and encourage smoking cessation. Also, there is need for continuous advocacy and awareness programs for the population particularly at all levels of prevention to not only offset recruitment of new smokers but also enable present smokers to switch to safer alternatives. Intense training and retraining of individuals about dangers of smoking and Tobacco Harm Reduction and benefits of THR products will also go a long way in curbing the menace associated with tobacco smoking. Furthermore, the gaping research gulf in tobacco harm reduction in sub-Saharan Africa region need be bridged by facilitating more initiatives that encourage research, erudition and academic prolificity on THR.
Aishat Alaran is a KAC THR scholar and an eminent advocate for Tobacco Harm Reduction in sub-Saharan Africa. As part of her research, and advocacy and awareness projects, she devised an information material for THR translated to the four common languages spoken in Nigeria and she also embarked on a door-to-door campaign to heighten awareness on smoking cessation and tobacco harm reduction in Nigeria.
