Combustible tobacco continues to be one of the leading causes of preventable disease worldwide, with millions of people suffering the health consequences of nicotine and tar addiction. As the global community grapples with the burden of tobacco-related disease, a growing number of countries are exploring the potential of Tobacco Harm Reduction (THR). The THR approach aims to minimize the health risks of smoking by providing safer alternatives.

The urgency of the THR approach is becoming increasingly apparent, especially in countries where smoking is prevalent, and Ghana is living at a pivotal moment to embrace the science of controlled strategies (quit or switch) over the traditional strategies (quit or die) to reduce combustibles . tobacco-related diseases to save lives.

The dilemma of quitting or switching

The traditional approach to tobacco control has been to encourage smokers to quit completely. This is an ideal scenario, where individuals are free from both nicotine and the harmful chemicals found in cigarettes. However, quitting is often extremely challenging due to nicotine addiction; which is why millions of smokers around the world struggle to give up the habit.

In light of these challenges, THR advocates suggest a different approach: “Instead of pressuring smokers to quit completely, governments can offer them safer alternatives that reduce health risks while satisfying their nicotine needs”. This approach has been successfully adopted in countries such as Sweden and New Zealand, where smoking rates have fallen significantly as a result of the introduction of safer alternatives such as nicotine pouches, e-cigarettes and heated tobacco products.

For Ghana, tobacco use is on the rise with 6 in 100 adults currently patronizing, compared to 4 in 100 adults in 2019. There is a higher prevalence in males of 7% and 0.4% among females, with combustible tobacco use causing more than 6,700 deaths , and 66% of these deaths are premature. This poses significant public health risks. Therefore, the adoption of a THR strategy could be a game changer in minimizing the public health impact of smoking without criminalizing or stigmatizing smokers. Again, the economic impact of combustible tobacco use in Ghana led to a loss of GH668 million, 0.2% of Ghana’s Gross Domestic Product (GDP) in 2029.

According to recent statistics, the smoking rate in Ghana is around 3.5% among youth. Although this figure is alarmingly lower than in many other countries, the consequences of smoking on public health are far-reaching. Smoking as a major contributor to cardiovascular disease, respiratory disease and cancer placed a significant burden on Ghana’s already strained public health system and contributed to increased healthcare costs and the government’s healthcare budget over the years.

Despite this, smokeless tobacco use remains largely unregulated in Ghana, with most policies focusing on traditional methods of tobacco control such as public smoking bans and advertising restrictions. Although these guidelines have had some effect, they are not sufficient to address the risks posed by smokers who are unwilling to quit.

This is where THR can play a critical role. By offering less harmful smoke-free alternatives, Ghana can reduce the health effects of smoking without forcing smokers to quit nicotine altogether. As Mr. Mensah Thompson of the Alliance for Social Equity and Public Accountability (ASEPA) noted during a recent policy dialogue for a smoke-free society by the Institute for Liberty and Policy Innovation (ILPAI), smoking is a personal choice, and while it should be regulated, it should it is not criminalized. Therefore, THR provides a balanced approach by protecting public health while respecting individual rights.

The Power of Substitutes: Case studies of Sweden and New Zealand

One of the most convincing examples of successful THR implementation is Sweden. In the 1960s, Sweden had one of the highest smoking rates in Europe, with 36% of the population smoking regularly. By 2022, that figure had dropped to just 5.6%, and Sweden is now on course to become the first country in Europe to be declared smoke-free, with a smoking prevalence of less than 7%.

The answer to this remarkable change lies in the adoption of Harm Reduction Strategies (HRS). Instead of outright banning smoking, Sweden thus introduced Snus, a smokeless, moist tobacco product. Snus delivers nicotine without the harmful byproducts of combustion, making it a much less harmful alternative to traditional cigarettes. Over time, many smokers switched to snus, which led to a dramatic decrease in smoking frequency.

It is important to recognize that Sweden’s success was not only due to the introduction of snus, but also to the government’s use of fiscal policy to encourage smokers to switch. This was done by taxing cigarettes more than snuff, creating a financial incentive for smokers to choose the safer alternatives. This strategic use of taxation proved to be a powerful tool for promoting harm reduction.

New Zealand also effectively used THR to reduce the number of smokers. Between 2020 and 2023, New Zealand saw its smoking prevalence decrease from around 15% to 6.8%, with the country on track to become smoke-free in the near future. Like Sweden, New Zealand did not rely solely on traditional tobacco control measures to achieve these results. Instead, the government introduced safer alternatives such as e-cigarettes and nicotine pouches while educating the public about the relative harms of different tobacco products.

The New Zealand success story demonstrates the importance of public health campaigns to promote harm reduction and educate smokers about the risks of traditional cigarettes and the benefits of switching to safer alternatives. This highlights an important lesson for Ghana to adopt harm reduction strategies to achieve a smoke-free society.

The Political Strategy of Ghana

One of the key messages from Sweden’s and New Zealand’s experiences is the importance of fiscal policy in promoting THR. Both countries used strategic taxation to create a price gap between traditional cigarettes and safer alternatives, making harm reduction products more affordable and accessible.

In Ghana, the adoption of similar fiscal policies could play a critical role in promoting THR. By cutting taxes on e-cigarettes, nicotine pouches and other harm-reduction products while maintaining higher taxes on traditional cigarettes, the government can encourage smokers to switch. This would help reduce the financial barrier to safer products and encourage more smokers to adopt them.

As Dr. Gyedu Owusu highlighted during the policy dialogue on THR, without a favorable tax structure, harm reduction products will remain inaccessible to many smokers, especially those from low-income backgrounds, leading to the use of substandard products that may exacerbate other public health challenges. If the price of safer alternatives remains higher than that of traditional cigarettes, smokers will have little incentive to switch. Therefore, any THR policy in Ghana must include a tax component that ensures these products are affordable and widely available.

There should also be significant changes to the country’s regulations. As it stands, Ghana’s public health laws provide little to no guidance on how to regulate alternative nicotine products such as e-cigarettes and nicotine pouches. This lack of regulation leaves both consumers and businesses in a gray area, with no clear guidelines for the safety, marketing or taxation of these products. Therefore, to effectively promote THR, Ghana needs to update its public health laws to include comprehensive regulations for harm reduction products. This includes ensuring that these products meet safety standards, are marketed responsibly and taxed in a way that encourages their use over traditional cigarettes.

As postulated by lawyer Richard Armah during the policy dialogue, Ghana’s current tobacco control laws are outdated and focus mainly on public smoking bans and advertising restrictions. Going forward, the government must prioritize updating these laws to reflect the changing landscape of tobacco use and the potential of harm reduction products to save lives.

Based on empirical evidence of success stories demonstrated by Sweden and New Zealand, ILAPI urges the government to adopt tobacco harm reduction strategies in Ghana. As smoking remains a significant threat to public health, and despite the country’s relatively moderate smoking rate, it is clear that traditional tobacco control measures are not enough, causing people to hide and smoke. Nevertheless, providing safer alternatives and creating a supportive regulatory and fiscal environment can reduce the health risks associated with smoking and move Ghana towards a smoke-free future. In this direction, Ghana needs a THR Blueprint document with extensive consultations to adopt the science of alternative products to save lives and reduce the burden on our health facilities.

In addition, Ghana should learn to adopt the strategies of successful countries such as Sweden and New Zealand, which include making smokeless tobacco products available with incentives to import for use. This should come with unique labeling as THR products cannot be labeled in the same way as combustible tobacco. This will also prevent illegal importation of the product through non-approved routes. These smoke-free alternatives must be made cheaper with continuous public education about their safe use to improve public health and consumer choice.

The time to act is now; whether smokers quit or switch, the goal is the same: a healthier, smoke-free Ghana is the focus!

About the author

Peter Bismark Kwofie is the CEO and President of the Institute for Liberty & Policy Innovation (ILAPI).

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