Helping people to breathe easy
Breathing easy is a political choice, and leaders must act to establish a nicotine-free and commercial tobacco-free future today
We have been witnessing commercial tobacco-related diseases and deaths while experiencing incremental successes in tobacco control for more than 70 years. This cycle of addiction, illness and premature death results in significant societal costs, affecting our communities’ health and well-being now and for future generations.
The commercial nicotine and tobacco industry fuels diseases and death. The industry includes any entities involved in commercial manufacturing, marketing and distribution of nicotine or tobacco products that are not ceremonial or regulated as evidence-based pharmacotherapy (that is, nicotine products other than medicines). Maintaining the status quo and allowing the nicotine and tobacco industry and its affiliates to continue profiting from commercial tobacco, nicotine and related products – despite the significant industry-generated harms – is a political decision.
Strong and decisive political leadership is well established in public health, ultimately striving to protect the human right to health. We witnessed such strong political leadership in the name of health at unprecedented levels during the Covid-19 pandemic. This included decisions with immediate and long-term implications. For example, the closure of domestic and international borders had diverse impacts, including social and financial consequences in addition to shaping political (re)election efforts. Furthermore, decisions on essential and non-essential goods, such as prohibiting the sale of commercial tobacco and nicotine products as non-essential goods, also required strong political leadership that can continue to inform public health today.
However, challenges persist as the commercial nicotine and tobacco industry and affiliates use various tools, including political influence, to actively undermine and prolong eradication efforts.
The colonial project
The colonisation of Turtle Island (North America) altered – and continues to alter – ways of knowing, being and doing, including traditions and protocols of Indigenous peoples to Turtle Island and the relationships with the sacred tobacco plant. There are many different species of tobacco plants native to Turtle Island, such as Nicotiana rustica, with many Indigenous peoples continuing to use tobacco as a sacred medicinal plant that promotes wellness. The word ‘tobacco’ is said to have been a Taíno term, a language of the Arawak people of the Caribbean that was claimed by the Spanish in 1550. This claiming of language is a form of colonisation, with the pattern of colonisation continuing with the development of the tobacco plant as a plantation crop: it has been industrialised, modified and commercialised for mass production and distribution and, when used as directed, it kills.
Commercial tobacco products are available and accessible in large quantities and at low cost, with ingredients added that can mask smells, exacerbate addictiveness and lower production costs. The industry and its affiliates have continued to adulterate and manipulate tobacco, through the production of novel and emerging products such as vapes, nicotine delivery devices, heated tobacco products and nicotine pouches, further distancing such products from the origins of the sacred tobacco plant.
Urgent action is required to help safeguard the human right to health
Eradication of the commercial tobacco industry and its affiliates has significant potential, with the opportunity to prevent more than 22,000 premature deaths daily, leading to substantial improvements in life expectancy. This is essential for health and well-being. However, the nicotine and tobacco industry and affiliates fiercely oppose eradication, promoting individual blame and employing strategies to circumvent, attack and undermine public health measures, to protect and expand their profits. This reflects the legal obligations of the industry and affiliates whose ‘best interest’ is centred on their shareholders. There is an inherent conflict of interest between public health and the nicotine and tobacco industry.
The tobacco industry and affiliates have promoted compromised versions of science and epidemiology that are designed to undermine concerns about tobacco-related harms. This includes manipulating commercial tobacco-related research and funding, publishing and disseminating research that supports their best interests, while continuing to sell commercial tobacco, promoting related products as harm reduction, and suppressing and critiquing research that does not support this position.
Public health continues to raise awareness about industry interference and the challenges it presents. This includes the conduct and dissemination of science and manipulation of evidence, as well as political decision-making processes. Clearly, the irreparable ongoing harms are irreconcilable with the human right to health. This is reflected in the World Health Organization’s Framework Convention on Tobacco Control Article 5.3, which requires that governments take measures to protect health policy from commercial and other vested interests of the tobacco industry.
Eradication is realistic and the goal remains: eradicate, eradicate, eradicate!
Despite the challenges, including political changes involved in eradicating commercial tobacco-related disease and death, it is crucial to establish clear targets to eradicate tobacco-related deaths. Various targets for minimising commercial tobacco harms are in place, generally aiming to reduce commercial tobacco prevalence to below 5%. Globally, if the prevalence of commercial tobacco use were less than 5%, it would mean that around 300 million people aged 15 years and older would use commercial tobacco, and half to two-thirds of them would face premature death unless they quit.
We must recognise the ongoing political challenges as the nicotine and tobacco industry and affiliates resource, adapt and mobilise accordingly. Despite FCTC Article 5.3, we continue to witness ongoing political challenges to suppress and influence tobacco control, such as the recent repeal of the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill in Āotearoa New Zealand.
Public health advocates and communities must increase efforts to expose industry tactics to address political interference and industry-generated harms. The political decision to continue selling commercial tobacco products must be taken seriously and is unethical and immoral. It disregards the fundamental responsibility of the human right to health. Whose interests are being served in allowing commercial tobacco sales to mass produce death and disease?
Clearly the nicotine and tobacco industry’s political power has been pivotal in shaping the regulatory landscape and public perception of its products. So, although public health practice is rooted in the belief that scientific research is positivist, it is not likely that more evidence of nicotine and tobacco harms alone will be enough to drive political leadership to eradicate such harm, given what we have known about commercial tobacco-related deaths for over 70 years.
But the time is now. We must mobilise our efforts to safeguard and enhance health and well-being and eradicate the commercial nicotine and tobacco industry and tobacco-related deaths so we can, ultimately, establish a nicotine-free and commercial tobacco-free future today.
