Stories

Harm reduction cannot only reach the people easiest to reach. Marginalised communities often face the highest burden of smoking-related harm, while also having less access to trusted healthcare, stable support and practical quitting routes. Tobacco harm reduction has to be built with those realities in mind: affordable options, credible messengers and policies that do not add stigma to disadvantage. Reducing harm means reaching the people public health too often misses.

A smoking ban may look like a clean public health victory, but bans rarely stay simple once they meet real life. Adults who smoke are still adults, and policy has to balance harm reduction with autonomy, enforcement and unintended consequences. The better question is not how far restrictions can go, but whether they actually reduce smoking-related harm without pushing people into stigma, avoidance or less visible use. Public health should persuade, support and reduce risk — not rely on prohibition as its default language.

A 74% fall in youth vaping changes the way the problem should be described. If use is declining sharply, the “epidemic” label may no longer reflect the evidence — and policy should adapt accordingly. Youth access still requires enforcement, but exaggerating the scale of the issue can distort public perception and justify restrictions that also harm adult smokers. Good public health depends on accurate labels, not outdated alarm.

Heat is no longer an abstract climate issue when people are trying to sleep, work or stay safe in homes built for a cooler past. The air-conditioning debate shows how quickly adaptation becomes political: some see cooling as wasteful, others as basic protection against extreme heat. A serious response should not shame people for needing relief, but make cooling cleaner, more efficient and more accessible. Climate policy has to help people live with the risks already here, not only argue about the emissions still to come.

A regulation that treats every nicotine product as equally dangerous starts from the wrong premise. South Africa’s tobacco policy should recognise that the greatest harm comes from combustion, not nicotine itself. Risk-proportionate regulation would still control access, protect young people and set product standards, but it would not make lower-risk alternatives harder to use than cigarettes. The aim should be to move smokers down the risk continuum, not trap them at the most harmful end.

Power, temperature and device design are often discussed as if they automatically translate into higher danger. With sub-ohm vaping, the more important question is what the evidence actually shows about emissions, exposure and real-world use. High-powered devices should be assessed carefully, but not through assumptions that ignore how experienced users control settings, airflow and liquid consumption. Safety debates need measurements, context and comparison with the risks of continued smoking.

The National Press Club discussion addressed Australia's illicit tobacco crisis, emphasizing the need to move beyond enforcement to consider broader policy implications. Speakers highlighted the unintended consequences of current strategies, including the role of public policy in fueling the illicit market. Different perspectives were presented, underscoring the need for a more comprehensive national strategy with measurable outcomes. The discussion also explored the intersection of science, regulation, and harm reduction in tobacco control. Ultimately, the event encouraged a reevaluation of Australia's approach to reducing smoking rates while addressing the complexities of the illicit tobacco trade and the need for evidence-based policy decisions.

Smoking among people who use drugs, such as heroin users in England, contributes significantly to premature deaths. Despite this, smoking is often overlooked in drug treatment services. David MacKintosh from the Global State of Tobacco Harm Reduction suggests incorporating safer nicotine options to improve health outcomes and longevity. Drug service providers face challenges in addressing smoking alongside drug issues due to resource constraints. Encouraging harm reduction services to consider smoking cessation could yield positive results. Smoking-related deaths in this population are comparable to drug-related deaths, highlighting the need for comprehensive support and awareness. The Global Forum on Nicotine fosters discussions on harm reduction approaches with a focus on consumer perspectives.

Smoking is not evenly distributed across society. It is increasingly concentrated among people facing poverty, stress and fewer routes to support — which means tobacco policy cannot be judged only by national averages. If lower-risk alternatives are made harder to access or understand, the burden will fall hardest on the people already most affected by smoking-related harm. A serious strategy must reduce risk without widening inequality.

Eight million pounds can buy a lot of public health activity. The harder question is whether it buys better outcomes. Funding should support evidence, transparency and interventions that help smokers move away from combustible tobacco — not campaigns that deepen confusion about lower-risk alternatives. In tobacco policy, spending money is not the same as reducing harm.