Graphic health warnings on tobacco products are not mandatory under the WHO Framework Convention for Tobacco Control. Yet a growing number of countries plan to introduce such warnings on the premise that by doing so, more smokers will be encouraged to quit than would be the case if existing text warnings were retained. However, according to a recent news article, a Health Canada poll has found that graphic health warnings are increasingly seen by Canadian smokers as being ineffective in this regard. Canada was the first country in the world to introduce graphic warnings back in 2001 and the results of the poll are seen by some as indicating that the existing warnings simply need refreshing. This could be so, but an alternative interpretation is that graphic health warnings fail in their purpose because they provoke outright denial, rather than fear, of the consequences of smoking. Also, from a harm reduction perspective, graphic health warnings do not steer smokers towards forms of tobacco and/or nicotine products such as smokeless tobacco, which are now widely considered to be much safer than cigarettes - it’s very much a ‘quit tobacco or die from a grisly death’ message. An alternative approach could be to use the health warning space on the packs to provide the consumer with less threatening information that might encourage him/her to move down the continuum of risk posed by different product formats. For example, packs of cigarettes could perhaps carry a health warning that simply says “Much safer nicotine-containing tobacco and non-tobacco products are available “. Following the same logic, cans of smokeless tobacco might carry a health warning that says “Safer non-tobacco nicotine-containing products are available” Nicotine replacement products might carry a health warning that says” Whilst this nicotine-containing product is safer than tobacco products, no product that contains nicotine is totally safe” Obviously one would have to do a fair amount of consumer research to get the vectored messaging right –but it’s a thought!   What do you think?    How might consumers react? How might governments react?

The UK Department of Health has recently published a consultation on the future of tobacco control. This consultation is seen as the first step in the development of a new UK tobacco control strategy and covers four main areas: Reducing smoking rates and health inequalities caused by smoking, protecting children and young people from smoking, supporting smokers to quit and lastly, helping those who cannot quit. While the first three areas build on orthodox tobacco control initiatives, in public policy terms the last area is potentially groundbreaking. This is because it considers the potential of a harm reduction approach. The consultation document (section 5 part D) points out that harm reduction strategies seek to minimize the adverse health and social consequences of substance use and that to date harm reduction approaches have not received widespread attention for tobacco. As the health impacts of smoking are largely unrelated to nicotine, it may therefore be possible to find new ways to reduce the risk to smokers who are unwilling or unable to break their addiction. For this reason it is argued that future UK government strategy in tobacco control should therefore address the needs of the smoker who cannot quit and give consideration to how the harms caused by smoking can be reduced. The consultation document acknowledges that for critics, the disadvantage of even a harm reduction strategy using only ‘pure’ nicotine products is that it involves an acceptance of addiction. Furthermore there are even greater concerns about a harm reduction approach using non-smoked tobacco products, as it would lead to the implicit abandonment of the goal of a tobacco-free society. The fact that harm reduction is incorporated in a consultation document coming from the country currently rated as having the most effective tobacco control strategies in Europe is a very interesting development. Hopefully it is a sign that the debate on tobacco harm reduction is going from fringe to more mainstream. The question posed in the consultation document is “Do you support a harm reduction approach and if so can you suggest how it should be developed and implemented?” Responses (from any group or member of the public with an interest in tobacco control) can be submitted online to the UK Department of Health by 8^th September 2008. A summary of responses will be made available on the Department of Health website at the end of the year. What are your thoughts? Will tobacco products get a look in? Will this have any influence on global tobacco control policy?