FCTC: Constructing a new assault on smokeless tobacco and electronic cigarettes: Part 3: or disregarding the context of tobacco use

This the third of a series on this latest development at the FCTC. See Part1: Background and Part2.

In the Convention Secretariat report concern is expressed over the welfare of the disadvantaged but a disparagement of cheap sources of nicotine that would soften their plight.

First a little context on how much of a threat smokeless tobacco (ST) actually is in the 3rd world. Research on these types is limited compared to that on Western forms of ST and among the questions remaining are what aspect of this use is the most harmful part of it; there are suggestions that the source of the harm may lie in the other substances that are combined with the tobacco rather than from the tobacco itself. But for the sake of argument let’s accept that these are relatively risky products.

One of the arguments for employing ST in harm reduction in the West is that not only is it so much less risky than smoking but that the absolute risk of using it falls below many more common activities. Non-Western ST which varies much more in risk (different product combinations, manufacturing conditions, less product reliability) might be considered unreasonably risky to allow in the overall quite safe Western sphere. However in respect to the contexts within which they occur, these products no longer qualify as unreasonable risks.

They are still risky but when you live in the Sudan there are more important things to worry about (like war after war, and access to clean water which only a little over half have). Of course, trying to prevent a harm is not wrong just because there are more pressing concerns. But there will always be competition for resources and money spent trying to suppress something that makes hardly a dent in that nation’s public health will not then go toward things that could.

The Secretariat seems to like the same logic when they write (on page 7):

“The consumption of smokeless tobacco also has adverse socioeconomic consequences. In many low- and lower-middle-income countries scarce family resources are spent on tobacco products instead of food or other essential needs.”

There is no argument that money that could have gone to these other needs are spent on tobacco products. However, this argument is always made by people who have never had to make those choices.

The worse your living conditions become the more important any distraction from it becomes. For most of us, we seek distraction because we are bored and not because life is difficult. Even our definitions of what is difficult are absurd when compared with what most people on the globe experience on a daily basis.

Finally, tobacco use cannot be constructed as simply an issue of someone using a harmful product. As said, a simple distraction from boredom becomes something else under dire conditions. There are times when nicotine might add more to overall welfare than some food.

(Just one proviso to this argument: though I believe that an adult has the right to decide between food and nicotine, in some cases adults, and typically the man, jeopardize the family food for their own desire. I am not arguing for that. And yet there may be circumstances where using tobacco gives the breadwinner just enough respite to remain a breadwinner and not abandon hope entirely. These are not simple questions and have no easy answers which bears on the issue as a whole when organizations like the FCTC simply work toward bans without realizing that someone always ends up paying a price.)

Addendum: I neglected to tie this up in regards to how it affects tobacco harm reduction. Basically, the more essential nicotine use is to an individual, the more likely harm reduction will be more effective than a ban. The higher the socioeconomic status the more successful (and therefore the easier) quitting is. Bans work better when the targets have access to alternative pleasures; if it is your only pleasure, you will try to work around the ban. This also means that bans or severe restrictions on a global scale would end up having a disproportionate effect and that the health disparity between rich and poor (both in regards to people and nations) would be greater than ever.

Later addendum: In this article my characterization of nicotine use as a distraction is a simplification and generalization and does not mean to suggest that it does not form a more substantial (or additional) benefit for many.

I thought this would be the last in the series but it looks as though there is more to say; there may be intervening posts from others but almost certainly there is a Part 4 just around the corner.

-Paul L. Bergen

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