Cigarette smoking continues to represent a major threat to public health, with a death toll that exceeds that of alcohol, AIDS, drugs and road accidents combined. In recent decades, research and development in the tobacco sector has given rise to a series of revolutionary innovations that could change the way we think about cigarette consumption and smoking. The new perspectives were addressed during the Brunel Annual Health Economics and Policy Forumwhich was held in London at Brunel University.
During the event, organized under the guidance of Francesco Mosconeprofessor of Business Economics at Brunel University, in collaboration with the University of Oxford, the idea emerged of imagining a future of healthcare centered on healthier habits and, consequently, the importance of discussing strategies for optimize resource allocation and address critical healthcare needs, especially considering the shift to potentially reduced risk products.
The introduction of innovative smokeless products, such as e-cigarettes and heated tobacco devices, opens a new era in the field of harm reduction, offering an alternative for adult smokers struggling to quit or who prefer not to and brings with it also a change of perspective in the way tobacco addiction is addressed. The discussion increasingly focuses on a less coercive approach and more focused on mitigating the negative effects on people’s health rather than completely stopping addiction. While some experts underline the need for precaution, highlighting the lack of exhaustive scientific evidence on new products, others see innovation as an opportunity to integrate prevention and control policies. The concept of harm reduction is based on the idea that combustion (and not nicotine) is the main cause of smoking-related diseases.
Countries such as the UK, US, New Zealand and Sweden have successfully embraced these new strategies with more flexible policies that have helped encourage a switch to potentially reduced risk products, demonstrating significant impacts on public health and the number of smokers. Italy, in line with WHO recommendations, has so far based its strategy mainly on smoking cessation.
Francesco Moscone himself addressed the topic of sustainable healthcare spending, examining the potential savings from both the demand and supply points of view within healthcare systems. On the one hand, the potential economic benefits of switching smoking populations to lower risk products such as vaping, encouraging moderate alcohol consumption and promoting physical activity to improve public health outcomes. On the supply side, his research explores issues related to productivity gains in hospitals, examining in particular how the adoption of cost-effective medical technologies by doctors can improve operational efficiency and allocation of resources within healthcare facilities.
Moscone compared the transition from high-risk to reduced-risk products in the United Kingdom and Italy, two countries that share several similarities, such as the presence of a National Health Service, despite some differences in health systems, with Italy which has regional health systems: “The research focused on studying official data from the Office for National Statistics in England to understand how much of the smoking population had switched to reduced risk products such as vaping or heating tobacco. Simulations have shown that if 50% of smokers in England switched to vaping, around half a billion pounds a year could be saved in the NHS in terms of direct costs alone. However, the research also looked at indirect costs, which include lost productivity due to smoking-related illnesses and the need for medical care. By reducing the number of people who develop these diseases, significant resources could be saved. In Italy too, data showed similar results, with potential savings of over £1 billion a year if 50% of smokers switched to reduced risk products,” Moscone said.
Research highlights that the transition to reduced-risk products can lead to significant economic savings and improve the sustainability of healthcare systems. This suggests that governments should consider policies to encourage such a transition, rather than focusing on increasing the supply of medical care.
The serious impact of risky behavior on health is a problem that affects everyone, explained Catia Nicodemo, professor of Health Economics at the University of Oxford, who spoke at the Forum. For example, young people identify sex as one of the most significant risk behaviors, however there are also other behaviors that are harmful to health, such as tobacco, poor nutrition, excessive speed while driving. These behaviors not only lead to personal injury, but also have an enormous economic cost for society. In the UK, for example, the cost of smoking alone represents around 3.6% of GDP, or around £90 billion.
The government, aware of this challenge, seeks to intervene to reduce risky behavior and related healthcare costs. However, some argue that individual choices should be respected without interference, while others believe the government must intervene to protect public health. The costs imposed on society by harmful individual behaviors push the government to seek solutions such as taxes and regulations to reduce risky behaviors. “Taxes on harmful products, such as tobacco and sugary drinks, are an example of government intervention,” Nicodemo explained. “However, there are concerns about the effectiveness of these policies, as they could disproportionately affect less well-off people.” Alternative solutions, such as the promotion of less harmful products such as e-cigarettes, are gaining popularity, but it is important to carefully evaluate the effects of these policies and adapt them according to the specific situation of each country.
Another interesting point of view was that of Ae Sun Shinexpert in Preventive Medicine at Seoul National University, who provided an in-depth analysis of public health challenges and opportunities in Korea, underlining the importance of preventive strategies and targeted interventions to address the growing challenges related to aging population and chronic diseases.
“There are four major chronic diseases: cardiovascular disease, chronic respiratory disease, cancer and diabetes. Some share common risk factors such as alcohol use and unhealthy diet. Risk factors overlap with several chronic diseases. So intervening on one of the risk factors does not only affect a single disease, but can influence several other chronic diseases” said Shin who then highlighted the success of anti-smoking campaigns in reducing the use of cigarettes in Korea, underlining the link between individual behaviors and large-scale health outcomes.
In short, while research continues to evolve, the debate on the future of anti-smoking policies remains heated. The transition to reduced-risk products can lead to significant economic and public health benefits and it is essential that governments adopt appropriate policies to support this transition, in a context where smoking continues to represent a global challenge.
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