How the Caribbean can capitalise on the safer nicotine revolution

By Dr. Delon Human

Smoking remains a major public health challenge in the Caribbean. In Trinidad and Tobago, for example, almost one in three men smokes[1]. Elsewhere across the region, the adult smoking prevalence ranges from 15% to 25%, contributing to high rates of cancer, heart disease and chronic lung illness.

The burden of smoking-related disease continues to place pressure on already stretched health systems. The region urgently needs new solutions.

One model already exists. Sweden has reduced smoking to just 5.3% of adults – the lowest rate in Europe – by making snus and nicotine pouches accessible, acceptable and affordable.

This has brought measurable health benefits: Swedish men record lung cancer death rates 61% below the EU average, and overall cancer deaths are a third lower. Researchers estimate that without safer nicotine alternatives, smoking-related male mortality would have been 70% higher.

Sweden is now set to become the first officially smoke-free country, well ahead of the EU’s 2040 target.

Real-world evidence

A new report from the Smoke Free Sweden movement, The Safer Nicotine Revolution: Global Lessons, Healthier Futures, shows that Sweden is not alone. Other countries that have embraced harm reduction – Japan, the UK and New Zealand – are also seeing rapid declines in smoking and clear improvements in health outcomes.

In Japan, cigarette sales have halved in a decade following the introduction of heated tobacco, and smoking prevalence has dropped from 21% to 16%.

In the UK, vaping is part of NHS quit services, helping millions of smokers to switch. Smoking rates have nearly halved since 2011, and researchers project vaping will prevent 166,000 premature deaths by 2052.

In New Zealand, smoking has halved in just six years since vaping was legalised and promoted as a quitting tool, with COPD hospitalisations down nearly 30% and smoking-related cardiovascular deaths down 20%.

What unites these examples is the principle of tobacco harm reduction – giving smokers access to safer alternatives.

An opportunity for change

Wherever it has been tried, the pattern is consistent: fewer smokers, fewer deaths and healthier populations.

For the Caribbean, this lesson has particular urgency ahead of COP11, the 11th Conference of the Parties to the WHO Framework Convention on Tobacco Control.

At COP10, St Kitts and Nevis showed leadership by proposing the creation of a Tobacco Harm Reduction working group.

At COP11 in Geneva this November, other Caribbean nations can join them in advancing this practical agenda.

COP11 is an opportunity to put evidence at the heart of global tobacco control. Safer nicotine alternatives are already improving health outcomes and reducing deaths elsewhere.

By supporting harm reduction within the COP framework, Caribbean governments can begin to secure the same gains for their people.

• Delon Human is a specialist family physician, global health advocate, published author, international speaker and healthcare consultant specialising in global health strategy, harm reduction and health communication. He is the former Secretary-General of the World Medical Association, International Food and Beverage Alliance and Co-founder of the African Harm Reduction Alliance (AHRA). He has acted as an adviser to three WHO Directors-General and to the UN Secretary-General on global public health strategies. He is leader of the Smoke Free Sweden movement.

• This article first appeared in Caribbean News Global

[1] https://tobaccoatlas.org/factsheets/trinidad-and-tobago/