It’s the largest preventable cause of death. It kills five times more people than road accidents each year. It amounts to millions of hours of lost productivity and costs our health systems billions. I am, of course, referring to smoking.
If we are serious about improving our health outcomes after coronavirus, it is essential that we take action to combat nicotine-related deaths. Fortunately, we already have the answer: e-cigarettes.
Smoking is dangerous because it involves the inhalation of thousands of combusted chemicals, including nicotine, the addictive component. It is not the nicotine itself that is harmful, but the chemical reactions associated with burning the tobacco in order for it to be inhaled.
When combustion occurs, carbon monoxide, CO2, heavy metals, and tar, all of which are toxic to humans when inhaled, are released. It is the burning process itself that causes cancer and is harmful to the body.
The tar released when anything is burnt kills the cilia cells in the lungs and the heavy metals inhaled interfere with metabolic processes. Breathing in any kind of smoke is harmful, including car exhausts and the smoke released from the herbal, tobacco-free cigarettes used by actors.
Cigarette smoke is especially harmful thanks to the extra chemicals added by tobacco manufacturers, like ammonia, a product used in cleaning products and fertiliser. The combustion of tobacco produces over 6,000 separate chemicals, including at least 300 toxic ones and over 70 that are known to be carcinogenic.
The health impacts of nicotine have been endlessly examined in countless studies. They overwhelmingly point to the conclusion that nicotine is not itself harmful to adults. This view is corroborated by studies looking at the consumption of tobacco in other forms, such as chewing tobacco or smokeless tobacco.
In Sweden for instance, researchers studied a popular product called Snus, a form of tobacco which user place under their upper lip. It found that when nicotine is consumed in this form, free from carcinogenic smoke particles, there was no increased risk of heart attack or atherosclerosis.
E-cigarettes, therefore, enable those who wish to consume nicotine to do so in a safe and easy way. If we are to end put an end to deaths associated with nicotine, we must incentivise their use over that of traditional cigarettes.
One significant reason why people are moving to e-cigarettes is the ability to consume nicotine in different flavours, which gives vaping an edge, and means people are more likely to stop smoking permanently.
These products are not without controversy. Critics point out that these flavours are attracting young people who would not otherwise have begun smoking to vaping. The truth behind this claim, though, remains unclear. A recent study found that the advertising of flavoured e-cigarettes does not increase the likelihood that children and adolescents will begin to use e-cigarettes.
While more research is needed and the industry should continue to work with health officials and psychologists, we should not pursue the bans on e-cigarette flavours implemented in some US states.
Allowing vaping in some indoor areas where children are not present, such as bars and casinos, would serve as another useful incentive to switch to e-cigarettes. The risk of allowing vaping in all public areas, while it would no doubt encourage many more smokers to make the switch, is that it could normalise the habit.
This is problematic, as one of the key reasons why smoking rates have declined is because it is not seen as normal, but is stigmatised. Allowing vaping in bars, adult-only sections of certain restaurants, some workplaces and other public venues such as casinos would encourage many more people to make the switch and thereby improve health outcomes for everyone.
Exempting e-cigarettes from VAT would also have a substantial impact. Exempting vape products, which are currently taxed at the standard 20% VAT rate, would make them markedly cheaper. That would encourage people, especially those in lower-income groups where smoking rates are higher, to make the switch.
The decrease in VAT revenue would be more than balanced out by savings in the NHS as fewer people require treatment for smoking-related diseases. In utilitarian terms, this would also have a far greater impact on public health than most other health measures.
We should not be afraid to experiment and encourage innovation in these fields, and we should approach such topics in an open-minded and pragmatic manner if we are to solve the issue of nicotine-related deaths for good.
