On average, homeless men die at 44 years old, compared to 76 in the general population, while women die at 42 years old, compared to 81, and smoking is a substantial contributor to this disparity.
The Global State of Tobacco Harm Reduction (GSTHR), a project by the UK-based public health agency Knowledge·Action·Change (K·A·C), has released a Briefing Paper exploring the potential of tobacco harm reduction (THR) in benefitting people experiencing homelessness.

Titled “Tobacco harm reduction and people experiencing homelessness – a UK perspective,” the paper addresses the severe impact of high smoking rates on the lives, health of homeless individuals. It also delves into harm reduction initiatives implemented in three UK cities during the COVID-19 pandemic, and the effect that these had on homelessness.

UK surveys consistently estimate that 76–85% of homeless people smoke, a significantly higher percentage than the general population’s historic low smoking prevalence of 12.9%. Homeless men, on average, die at 44 years old, compared to 76 in the general population, while women die at 42 years old, compared to 81. Smoking is a substantial contributing factor to this health disparity.

Respiratory health issues are a particular concern among the homeless, including chest infections, pneumonia, and breathlessness, often aggravated by tobacco smoking. The homeless also tend to smoke in ways that increase health risks, such as doing so heavily, sharing cigarettes, or smoking discarded ones. Despite their nicotine dependency, half of homeless individuals express a desire to quit, similar to the general population.

Most homeless individuals would happily switch to safer nicotine alternatives

THR offers a solution by providing alternatives to smoking. A 2019 study found that two-thirds of rough sleepers who smoked would be willing to switch to vaping with freely available devices. Initiatives during the COVID-19 pandemic provided free vape starter kits to homeless individuals in London, Manchester, and Edinburgh, offering immediate benefits and reducing health risks associated with smoking.

The Briefing Paper calls for further exploration of harm reduction routes for homeless populations, emphasizing the potential for substantial health improvements. While based on UK evidence, the findings are intended to be relevant to health and homelessness professionals globally, with translations available in multiple languages. K·A·C Director David MacKintosh, stressed the need to address the disproportionate impact of smoking on homeless populations, offering harm reduction as a pragmatic approach to improving their well-being.

GSTHR report on COP10

In 2023, GSTHR conducted an analysis of the contrasting COP10 agenda and its accompanying documents, with the aim of assessing the potential impact of the conference on THR.

The findings revealed a tragic but non-surprising absence of any consideration for THR and its capacity to mitigate smoking-related health issues in the planned proceedings. As expected, the publicly accessible documentation leading up to FCTC COP10 portrays safer nicotine products as a menace to tobacco control rather than potential tools which could help smokers quit or reduce the harm from combustible tobacco.

Sadly, it is expected that FCTC member states will be urged by the WHO to categorize and regulate nicotine vapes, snus, nicotine pouches, and heated tobacco products in a manner similar to combustible tobacco. Data has consistently shown that such an approach poses the risk of limiting or obstructing access to safer alternatives for individuals already using them, potentially leading them back to smoking. It also threatens those who smoke and could potentially switch to improve their health.

The 6th Summit on Tobacco Harm Reduction

All this was also discussed at the 6th Summit on Tobacco Harm Reduction: Novel Products, Research & Policy which was held in Athens last September. The panelists, all experts in the field public health highlighted that strategies offering smokers less harmful alternatives to traditional cigarettes are more effective at reducing smoking compared to the WHO’s Framework Convention on Tobacco Control (FCTC) approach which is based on prohibition.

Dr. Lorenzo Mata, President of Quit For Good, a non-profit organization promoting harm reduction in the Philippines, stressed the importance of advocating for science-based policies on a global stage, especially in countries experienced in regulating these new products.

This discussion had taken place in anticipation of COP10 before it was postponed. Dr. Fernando Fernandez Bueno, a Spanish physician, emphasized the need for a scientific and data-driven debate on tobacco control, moving away from emotional responses and opinions to make real progress in the fight against tobacco.

Professor Andrzej Fal, President of the Polish Society of Public Health, highlighted the importance of prevention in curbing the financial and health effects of smoking. He advocated for funding primordial prevention and a “less harm, less tax” regulatory approach. While Professor David Sweanor from the University of Ottawa pointed out the failure of the FCTC and the WHO in acknowledging the benefits of less harmful tobacco and nicotine products in replacing cigarettes and warned of the resulting unnecessary deaths and loss of credibility.

Dr. Konstantinos Farsalinos, the renowned Greek physician and researcher in the field, cited data from countries supporting less harmful products such as like vapes, snus and heated tobacco products (HTPs), indicating how these nations have achieved lower smoking rates thanks to these.

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