obacco use remains a significant threat to global public health. The ongoing tobacco epidemic is increasingly dangerous in countries with developing economies like Pakistan.

While evaluating the integration of harm reduction measures coupled with conventional measures for the management of tobacco use, it is apparent that there is a need for community interventions and to dispel some myths about harm reduction products. Currently, most approaches to tobacco control are focused on abstinence or prohibition.

The relevant law, for example, is known as the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance. The harm reduction approach is based on an understanding that there are various levels of nicotine addiction and aims at the reduction of potential adverse health effects of tobacco consumption.

The burden of tobacco use in Pakistan presents a significant public health challenge, characterised by high prevalence rates and limited awareness about the health risks associated with it. The country has more than 24 million adults who use tobacco products that affect other people’s health. However, researchers define these non-communicable diseases. The high prevalence of these diseases in developing countries such as Pakistan requires immediate interventions. The incidence of smokeless tobacco use, too, has not ceased. This makes the problem even more challenging for public health practitioners.

Pakistan’s tobacco control plans must focus on the principles of harm reduction to reduce tobacco-related diseases and deaths.

Currently, some of the government policies comply with the World Health Organisation’s Framework Convention on Tobacco Control. These include taxation, restrictions on advertising and smoking in the public. However, the measures are offset by the relentless marketing strategies employed by the industry, particularly to target the youth and the poor.

Recent studies have stressed the need for complex policy interventions, such as school-based campaigns, lectures and media campaigns that have been found effective. However, these accomplishments are threatened by the interference and manipulation of the industry in local economies for promoting the use of tobacco products, especially in low and middle-income countries such as Pakistan.

There are almost no cessation services or guidelines available for those wanting to quit smoking. While some products are available in the market to help smokers quit there is a need for a regulatory mechanism for these products. The market has been flooded with all kinds of products and there is almost no way to determine the safety and quality of these products.

Pakistan’s tobacco control plans must focus on the principles of harm reduction to reduce tobacco-related diseases and deaths.

The existing tobacco control policies in Pakistan warrant an assessment of their impact on various tobacco products such as smokeless and water-pipe tobacco. A cross-sectional study has found that generic regulation of tobacco products fails to address the water-pipe smoking.

The smokeless tobacco policies in Pakistan extend beyond the WHO FCTC. A systematic review suggested that policy measures including taxation reduced the use of smokeless tobacco in other countries. It is important to integrate the harm reduction strategies in the context of the existing framework to improve the efficiency of these policies.

There is an urgent need to implement evidence-based cessation interventions and policies for those who choose to use tobacco or its by-products. The WHO Framework Convention on Tobacco Control requires the development of culturally appropriate strategies to reduce tobacco use as well as cessation support among users. Such strategies can include educational campaigns aimed at increasing public health knowledge on the risks involved with the use of smokeless tobacco.

In some developed economies, strong CSR practices have helped enhance the health of the public. This suggests that there is a need to include key stakeholders and be transparent, especially in the process of issuing and preparing CSR in health-related issues.

In areas affected by terrorism there is a need also to establish supply chain risk management strategies for the protection of the public health agenda against disrupting factors.

Pakistan must come up with policies that address the issues of complex regulation by focusing efforts on global best practices associated with the reduction of the use of tobacco products.

Integrating harm reduction strategies in the framework of tobacco control is vital for tackling the threat of diseases associated with tobacco consumption. Any agent affecting an environment is likely to affect the health of an individual or a community.

Adopting a harm reduction strategy in national tobacco control requires comprehensive policies that go beyond the abstinence approach towards tobacco use. It calls for the development of other evidence-based protocols that call for reduced-risk exposure products such as e-cigarettes and nicotine replacement therapeutic products (pouches) which act as interim help to those who cannot quit or do not wish to quit entirely.

There is a need also to establish a reliable regulatory structure that keeps these products from posing risks to the people. Such regulation requires consultation with public health bodies to ensure that the harm reduction measures are culturally sensitive to the specific socioeconomic status of the population being targeted.

The writer is a public health professional. He has been a focal person of the government of Pakistan to FCTC and ITP of WHO’s FCTC. He can be reached at Ziauddin.islam@gmail.com