Tobacco-free Bangladesh: Science can offer a mid-point between Quit or Die for Smokers

Tobacco free Bangladesh

NCDs in Bangladesh: A Growing Public Health Crisis

In Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden – namely heart attacks, strokes, chronic respiratory disease, cancers & diabetes. Additionally, around 20% of the population suffer from hypertension, 10% from diabetes, and as much as 2 million people suffer from cancer each year in the country, with around 50,000 new patients joining the list annually.

NCD Risk Factors Worsen in Bangladesh

A study conducted by NCD Control unit at the Directorate General of Health Services (DGHS), published in June this year, stated that the NCDs risk factors have further worsened in the country compared to 2018 – with 44.9% of the population using tobacco products (smoke and smokeless), one of the leading risk factors for NCDs.

With close to 6.2 million adult smokers in the country, it is essential to embrace innovative measures and harm reduction alternatives rooted in science, to transform and save lives.

Harm reduction alternatives reduce the level of harmful toxins while providing the user with Nicotine. In the recent years, there has been a growing debate surrounding nicotine and its potential health risks. Misinformation and lack of awareness have clouded the understanding of nicotine’s true nature and its relationship with combustion, leading to misconceptions about its effects on human health. Contrary to popular belief, nicotine itself while addictive, does not cause diseases, and is present in various everyday products we use. The primary health risks associated with smoking, stem from the combustion of tobacco.

Nicotine vs. Combustion: What’s the Difference?

Understanding the distinction between nicotine and the combustion process is of particular importance. Research conducted by the U.S. Department of Health and Human Services reveals that the majority of toxic substances released during smoking are a direct result of the combustion process, including carbon monoxide, tar, and carcinogens. Nicotine, while it is highly addictive, it does not cause the myriad of health issues commonly associated with smoking.

Decades of research have led to the introduction of safer and better alternatives like heated tobacco products (HTPs)- that offer a way for those battling addiction and those who do not quit. HTPs have gained recognition as a promising safer alternative to traditional cigarettes. These devices operate by heating tobacco instead of burning it. Since the tobacco is not burned, the levels of harmful chemicals released are significantly reduced compared to cigarette smoke – hence provide a safer option for those seeking nicotine with significantly reduced detrimental health effects compared to smoking.

The Future of Smoking: Will HTPs Replace Cigarettes?

In conventional cigarettes, the combustion of tobacco at high temperatures not only releases nicotine, but also produces harmful byproducts that damage the respiratory system and contribute to various diseases, including lung cancer and cardiovascular ailments. In contrast, HTPs heat the tobacco at lower temperatures, reducing or eliminating the release of specific chemicals, thus providing a safer alternative, resulting in a more satisfying experience for smokers. 

Transition from conventional cigarettes to safer alternatives has the potential to reduce the risk substantially at both the individual and societal levels. This is best evidenced by the case of Japan. In recent years, Japan has experienced a significant decline in smoking rates as more individuals switch to HTPs.

The future of HTPs in public health

However, the introduction of these alternatives to the market has sparked discussions among public health experts, policymakers, and the tobacco industry. Some argue that promoting HTPs might inadvertently encourage smoking or deter current smokers from quitting altogether. It is critical for the government and the regulatory bodies to carefully consider the scientific evidence when formulating policies for harm reduction. Striking a balance and ensuring access to safer alternatives for current smokers and preventing non-smokers from initiating cigarette and nicotine consumption is important.

By educating consumers about safer and better alternatives, we can empower them to make informed choices and ultimately contribute to a healthier society. Encouraging further research into better alternatives and implementing science and evidence-based policies will be essential in tackling the global tobacco epidemic.

It is quite clear that the old “quit or die” approach to smoking control is no longer good enough on its own, as millions of lives are at stake.  We can work towards a future where the adverse health effects of smoking become a thing of the past, and individuals are empowered to make choices that contribute to their wellbeing. By providing consumers access to credible, evidence-based information, and science-based products we have an opportunity to benefit society at large. 



Dr. Ziaul Huq

Senior Consultant

Respiratory Medicine Department

Evercare Hospital Dhaka