Every year on 31 May, the world observes World No Tobacco Day. Governments, health agencies, advocacy groups, and international organisations release statements highlighting the devastating health consequences of smoking and the need to reduce tobacco use.
As someone who has spent years advocating for tobacco harm reduction, I support the goal of reducing smoking. I support efforts to prevent young people from starting to smoke. I support evidence-based policies that reduce disease, disability, and premature death.
But every year, I find myself asking the same question:
Who speaks for the smoker?
Not the smoker as a statistic.
Not the smoker as a policy target.
Not the smoker as a public health problem to be solved.
The actual smoker.
The person who wakes up every day knowing cigarettes are harming them, yet struggles to stop.
The person who has tried nicotine replacement therapy, counselling, quit lines, patches, gum, medications, and repeated quit attempts without success.
The person who wants a better option but finds themselves increasingly absent from the global conversation.
For decades, tobacco control has achieved remarkable progress. Smoking prevalence has fallen in many countries. Public awareness of smoking-related disease has increased. Smoke-free environments have become the norm. Millions of lives have undoubtedly been saved.
Yet somewhere along the way, the focus appears to have shifted.
Increasingly, public health messaging centres on preventing future nicotine use rather than reducing harm among current smokers. The emphasis is on protecting non-users, protecting youth, restricting products, and countering industry influence. While these are legitimate objectives, they are not the entire story.
More than one billion people worldwide still use tobacco.
They are not hypothetical future users.
They are here today.
Many of them are poor. Many live in countries where cessation services are limited or unavailable. Many have repeatedly tried to quit and failed. Many will continue smoking regardless of how many warnings appear on cigarette packs or how many public awareness campaigns are launched.
What are we offering these individuals?
This is where tobacco harm reduction enters the conversation.
The principle is simple.
If a person cannot or will not quit nicotine entirely, should they have access to products that are significantly less harmful than smoking?
This is not a radical concept.
Public health has embraced harm reduction in many other fields. We distribute condoms to reduce sexually transmitted infections. We provide clean needles to reduce HIV transmission. We offer opioid substitution therapies to reduce overdose risk. We acknowledge that while eliminating risk entirely may be ideal, reducing risk is still a meaningful and worthwhile public health achievement.
Yet tobacco remains an exception.
The very idea that a smoker could improve their health by switching to a lower-risk alternative often remains controversial, despite growing evidence that non-combustible nicotine products expose users to substantially fewer toxic substances than cigarettes.
The debate is frequently framed as a choice between preventing youth uptake and supporting adult smokers.
It should not be.
We can do both.
We can support strict measures to prevent youth access while also recognising that adult smokers deserve accurate information about relative risk.
We can oppose irresponsible marketing while still acknowledging the experiences of millions of former smokers who successfully left cigarettes behind through alternative nicotine products.
We can protect future generations without abandoning the current one.
What troubles me most about modern tobacco control is not disagreement. Scientific debate is healthy. Evidence should always be challenged and scrutinised.
What troubles me is the absence of the people most affected.
In virtually every other area of public health, lived experience is considered valuable. Patients are consulted. Consumers are included. Communities are engaged. Their experiences are not treated as inconvenient obstacles to policy development.
Yet in tobacco control, people who have successfully reduced their risk are often viewed with suspicion or dismissed entirely.
The former smoker who switched is rarely treated as an expert in their own experience.
Their story is often ignored because it does not fit neatly into existing narratives.
As a former smoker and current advocate for tobacco harm reduction, I do not claim that alternative nicotine products are risk-free.
Nothing is risk-free.
The question has never been whether vaping, nicotine pouches, or heated tobacco products are perfectly safe.
The question is whether they are safer than smoking.
For the smoker facing a choice between continuing to inhale smoke from burning tobacco or switching to a non-combustible alternative, that distinction matters enormously.
World No Tobacco Day should absolutely remind us of the devastating consequences of smoking.
But it should also remind us of the people living with those consequences today.
The smoker is not the enemy.
The smoker is the person we are trying to help.
And until the voices of those who have successfully reduced their risk are welcomed into the conversation, tobacco control will remain incomplete.
If public health truly seeks to reduce tobacco-related disease, it cannot afford to ignore the experiences of the very people it claims to serve.