When Prime Minister Sunak was challenged at Westminster on how the UK’s National Health Service could be relieved of ever-growing pressures, he put anti-smoking policy at the centre of his reply. In the UK, it’s recognised that long-term adult smokers are unlikely to quit without being offered a safer alternative that satisfies their craving for nicotine.

“On smoking, the ‘swap to stop’ programme is trying something quite proactive … quite innovative”, he said. “There is such persuasive evidence from that programme and the schemes that we have done on a smaller scale that if you can help existing adult smokers to switch away from smoking to using vapes -this is not about disposable vapes for children, which is obviously concerning … there are clearly public health benefits of acting before the bigger problems come down the line”.

He linked the policy to a wider public health approach. He pointed to calorie labelling that gives people the information they need to make informed lifestyle choices, together with the provision of anti-obesity medicines for those who need greater help. The Prime Minister himself doesn’t smoke or drink but admits to being addicted to Mexican Coca-Cola.

He hopes its cane sugar content is better for him than standard fructose-based Coke but that wouldn’t satisfy the exacting if unachievable standards of the World Health Organisation. It puts idealism before pragmatism in its approach to non-communicable diseases largely caused by lifestyle choices like alcohol, sugary foods and tobacco.

It has declared that there is “no safe amount” of alcohol consumption while at the same time characterising no- or low-alcohol beverages as “normalising” drinking. The WHO urges us to consume much less sugar without switching to sugar substitutes, contradicting the British NHS advice that all sweeteners on the market undergo a ‘rigorous safety assessment’. Similar guidance has been given by the Food and Drug Administration in the United States and by Germany’s Federal Institute for Risk Assessment.

The WHO also actively pursues a prohibitionist approach to smoke-free alternatives to cigarettes. Although these can play an important role as a better alternative for smokers who don’t quit, according to many countries’ health bodies, not just in the UK but for example in the Netherlands.

It might be the case that we would live truly healthy lives without sugary foods alcohol and nicotine but in the real world it’s persuading people to at least lead healthier lives that counts. Without less harmful substitutes, billions of people will continue drinking, smoking and eating sugar, salt and other unhealthy foods.

The danger is particularly acute when it comes to the goal of reducing tobacco smoking to as close to zero as possible. Over the past decade, support from public health institutions and experts has grown substantially in recognising smoke-free alternatives to cigarettes as a better choice for smokers who do not quit.

Indeed, a 2015 WHO study group on tobacco product regulation noted that ‘less toxic or less addictive’ products ‘could be a component of a comprehensive approach to reducing tobacco-related deaths and disease’. Evidence has grown substantially that tobacco and nicotine products that do not burn are better alternatives to smoking.

It is no coincidence that the lowest smoking rate in Europe is in Sweden, where it’s down to 5% of the population. It’s the one country in the EU where there’s a long-established and popular alternative to cigarette smoking, with a form of oral tobacco known as snus. Cancer rates, including for mouth cancer, have plummeted as the Swedes have abandoned cigarettes, with those who cannot give up nicotine often switching to snus.

In an ideal world, the best way of eradicating cigarettes would be for people never to start smoking. But the best should not be the enemy of the good and vaping, snus and other smoke-free alternatives are a good way, often the only way, for smokers to quit cigarettes.

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