Tashkent, Uzbekistan (UzDaily.com) – On 5-6 April, the III International Scientific and Practical Conference “Innovative Technologies in Healthcare: New Opportunities for Internal Medicine” was held in Samarkand. Uzdaily turned to Katarzyna Kowalczuk – Ph.D., Director of the Global Public Health Network (International Public Health Network, Poland) to find out how the concept of harm reduction works in modern world practice of combating non-communicable diseases.

Katarzyna, for Uzbekistan and its healthcare system, the concept of harm reduction is still a new approach. Let’s start with how this works in practice.

According to WHO, 41 million people worldwide die from noncommunicable diseases (NCDs) every year—that’s 74 percent of all deaths. More than 86% of premature deaths occur in low- and middle-income countries. These are mainly those states where the principles of the harm reduction concept have not yet been introduced or are just beginning to be introduced.

Non-communicable diseases are also called “lifestyle diseases”. In most cases, they arise not from external factors, but as a consequence of human behavior, his habits, for example, in nutrition. The catch is that the manifestation of chronic NCD symptoms takes quite a long time in a person’s life. Because of this, most people right here and now do not perceive the seriousness of the risks of their daily erroneous behavior, the threats that it poses to their health in the future.

Do people underestimate the consequences of bad habits?

Yes, but many people don’t even think about it. That is, for example, a smoker does not quite perceive the fact that he has an increased risk of getting some serious illness in the future, most likely COPD or lung cancer. A lover of sugary drinks does not think about the risk of developing diabetes. And so - for every bad habit. We pay for our unhealthy lifestyle with our lost health, and in most cases we pay prematurely. Most NCD-related deaths can be prevented through behavioral interventions.

What principles are harm reduction based on?

In the global medical community, the principle of harm reduction is hailed as a forward-looking, pragmatic approach to solving the problem of non-communicable diseases. This is a kind of “soft power” when basic prevention measures do not produce the expected effect. For example, measures to limit smoking, long ago developed and applied everywhere, and price mechanisms (increasing excise taxes on cigarettes), as practice has shown, have had a very limited effect. People still continue to smoke. When these mechanisms are added to the promotion of alternative, less harmful methods of delivering nicotine to the body - including various smoke-free devices - we see that a set of measures begins to work. Thanks to this approach, for example, it was possible in a relatively short time to reduce the proportion of the smoking population in the UK and Sweden to a minimum level of 10 percent or less. In Sweden, this share is now generally about 5%.

Of course, we understand that the substitution approach - where a harmful product is replaced with a less harmful one - is not an absolute panacea for NCDs. However, experience shows that switching to less harmful alternatives for health - for example, switching to a proper, balanced diet, or switching to smokeless sources of nicotine instead of cigarettes - is already a huge step forward in disease prevention.

Does this approach have a scientific basis?

Of course, here too the results are visible not only on the basis of the actual medical assessments, showing a significant improvement in the condition of the patients studied.

Harm reduction is a scientifically based method from a psychological point of view. Bans never work as expected - this is a well-known fact.

Harm reduction is based on the idea that everyone has the right to choose. It is also essential that all people receive reliable information about harm reduction tools and the results of such approaches.

It is also important to note that this approach is cost-effective from the point of view of the development of national health systems. The practice of countries that have switched to the principles of harm reduction shows that due to the reduction of risk factors and, as a result, a significant reduction in the number of diseases, public health costs are significantly reduced. And most importantly, the country’s population is becoming healthier. This is especially important from the point of view of the health of people of active age - after all, NCDs often strike very young, active, able-bodied people. Reducing risk factors means that people are much less likely to encounter chronic diseases and their quality of life improves.

Does harm reduction work selectively or target specific groups of people?

Of course, harm reduction is aimed at certain groups of people, let’s say – the groups at greatest risk of developing a chronic non-communicable disease. Working with them requires a different approach than the traditional one. In particular, if we return to smokers, we see that the vast majority of smokers understand the dangers of the consequences of their habit, but due to their dependence on nicotine they are unable to completely quit. However, these people at least strive for this. And there is a category of smokers who fundamentally do not want to quit - they say that despite the harm they will continue to smoke. It was for them that low-risk nicotine products were primarily created. And this approach, as we see from the experience of Britain, Sweden and many other countries, has worked.

People must be informed about the very possibility of reducing harm. This is their important right - do you share this opinion?

Yes, undoubtedly, and from this point of view, the principles of harm reduction mean empowering people. A person independently chooses whether to solve the problem of his addiction or to know about the existence of alternative options for reducing harm to his health, based on reliable information that he owns. And this right to objective information is one of the key rights of an adult citizen. This means that it is not commercial structures (for example, manufacturers), but state medical authorities with independent expertise who should reliably inform people about the greater and lesser harmfulness of certain products. This task has been achieved in several developed countries, and our job is to ensure that the civil society of more and more countries understands its importance.