Thammasat University students interested in the allied health sciences, business, sociology, law, and related subjects may find a new book useful.

E-Cigarettes and the Comparative Politics of Harm Reduction: History, Evidence, and Policy is an Open Access book available for free download at this link:

https://link.springer.com/book/10.1007/978-3-031-23658-7

The Thammasat University Library collection includes other research about different aspects of e-cigarettes.

The publisher’s description notes:

This open access book offers the first in-depth study of the history and current debates surrounding electronic cigarettes comparing the UK, US and Australia. Since their introduction, e-cigarettes have been the subject of much public, media and regulatory attention, with discussion centring on whether these devices encourage or discourage smoking. This study delves into the history of policymaking and institutions in three countries which have taken different approaches to the regulation of e-cigarettes. In the UK, the tradition of harm reduction through nicotine has helped form a response which has endorsed e-cigarettes, though not without considerable controversy. In contrast, the US has a cessation-only anti-tobacco agenda, and Australia has effectively banned e-cigarettes. This book argues that each country frames the long-term use of nicotine differently and prioritizes the health of different groups within the population of smokers or non-smokers, set against a broad backdrop of national responses to addiction. By taking this comparative approach, the authors explore the relationship between history, evidence and policy in public health more widely.

Researchers have noted that policies towards e-cigarettes differ widely in the United Kingdom (UK) and Australia, two countries with a shared public health history.

Some findings from the book:

The United States of America (US) further influenced international case studies through its history of tobacco and anti-tobacco activism.

A major change in sensibilities occurred after World War II, when tobacco became a key issue of public health concern. The UK, US, and Australia all developed stances hostile to tobacco smoking and to the tobacco industry, but differences in the way this was done helped to inform their policies towards e-cigarettes, which cover a range of tolerance.

An important source of divergence between the three countries was a history of policy in the

UK favoring a harm reduction approach to nicotine. In the US and Australia, while nicotine was used as individual therapy, it was in pursuit of a stopping-only strategy.

E-cigarettes entered the global tobacco and nicotine market between 2003 and 2008.

Although all three countries had a similar history of hostility to tobacco as a central plank of public health policy, summaries of the prehistory of e-cigarette policy underscore differences between them. For example, in the US there was unwillingness to control advertising because of the right to freedom of speech and focus on individual smoker treatment; the Australian belief in the superiority of giving up smoking entirely rather than being gradually treated to do so; and the British tradition of harm reduction using nicotine.

Each of the three countries had, by the twenty-first century, embraced increasingly restrictive measures to limit the damages from tobacco cigarette smoking. Each in its own way moved in the direction of neoprohibitionist policies that would have been unthinkable decades earlier.

In each, years of confrontation with the tobacco industry transformed a formerly vibrant industry into a social pariah. In each nation, there was a dramatic decline in prevalence of smoking so that smoking which had been normative behavior in the 1950s had become increasingly marginalized. For some, the policy question at hand was how the “tobacco end game” would be played out.

The ensuing policy battles over e-cigarettes in each country can only be understood with an appreciation of this public health context. Strikingly, each of these countries pursued differing public health policies while appealing to the same bodies of evidence. In the case of England and

Australia, in particular, the difference in approach was dramatic. Yet, as influential as each was in the global debate, all three nations came to understand the promise and risk of e-cigarettes in radically different ways. Each came to interpret the available evidence differently; each addressed the evidence from the perspectives of harm reduction and the precautionary principle in utterly divergent manners.

The national narratives to which we will now turn make it abundantly clear that it is inadequate to understand sound public health policy making as a matter of “implementation science.” Only a direct recognition of the role that history and politics played in shaping public health policy can permit us to fully understand how and why very different policy determinations were made. Amassing scientific evidence on the public health effects of e-cigarettes is not the end of the story; it is just the beginning. […]

There would be particular value in similar analyses of the factors influencing e-cigarette policies in Canada and New Zealand, two countries that initially adopted much the same the medical regulation approach as Australia’s approach, before allowing the sale of e-cigarettes as consumer goods under tighter regulation. Similarly, there would be value in policy case studies in other high- and middle-income countries that have adopted e-cigarette sales bans, such as Brazil, Malaysia and Singapore.

Expanding the cross-national comparative frame is important because what we can take from this study of three countries who were early leaders in global debates is that interpretation of “the evidence” on the effectiveness and safety of e-cigarette was refracted through pre-existing policy commitments produced by a host of contextual and historical factors highlighted above. British research and evidence focused on the beneficial impacts that e-cigarettes had on smokers who wanted to stop smoking. US research, by contrast, highlighted the threat to the “innocent victim” and children, traditional tropes within the tobacco field. Australian policy makers were very much more influenced by research from the US on the adverse effects on youth than by British research on its benefits for smoking cessation. This was a departure from the previous Australian response to evidence on the harms of cigarette smoking that looked primarily to the UK. The invocation of the precautionary principle to justify an Australian sales ban was strongly mediated by the historical and contextual issues we have outlined.

Some commentators have drawn attention to the inconsistency in the hostility shown to harm reduction using e-cigarettes in the US and Australia, when both countries are in the process of liberalizing access to cannabis which is still primarily smoked and vaped. There has also been a debate in the public health field as to whether England’s policy is an “outlier” in a world where hostility to e-cigarettes is the norm, or whether it is blazing a pioneering path towards a more rational policy that other countries will eventually follow. Optimists of the latter persuasion have pointed to policy movements in this direction in the US and more recently in Canada and New Zealand.

What emerges strongly in this comparison of the three countries is the importance of pre-history in relation to nicotine and its usage for cessation and harm reduction. This experience needs to be understood within the context of state decision making and the durable “policy communities” that form around particular issues, such as nicotine and e-cigarettes, and exert considerable influence in concert with powerful interests within government.

(All images courtesy of Wikimedia Commons)