Former Health Committee Chairperson States Government Must Reduce Harm, Not Just Ban Risky Behavior

Sibongiseni Dhlomo, the former Portfolio Committee Chairperson of Parliament on Health matters, stated on Tuesday that South Africa has long employed a harm reduction approach in areas such as HIV prevention, sexual health, and substance abuse, and this same method should form the basis of policy discussions concerning smoking.

Dhlomo emphasized that the government should promote harm reduction instead of merely urging South Africans to avoid risky actions. His remarks came amid Parliament's preparations for a detailed discussion of the tobacco control and electronic product delivery systems bill, following the Health Committee's resolution in June expressing desirability, which advanced the legislation to the next stage.

Speaking before delegates at The Wellness Collective event, dedicated to South Africa's transition from selling harm to promoting well-being, in Johannesburg, Dhlomo noted that the government bears responsibility for minimizing harm wherever possible, especially when eliminating risky behavior is unlikely.

He provided examples: 'The government doesn't just tell people not to have sex. It provides condoms, antiretroviral treatment, and education. That is harm reduction.' He added that the same principle applies to people who use injectable drugs, as providing clean needles and syringes helped prevent the spread of HIV and hepatitis while encouraging people to seek help.

In Dhlomo's view, the tobacco issue should be approached similarly. He asked: 'If someone cannot or does not want to quit nicotine, should we encourage them to continue smoking cigarettes, or should we support their transition to a less harmful alternative?'

He also noted that public consultations during the development of tobacco legislation changed the understanding of nicotine products among policymakers. As the former Chairperson of the Portfolio Committee on Health, Dhlomo reported that legislators visited 27 municipalities, gathering over 7,900 people, receiving more than 40,000 written submissions, and hearing presentations from 52 organizations before finalizing the law.

Dhlomo concluded that 'the policy we arrived at is different from where we started because we listened to evidence and the public.' He also mentioned that consultations with scientists, industry representatives, and public health experts highlighted the need to distinguish between combustible tobacco products and non-combustible nicotine products. He admitted that he initially viewed all nicotine products equally but better understood concepts like the risk continuum and the reasons why different products might require different regulatory approaches after engaging with experts.

Faith Mazibuko, Gauteng MEC for Health, noted that harm reduction acknowledges that sustainable behaviour change often happens gradually. She explained: 'Harm reduction is about reducing preventable harm by helping people move towards healthier choices. It recognizes that changes do not always happen overnight, but every positive step toward improving health matters.'

Mazibuko stated that the government already uses this approach in several public health measures, including promoting healthier eating and responsible alcohol consumption, as well as advancing safer sexual practices and protecting people from preventable diseases. She emphasized: 'The message we convey is that prevention works, and every healthier choice contributes to building a healthier society.'

Turning to the topic of tobacco, Mazibuko stated that the same principles apply. While she believes that 'the healthiest decision anyone can make is never to start smoking,' and that complete cessation remains the best option for smokers, she acknowledges the complexity of nicotine addiction and the need for support. She added that healthcare workers continue to recommend behavioural counselling, approved smoking cessation medications, and other evidence-based interventions for those who wish to quit. For adults who cannot quit immediately, public health approaches must continue to focus on harm reduction while encouraging cessation.

Dr Bandile Masuku, former Gauteng MEC for Health and a gynecologist who participated in the panel with Dhlomo, agreed that South Africans already understand the concept of harm reduction, comparing it to wearing a seatbelt in a car—it significantly reduces the risk of serious injury or death, although it does not eliminate the risk of an accident.

He also supported the idea that the government should pay more attention to harm reduction and create policies that encourage a healthier lifestyle.

Buhle Binta, Head of Scientific Communications for Sub-Saharan Africa at Philip Morris International, explained that instead of ignoring the fact that many continue to smoke, harm reduction focuses on encouraging smokers to fully switch to less harmful, non-combustible alternatives. According to the World Health Organization, over a billion people still smoke worldwide, and there are about 11 million smokers in South Africa who use combustible cigarettes, which is one of the main causes of preventable diseases and mortality. She reiterated that the best choice is always complete cessation, but for adults who cannot or do not want to quit, the conversation shifts to harm reduction to help them move away from the most harmful products.