Closing the Harm Reduction Gap: EMPOWERing People Who Smoke

Global tobacco control efforts, influenced substantially by the World Health Organization Framework Convention on Tobacco Control and the MPOWER package, have lowered smoking prevalence in some populations but have failed to address the lived realities of the people who continue to smoke. These individuals increasingly come from communities marked by socioeconomic disadvantage, lower educational attainment, and limited access to healthcare, contexts where structural constraints, chronic stress, and reduced opportunity shape tobacco use far more powerfully than individual "choice." Yet tobacco control frameworks continue to prioritize abstinence-only strategies, punitive measures, and restrictive regulatory environments that rarely reflect the perspectives or needs of the people most affected. Countries are praised for adopting increasingly restrictive policies, with little attention given to the actual reductions in smoking rates. This editorial argues that further decreases in smoking rates can be achieved if the focus shifts from moralizing nicotine use in any form to empowering people who smoke with practical, science-based harm reduction tools. Noncombustible nicotine products that reduce toxicant exposure are often dismissed or prohibited despite growing evidence of their value for people unlikely to achieve abstinence. This disconnect widens health inequities and alienates those currently navigating stigma, misinformation, and limited cessation support. We propose a real-world EMPOWER framework that integrates evidence, pragmatism, risk-proportionate regulation, and person-centered communication. To reduce smoking-related harm more effectively, policy must move beyond ideology and prioritize autonomy, equity, and practical harm reduction.