
E-cigarette users are not non-smokers
The theme for this year’s World No Tobacco Day on 31 May is “Tobacco – a threat to development”. E-cigarettes have long been considered by many to be a safe alternative to tobacco, but in fact they pose a number of serious health risks.

Trivialising the dangers has helped to promote the trend towards e-cigarettes
Research carried out in 2016 shows that roughly one third of all e-cigarette users in the USA have never smoked before1. The proportion of young people in this group is exceptionally high. These findings are especially alarming, as they show that the younger generation in particular can develop a nicotine dependency via e-cigarettes. This threatens to undo the success achieved by many decades of information campaigns, which had recently led to a noticeable decrease in the number of young people who smoke.
Smoking e-cigarettes damages health
The popularity of e-cigarettes is the result of a widespread misconception. The fact they may be recommended by some physicians as an aid to overcoming tobacco addiction does not in any way mean that inhaling vapours containing nicotine is healthy. On the contrary, studies confirm that in addition to nicotine, e-cigarette aerosols also contain various carcinogenic substances, such as formaldehyde and acetaldehyde. Moreover, the aerosols intensify inflammatory activities in the lungs and inhibit the healthy development of embryos. Adverse effects on the cardiovascular system cannot yet be clearly determined due to the lack of long-term studies, although they are likely1.
While smoking e-cigarettes is indeed almost certainly less harmful to health than conventional tobacco usage, it nonetheless represents a significant health risk. Even the supposed medical benefit as an aid to kicking a heavy nicotine addiction has yet to be statistically proven through empirical studies. On the other hand, it is indisputable that the health-related costs, and by extension the economic costs, of using e-cigarettes could reach phenomenal levels.
Lawmakers respond – now in Germany as well

The European Union has recognised this danger and revised its Tobacco Products Directive in 2014. In the revised Directive, e-cigarettes are classified as tobacco products, making them subject to the same requirements and restrictions that apply to ordinary cigarettes. After adoption by the European Parliament, national legislatures were given two years to transpose the Directive into national legislation.
Many EU Member States fulfilled this requirement in 2016. Germany is one of the last countries to initiate and bring into force appropriate legislation. Since 20 May 2017, e-cigarettes are also classified as tobacco products in Germany. They are subject to stringent restrictions, such as special packaging and labelling, and strict limitations on advertising.
Substantial risks from an insurance perspective
From a medical perspective as well as from the viewpoint of new legislation, the message is clear: e-cigarette smokers are not non-smokers. From an insurance perspective, the large proportion of young e-cigarette smokers in particular is a cause for concern. In addition to the health risks, the growing popularity of e-cigarettes will also have serious economic implications for vapers.
This is because in many markets people classified as smokers have to pay higher premiums for life insurance products than non-smokers. For the growing number of young users of e-cigarettes in particular, this translates into more expensive access to insurance cover. E-cigarettes are therefore not only associated with health risks; they could also result in a further widening of the insurance gap for young people especially, with corresponding financial consequences for individuals and society as a whole.
1 The Health Effects of Electronic Cigarettes; Chitra Dinakar, M. D., and George T. O’Connor, M. D.; N Engls J Med 2016; 375:1372-81

- cbodelschwingh@munichre.com