Tobacco usage continues to stake its claim atop of the global podium for causes of preventable deaths. According to the World Health Organisation (WHO) tobacco kills almost 6 million people a year and causes billions of dollars of economic damage worldwide. If the world continues along this current trajectory tobacco will kill more than 8 million people worldwide each year by 2030. It is estimated that over the course of the 21st century, tobacco could kill a billion or more people. Quite a sobering statistic when compared to the 20th century where wars, conflict, famine and disease combined killed roughly the same number of people.
Most deaths due to tobacco-attributable illnesses occur in low and middle income countries. The costs to society due to smoking and tobacco abuse are many. Families are torn asunder, loved ones are lost and breadwinners perish due to smoking related illnesses every year. Not to mention the detrimental effect tobacco related illnesses and deaths have on the economy and levels of productivity. Against the backdrop of this incapacitated global tobacco epidemic, where does South Africa stand in terms of its management of tobacco and smoking and how do we compare to other nations?
South Africa has a rather capricious history with tobacco consumption. In 1994, the Medical Research Council estimated that for every R1 the government received from taxes on cigarettes, it spent R2 on treating tobacco related diseases. South Africa’s prevalence of smoking also ranks 20th in the world and on average 8% of all deaths in South Africa, which equates to approximately 50, 000 deaths each year are a direct result of smoking related illnesses. Tobacco is a drain on our already ailing healthcare system and it comes as no revelation that South Africa is embroiled in a constant melee to find enough money to overhaul the overburdened health system and deal with the country’s quadruple burden of disease. It is estimated that the direct costs of smoking to South Africa can be quantified to approximately U$127-million which equates to about 1 billion 156 313 rands. This figure is representative of both private and public direct medical costs of treating tobacco related diseases. Indirect costs include environmental damage due to cigarette butt littering, suffering of victims and their families and losses in productivity. A recent review published in the journal Addiction found that smokers take on average three more sick days from work every year than non-smokers. Occupational Care South Africa (OCSA) estimated that productivity lost due to absenteeism cost our economy R12 billion in 2009. Therefore one must ask what steps South Africa has taken to curb this rather counter intuitive phenomenon and control the use of tobacco in order for the state to save money?
South Africa has indeed made significant strides in curbing the use of tobacco and preventing tobacco-attributable illnesses and deaths during the past decade. We have done this by implementing strong tobacco control legislation. The Tobacco Products Control Amendment Act ratified by President Nelson Mandela in 1999 provides South Africa with one of the most comprehensive tobacco control legislation packages in the world. This act bans tobacco advertising and promotions from tobacco companies. It also protects children and adolescents from multimillion-rand marketing schemes and ensures the rights of non-smokers to a smoke-free environment. More recently in 2009, President Jacob Zuma gazetted into law new anti-smoking regulations that strengthen limits on smoking in public places and put more regulations on the manufacturing and marketing of tobacco products. These include:
§ Larger fines for smoking in non-smoking areas
§ Prohibitions of smoking in partially enclosed public spaces, cars with passengers under the of 12 and areas used to commercial childcare, schooling or tutoring
§ Limited smoking areas to persons only over age the 18
§ Outlawed tobacco industry-sponsored ‘parties’
§ Prohibitions of the sale of tobacco products to and by persons under the age of 18.
South Africa has also stood firm in its relentless battle against tobacco companies. In 2012 British American Tobacco South Africa, the country’s largest cigarette manufacturer tried to lift the ban against the advertising of tobacco products. The Constitutional Court denied to the company leave to appeal. Yusuf Saloojee, executive director of the National Council against Smoking South Africa, said in a media report at the time of the ruling: “We welcome the Constitutional Court’s decision, which confirms our confidence that the country’s tobacco control laws are fair, reasonable and based on solid science.”
Thus despite our slightly tenuous history with tobacco, South Africa has actually made significant progress during the last decade in reducing tobacco usage. As a result of these tobacco control measures South Africa’s smoking rates have experienced a significant decline. Between 1995 and 2004 adult smoking rates fell by 20% and approximately 2.5% of smokers have stopped smoking resulting in a 40% decrease in annual cigarette consumption rates. South Africa was also one of the first signatories to the WHO Framework Convention on Tobacco Control’s (FCTC). The convention, which took effect in 2005, is ratified by nearly 170 countries. The recommendations state that smoke-free laws must cover all enclosed public places, workplaces, and public transport without exemption and avoid designated smoking rooms, ineffective ventilation, and air filtration schemes. However South Africa unfortunately falls somewhat short of the robust anti-smoking FCTC standard because we allow for designated smoking areas which negate the smoke free premise upon which the FCTC protocol is based.
In spite of this, South Africa, in comparison to many other middle to low income countries where the tobacco epidemic is still a burgeoning epidemic, has actually shown that the epidemic can be curtailed if evidence-based policies and initiatives such as those contained in the WHO’s Framework Convention on Tobacco Control are implemented properly. In addition a heartening study found that in contrast to the US, UK and Canada where tobacco causes 1 in every 5 or 6 deaths, in Africa it causes only 1in every 84 deaths. However, according to a 2009 smoke-free status report, Global Voices: Rebutting the Tobacco Industry, Winning Smoke free Air, Africans are set to experience the highest increase in the rate of tobacco use among developing countries. This is due to the illicit trade on black market cigarettes as well as African countries proving themselves lucrative target markets for predatory tobacco companies. In a report filed for the Los Angeles Times Online in December last year, Saloojee expressed concern over this growing interest in African countries saying, “The African population is very young. If they [tobacco companies] can hook customers now, they’ve got customers for the next 40 or 50 years. So the prospects of an increasing market share are very good.” The more countries move to fully meet their obligations under the FCTC the more aggressive tobacco companies are becoming to try and weaken public health efforts to ban tobacco advertising, promotion and sponsorship. And Africa is in their direct line of vision.
Thus South Africa still has a great deal of ground to cover and hurdles to overcome before it reaches its goal of a truly smoke and tobacco free society. However one thing is for certain and that’s the fact that South Africa can consider itself a success story in terms of reducing tobacco usage and implementing progressive anti-smoking regulations. South Africa has also proven that cultural or regional factors need not prove insurmountable barriers to effective tobacco control, an example from which the rest of Africa should imbibe and attempt to emulate.
