Fight against the tobacco epidemic

It is estimated that by 2030 almost half of the African civilians will be living in cities, more than 300 million people will be part of a new middle class of consumers and the life expectancy will be as high as ever. As a result of these new developments, which are already in progress, African consumer behaviour has changed significantly.

One of these changes induced by new opportunities is the future growth in tobacco use. Not only do 77 million smokers live in African countries, there is also an expected increase of smoking prevalence by 39% in 2030. In a world that is giving up on cigarettes, the African market is one of the few markets still showing growth. It is even predicted that in the next decade the tobacco consumption in sub-Saharan Africa will double if there are no major policy interventions to be made. In order to prevent this trend from growing, the UN has stated that it will expand its efforts in Africa to increase tobacco control.

Six strategies

On November 18, 2016 the World Health Organisation organised the seventh session of the Conference of the Parties (COP7) on the Framework Convention on Tobacco Control where they decided on the growing role of tobacco control measures. Dr Vera Luiza da Costa e Silva, the Head of the Convention Secretariat elaborates: “Despite all the hard work by the Parties it is sad to see tobacco industry interests, yet again, being promoted. It is determined to undermine and distract us from our goal – to fight against the tobacco epidemic that not only damages health and kills people.”

With a package of six policies the UN will combat tobacco use in African countries, but does not exclude others. “While efforts to combat tobacco are gaining momentum, virtually every country needs to do more. These six strategies are within the reach of every country, rich or poor and, when combined as a package, they offer us the best chance of reversing this growing epidemic,” said Dr Margaret Chan, Director-General of the World Health Organization.

MPOWER

Six strategies have been formulated. This approach is called MPOWER:

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce bans on tobacco advertising, promotion and sponsorship

Raise taxes on tobacco

Fake science

The concern pronounced by the UN on the growing market in Africa is practically visible and very important to pay attention to. Due to the efforts of the tobacco industry to reach the African consumer, the consumption of tobacco went up alongside the increasing income. Marketing their products in Africa, they made use of the policy environment in terms of taxes, freedom of advertising. They even tried to influence the African governments of tobacco-growing countries to believe how important tobacco is to the economic activity in order to prevent a tax raise on cigarettes. The Global Voices Report even accuses tobacco-companies of using fake science and stories to scare people.

But there is also a lot to be done about current legislation. For example, both in Kenya and Zambia it is still possible to challenge or dilute already accepted smoke-free laws. And in South-Africa the largest company within the national tobacco industry, BAT South Africa, amended the anti-smoking laws because it would harm their “constitutional right” to market cigarettes, since the usual advertising methods were banned in 2000.

Affected people

According to the World Health Organisation (WHO) from the 27 countries with an increase of tobacco consumers, seventeen of them can be found in Africa. It was in Congo-Brazzaville where the largest growth in consumers can be found when it went from 6% to 22% of the national population. Cameroon came in second as it went from 7% to 22% tobacco-consumers.

A special concern stated by the report is the shift of the tobacco’s industry to the developing world and its focus on young people. According to the WHO the majority of the new consumers are youths, with most of them being under the age of 18 and even a quarter of this group tobacco users are under the age of 10. Being a target of the industry at such a young age does not only induce direct danger to one’s own development, it could lead to a prolonged time of addiction and creates a cultural acceptance among the youngsters; the more people in their immediate surroundings smoke, the more normal such behaviour becomes. As a result, young people often seem to underestimate the risks of their consumption and do not expect to become addicted to it. The report particular states the targeting of young women as one of the “most ominous potential developments of the epidemic’s growth”. But also the mentioning of young men in Africa is important. Among African boys, 9% does smoke, which is more than the Middle-Eastern 8% and the Western world’s 6%.

Action

Although the tobacco industry actively targets African countries, there is already a responsive counter movement in addition to the one of the WHO. Across the region, the urgency of supporting proven tobacco control policies is recognized by local policy makers, public health experts and the public itself. Various countries have enacted strong national tobacco control measures to limit the tobacco industry’s grip on society. Also the ngo Amref Health Africa is contributing to this important issue: together with the local authorities and companies like GlaxoSmithKline they work on launching new programmes to train health workers including nurses, clinical officers, laboratory technicians, nutritionists, pharmaceutical technicians, community health volunteers and community health extension workers to increase the local knowledge on tobacco consumption and its consequences. This is an important step in order to improve and strengthen health systems. Amref Health Africa Group CEO Dr Githinji Gitahi said non-communicable diseases were no longer diseases of the very old or very rich as perceived in the past. “They are now a health priority for all. We need to reduce risk factors such as smoking, drinking pollution, and drive a mindset change among out people to adopt healthier lifestyles,” he said. He emphasised the importance of ensuring access to essential medicines, and of improving surveillance in order to determine the extent of the problem in Africa so that we can effectively deal with the it. “In this way, we will save lives and economies, we will promote social cohesion, and we will support a healthy planet.”

Non-communicable diseases

With this, the before mentioned ngo works hard to induce healthy lives and well-being for all ages, thereby echoing the Sustainable Development Goal of strengthening the capacity of a country to early warn its civilian and thereby reducing the national and global health. The progress that will be induced by these new legislations will not only affect the direct consumption of tobacco, it will also affect the exposure to second-hand smoking, thereby protecting more people at once. Ala Alwan, WHO’s Assistant Director-General for Non-communicable Diseases and Mental Health echoes: “Urgent action is needed to protect people from the death and illness caused by exposure to tobacco smoke.” Tobacco use is a major risk for the non-communicable diseases in WHO’s African regions, as it is for example known to be a cause for cancer. Currently the non-communicable diseases are responsible for approximately 35% of African mortality. These kinds of deaths are often called “premature” since they occur before the age of 70.

Grassroots comics

But not only legislation contributes to the abandonment of tobacco consumption. According to McKinsey’s Africa Consumer Insights Centre it is the African consumer who relies on both traditional and non-traditional sources to gather information on their consumption products. Word of mouth is in Africa still the major source with nearly 50% of Sub-Saharan civilians and 81% of North Africans relying upon their friends and family to supply each other with truths.

It is on this point where the Youth Empowerment Alliance (YEA) found a new way to communicate important knowledge among youngsters. This August, the Grassroots Comics Pilot Project showcased important issues young people would like to discuss and pass on to each other. The program’s concern is to provide young people with as much information on Sexual and Reproductive Health and Rights (SRHR) through the creation of comics. Next to the wonderful effect of these stories reaching youngsters with SRHR information, the project also provides an opportunity to exchange thoughts on tobacco use, the addiction and its consequences.

The ngo mentioned earlier is pleased to see how this topic takes the stages at so many different levels. It believes that the increasing attention of the world politics will help in the combat of the local authorities to maintain a healthy environment for their civilians to live in. Being able to provide multiple ways of reducing the tobacco use within a community and thereby improving the public’s health and strengthening their health systems is what the organization strives for.

*Patricia Vermeulen is CEO of Amref Flying Doctors in the Netherlands.

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