Tobacco a Rising Problem in sub-Sahara Africa

The photo by Jeroen van Loon

In the last decades the rise of deaths have not only been related to communicable or non-communicable disease in sub-Sahara Africa, but another important factor does that there is a rise in deaths that is not related to illnesses such as diabetes, malaria, and HIV. The use and intake of tobacco has been rising in the last two decades and even though considerable steps have been made on a global level to decrease the number of smokers in sub-Sahara Arica, much has to be done to diminish the use of tobacco and the stop the marketing around the product.

However, despite the efforts made in the past years, tobacco consumption is still on the rise at about 4% per year with an estimated number of users of over 1 billion people. There has to be some sort of tobacco control to ensure there will not be a bigger rise in tobacco use in sub-Sahara Africa. According to the World Health Organisation (WHO) about 80% of the smokers are parts of the lower and middle income countries according to the DAC list of ODA recipients. The rate of tobacco use in Africa is about 14% which is little compared to the United States which amounts to 23% and Eastern Mediterranean to 31%, however the rise of tobacco use is the highest in the world is Mozambique which has had a growth of 220% in cigarette consumption in the past 16 years.

Information on Tobacco Use Remain Scarce

Regardless of the growing problem of global tobacco use, precise information of the prevalence and patterns of the use of tobacco in the world poorest nations remain scarce. For sub-Sahara Africa little information is available to combat the potential rise of tobacco use and the harmful effects it has on the growth of mortality linked to the tobacco use. Several statistics have shown that the highest use of cigarette use is among men in different countries of East central Africa and the lowest use if in countries of West central Africa, and the medium use of tobacco happens to be in the southern part of Africa.

It seems that the highest cigarette use is in the group of men and thus among urban, less educated, and lower status workers. When looking at the use of tobacco by women there is much lower prevalence than men however there do seem to be similar social patterns than the ones described above. Different results thus give new and comparable information about tobacco use in low-income nations, disadvantaged social groups, and an understudied region of the world such as sub-Sahara Africa. However, if we look at several reports about the ranking of the world’s lowest incidences and mortality linked to smoking tobacco several African countries are in the top 20 such as Ghana, Nigeria, Ethiopia and Guinea.

North Africa High Rate Smokers

The continent of Africa is also home to some of the highest ranked smoker countries in the world, with for example North African countries such as Tunisia which is estimated at about 1628 cigarettes per adult each year, which amounts at about 4,4 per day for each person older than 28years of age. Other Northern African countries follow as second and third place.

Sub-Saharan Africa – Smoke-free zone

Smoking tobacco arrived a little later in sub-Sahara Africa, albeit only slightly. It quickly became more of a cultural tradition – bridging the spheres of rituals and politics alike.

Nonetheless, sub-Saharan Africa, greatly like Mauritania’s customs, is considerably more driven by tobacco-related taboos. In sub-Saharan culture it is not customary for young people to smoke in front of elders unlike in other places in the world where smoking can simply be viewed a social gathering as such, where non-participating elders are not a matter of concern.

A negative toll on this tobacco rise in sub-Sahara Africa links to the fact that companies have adjusted their cigarette prices to the local demand, meaning that they have changed the quality of the tobacco. This leads to the fact that wealthier countries can afford the tobacco and less wealthy countries cannot.

Sub-Saharan Africa is a different market altogether – principally – much more diverse and, therefore, complicated so hard to trace the patterns of tobacco use and rise, similarly than other parts of the world.

Potential Growth

Because the Northern African tobacco market sales reached a high, the marketing target has now switched to Sub-Saharan countries. Even if there is little prevalence among these states, the potential for growth is overwhelming – especially combined with a universal improvement in well-being and disposable income. This can lead to a rise in illnesses and a lack of knowledge of the health dangers tobacco can lead to.

But there is still a long road ahead to ensure that this tobacco consumption does diminish and that there is a drop in the marketing of the “bad habit of smoking”. In countries struggling with alarming rates of infectious diseases, malnutrition and often unstable political situations, the chronic illnesses caused by smoking seem less urgent in the eyes of decision-makers whereas it should also become a priority as it does lead to more deaths. Poor countries are thus viewed as ‘short-termites’ instead of looking at long term solutions and thus try to boost the whole country to a positive toll.

How to Prevent a Health Crisis

Nonetheless, the use of tobacco is a ticking time bomb. According to the WHO report, by 2030, 80% of all deaths will be caused by tobacco and will thus occur in low- or middle-income countries. The problem is that in sub-Sahara Africa the hospitals and just in general the health care system is not equipped to deal with chronic illnesses. If we look at cancer it is estimated that for 10 people that need some kind of treatment, only 3/10 will be able to have treatment. Looking at it from this perspective, the poor are often the first ones to suffer from this problem.

In Senegal, for example, most patients are expected to cover all the costs, meaning the costs of consultation and treatment. In many cases, cancer linked to tobacco use is not diagnosed, due to the fact that the patients cannot afford paying for the tests. Most patients who are in pain request a type of sedative for the pain, and afterwards the patients do not come back in most of the cases. This means that sometimes the doctors do not know what happens with the patients, hence this issue is alarming.

Danger Smoking

According to the 700-page report released at the start of 2017, the WHO projected that about 226 million smokers live in poverty. Therefore, in order to tackle the health crisis and the protection of the population in sub-Sahara Africa, tax measures must be put in place, states the WHO, even if some people are scared that this may add insult to injury. People who smoke a lot, can already barely afford it. However, since the addiction to tobacco is so high, people will still purchase it no matter what the pack costs. Instead of changing the price of tobacco by putting higher tax prices, it is important that the population is educated about the dangers of smoking and the negative effects it can have on people their health. And for those who are addicted they must be educated on how to quit smoking.

In an interview retrieved from the International Development Research Centre came out that when they asked how long a man had been smoking, the man laughed and answered “Since forever! But I am okay with it, I still have a little breath in me,”. He then continued with stating even if a pack would cost 2,000 CFA francs [$4.35], I would still buy the pack of cigarettes!” This leads us to think that there is no doubt that the tobacco industry has a few good years ahead of it yet before real change will happen and that it is an urgent matter for the rise to turn around in the fall of tobacco.


To conclude, what needs to happen is for people to get educated on the negative health impact that tobacco can bring. The marketing around tobacco is too prominent in sub-Sahara Africa and thus needs to occur less frequently. Smoking is very addicting and in order for people to quit smoking they need to see the bad toll it can take over their lives and that can only be achieved through education. Changing the prices of a pack of cigarettes will not stop people from purchasing a pack. Adding 1,50$ to a package of cigarette will not be the main factor of change to diminish the amount of deaths related to tobacco, education on the health factors of smoking is the key that will lead to change.

*Patricia Vermeulen is CEO of Amref Flying Doctors.