The challenge of making Africa smoke-free

There’s no doubt that the tobacco industry is losing huge influence in richer countries, as fewer people use tobacco than ever before.

The harsh reality, however, is that the industry is now getting away with aggressively exploiting less wealthy countries and, a decade later, many low- and middle-income countries (LMICs) are still as ripe a market as ever for exploitation by the tobacco industry.

Increase in tobacco-related deaths

Smoking currently costs the global economy more than $1 trillion (about R13 trillion) a year. Yet the global health and economic burden of tobacco use is increasingly borne by low- and middle-income countries. Eighty percent of smokers live in LMICs.

While smoking prevalence is falling in some high-income countries, the total number of smokers worldwide is not decreasing, largely due to population growth in the countries where poor people are targeted by the tobacco industry. The number of tobacco-related deaths is projected to increase from around six million deaths annually to eight million by 2030. More than 80% of these deaths occur in LMICs.

By 2030, the number of African smokers is projected to increase by 40%. If the tobacco industry is allowed to operate as they want, the current 77 million adult smokers in Africa will increase to a staggering 572 million this century. This potentially makes Africa the future epicentre of the tobacco epidemic.

But it does not and cannot come to that. As history has shown, the key to protecting people from the exploitation of the tobacco industry is to mobilise and unite governments and civil society on tobacco control. Protecting health policies from tobacco industry interference has to become a major priority throughout the region.

Boost for other health services

This will necessarily involve suffering some pain for gain – and a new approach to public health policy which will see the government committed to transparent and curtailed dealings with the tobacco industry.

Simultaneously, action is needed across the continent on tobacco taxation. Not only is raising taxes on tobacco the most powerful measure for reducing tobacco use in the long term, when used properly, it can both fund national tobacco control programmes sustainably into the future and direct increased revenue to provide a much-needed boost for other health services.

Again, this requires commitment and collaboration from multiple government departments – ministers of health and finance working together to protect and promote the physical and economic health of citizens. If we want to truly advance tobacco control, it must become a whole-of-government issue

A similarly robust regional conversation will also need to be had sooner than later with the tobacco farmers themselves. They need to be reassured that there are alternatives to tobacco farming. We know that the number of jobs dependent on tobacco has been falling in most countries.

Total bans the only answer

For those countries that are particularly reliant on tobacco farming and exports, the time to act is now. Authorities need to work with the farming community and begin mapping out alternative livelihood programmes that in in the long term will positively impact on current tobacco farmers, their families and communities, by ensuring a smooth transition to equally, if not more profitable crops.

Governments across the region also need to protect those groups targeted by the tobacco industry’s powerful marketing tactics – young people and women. Total bans on tobacco advertising, promotion and sponsorship is the only way to achieve this. And Corporate Social Responsibility schemes must also fall under this ban.

In addition to the growing burden of tobacco-related disease, African countries have over the past three decades endured the effects of the Aids and tuberculosis (TB) epidemics. If those crises have taught us one thing it is that effective management of epidemics of this magnitude means including affected communities in the response.

A tobacco-free generation

In some parts of Africa that will also necessarily translate into considering the impact of tobacco-related disease on the health of a person living with HIV, and on the susceptibility of smoker populations who are also vulnerable to TB. Such considerations are long overdue.

In 2018, the biggest public tobacco control conference in the world is coming to Africa for the first time. This represents a major opportunity for Africa and the developing world to get tobacco control policy right. In Cape Town they will have the chance to unite the world for a tobacco-free generation.

Olalekan Ayo-Yusuf:Director, Africa Center for Tobacco Industry Monitoring and the Co-Chair of the Scientific Committee of the 17th World Conference on Tobacco or Health (WCTOH)

Harry Lando: Distinguished International Professor in the Division of Epidemiology and Community Health, School of Public Health at the University of Minnesota and the Chair of the 17th WCTOH Organising Committee.

Gan Quan: Director ofTobaccoControl at the InternationalUnion Against Tuberculosis and Lung Disease (The Union) and Co-Chair of the 17th WCTOH Scientific Committee.

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