Presentation for APHA November 5, 2007 Why are more Africans smoking? The policy, politics and public health challenge of smoking in Africa ‘Dunsi Oladele-Rabiu and Dr. Carl V Phillips University of Alberta, Edmonton, Canada Presentation for APHA November 5, 2007 notes

Objective Provide an overview of the major issues involved (and necessary to be tackled) in the reduction of smoke rates in Africa notes

Background WHO – 1 in 10 adults worldwide (about 5 million people) die annually from tobacco use (WHO, 1996) World Bank – Deaths resulting from smoking tobacco in 2025 will exceed deaths due to AIDS, tuberculosis and complications of childbirth combined, especially in developing countries (Barnum, 1994) Mathers and Loncar (2006) –Total tobacco-attributable deaths will rise from 5.4 million in 2005 to 6.4 million in 2015 … and then to 8.3 million in 2030 notes

Health and Smoking…State of Affairs In 2007, in the midst of blistering messages to quit and implementation of well-funded support for cessation programs: In the US alone, 46 million people smoke and > 400,000 die each year from smoking-related causes (CDC, 2006) In Canada, 6 million people remain smokers and 45,000 die each year from related causes (Health Canada, 2006) notes

Health and Smoking…State of Affairs For a brief period, tobacco smoking or use rates declined in the US and other developed countries. However, the decline in smoking appears to have slowed or stalled: There was no observed change in US adult smoking rates from 2004-2006 (MMWR: 55(42): 1145-1148, 2006 – CDC study) From 2000-2006, the Canadian Tobacco Use Monitoring Survey (CTUMS) indicates that smoking prevalence is declining in smaller increments as opposed to the 50% decline seen in 1965 and 24% decline experienced in 2000 (Moving Forward Progress Report on Tobacco Control, 2006) notes

The Problem in Africa Tobacco consumption rose from 131 million in 1995 to 213 million in 2000 Representing a 38% increase in five years (Yussuf Saloojee, 2000) To compensate for their increasing losses in the Western countries, tobacco companies are counting on an increase in the consumption of tobacco over the next decade in Africa (WHO World Tobacco Atlas) Due to the weak tobacco control legislation in Nigeria, it has become one of the biggest markets for tobacco producers in Africa more tobacco companies have relocated to the country Invariably more Nigerians are lured to smoking By the year 2020, tobacco-related diseases will become Africa’s biggest killers (Slama, 1996) notes

Tobacco advert in Africa Source: World Tobacco Control Image Database –Images from Africa notes

Tobacco advert in Africa Source: World Tobacco Control Image Database – Images from Africa notes

Tobacco advert in Africa Source: World Tobacco Control Image Database – Images from Africa notes

The Problem in Africa - continued Clearly tobacco control has not been a high priority in African countries due to other overwhelming health problems like infectious diseases, AIDS/HIV, tuberculosis and malaria Increased risk of Africans to Tuberculosis, HIV/AIDS and smoking will worsen the health problems in Africa “the problems of controlling smoking in Africa are more challenging than those faced by the developed countries, as Africa is the only continent where smoking is generally tolerated both by the government and the public” - BC Simpson, the then Secretary General of the World Tobacco industry’s main public relations agency (Clark, 1984) notes

Tobacco Control Interventions In 2003 the World Bank came up with a list of tobacco control interventions. The Bank enumerates effective tobacco control interventions as: Price increases through higher taxes on cigarettes and other tobacco products Bans or restrictions on smoking in public and work places Better consumer information, including public information campaigns, media coverage and publicizing research findings Comprehensive bans on the advertising and promotion of all tobacco products, logos and brand names Large direct health warning labels on cigarette boxes and other tobacco products Treatment to help dependent smokers stop, including increased access to medications There is very little between what the Bank recommends as effective control interventions and the general state of things in Africa on smoking interventions notes

Africa: Key Issues The state of the medical facilities Inadequate facilities to support those who need help quitting Inadequate resources for those working in the tobacco control arena Tobacco companies enticing poor African farmers to grow tobacco as opposed to food crops The link between poverty and tobacco Difficulty enforcing tobacco control interventions notes

Recommendations Set up a body in Africa that will foster policies that will work in Africa to reduce smoke rates and to fight tobacco industry’s corrupt practices in that region A ban on all direct and indirect advertisements Increase the price of tobacco products – Proven to reduce tobacco use among low income populations or countries More funding for health workers in Africa especially those working in the tobacco control arena Empower Africans through better education on the adverse health effect of smoking as opposed to placing emphasis on smoke ban in public places Develop programs to help smokers stop and also have systems in place to assess and report on progress Develop global partnership on tobacco control like the South Africa and Sweden Health Forum Cooperation – This will help to eliminate the disparities related to tobacco use between developed and developing countries Tailor tobacco interventions to the peculiarities of the different communities notes

Conclusion The global harm caused by smoking is the leading health issue of the day, so the case for tobacco control in Africa is important There is no doubt that the smoking epidemic is already in Africa, the challenge is to slow it down by creating awareness and implementing measures for tobacco control in that region notes

Selected References Barnum H. (1994). The economic burden of the global trade in tobacco. Tobacco Control. 3(4), 358-361 Clark R. (1984). Three theme inspiration and elegant encounters. World Tobacco Symposium in the Hague. World Tobacco. International Development Research Center. (2001). Exporting the epidemic Mathers and Loncar. (2006). Projections of Global Mortality and Burden of Disease from 2002 to 2030. Plos Medicine. Vol 23, issue 11, e442. www.plosmedicine.org Slama K. (1996). Tobacco and Health. Why tobacco is an urgent problem for Africa today World Bank. (2003). Tobacco control at a glance, Washington DC. www.worldbank.org/tobacco World Health Organization. (1996). World no-tobacco day. Tobacco Alert (Special Issue). Geneva Contact information Dunsi Oladele Rabiu PhD Candidate School of Public Health, University of Alberta, Edmonton, Canada Email:Oladeler@ualberta.ca Acknowledgement Supported by an unrestricted research grant from Dr. Carl V Phillips, Associate professor, School of Public Health, University of Alberta, Edmonton, Canada through the US Smokeless Tobacco Company notes