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Tobacco in Africa.

Africa has public health problems enough, what with malaria, tuberculosis, and the highest rate of HIV of any continent. Average life expectancy is 52 years and falling, largely due to HIV. Public health officials might be excused if they were simply to ignore tobacco, which is estimated to kill only 1 out of every 84 Africans.

But tobacco-related diseases are expected to become Africa's biggest single killer within 20 years, according to Larry Green, acting director of the Office of Smoking and Health at the U.S. Centers for Disease Control and Prevention (CDC). South of the Sahara, average consumption of manufactured cigarettes is just 700 per adult per year, compared to 1,200 for the developing world at large, says Yussuf Saloojee, executive director of the National Council Against Smoking in Johannesburg, South Africa. Consumption is constrained by the region's penurious per capita income of US$481, says Saloojee. But its sheer size marks the African market as having huge potential, as does the prospect of improving African economies. Observers in many countries report aggressive marketing by companies. "It would be ironic indeed if we were to conquer HIV only to see those spared succumb to the ills of tobacco," says Karen D. Klimowski, a technical officer for the World Health Organization (WHO) Tobacco Free Initiative in Harare, Zimbabwe.

Africa may yet evade that fate. In October 2000, under the auspices of the WHO, 70 parliamentarians, public health officials, tobacco control experts, and activists from 21 African nations gathered in Nairobi, Kenya, to share information on how best to control tobacco. The meeting produced "an extremely strong endorsement from African ministers for a more rigorous approach to tobacco control in Africa," says Derek Yach, executive director of noncommunicable diseases and mental health at the WHO. Participants signed the Nairobi Declaration on Tobacco Control Policy and Programming in the African Region, a series of declarations on measures needed to address the growing tobacco epidemic.

Recommendation number one in the Nairobi Declaration is to develop a way to collect, analyze, and monitor data on tobacco use, economics, and health effects, and disseminate it to policy makers and the general public. Sixty-six percent of African countries have no data on smoking prevalence, and the rest have little, according to Saloojee. Even data on the manufactured cigarette trade is available from only half of African nations. Attendees also called for enactment of comprehensive legislation and regulations, including stiff tariffs, prohibitions on advertising and sponsorship of cultural and sports events, and establishment of nonsmoking as the norm in public places, as well as support of the Framework Convention on Tobacco Control, a WHO initiative to create a global treaty to enact strict tobacco control legislation.

Although most countries present reported some tobacco control activity--10 have total or partial bans on advertising and promotion, and at least 4 tax cigarettes at more than 50% of retail price, says Saloojee--few have comprehensive strategies. But since the meeting, tobacco control efforts appear to have accelerated in some countries. Botswana, for example, has requested technical support from the WHO to strengthen bans on advertising, sales to children, and smoking in public places, says Laurence Mosweunyane, environmental health officer for the WHO Botswana office, which provides technical support to that country's Ministry of Health. In addition, training meetings on implementing the findings of the Global Youth Tobacco Survey, a study developed by the WHO and the CDC, had been scheduled for February and June 2001 prior to the Nairobi meeting.

For further inspiration, African countries can look to South Africa. From 1994 to 1999, South Africa's cigarette tax quintupled to more than 50 [cts.], a hefty tariff in a land with a US$3,170 average per capita income. During this time, sales--which had grown steadily since 1963--shrank from 36 billion to 30 billion cigarettes, and the fraction of smokers in the population fell from roughly one-third to one-quarter. As of 1 January 2001, smoking in public spaces in South Africa is proscribed, an edict that has support from 90% of nonsmokers and 70% of smokers. Advertising there will be banned as of April 2001, and a prohibition on sponsorship of sports and cultural events also takes effect in April.

Of course, when you squeeze the balloon on one end, it pops out somewhere else. Mosweunyane reports that representatives from cigarette maker Peter Stuyvesant are negotiating with a certain music promoter to bring popular musicians into Botswana as a way of advertising, since they can no longer do so in South Africa.
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Author:Holzman, David C.
Publication:Environmental Health Perspectives
Date:Mar 1, 2001
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