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Tobacco to kill one billion people

By Henry Zakumumpa

Epidemic already killing more people than AIDS, TB, and malaria combined

The Tobacco diseases epidemic is already with us in Africa’’ says Prof Peter Odhiambo, Chairman of Kenya Tobacco Control Board. ‘’Soon you will hear people announcing that the epidemic is coming to Africa. It is already here. I treat the victims of tobacco every day.’’ He was speaking in Kampala on Nov. 1 at a public lecture entitled ‘The journey from the Farm to the Lungs: Who gains from Tobacco in Africa?’ at the inauguration of the new regional Centre for Tobacco Control in Africa (CTCA) to be hosted by Uganda.

Tobacco use is the single most preventable cause of death in the world today. It claims more lives globally than HIV/AIDS, Tuberculosis and malaria combined. According to the World Health Organisation (WHO), unless urgent action is taken, tobacco could kill one billion people during this century. WHO data also shows that in comparison to HIV/AIDS which claimed three million lives globally last year, Tobacco deaths were nearly six million cases.

According to WHO, more than 80% of the world’s tobacco-related deaths will be in low and middle-income countries by 2030.

Dr Sheila Ndyanabangi, the Tobacco Control focal person in the Ministry of Health noted that tobacco is the only legal product in the world which, when used as intended by the manufacturer, kills half of all the people who use it.

Tobacco use is known to cause at least 15 cancers (particularly lung cancer), heart and respiratory diseases and lead to lifelong health and developmental disorders among exposed children.

In a study conducted at Mulago, Uganda’s national referral hospital, 75% of patients with oral cancer had a history of smoking, with the number of years of smoking ranging from 2-33 years, according to a 2008 study report by Fredrick Musoke of Makerere University Kampala.

Almost a quarter of Ugandan males (22%) aged between 15 and 49% are smokers while 4% of females are smokers, according to  the 2006 Uganda Demographic and Health Survey.

Exposure to second hand smoke increases the risk of heart disease by 25-30% and the lung cancer risk by 20-30%.

Smoking has been banned in public places, including  bars, restaurants and educational institutions in Uganda since 2004 . But the judicial and political will to enforce this law has been lukewarm. Not a single person has been prosecuted under this law.

In August, British American Tobacco (BAT) Uganda, announced that cigarette sales had gone up by 29% in Uganda compared to a similar period in 2010.

BAT argues that tobacco is a leading tax revenue payer and that the livelihoods of 600,000 tobacco farmers, particularly in Arua District in the West Nile region, where BAT runs an out-growers programme, depend on it. BAT also argues that it is an important export for the country.

“It is not the tobacco companies which pay tobacco taxes, it is the smokers,” counters Dr Ndyanabangi, who argues that taxes on tobacco are simply passed on to consumers. She also maintains that the health care costs of treating tobacco-related diseases outweigh the economic benefits of the tobacco industry.

Tobacco use poses a heavy burden on the governments of low and middle-income countries, through increased healthcare costs, aggravates environmental degradation through clearing forests to make way for tobacco farms and leads to diversion of agricultural land to tobacco farming since the crop can only be grown alone.

According to Rachel Kitonyo, a Kenyan working with the Africa Tobacco Control Consortium based in Lome in Togo, Uganda is out of step with other East African countries Tanzania and Kenya which passed a tobacco control law in 2007.

Uganda is yet to pass a tobacco control law although a Bill has been in the works for the past few years with a draft announced in 2010. The Ugandan parliament is now set to discuss the Bill.

The resurrection of the Bill was disclosed on  November 1, 2011 by Rebecca Kadaga, the Speaker of  Parliament, while opening the Centre for Tobacco Control in Africa based in Kasangati township, about 5km from the capital, Kampala. One of the proposals in the Bill is a two-month jail sentence for public-smoking offenders.

According to Kadaga, the Bill will be tabled before parliament as a Private Members’ Bill moved by Dr Chris Baryomunsi (MP Kinkizi East).

In addition to the control law, Dr Joaquim Saweka, the WHO Uganda Country Representative, calls for an increase of tax on tobacco. A World Bank study shows that a 10% increase in tobacco taxes was followed by an 8% reduction in consumption of tobacco.

Uganda’s tax on tobacco products has been increasing marginally in the last three years but is still far below the threshold set by the WHO Framework Convention on Tobacco Control (FCTC).Uganda consented to the FCTC in June 2007, which is a set of internationally-agreed strategies for tobacco control. The FCTC calls for a ban on advertising of tobacco products and display of graphic warnings on cigarette packs, an increase in tobacco taxes and alternatives to tobacco farming. However, Uganda is yet to give full effect to FCTC guidelines.

The size of health warnings on cigarette packs, as a percentage of the surface area of the cigarette packs in Uganda is still small and below FCTC guidelines, says Gilbert Muyambi, Secretary General of Uganda National Tobacco Control Association.

An effective tobacco control regulatory regime in developed countries has constrained the operations and profits of big tobacco companies such as Phillip Morris and BAT which has made them consider Africa as a lucrative alternative – an untapped market with weak anti- tobacco laws and policies.

The non-communicable disease epidemic which until now have been more widespread in the West, are certain to shift to African countries.

It is projected that by 2030 tobacco-related illnesses will be the leading cause of death in the world and 70-80% of these deaths will occur in low and income countries.

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