A presentation posted on the site of the Cancer Association of South Africa:
Tobacco smoking is killing almost 50 000 South Africans a year, placing a huge burden on the already overloaded healthcare system and volatile economy. So what is being done to curb what are essentially preventable deaths?
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Fortunately
the news on this front is not quite so grim, and the Tobacco Products
Control Amendments Bill is not only getting tougher on smoking in
public, but it has the potential to reduce the burden of smoking on the
system while saving lives.
Smoking in public just got a little harder
The
National Assembly passed the Tobacco Products Control Amendment Bill in
June 2008. It was then sent to the National Council of Provinces (NCOP)
for approval where some more amendments were made. This means it must
go back to the National Assembly and will probably be passed during the
November 17 – 21 sitting.
This step, which was supported by
all political parties, will prohibit the sale of tobacco products in
health and education institutions, increase the legal age for buying
tobacco from 16 to 18, and restrict the sale of tobacco products from
vending machines.
It will make advertising, promotion and
sponsorships by tobacco industries illegal, unless they are made
anonymously, and will also force manufacturers to display some rather
graphic images of people suffering from smoking-related diseases to
create public awareness on the dangers of smoking.
The first
part of the Bill, which has already been gazetted, deals primarily with
smoking in public and the regulation of tobacco products. If you are a
smoker, this means no more smoking in partially enclosed areas such as
verandas, no smoking near doorways of buildings, and no smoking in
commercial vehicles or in a vehicle if there is a child in it, amongst
other strict regulations.
But will it work?
The
big question however, is whether the Bill will work to curb smoking and
help reduce the staggering number of tobacco-related deaths each year.
The answer, according to Peter Ucko of the National Council Against
Smoking, is a resonant 'yes'.
"We are thrilled about this
amendment to the legislation, it will mean that more people are likely
to quit smoking, fewer children will start smoking and we will in
effect be saving lives and protecting our children," he said.
Ucko
added that international trends in countries which have strict bans on
public smoking have shown marked decreases in smoking numbers. And not
only does make the nation more healthy, it has the added benefit of
taking a rather heavy load off the already burdened healthcare system
and the struggling economy.
International bans show positive trend
And
he's right, as shown by a recent study which found that more than 400
000 people in England have given up smoking as a result of the ban on
smoking in public places introduced in July 2007, with researchers
estimating that 40 000 deaths will be prevented over the next decade as
a result of the ban.
In the US, researchers found that
California's large-scale tobacco control campaign has saved $86 billion
in healthcare costs in its first 15 years. The $86 billion reduction in
health costs, based on 2004 dollars, represents about a 50-fold return
on the $1.8 billion California spent on the programme.
Ucko
also rubbished claims made by many in the hospitality industry that
stricter measures against smoking in public will affect their business,
and said that much research had been done into this which showed that
if anything, there will be a slight increase in the number of people
eating out.
"It's a misconception that there are more smokers
out there than non-smokers, in fact, in SA only 22% of adults over the
age of 15 smoke, which means that 78% of the population are
non-smokers.
"Also, smokers will not stop eating out just
because they cannot smoke, but more non-smokers will go out and this
will have a positive effect on the hospitality industry as has been
proven time and again in countries where smoking in public places has
been completely banned such as in Ireland and England," he said.
WHO report shows high tax led to reduction in smoking
One
of the ways smoking is also being reduced is by adding higher tax to
tobacco products, a move which the Department of Health (DoH) has found
to be quite effective. According to a report issued by the World Health
Organisation (WHO) in February 2008, tobacco use in SA was reduced
dramatically primarily because of these higher taxes.
Again,
this is reflected international trends which show that higher taxes are
especially important for deterring tobacco use among the young and the
poor, who benefit most from a decrease in consumption.
"People
in these socio-economic groups are much more sensitive to the price of
goods. Higher tobacco prices help convince them to quit or not to start
using tobacco in the first place," a DoH statement on the WHO report
said.
The WHO report also indicated that consumption had
decreased from a staggering 2 billion packs of cigarettes in 1990 to
1.3 billion in 2005, with 40% of the decrease attributable to smokers
quitting because of significant increase in prices of cigarettes. The
largest decrease was among young people and low-wage earners who
reduced smoking most when prices increased.
In addition, it
gave SA a rather impressive seven out of 10 for enforcement of bans on
advertising, promotion and sponsorship relating to tobacco and five out
of 10 for protecting people from tobacco smoke through smoke-free
environments. The country has complied with all requirements on placing
health warnings on tobacco packages except for placing pictorial
warnings. Amendments are being made to the Tobacco Control Act to add
this obligation onto tobacco producers.
South Africa was also
found to be "doing well in providing counselling and treatment for
tobacco dependence, and in allocation of resources for tobacco
prevention."
Smoking still killing thousands every year
However,
while these figures may be encouraging, the battle is still far from
over, as an article in the South African Medical Journal which showed
that smoking caused between 41 632 and 46 656 deaths in South Africa,
and accounted for 8.0 - 9.0% of deaths and 3.7 - 4.3% of death and
disability adjusted life years in 2000.
The article was
published in August 2007 by the Medical Research Council (MRC) and was
titled, Estimating the burden of disease attributable to smoking in
South Africa in 2000.
They also found that smoking ranked
third (after unsafe sex/ sexually transmitted disease and high blood
pressure) in terms of mortality among 17 risk factors evaluated. Other
findings included:
- Tobacco smoking caused an estimated 34 108 deaths in males and 10 306 deaths in females in SA in 2000.
- Three times as many males as females died from smoking.
- Deaths attributable to smoking peaked in the 45-59 age group.
- Lung cancer had the largest attributable fraction due to smoking.
- Cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking.
- Prevalence increased dramatically in the 20-24 age group across all population groups.
- Lung cancer was the highest attributable fraction with 78% in males and 67% in females, followed by COPD and then upper aero-digestive cancer.
- 24% of tuberculosis deaths were attributed to tobacco smoking.
- Smoking accounts for between 12% and 15% of deaths in adults over 35 years of age in SA from preventable diseases.
Yet
while the figures for tobacco-related illnesses and deaths are still a
major problem the Health Department, it's encouraging to know that not
only is the problem being taken seriously, but that South African
policies on tobacco control meet international standards. The hope now
is that they will work as well as they have in other countries.
Read more about the Health24's Health of the Nation Survey which provides some interesting insight into smoking habits:
Lighting up in SA
Sources:
Estimating the burden of disease attributable to smoking in South
Africa in 2000 by Pam Groenewald, Theo Vos, Rosana Norman, Ria
Laubscher, Corné van Walbeek, Yussuf Saloojee, Freddy Sitas, Debbie
Bradshaw and the South African Comparative Risk Assessment
Collaborating Group; National Council Against Smoking; Sapa.
Health24.com, October 2008
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