Friday, February 19 1999
Thank you Yussuf for accepting our " rendez-vous ". May I ask you to introduce yourself ?
The affair began at age thirteen but it was brief and never consummated. Like Clinton I did not inhale.
Tobacco only took control of my life much later.
After graduating as a biochemist I went to work at St Bartholomew's Hospital in London (UK) to research the use of biochemical markers (CO) as measures of the absorption of tobacco smoke.
While there, I was lucky to collaborate with Mike Russell's group - they were doing outstanding work on nicotine dependence, NRT and smoking cessation.
In 1988, I returned home to South Africa and found employment at the then Council on Smoking & Health.
I became its Executive Director in 1989.
A position I still hold in the renamed National Council Against Smoking.
Outside of work, my passions are music and sport.
1. I think the last time we met was in Harare in 1993.
Do you consider things changed a lot in tobacco control in South Africa since then?
Can you tell us what you see as the most significant changes?
The recent political changes in SA have been accompanied by an important shift in the role of the TC movement.
We have moved from agitating for change on the sidelines to working with government on policy and strategic options.
A key development in SA was the advent of a new Health Minister, Dr Nkosazana Zuma.
She is not only committed to TC but is also near the centre of political power within the government.
A vital combination if one is to withstand the charge of the puff brigade.
Most of the important elements of a comprehensive tobacco control policy are in place or about to be put in place: taxation policy, clean indoor air legislation, promotional bans, prominent health warnings, etc.
Since 1994, tobacco consumption and smoking prevalence have both declined by about 20% while government tobacco revenues have doubled.
David Sweanor is quite correct:
"Tobacco taxes are win, win: they are good for health and good for the treasury."
Much remains to be done though on many fronts including: youth smoking, smuggling, the establishment of a health promotion foundation...
An intriguing puzzle for all developing countries is how to maintain low-smoking rates among women in the face of greater cultural and economic independence.
It will be fascinating to see what impact SA's coming advertising ban will have on women's smoking.
2. The meeting in Zimbabwe was international with people from other African countries (Kenya, Zambia, Tanzania, Uganda, etc).
Have you been able to continue and develop such regional cooperation?
An interim TC Committee was established in Harare.
The grouping was formalised into the Tobacco Control Commission for Africa (TCCA) at the 1994 Paris Conference.
The TCCA was assigned primary responsibility for the development and coordination of TC initiatives in the region.
It has since developed a 5-year Regional Action Plan.
However, its activities are hampered by many 'lacks'
- a lack of human, institutional and financial resources;
- a lack of communications and a lack of priority as a public health problem.
Such problems may be universal but they are particularly acute in Africa. It is not David vs Goliath - but Goliath vs micro-dwarf.
The TCCAs Action Plan outlines an agenda that encompasses capacity development, sustainable growth, resource development, research, programmes and communications.
3. Often tobacco control activists work with little money and staff.
Could you explain how you are organized now, what your budget is,
how many people are on your payroll, where your funding comes from?
The TC movement in SA is a broad church.
There is a formal coalition between the Cancer Association, Heart Foundation and my Council called the Tobacco Action Group (TAG).
In addition, there are good working relationships with the MRC, medical and nurses associations, Soul City, academics and other NGOs.
Importantly, there is trust between the Department of Health and TC groupings plus widespread public support for TC (although the latter has eroded a little during a year of sustained hostile attacks by sections of the media on our new tobacco bill).
Within this context, the relative lack of size of the Council is not the impediment it might otherwise have been.
The Council has a staff of 5, and an annual budget of around US$66,000.
It is funded through private sector donations and is contracted by the government to run a "Quit Line" service.
It concentrates on providing core expertise that other groups can utilise.
Through TAG we maximise geographical reach, multiply resources and avoid duplication of effort.
4. In a recent interview Martin Broughton, CEO of BAT stated that in
developing countries "to put it bluntly people don't live long enough
to worry about developing cancer" (ref Le plat du jour, January 18).
I read a very different opinion about the situation in Ivory Coast, what about tobacco victims in South Africa?
The industry, and groups like the growers association (ITGA), have long tried to portray tobacco as a concern of the middle-classes.
The intention being to marginalise the WHO by claiming that it was foisting the agenda of its first world paymasters on developing countries, and ignoring more urgent health concerns.
Tobacco is in honesty not a major killer in Africa.
TC is about disease prevention and health promotion.
However, to get a glimpse of Africa's future in the absence of strong preventive TC measures one has only to look at the so-called "coloured" (mixed race) community in SA.
There is a high prevalence of smoking among both sexes, and lung cancer death rates are escalating while at the same time TB and childhood diseases remain major killers.
It is the worst of all worlds: diseases of poverty compounded by diseases of lifestyle.
5. Even before the merger with BAT, Rothmans was a very big and powerful corporation.
Do you think this merger is going to make things more difficult for tobacco control activists?
More
generally, as far as African countries are concerned, do you feel the
tobacco industry is still very influential or somewhat less?
BAT and Rothmans are already market leaders in most of Africa and the merger will consolidate their dominance.
The merger will result in the new BAT controlling 95% of the South African market.
I think this presents many dangers and some opportunities for TC.
The merger will result in a larger, more profitable tobacco group which will achieve cost savings through rationalization and also greater flexibility in pricing and marketing.
Ahead of the merger BAT has already closed its plant in Malawi and scaled down production in Zimbabwe.
Cigarettes for Malawi are now being manufactured under contract by BAT in SA.
There are suggestions that if the Competition Board in SA does not approve the merger BATSA will simply close its operations, leaving Rothmans as the sole player in SA.
Given that price is perhaps the single most important short-term determinant of tobacco use the dangers of lower production costs and increased price flexibility are clear.
On the other, when it shuts down plants the importance of the industry as a provider of employment diminishes.
With reduced competition the industry's argument that they advertise simply to gain market share is also demolished.
But these are small benefits.
What you feel like adding :
They say the greatest praise belongs not to those who push stones downhill but to those who build where nothing existed before.
TC in Africa is a new born fledgling.
But it faces neglect.
With one or two notable exceptions, and here I must mention Bob Robinson and CDC in Atlanta, there is little international commitment to supporting advocacy activities in Africa.
If we are to change the current level of performance we need to change the current status quo.
Thank you Yussuf for taking the time to be with us today.
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