Tobacco and Public Health - TCSC Indonesia

Chapter 15
Tobacco in Africa: More than
a health threat
Yussuf Saloojee
Tobacco control has not been assigned a high status as a public health concern in most
of sub-Saharan Africa (SSA). Social and economic factors are therefore the main determinants
of tobacco use on the continent. Urbanization, increased literacy, the entry of
women into the workforce and higher disposable incomes are among factors facilitating
the adoption of consumer patterns similar to those in higher-income countries,
including increased cigarette smoking.
‘Across Africa the total lifestyle is starting to change’ claims the head of the advertising
agency Saatchi Africa, Eric Franc. ‘There is a stronger move towards the western
lifestyle as the pace of urbanization increases. People becoming more aware of luxury
goods and consumer items they never had before’ (Koenderman 2002). Cigarettes,
beer, soft drinks, cellular phones, and banking are the products most prominently
advertised in African markets.
On the other hand, the World Bank warns that the rapid spread of HIV/AIDS,
dwindling aid and investment flows, and weak commodity prices threaten to undo
the development gains achieved from 1970 to 1995 (World Bank 2002). Reduced
economic growth will diminish business opportunities for the transnational tobacco
companies.
Africa cannot continue to ignore tobacco control issues if it is to avoid the ‘epidemiological
trap’ with diseases of lifestyle adding to the toll of disease caused by poverty.
This chapter presents an overview of tobacco use, trade, and health policy in SSA.
Tobacco use in sub-Saharan Africa
Due to low consumer purchasing power SSA has the lowest rates of cigarette consumption
in the world. In 1963, it is estimated that fewer than 400 cigarettes per adult (aged 15+)
per year were sold in this region; by 1995, consumption had risen to 480 (compared to a
global average of about 1325) (World Health Organization 1999).
Disposable income is a major determinant of cigarette consumption levels—there is
positive relationship between gross national product (GNP) and average cigarette
consumption per adult (Fig. 15.1). Cigarette usage is greatest in upper-middle income