Tobacco and Public Health - TCSC Indonesia

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TOBACCO IN AFRICA: MORE THAN A HEALTH THREAT
It is estimated that in 1998, two million of the eight million deaths in Africa occurred
beyond the age of 30, and that about 125 000 of these could be attributed to smoking
(World Health Organization 1999). In contrast to some developed countries
where tobacco causes 1 in every 5 or 6 deaths, in Africa it causes only 1 in every 64
deaths.
However, this may be an underestimate. The health consequences of tobacco use
may not be fully apparent in Africa because insufficient data are available to demonstrate
its effects. For instance, analyses of death certificate data in South Africa found
that smoking increased the risk of dying from TB by 60% (Sitas 2000). As TB causes
over half-a-million deaths each year in SSA, this suggests that smoking may contribute
to more deaths in Africa than was previously supposed.
Although information is scanty, the available data indicates that the rates for
lung cancer are intermediate to low in Africa compared to developed countries. The
rate, however, is increasing in populations that have smoked tobacco for prolonged
periods. Age-standardized lung cancer rates per 10 00 000 in Harare, Zimbabwe
are 24.6, in Mali 4.8, and in Gambia 1. This compares to rates of 64.3/100 000 in
the UK.
If African countries follow the same trend as in developed countries, its tobacco
epidemic can be expected to peak in the middle of the next century. Very rarely do we
have the ability to predict an epidemic that far into the future and the knowledge to
prevent it now.
Tobacco control
The past two years have seen remarkable support from the African region for the
Framework Convention of Tobacco Control (FCTC)—an international treaty that is
due to be concluded in 2003 and which will set global standards for action and
co-operation in controlling tobacco. Representatives of governments—together with
non-governmental organizations as observers—have met regularly in Geneva, and
regionally in Johannesburg, Algiers, and Abidjan to discuss the policies that should be
included in the FCTC.
African governments have formed a common front, pressing both for progressive
regulatory measures (advertising bans, tax increases, restrictions on smoking in public
places, anti-smuggling measures, etc.) and for provisions to assist in providing alternative
livelihoods for tobacco workers. The common front included both tobacco growing
and non-tobacco growing countries.
The African position is perhaps summed up by Uganda’s agriculture minister,
Dr Kibirige Sebunya, who stated: ‘As a government we are concerned about the illhealth
caused by tobacco, but at the same time we cannot ignore the economic and
social benefits the crop brings to our country.’ He pledged support for the FCTC provided
‘tobacco farmers are facilitated to produce an equally viable alternative crop to