SA’s stricter anti-smoking measures awaiting Cabinet approval

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The SA Health Department is adopting stricter measures on smoking across the country and, reports Eyewitness News, Minister Aaron Motsoaledi is calling for zero tolerance on smoking in public.

The Health Minister says amendments to tobacco legislation has been signed and the document is now waiting on Cabinet’s approval. The proposal includes no smoking in public spaces, increasing the distance of no-smoking perimeters around buildings, banning advertising inside shops and preventing vending machines from selling cigarettes.

Motsoaledi says: “We’re amending the issue of 25% space in a public area like airports, hotels and restaurants.”

In 2005, the Tobacco Control Act was passed, which allows people to use 25% of public spaces.

The report says smokers are not happy with the proposal.

Motsoaledi says South Africa was previously at the forefront of global efforts to crackdown on smoking, but says we have since been overtaken by other countries and is currently ranking 145th in the world.


Meanwhile, aggressive marketing by tobacco companies and weak laws is fuelling the rise of smoking in Africa. Lesotho has seen an explosion in smoking in the past decade – from 15% in 2004 to 54% in 2015 and in addition, there has been a 52% surge in cigarette consumption in sub-Saharan Africa between 1980 and 2016, with 250bn cigarettes now being smoked.

Health-e News reports that these are some of the findings of the 6th Tobacco Atlas released the World Conference on Tobacco or Health. “In Lesotho, there is a lack of government policy on tobacco control, unlike South Africa, and a very strong industry presence, particularly targeting young people,” said Atlas co-author Dr Jeffrey Drope from the American Cancer Society which produced the report with Vital Strategies.

The report says one in eight deaths globally are tobacco-related, and 7.1m people died in 2016 from smoking or passive cigarettes.

The cost of treating tobacco amounts to $2trn – 2% of the economic activity in the world, according to Jose Luis Castro, president of Vital Strategies. “For every person who dies, the tobacco industry makes a $10,000 profit,” said Castro. “Political will is key to stop these merchants of death.”

Emma Wanyonyi, CEO of the International Institute of Legislative Affairs in Kenya, said it had taken 10 years for tobacco control laws to be passed in her country because of industry interference. “Every time the time came for Parliament to vote, there was a holiday,” said Wanyonyi. “More recently, government officials were approached and offerered bribes to take actions that support the industry, not only in Kenya but in Burundi and Uganda. We need to think of ways to address this.”

Meanwhile, Dr Neil Schluger from Vital Strategies said in the report that tobacco farming was extracting a toll on the environment. “The impact on the environment is substantial. There is land clearing and de-forestation, and a lot of chemicals are put in the soil and tobacco has a high-water requirement,” said Schluger. “The benefits for the tobacco farmers are miniscule and many are in debt.”

However, Schluger said that the overall percentage of people smoking had dropped in the world other than in the eastern Mediterranean and Africa. “This is due to strong and good policies, including excise taxes and laws about smoking in public places,” said Schluger.

Over the past 15 years, Turkey has managed to reduce its smoking rate from almost 40% to 26% thanks to the implementation of a comprehensive tobacco control policy.


Twice as many women die of exposure to second-hand smoke as men, according to the Atlas. Nearly 600,000 women died from second-hand smoke-related deaths in 2016, more than double the number of men during the same period, IoL reports according to the Atlas, which collates global and country-based tobacco statistics and is published every three years. Far more men than women smoke worldwide, but many women get exposed to smoke from their partners.

A recent South African study of two communities in the Western Cape found that over a third of the pregnant women in Mbekweni township – 200 out of 584 – were exposed to passive smoking. The researchers at the Drakenstein Child Health Study (DCHS) found that the high rate of passive smokers was because of overcrowding in the informal settlement and more people sharing a sleeping room in a single household.

“We were alarmed by the high household tobacco smoke exposure and also by the fact that 18% of infants were born with urine nicotine levels suggestive of active smoking,” said researcher Dr Aneesa Vanker. “Despite, strict anti-tobacco smoking laws (ban on advertising and smoking in public places), smoking in homes is uncontrolled,” says Vanker.

The report says in many populations, home environments are the main places where women and children are exposed to nicotine gasses, according to the Atlas, and people from lower socioeconomic groups and non-smoking women are particularly at risk.

The Atlas shows that in 2016 alone there were an estimated 884,000 second-hand smoke related deaths in the world, while more than 6m people die every year from smoking tobacco. The report says tobacco smoke exposure is linked to many serious health problems and in severe instances leads to death. Some of the notable effects are among young children and unborn babies as respiratory diseases caused by passive smoke contribute substantially to mortality and morbidity.

Despite daily smoking being the highest among male smokers in countries with a medium or high-income, there has been a steady increase in prevalence in low-income sub-Saharan African countries. This is figure is likely to get higher in other low-income countries because of income growth and increasing cigarette affordability, consequently pushing up incident of second-hand smoking.

Senior policy advisor at World Health Organisation (WHO) Professor Judith Mackay says that Africa has become a specific target for the industry at the moment. “The industry is manipulating public opinion to gain appearance of respectability, fabricating support through front groups as well as exaggerating the economic importance of the industry,” says Mackay.

Mackay also highlighted that in countries like Italy, the tobacco industry supports women’s group including the Italian Chamber of Commerce’s women activities. This makes it hard for organisations to speak out against the adverse effects of smoking.


South African-born Derek Yach, a former WHO official, has been expressly forbidden to attend the conference because of his links with Marlboro maker’s Philip Morris International (PMI), Health-e News reports. When he worked at the WHO as executive director for non-communicable diseases, he was one of the architects of a global tobacco control convention that is now supported by 180 countries. But, the report says, today, he is a pariah in the tobacco control world, accused by former colleagues of “moving to the dark side”.

The main reason for Yach’s ostracisation is his appointment last September to head a multi-million-rand venture, the Foundation for a Smoke Free World, which is being bankrolled by PMI, the manufacturer of Marlboro cigarettes. The report says Philip Morris is channelling $80m a year for the next 12 years – a massive $1bn – into the foundation, which has set up offices on 5th Avenue in New York. The foundation says it will fund research into “smoking cessation and harm reduction” including supporting “better products and services” aimed at helping people to stop smoking and assist tobacco farmers to transition to other crops.

The report says Yach’s appointment shocked his former colleagues in the tobacco control sector who worked alongside him to develop the Framework Convention on Tobacco Control (FCTC), which has become the public health world’s game plan for fighting the effects of tobacco, including “sin” taxes and the regulation of tobacco products, their packaging and marketing.

The attendance section of the 17th World Conference of ‘Tobacco or Health’ website expressly forbids access to anyone associated with the new foundation or any tobacco company. In an unusually blunt statement, the WHO condemned the new foundation, saying that if PMI was truly committed to a smoke-free world, it would support evidence-based policies outlined in the Convention, including “tobacco taxes, graphic warning labels, comprehensive bans on advertising, promotion and sponsorship, and offering help to quit tobacco use”.

“Instead, PMI engages in large-scale lobbying and prolonged and expensive litigation against evidence-based tobacco control policies,” said the WHO. It referred to a six-year arbitration process in Uruguay that Philip Morris lost recently, in which it “spent approximately $24-million to oppose large graphic health warnings and a ban on misleading packaging in a country with fewer than four million inhabitants”.

The International Union against Tuberculosis and Lung Disease dismissed the foundation as a “billion-dollar bribe the tobacco company hopes will secure it a seat at the table with public health policymakers around the world”. “Philip Morris International makes huge profits each year off the back of people who are sick, impoverished and dying as a result of its cigarettes. Tobacco kills half of its users. And nearly 80 percent of smokers live in the world’s poorest countries.

“Meanwhile PMI spends over $6bn each year on campaigns to hook new tobacco users. With its new foundation PMI aims to gain the ear of policymakers and public health experts—and respectability through association. But the tobacco industry has a four-decade track record of disseminating junk science to confuse the public about the deadly truth of smoking.”

The report says ironically, Yach said something similar thing in a journal article back in 2001, when he wrote in that “the use of front groups and consultants is a well-established tobacco industry practice to avoid dealing with its lack of public credibility. Scientists were constantly at hand to assist in maintaining the industry-created controversy on the tobacco and health issue”.

As awareness of the dangers of smoking – which is associated with 23 different cancers and a host of other health problems – have become more widely known, cigarette companies have starting to promote electronic cigarettes that deliver nicotine-based vapour to users and heat-not-burn devices, that heat up tobacco.

The report says Dr Stanton Glantz is the director of the University of California San Francisco’s Centre for Tobacco Research, Control and Education and one of the world’s foremost authorities on the harmful effects of tobacco. To Glantz, Yach’s “journey to the dark side is complete” as he sees Foundation for a Smoke-Free World as simply part of Philip Morris’s “efforts to promote its new heat-not-burn IQOS product”.

The report says IQOS is the company’s trade name for its heat-not-burn device, that looks like a pen. Unlike e-cigarettes that heat up liquid that usually contains nicotine until it releases a vapour, the IQOS actually heats up tobacco – but doesn’t burn it, and Philip Morris claims that this makes it much less harmful.

Writing in the Lancet last October, Yach said that millions of people now used e-cigarettes and heat-not-burn products and that “there is emerging evidence of the health benefits relative to continued smoking”. “For e-cigarettes (vaping) in particular, there is emerging evidence from the UK and the US that increases in use are helping some smokers to switch and to quit, and that these products are not directly associated with daily cigarette smoking among youth,” argued Yach.

The report say while there is little doubt that vaping is less harmful than smoking, electronic devices are not simply being used to wean people off cigarettes. “Studies are increasingly documenting that, instead of prompting smokers to switch from conventional cigarettes to e-cigarettes or quitting altogether as some scientists and policymakers had hoped, e-cigarettes are reducing the likelihood that people will quit smoking, while also expanding the nicotine market by attracting more youth to start,” according to the University of California San Francisco.

“While e-cigarettes deliver lower levels of carcinogens than conventional cigarettes, they also expose users to high levels of ultrafine particles and other toxins that have been linked to increased cardiovascular and non-cancer lung disease risks – which account for more than half of all smoking-caused deaths,” added the university. Late last month, a study of almost 70,000 people led by UCSF found that daily use of electronic cigarettes nearly doubles a person’s risk of a heart attack.

“The new study shows that the risks compound. Someone who continues to smoke daily while using e-cigarettes daily has an increased risk of a heart attack by a factor of five,” according to Glantz, who co-authored the study. “E-cigarettes are widely promoted as a smoking cessation aid, but for most people, they actually make it harder to quit smoking, so most people end up as so-called ‘dual users’ who keep smoking while using e-cigarettes.”

Dr Ramla Benmaamar, director of global scientific communications for the Foundation for a Smoke-Free World confirmed that Yach would be in Cape Town at the time of the conference but would not attend “due to a ban that has been implemented on the Foundation and its associates”.

“Although Dr Yach has supported and led smoking cessation research and policy development and has been a strong proponent of harm-reduction policies, calling for a greater emphasis on harm reduction as early as 2005, the conference organisers have not taken into account the benefit his attendance would have provided the community with,” said Benmaamar. “They have also violated the basics of the South Africa’s Bill of Rights’ freedoms of association and academic exchange.”


Also, the WHO has launched new guidance on the role tobacco product regulation can play to reduce tobacco demand, save lives and raise revenues for health services to treat tobacco-related disease, in the context of comprehensive tobacco control.

A new guide and a collection of country approaches to regulation of menthol, presented in the publication have been launched at the 2018 World Conference on Tobacco or Health in Cape Town, South Africa.

Many countries have developed advanced policies to reduce the demand for tobacco, which kills over 7m people annually, but governments can do much more to implement regulations to control tobacco use, especially by exploiting tobacco product regulation.

Dr Douglas Bettcher, WHO’s director of the department for the prevention and control of noncommunicable diseases (NCDs), said: “The WHO Framework Convention on Tobacco Control (WHO FCTC), a global treaty established under the auspices of the WHO to combat the tobacco epidemic, has played a critical role in tobacco control. The launch of these important publications will further aid the implementation of Articles 9 and 10 of the WHO FCTC, contributing to building tobacco product regulation capacity in WHO Member States”.

He further said: “Tobacco product regulation is an under-utilized tool which has a critical role to play in reducing tobacco use. The tobacco industry has enjoyed years of little or no regulation, mainly due to the complexity of tobacco product regulation and lack of appropriate guidance in this area. These new tools provide a useful resource to countries to either introduce or improve existing tobacco product regulation provisions and end the tobacco industry ‘reign’.”

“Only a handful of countries currently regulate the contents, design features and emissions of tobacco products,” says Bettcher. “This means that tobacco products are one of the few openly available consumer products that are virtually unregulated in terms of contents, design features and emissions.”

Most countries hesitate to implement policies, due in part to the highly technical nature of such policy interventions and the difficulties in translating science into regulation, explains Dr Vinayak Prasad, who leads WHO’s Tobacco Free Initiative.

“Failure to regulate represents a missed opportunity as tobacco product regulation, in the context of comprehensive control, is a valuable tool that complements other tried and tested tobacco control interventions, such as raising taxes, and ensuring smoke-free environments,” adds Prasad.

The guidance provides practical, stepwise approaches to implementing tobacco testing. Such guidance is relevant to a wide range of countries in various settings, including those with inadequate resources to establish a testing facility. This laboratory guide is a useful resource for countries and provides regulators and policymakers with comprehensible information on how to test tobacco products, what products to test, and how to use testing data in a meaningful way to support regulation.

Further, it provides a step-by-step guide to developing a testing laboratory, using an existing internal laboratory, contracting an external laboratory, and making use of the available support mechanisms both within WHO and externally. This calls for country prioritisation and commitment of resources to tobacco product regulation, as the guide equips regulators with the necessary tools to strengthen tobacco regulation capacity, especially in relation to Article 9 of the WHO FCTC.

The case studies complement the 2016 advisory note on menthol published by the WHO Study Group on Tobacco Product Regulation, which set out the available evidence on prevalence and health effects of menthol in tobacco products, as well as evidence-based conclusions and recommendations for policy-makers and regulators on menthol in its various forms.

The case studies provide practical guidance and policy options to countries about effective regulatory strategies in tobacco product regulation. This includes lessons learned and challenges encountered in developing and implementing menthol related regulation. To date, regulators have adopted multiple approaches to restricting the use of menthol. These include a ban in some product categories, a total ban on the use of all flavours and a ban on all products with a perceived menthol flavour. This publication also provides useful information on the merits and drawbacks of various regulatory approaches.

Eyewitness News report
Health-e News report
6th Tobacco Atlas
IoL report
Drakenstein Health Study
Health-e report
WHO statement
American Journal of Public Health abstract
The Lancet article
World Health Organisation material
WHO guidance
WHO case studies

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