Reducing tobacco-related deaths in Africa

-Alexander Chiejina

As stakeholders advocate passage of Nigeria Tobacco Control Bill

African nations seem poised to undergo the highest increase in the rate of tobacco use among developing countries. This is as about 90 percent of people on the continent, perhaps, remain without meaningful protection from second-hand smoke.

Earlier this year, it was estimated that smoking will claim the lives of six million people globally in 2010, 72 percent of whom reside in low and middle-income countries, Nigeria inclusive. However, it is believed that if current trends continue, tobacco may kill seven million people annually by 2020 and more than eight million people annually by 2030.

Following health risks associated with tobacco consumption, which according to health experts is the second leading cause of death (after hypertension) and currently responsible for the death of one in 10 adults globally, experts are of the view that enacting effective policies towards reducing tobacco consumption in Nigeria will go a long way in saving the lives of people.

In an interview with BusinessDay, Akinbode Oluwafemi, programme manager, Environmental Rights in Nigeria/ Friends of the Earth, said cigarette contains about 4000 toxic and cancer-causing chemicals which are responsible for most cases of lung cancer.

While acknowledging the fact that smoking causes various forms of cancer, Akinbode noted that measures aimed at reducing smoking in Europe and America has driven the tobacco industry to developing countries like Nigeria, where the industry continues to flout regulations, marketing to young and impressionable youths, and ity, there is the need for Nigeria to key into WHO”s FCTC which seeks to protect people from the consequences of tobacco consumption by reducing the demand for and supply of tobacco, call for stronger tax and price measures, regulation of tobacco advertisements and the introduction of strong health messages on tobacco packages, adopting protective measures against exposure to tobacco smoke, the lives of Nigerians would greatly be protected.

It is noteworthy to state that in about less than two years, Kenya and Niger Republic enacted national smoke-free policies, and South Africa, which has been smoke-free since 2007, demonstrated that smoke-free laws could work in Africa. In what seemed as a first for the region, Mauritius recently passed a law that hooking them on smoking.

“Several African countries are fighting against the tobacco industry‘s aggressive campaigns to stop public health interventions by putting smoke-free laws into place, probably protecting more than 100 million more people since 2007. Smoke-free public places are one example of a low-cost and extremely effective intervention that must be implemented now to protect health,” he observed.

For Tosin Orogun, programme manager, Africa Tobacco Control Regional Initiative, Nigeria, “the World Health Organisation insists that strong worldwide enforcement and implementation of the Framework Convention on Tobacco Control (FCTC) could save 200 million lives by the year 2050.”

Orogun stated that though Nigeria signed the FCTC, which had been ratified by over 168 countries since 2005, there have been deaths relating to tobacco, especially cancer.

As parties to the global tobacco treaty begin their biennial meeting in Uruguay, the African Tobacco Control Consortium (ATCC), a coalition of global and African public health organisations focused on preventing the tobacco epidemic in Africa, there is the need to ensure that adoption of effective guidelines on Article 9 & 10 of WHO’s FCTC which seeks to promote smoke- free environment which tobacco multinationals’ are alleging to scuttle.

At the moment, only Osun, Cross River States and the Federal Capital Territory have passed the law prohibiting people from smoking tobacco in the public in Nigeria. Giving this realCancer

and challenge of management in Nigeriais close to meeting the Framework Convention on Tobacco Control standards, ranking among the most robust anti-smoking measures in the world.

The National Tobacco Control Bill (NTCB), which seeks to prohibit tobacco smoking in places and is now before the National Assembly, saw over 45 non-governmental organisations (NGOs), including local and international organisations, making presentations in support of the bill.

Since the Public Hearing in July 2009, Nigerians and other stakeholders in public health including Babatunde Osotimehin, former health minister; Umar Modibbo, former FCT minister, Nigerians are expecting Senator Iyabo-Obasanjo Bello, chairman, Committee on Health at the National Assembly to return the bill to plenary for adoption. But for how long will the hope of 150 million people be eventually realised?

Stakeholders are of the view that when the bill is passed and enforced, two outcomes are possible: The level of national savings will increase and other forms of consumption expenditure will be substituted for tobacco expenditure.

Studies in several countries have examined the potential economic impact of the complete elimination of tobacco use and production. The evidence shows that elimination of tobacco will not affect the economy. This is because tobacco use has many externalised costs (costs not paid for by smokers or tobacco manufacturers). This involves healthcare costs incurred by governments to take care of smoking -related diseases.

When people no longer spend their money on tobacco, they will spend their money on other things. This alternative spending will stimulate other sectors of the economy. If the money is saved rather than spent, the increased savings are likely to have stimulatory macroeconomic effects.

SOURCE

HEALTH WINS, TOBACCO INDUSTRY FAILS

Barring a last-minute problem in plenary today, delegates can go home with the satisfaction of having collectively stood up to the biggest tobacco industry assault on the FCTC process that we have seen to date.

Over the last year, the tobacco industry has orchestrated a global public relations campaign to head off adoption of (partial) guidelines on Articles 9 & 10. This involved outlandish claims that “WHO bureaucrats” were trying to ban burley tobacco, or that restrictions on additives used to make cigarettes attractive to children would put burley farmers out of business.

In the end, despite the press conferences, “studies” and extensive lobbying by the industry and its front groups, despite the demonstrations outside the conference venue, Parties were not fooled. After some drama last night in Committee A, they found compromise language to satisfy China and the guidelines were accepted.

Shortly thereafter came a second victory for tobacco control: Committee A accepted the idea of a working group on Article 6, which deals with price and tax measures. The European Union, which had opposed the idea only 24 hours earlier, not only bowed to the collective will of numerous developing countries but announced it would participate in the group, possibly even as a key facilitator. China and Japan, the only other opponents, dropped their objections without comment.

This is potentially a major gain for the FCTC: the working group should help integrate finance ministries into tobacco control. Tobacco tax increases are the single most effective short-term measure to reduce tobacco consumption, but are often blocked by lack of awareness in finance ministries of the added revenue (and public health gains) to be made. Of course, setting up the working group is only the first step – now delegates will have to work hard to ensure the right people get sent to the meetings, and we can assume the tobacco industry will lobby very hard, at COP-5 or COP-6, against the adoption of strong and effective Article 6 guidelines.

As Committee A drew to a close, there were further gains, with the important decision to initiate work on Article 19 to support Parties in effective liability strategies, as well as steps forward in the FCTC reporting system.

With these victories, as well as the approval of Articles 12 and 14 guidelines and measures to combat tobacco advertising, promotion and sponsorship on Thursday, Committee A delegates can go home tired but satisfied.

Committee B delegates have a little more work to do. While progress was made yesterday, with the adoption of important decisions on financial resources, mechanisms of assistance and international co-operation, and South- South co-operation, a final decision on the budget must be made this morning. Substantial lack of clarity in last night's session will make this a difficult task.

But there were also encouraging signs, with extra budgetary contributions announced and a creative solution found to make up the US$600,000 deficit expected in the proposed zero nominal increase budgets. Today, Committee B is urged to adopt a budget that matches Committee A's commitment and supports the vision of the FCTC.

-Extracted from the FCA COP 4 bulletin – issue 110 (front page)

New report exposes how tobacco companies undermine WHO health policy : Uruguay proposes resolution calling for unity in face of tobacco industry interference

 A new investigative report by the International Consortium of Investigative Journalists

 exposes a wide range of tactics employed by the tobacco industry to undermine advances being made by the global tobacco treaty – Framework Convention on Tobacco Control (FCTC). Threats to health policy include aggressive lobbying and legal intimidation, to charitable donations and even outright payoffs.

Even as Parties- including delegates from Nigeria’s ministry of health and other countries are discussing how to overcome such obstacles – the primary threat in advancing a treaty the World Health Organization projects could save 200 million lives by 2050 – industry tactics have followed countries to this week’s treaty negotiations in Uruguay.

Not only are dozens of tobacco industry representatives from Philip Morris and British America Tobacco (BAT) crowding the halls of the negotiation each day, they are also playing a role in the seating of delegates in attendance. These delegates are the eyes, ears, and voice piece of an industry that has otherwise been prohibited from directly participating in the negotiations and health policy under a core provision of the treaty.

One example is Zimbabwe, a non-Party observer. Despite being cash strapped the country somehow mustered the funds to send 10 delegates to Uruguay days after a prominent tobacco industry front group disparaged guidelines being negotiated this week to the Wall Street Journal. To put this in perspective, more than 35 ratifyingcountries were unable to send even a single representative. Worse, though the treaty requires that health policies and negotiations being protective from “commercial and other vested interests of the tobacco industry,” Zimbabwe’s delegation includes representatives from the Tobacco Industry Marketing Board, as well as ministries whose priority is either trade or agriculture.

“A reminder is needed that we are here to devise solutions to save people’s lives,” said Sam Ochieng of the Network for Accountability of Tobacco Trans-nationals and Consumer Information Network Kenya. “Progress is not possible if the long arm of industry is able to reach into and manipulate a conversation that rightly excludes Big Tobacco.”

“The report by the International Consortium of Investigative  Journalists is revealing. It is not surprising that Philip Morris is instituting a suit against the Uruguay government for introducing warning labels on cigarettes sold in the country or the presence of tobacco industry representatives in the halls during negotiations. Parties must however be be vigilant to the avowed intentions of the industry to fight provisions that prohibit them from interfering in the process,” said Philip Jakpor of Environmental Rights Action. 

Tobacco growing countries like Zimbabwe may be the most brazen, but are not unique when it comes to sending representatives from ministries whose objectives may be at odds with the treaty’s guiding principle that the public’s health be prioritized over trade. Of the 438 Party delegates listed in the provisional list of participants, 74 delegates represent ministries other than health. Egregious examples include Macedonia’s delegation which has no health ministry representation. Of its 19 member delegation, China sent five delegates from its state-owned tobacco corporation.

While some non-health ministries may have legitimate reason for inclusion in a delegation, such as representation from finance ministries in anticipation of discussions regarding tobacco taxation; for others such appointments further expose the primary obstacle to treaty implementation – the fact that industry has a voice it shouldn’t within government in deciding health policy.      

“This is not to say the vast majority of countries here are not acting with integrity, just that parties must be unified in challenging tobacco industry interference for the treaty to progress,” said Corporate Accountability International’s Latin America Director Yul Francisco Dorado.

In this vein, Uruguay has proposed a resolution calling for parties to stand together in confronting the manner of legal intimidation it and other countries are now facing from Philip Morris International.

Corporate Accountability International and its partners which ERA is part of, are pushing for the inclusion of a provision giving the secretariat representing the parties to the treaty a voice during legal proceedings.

FULL REPORT

‘Tobacco-induced death on the rise worldwide’

Deaths from diseases such as tuberculosis, HIV/AIDs and malaria are declining while those induced by tobacco consumption are on the increase.

This was disclosed at the weekend by Thomas Frieden, director of the Centre for Disease Control and Prevention (CDC), Atlanta, USA, while delivering a lecture at the 41st Union World Conference on Lung Health in Berlin, Germany. He said this trend could be reversed if governments across the world take actions to stem the tide. Among the steps he recommended were the imposition of heavy tax on cigarettes, adherence to and the implementation of steps laid out in the Framework Convention on Tobacco Control (FCTC).

The Framework is the first health treaty negotiated under the auspices of the World Health Organisation (WHO). It was adopted by the World Health Assembly seven years ago and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history with about 171 parties. Mr Frieden said it is unfortunate that tobacco has wreaked so much havoc on the human race when death and illness from it could be curbed. He advised governments to impose yearly heavy taxes on tobacco industries as a way of making the commodity expensive and out of the reach of the people.

According to the WHO, tobacco is the leading cause of death, illness and impoverishment, adding that its “use is one of the biggest public health threats the world has ever faced. It kills more than five million people a year - an average of one person every six seconds - and accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease.” Mr Frieden said all efforts must be made to reverse this dreadful trend.

Also speaking at another event at the conference, Nils Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) made a case for more money to be invested in the fight against tuberculosis (TB) so as to curb the drug-resistant epidemic of the disease. He observed that there are increasing reports that TB drugs are going out of stocks in several countries and this could lead to a drug-resistant epidemic.

Poor man’s burden

Anthony Harris, an advisor at The Union said poverty and malnutrition have strong links to TB and that the poor are usually at greater risks. Lee Reichman, a professor of medicine at the New Jersey Medical School of Global Tuberculosis Institute, who described TB as “forgotten but not gone” disease said the it could be eliminated because its cause was known. According to him, “More people died from TB last year than any year in history.” Mr Harris added that in the last 10 years there have been 300 million infections, 90 million cases and over 30 million deaths. He regretted that TB kills about 1.7million people per year yet not much attention was being paid to it compared to SARS which killed 813, Avian influenza (6250), anthrax (5) and small pox which killed no one.

He also said the cure for TB has remained a sort of mirage due to economic considerations because it is not a disease that fetches big money.

“Nobody seems to care. This wouldn’t be tolerated for any other disease. Why does TB still infect one-third of the world’s population and remain a global threat despite the fact that highly cost-effective drugs are available to eradicate it?,” he said.

The ongoing Union World Conference is the largest annual conference focusing on lung health issues as they affect low and middle-income countries. It is organised each year by the Paris-based International Union Against Tuberculosis and Lung Disease. Some 2,500 delegates from more than 100 countries are attending.

SOURCE

HHS announces new tobacco strategy and proposed new warnings and graphics for cigarette packs and advertisements

U.S. Department of Health and Human Services today unveiled a new comprehensive tobacco control strategy that includes proposed new bolder health warnings on cigarette packages and advertisements.  Once final, these health warnings on cigarettes and in cigarette advertisements will be the most significant change in more than 25 years.  These actions are part of a broader strategy that will help tobacco users quit and prevent children from starting.
 Tobacco use is the leading cause of premature and preventable death in the United States, responsible for 443,000 deaths each year.  Thirty percent of all cancer deaths are due to tobacco.  Each day 1,200 lives of current and former smokers are lost prematurely due to tobacco-related diseases.
“Every day, almost 4,000 youth try a cigarette for the first time and 1,000 youth become regular, daily smokers,” said HHS Secretary Kathleen Sebelius. “Today marks an important milestone in protecting our children and the health of the American public.”
The strategy includes a proposal issued by the Food and Drug Administration titled Required Warnings for Cigarette Packages and Advertisements. Specifically, the proposed rule details a requirement of the Family Smoking Prevention and Tobacco Control Act that nine new larger and more noticeable textual warning statements and color graphic images depicting the negative health consequences of smoking appear on cigarette packages and in cigarette advertisements.  The public has an opportunity to comment on 36 proposed images through January 9, 2011.    
By June 22, 2011, FDA will select the final nine graphic and textual warning statements after a comprehensive review of the relevant scientific literature, the public comments, and results from an 18,000 person study.  Implementation of the final rule (September 22, 2012) will ultimately prohibit companies from manufacturing cigarettes without new graphic health warnings on their packages for sale or distribution in the United States.  In addition, manufacturers, importers, distributors and retailers will no longer be allowed to advertise cigarettes without the new graphic health warnings in the United States.  By October 22, 2012, manufacturers can no longer distribute cigarettes for sale in the United States that do not display the new graphic health warnings. 
“Today, FDA takes a crucial step toward reducing the tremendous toll of illness and death caused by tobacco use by proposing to dramatically change how cigarette packages and advertising look in this country.  When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” said FDA Commissioner Margaret A. Hamburg, M.D. ” This is a concrete example of how FDA’s new responsibilities for tobacco product regulation can benefit the public’s health.”
The FDA action is part of a broad department-wide strategy that was announced by Assistant Secretary for Health Howard K. Koh, M.D., MPH.  While progress has been made, smoking remains particularly high with low-income and within certain racial/ethnic groups and in certain populations, including people with mental illnesses and substance abuse disorders.  Ending the Tobacco Epidemic: A Tobacco Control strategic Action Plan outlines specific, evidence-based actions that will help create a society free of tobacco-related death and disease. 
“We are at an unprecedented time in our nation’s history to protect the public’s health from tobacco use, the leading cause of preventable, premature death in the United States,” said Dr. Koh. “It will take renewed commitment from every sector of society to end the tobacco epidemic.” 
In addition to the announcements made today, other recent tobacco control and prevention efforts include:

• The Affordable Care Act is giving Americans in private and public health plans access to recommended preventive care, like tobacco use cessation, at no additional cost.
• The American Recovery and Reinvestment Act (ARRA) invested $225 million to support local, state and national efforts to promote comprehensive tobacco control and expand tobacco quitlines.
• The Prevent All Cigarette Trafficking Act (PACT) aims to stop the illegal sale of tobacco products over the Internet and through mail order, including the illegal sale to youth.
• The Family Smoking Prevention and Tobacco Control Act (FSPTCA) gives FDA the authority to regulate the manufacture, marketing and distribution of tobacco products.  Significant progress has already been made by restricting the use of  the terms “light,” “low,” and “mild,”  banning characterizing fruit, candy, and spice, flavors from cigarettes, and putting in place restrictions on the sale and distribution of cigarettes and smokeless tobacco products to youth.
• The Children’s Health Insurance Program Reauthorization Act (CHIPRA) raised the federal cigarette tax by 62 cents per pack.  Raising the price of tobacco products is a proven way to reduce tobacco use, especially among price-sensitive populations such as youth.

SOURCE

TOBACCO CONTROL GROUPS RAISE ALARM OVER TOBACCO INDUSTRY’s ATTACKS ON FCTC UNDER GUISE OF PROTECTING FARMERS

Lagos, November 5, 2010 - As Parties to the global tobacco treaty prepare for their biennial meeting in Uruguay, the African Tobacco Control Consortium (ATCC *), a coalition of global and African public health organizations focused on preventing the tobacco epidemic in Africa, is raising the alarm against tobacco multinationals’ tactics to hinder the adoption of effective guidelines on Article 9 & 10 of the WHO Framework Convention on Tobacco Control (FCTC).

In recent months an organization claiming to represent tobacco growers worldwide has been publicly lobbying against items on the agenda of the Fourth Session of the Conference of the Parties to the FCTC (COP 4). The International Tobacco Growers Association (ITGA), a public relations vehicle created by the tobacco industry in the 1980s to front its lobbying efforts against international tobacco control initiatives, has been focusing on draft guidelines that recommend countries “restrict or prohibit” flavorings added to tobacco to make it more palatable, especially to young smokers and potential smokers. Similarly, the Common Market for Eastern and Southern Africa (COMESA) is calling on its 19 members to oppose what it calls “a ban on non-tobacco ingredients used in producing cigarettes”.

According to the ITGA, the guidelines on flavorings if adopted would effectively ban burley, a type of tobacco popular in "American-style‟ cigarettes. Burley is grown widely in the developing world, –and the ITGA is telling farmers there that the guidelines would have a catastrophic impact on their jobs and livelihoods by resulting in a shortage in the demand for leaves. “What the ITGA fails to mention is that burley cigarettes continue to be sold in countries that are already restricting tobacco flavorings,” said Laurent Huber, Director of the Framework Convention Alliance (FCA), a global alliance of more than 350 civil society organizations working for the FCTC. “It is also a fact that the economies of countries dependent on tobacco for foreign exchange, such as Malawi and Zimbabwe, have remained poor and suffering economic woes. Tobacco farming does not alleviate poverty,” he added.

The African Tobacco Control Consortium strongly encourages African Parties to the FCTC to resist any attempt by the tobacco industry to manipulate them. ATCC therefore calls on all African delegates heading to COP 4 to support the adoption of the draft guidelines on Articles 9 and 10 without change.

From 15-20 November, Uruguay will host the Fourth Session of the Conference of the Parties to the FCTC, which now has 171 Parties, representing 89% of the world’s population.

Smokers: They die...but remain addictive