by Dr Sharon Nyatsanza, Deputy Director, National Council Against Smoking

Imagine a world where the air we breathe in public spaces isn’t tainted by a deadly substance and where people are free from all forms of nicotine. Imagine laws so robust that the marketing tactics of tobacco and electronic cigarette companies couldn’t hook our youth on a lifetime of addiction. Sadly, this is not yet the reality – not in South Africa, nor in numerous countries where the battle against smoking and its modern iterations rages. The pressing question is this: in our pursuit of public health, is the government doing enough to protect our right to clean air and knowledge of threats to our health, or are we faltering in the face of the tobacco industry’s might?

In the ongoing battle between public health imperatives and industry interests, South Africa finds itself at a critical juncture with the pending Tobacco Products and Electronic Delivery Systems Control Bill. The legislation, aimed at enhancing public health measures, seeks to introduce stricter regulations on tobacco use, including limitations on smoking in public places, stronger rules on packaging, and restrictions on tobacco point-of-sale advertising. However, it faces significant pushback from the tobacco industry.

Finally approved to go to Cabinet in 2022, the comprehensive Tobacco Control Bill still awaits Parliament’s final approval, but has stalled at the public consultation process. Public consultations were carried out in seven of the nine provinces by the parliamentary portfolio committee on health. Two provinces were yet to complete this crucial step in the parliamentary process – KwaZulu Natal and the Northern Cape – but these have been postponed since January 2024. As they were not concluded before the elections, the future of the Bill will be left up to the next administration’s discretion.

Industry interference

In an environment where there is strong tobacco industry interference, we must question why. Delays in the passage of the Tobacco Control Bill only favour the tobacco industry, not the public health of South Africa. The 2023 Tobacco Industry Interference Index Report highlights a concerning rise in tobacco industry influence on South African policy-making, noting an increase in tobacco companies targeting non-health government sectors, sponsoring organisations close to the government, and having unnecessary interactions with officials. The report calls for urgent government action against the tobacco industry’s tactics that hinder tobacco control efforts. Recommendations include fast-tracking crucial tobacco control legislation, banning industry contributions, raising official awareness about interference, and promoting transparency in government-tobacco industry interactions.

This tussle is not just a local issue, but reflects a global challenge where health policies often collide with powerful industrial sectors. The tobacco industry’s influence is not new; historically, it has employed extensive lobbying and legal challenges to dilute health regulations. Yet, the cost of inaction is measured in lives lost and healthcare systems burdened by tobacco-related illnesses. 

Public health imperative

South Africa’s move to tighten tobacco control is not merely legislative; it’s a moral imperative to prioritise the health and well-being of its citizens over corporate profits, and a Constitutional duty of government to protect the health of the nation. The World Health Organisation (WHO) has long advocated for such measures, highlighting their effectiveness in reducing tobacco consumption and, consequently, lowering the incidence of diseases like cancer and heart disease. Passing the bill will reduce exposure, delay initiation by young people and bring South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard. 

This Bill will contribute significantly to reducing heart diseases, cancer, diabetes and respiratory disease, reducing preventable harm, death and disability from noncommunicable diseases (NCDs) – an essential factor in the successful implementation of South Africa’s National Health Insurance (NHI). Tobacco is also a key risk factor for NCDs which now account for 51% of deaths in the country. Tobacco adds to the economic and healthcare burden, and these costs are subsidised by the taxpayer while the tobacco industry reaps the profit.

The Bill is about more than health. Tobacco-related premature deaths through NCDs and other tobacco-related diseases stifle South Africa’s economic development. Families lose income and suffer crippling healthcare costs. As tobacco use is currently estimated to cost South Africa R42 billion per year in tobacco-related illnesses, reducing these costs is essential. Estimates show that the economic cost due to productivity losses arising from absenteeism and early retirement due to ill health in South Africa, largely from NCDs, is expected to increase to 7.0% of GDP by 2030. The Tobacco Control Bill can make a vital contribution to curbing health-care costs and improving standards of living, with benefits only increasing over time.

Critics of the bill must recognise that the health benefits far outweigh the purported economic drawbacks. It’s time to reframe the narrative from one of economic loss to one of health gains, societal wellbeing, and long-term sustainability.

The Tobacco Control Bill represents a pivotal step forward in safeguarding public health and wellbeing.  As such, it is incumbent upon policymakers to pass the Bill, and for health advocates and the broader community to rally for swift action on this. Doing so will not only reaffirm the government’s commitment to public health but also set a precedent for addressing other health challenges with the same vigour and determination. In the end, the lasting legacy of robust public health policies will be a healthier, more resilient population, capable of contributing more fully to the nation’s growth and prosperity. – Health-e News