To smoke or not to smoke

As the campaign against the proposed Control of Tobacco and Electronic Delivery Systems Bill rages on with claims and counterclaims from industry players and the health department on its possible negative effects on the economy, it’s important not to forget the person at the centre of it all – the smoker.

So said Dr Kgosi Letlape, president of the Health Professions’ Council of SA and co-founder of the Africa Harm Reduction Alliance, this week.

He was on a panel debating how imperative it was to reconcile conflicting agendas between tobacco-product manufacturers and public health institutions.

“Yes, we need regulation [of tobacco] in Africa otherwise we’re going to be the dumping ground for all the combustibles [cigarettes]; but regulation cannot be done on a faith or moral basis – it has to be done based on fact,” Letlape said.

He argued that “the first major disagreement I have with the proposed bill is that it puts the quitting of smoking as primary and there are no alternatives”.

“So it can be read as though it’s saying, ‘quit or die’, but it really should be, quit or switch [to a safer product]. The smoker matters … we must not forget the smokers. They have rights too and we should be offering alternatives,” he said.

The bill – which went through a comment process that closed earlier this month – proposes to control smoking through a total ban of smoking in outdoor public areas, to regulate the sale and advertising of cigarettes and electronic devices (e-cigarettes) and to regulate the packaging and appearance of tobacco products and electronic-delivery systems to plain packaging.

It has been submitted to Parliament for a review.

The health ministry said the bill seeks to comply with the standards set in the framework on tobacco by the World Health Organisation (WHO), which South Africa signed in 2005.

Letlape said that made it even more problematic.

“The elephant in the room for Africa, in particular, is the WHO and accepting everything it recommends hook, line and sinker.

“Other countries, such as the US, don’t take on all the WHO recommendations; they think around them and apply them according to the needs of their environment,” Letlape said.

“Why is the African Union not using its intelligentsia to find answers on how we can domesticate the framework and make it applicable in our environment? We must take collective responsibility as Africans for not asking for assistance but waiting for aid.”

The WHO asserts that cigarette smoking in adults causes heart disease and strokes and the global tobacco epidemic kills more than 7 million people each year, of which nearly 900 000 are non-smokers dying from breathing second-hand smoke.

The Tobacco Atlas said more than 42 100 South Africans are killed by tobacco-related diseases each year, equivalent to about 10.1% of the nation’s deaths.

Because of this, the health department believes that reducing tobacco consumption would lead to reduced deaths and illness and higher productivity and economic growth.

Hugo Marcelo Nico, managing director if Philip Morris SA – the manufacturers of popular cigarette brand Marlboro – agreed that there needed to be regulation of cigarettes but there also needed to be “safer” alternatives for those not willing to quit smoking.

“Treating all products the same way will not help – what we need to do is give the correct information to smokers.

“There are 7 million smokers in South Africa and there’s a market for harm reduction … if all packets are the same, then smokers will not know the difference in what they are smoking.

“We need to be able to differentiate between combustible and non-combustible products because there is a difference,” Nico said.

Speaking on lessons learnt in the US, Gregory Conley, president of the American Vaping Association, said public health organisations had done well in reducing harm in the arenas of sex and drugs but the “harm elimination strategy” as it pertained to nicotine unwisely ignored the “reality of smoking”.

“For 25 years public health organisations have said that ‘if you can’t quit by yourself, then use pharmaceutical items such as gum, the patch or lozenge’.

“But, in the real world, those products have a 3% to 9% success rate. Of course most smokers want to quit but many don’t; they smoke because they like it,” Conley said.

Last week the agriculture industry association AgriSA, the Food and Allied Workers’ Union and the SA Spaza and Tuckshop Association said in a joint statement that were the bill to be implemented in its current form, it would put thousands of law-abiding Spaza shop owners and hawkers out of business and drive 80% of tobacco sales into the hands of criminals.

They also said it would lead to an estimated 7 000 job losses.

Letlape said this kind of pushback from industry was expected.

“Everyone will sing of their own pain when change is coming but we need to look beyond the noise of the industry.

“What we should look at is creating a product that reduces the risks associated with smoking a combustible,” Letlape said.

“We should accept that human beings are risk-taking animals and our duty as health professionals is to introduce ways to reduce the risk to their health. If we are producing new products, we are producing new jobs too. We can’t be talking about job preservation when those jobs create harm in society.”