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Tobacco Control in Africa


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An important contribution to the literature on global public health and international development, featuring the most comprehensive evidence-based analysis of tobacco policy in the African region.

This volume utilizes the work initiated and executed under a recent major public health initiative, the African Tobacco Situational Analyses (ATSA), which was sponsored by the Canadian government's International Development Research Centre (IDRC) with funds from the Bill and Melinda Gates Foundation. The program was conceived to illuminate the factors that will facilitate the reform of major public health policies, particularly, but not limited to, tobacco. The results, presented in this volume, are an important contribution to the literature on global public health and international development, and comprise the most comprehensive evidence-based analysis of tobacco policy in the African region.

List of Figures and Tables; Foreword by O. O. Akinkugbe; Preface by Jacqui Drope; Acknowledgments; List of Abbreviations and Acronyms; 1. Introduction; 2. The Political Mapping Process; 3. Progress on Smoke-Free Policies; 4. Taxation as a Tobacco Control Strategy; 5. The Challenges of Implementing Bans on Advertising, Promotion and Sponsorship; 6. The Pursuit of Packaging and Labeling Requirements; 7. Burkina Faso; 8. Cameroon; 9. Eritrea; 10. Ghana; 11. Kenya; 12. Malawi; 13. Mauritius; 14. Nigeria; 15. Senegal; 16. South Africa; 17. Tanzania; 18. Zambia; 19. Conclusion: Tobacco Control in Africa – People, Politics and Policies; Notes on Contributors; Index



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Published 15 October 2011
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EAN13 9780857288134
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Tobacco Control in Africa
Tobacco Control in Africa
People, Politics and Policies
Edited by Jeffrey Drope
International Development Research Centre Ottawa  Cairo  Dakar  Montevideo  Nairobi  New Delhi  Singapore
Anthem Press An imprint of Wimbledon Publishing Company www.anthempress.com
This edition rst published in UK and USA 2011 by ANTHEM PRESS 75-76 Blackfriars Road, London SE1 8HA, UK or PO Box 9779, London SW19 7ZG, UK and 244 Madison Ave. #116, New York, NY 10016, USA
A copublication with the International Development Research Centre PO Box 8500, Ottawa, ON K1G 3H9, Canada www.idrc.ca / info@idrc.ca ISBN: 978 1 55250 510 6 (eBook)
© 2011 Jeffrey Drope editorial matter and selection; individual chapters © individual contributors
The moral right of the authors has been asserted.
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.
British Library CataloguinginPublication Data A catalogue record for this book is available from the British Library.
Library of Congress CataloginginPublication Data Tobacco control in Africa : people, politics, and policies / edited by Jeffrey M. Drope.  p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-85728-783-0 (hardback : alk. paper) ISBN-10: 0-85728-783-4 (hardback : alk. paper) I. Drope, Jeffrey M. [DNLM: 1. Smokingprevention & controlAfrica South of the Sahara. 2. Health PolicyAfrica South of the Sahara. 3. Smokinglegislation & jurisprudenceAfrica South of the Sahara. 4. Tobacco Industrylegislation & jurisprudenceAfrica South of the Sahara. HV 5740] LC classication not assigned 362.296096dc23 2011032528
ISBN-13: 978 0 85728 783 0 (Hbk) ISBN-10: 0 85728 783 4 (Hbk)
This title is also available as an eBook.
List of Figures and Tables Foreword Preface Acknowledgments List of Abbreviations and Acronyms
1. Introduction  2. The Political Mapping Process  3. Progress on Smoke-Free Policies  4. Taxation as a Tobacco Control Strategy  5. The Challenges of Implementing Bans on Advertising, Promotion and Sponsorship  6. The Pursuit of Packaging and Labeling Requirements 7. BurkinaFaso
8. Cameroon
9. Eritrea 10. Ghana 11. Kenya 12. Malawi 13. Mauritius
14. Nigeria
15. Senegal
vii ix xi xv xix
1 13 29 43
63 79 97 107 123 135 149 167 185 201 219
16. SouthAfrica
17. Tanzania 18. Zambia 19. Conclusion: Tobacco Control in Africa  People, Politics and Policies
Notes on Contributors Index
227 247 261
295 299
Figures Figure 9.1 Eritrean tobacco production by value, 19952006 Figure 10.1 Ghana GYTS 2005 prevalence highlights Figure 16.1 Cigarette price and consumption in South Africa, 19922001 236
Tables Table 3.1 Table 4.1
Table 4.2 Table 5.1
Table 5.2 Table 6.1
Table 8.1 Table 8.2 Table 8.3
Table 8.4
Table 9.1
Status of smoke-free policies in the 12 ATSA countries Affordability of a 20-cigarette pack of the most widely consumed brand National tobacco taxes  200910 Status of advertising, promotion and sponsorship requirements and prohibitions in the 12 ATSA countries
Youths and tobacco in the 12 ATSA countries
Packagingandlabelingprovisionsinthe12 ATSA countries
Manufactured tobacco production in Cameroon (tons)
Tobacco imports and exports in Cameroon
Customsandexcisedutiesonimportedtobaccoin Cameroon (CFAF, millions)
Taxesondomestictobaccoproductionin Cameroon (CFAF, millions)
Eritrean tobacco consumption by product type, 2000
131 138
46 50
66 74
80 118 118
119 131
Table 13.1 Table 13.2 Table 16.1
Table 16.2 Table 18.1 Table 18.2
Mauritius prevalence rates  NCD surveys
Mauritius prevalence rates by age groups
Dailyadultsmokingprevalenceratesbyraceand gender in South Africa, 2008
Tobacco farming in South Africa  2000 versus 2007 Zambia  Most recent national prevalence rates Ranking of six public health programs in Zambia, 2008
188 188
230 241 264 280
This magnum opuson tobacco control in Africa could not be timelier as we begin to confront the next global epidemic of noncommunicable diseases. Its 19 chapters and 12 country situational analyses carry the message effectively for all those who care to listen  governments, industry, health professionals and most poignantly of all, consumers, particularly todays youth. As this is a book on the African odyssey relating to a dreaded risk factor to health in world history, two timeless African proverbs seem apposite:
“The choreographer has given birth to her child; it not remains for the child to know how to dance.”That is, there is no longer any excuse for not knowing how to proceed. “To prevent the branch of the tree sticking out dangerously from hurting your eyes, you must begin to contemplate that possibility from afar.”The epidemic is already upon us, not looming, so we must act now.
Anti-smoking policies have been developed and strategies mounted at global, regional and country levels, but the tepid response and lackluster attention paid to implementation have continued to thwart our efforts. The political will has not yet been consummated, and the shifting of the theater of war and skillful manipulation of unsuspecting nations by the tobacco industry continue to exact hardship on the expected impact on tobacco control. Yet populations are acutely aware of the pervasive and devastating complications of the short- and long-term use of tobacco. A few may be ignorant, but many are simply indifferent or even de ant. The politics of tobacco control is a complex one: the lobby is often strong and determined, but at one point or other it meets with an equally powerful pro-tobacco counterlobby. In a corrupt political system it is easy to guess which side eventually triumphs. Twelve countries in Africa have been appraised out of a total of over  fty, but the ndings apply to the restmutatis mutandis. But as the concluding chapter emphasizes, the approach varies with the social, political and economic
environment and the solution cannot be one size  ts all. At the end of the day, political leadership is the most powerful activator for change and its impact on social, lifestyle, habit, environmental and economic integrity will determine whether a country is winning or losing this battle. Africa has a responsibility to resist the carrot of industrial temptation. History will judge leaders harshly, including the health professions themselves, if we continue  like the proverbial ostrich  to bury our heads in the sand. The solution demands a doggedness that must permit us to shun quick returns and instead to focus on long-term gains, the types of dividends in human health that we cannot begin to compare with material resources. The developed world has devised its own approach and the wily industrialists in the tobacco camp have relocated to the less-developed world, knowing that the index of compromise in this new environment is high. They increasingly dazzle the economically weak with ephemeral incentives. Impoverished populations must hold their destinies in their hands and hearken to the remonstrating cries of those in their indigenous communities who never tire of explaining the ruinous effects of tobacco on health. Advice, like water constantly dripping, will eventually wear away stone. I warmly recommend this monumental work  a truevade mecum to all stakeholders, policymakers and real and potential consumers in the African setting. Dr Jeffrey Drope and his team must be congratulated for putting together a compendium that clearly addresses the various facets of this problem. It is a compelling read and a clarion wakeup call, and I hope that the Doubting Thomases on the continent will no longer be content to sit on the fence.
O. O. Akinkugbe, MD, PhD Emeritus Professor of Medicine University of Ibadan, Nigeria October 2010