Sunday, November 27, 2011

Forget AIDS: Tobacco-related diseases are the next big epidemic in Uganda

‘’The Tobacco diseases epidemic is already with us in Africa’’ says Prof Peter Odhiambo, Chairman of Kenya Tobacco Control Board. ‘’Soon you will hear people announcing that the epidemic is coming to Africa. It is already here. I treat the victims of tobacco everyday’’. Prof Odhiambo was speaking at Kampala Serena Hotel on 1st November 2011 in a public lecture entitled ‘The journey from the Farm to the Lungs: Who gains from Tobacco in Africa?’ at the inauguration of the new regional Centre for Tobacco Control in Africa (CTCA) to be hosted by Uganda.

Tobacco use is the single most preventable cause of death in the world today. Tobacco use claims more lives globally than HIV/AIDS, Tuberculosis and malaria combined. According to the World Health Organization (WHO), unless urgent action is taken, tobacco could kill one billion people during this century. WHO data also shows that in comparison to HIV/AIDS which claimed three million lives globally last year, Tobacco deaths were nearly six million cases.

According to WHO, more than 80% of the world’s tobacco-related deaths will be in low and middle-income countries by 2030.

‘’Tobacco is the only legal product in the world which, when used as intended by the manufacturer, kills half of all the people who use it ’’ says Dr Sheila Ndyanabangi, who is the Tobacco Control focal person in the Ministry of Health.

Tobacco use is also known to cause at least 15 cancers (particularly lung cancer), heart and respiratory diseases and leads to lifelong heath and developmental disorders among exposed children.

In a study conducted at Mulago Hospital, Uganda’s main referral Hospital, 75% of patients with oral cancer had a history of smoking, with the number of years of smoking ranging from 2-33 years, according to a 2008 study report by Fredrick Musoke of Makerere University.

“Tobacco use is the only risk factor associated with all major non communicable Diseases (NCDs) such as lung cancer, cardiovascular diseases, tuberculosis, asthma and pneumonia. It is a risk factor for six out of eight leading causes of death, globally” said Dr Douglas Bettcher, Head of WHO’s Tobacco-Free Initiative at the opening ceremony of a regional Tobacco Control centre in Kasangati, near Kampala.

Dr Bettcher also said that tobacco use in women causes infertility and leads to low birth weight of babies born to tobacco-using mothers. For men, tobacco use can cause low sperm count.

Almost a quarter of Ugandan males (22%) aged between 15 and 49% are smokers while 4% of females are smokers -according to the 2006 Uganda Demographic and Health Survey.

However,the threat posed by second-hand smoking or ‘environmental tobacco smoke’ which is said to affect almost a half of all youths in Uganda and is a much more mainstream public health threat in Uganda. Exposure to second hand smoke increases the risk of heart disease by 25-30% and the lung cancer risk by 20-30%.

Smoking has been banned in public places, including in bars, restaurants and educational institutions, in Uganda since 2004 . But the judicial and political will to enforce this law has been lukewarm. Not a single person has been prosecuted under this law despite smoking in public places, such as bars, being widespread in Kampala and other towns of Uganda.

In August, British American Tobacco (BAT) Uganda, announced that that cigarette sales had gone up by 29% in Uganda compared to a similar period in 2010.

The Ugandan tobacco industry argues that tobacco is economically important to Uganda given that the industry is a leading tax revenue payer and that the livelihoods of 600,000 tobacco farmers, particularly in Arua District in the West Nile region, where BAT runs an out-growers programme, depends on the cash crop. The industry also argues that it is important export crop for the country.

‘’It is not the tobacco companies which pay tobacco taxes, it is the smokers’’ counters Dr Sheila Ndyanabangi, who argues that taxes on tobacco are simply passed on to consumers. Dr Ndyanabangi also maintains that the health care costs of treating tobacco-related diseases, such as lung cancer and heart diseases, far outweighs the economic benefits of the tobacco industry.

Tobacco use poses a heavy burden on the governments of low and middle-income countries, through increased healthcare costs, aggravates environmental degradation through clearing forests to make way for tobacco farms and leads to diversion of agricultural land to tobacco farming since tobacco crops can only be grown alone.

According to Rachel Kitonyo, a Kenyan working with the Africa Tobacco Control Consortium based in Lome in Togo, Uganda is out of step with other East African countries such Tanzania and Kenya which passed a Tobacco control law in 2007.

Uganda is yet to pass a tobacco control law although a Bill has been in the works for the past few years with a draft announced in 2010. The Ugandan parliament is now set to discuss the Bill after being dogged by delays.

The resurrection of the bill was disclosed on 1 November 2011 by Rebecca Kadaga, the Speaker of Parliament, while opening the Centre for Tobacco Control in Africa(CTCA), which is based in Kasangati township, about five kilometers from the Ugandan capital, Kampala. One of the proposals of the bill is a two-month jail sentence for public-smoking offenders.

According to Kadaga, the bill will have its first reading in parliament soon and will be tabled before parliament as a private members’ Bill moved by Dr Chris Baryomunsi, Member of Parliament for Kinkizi West.

In addition to tobacco control law, Dr Joaquim Saweka, the World Health Organization’s (WHO) Uganda country representative, calls for an increase of the tax on tobacco in which globally is recognized as the most effective tobacco control measure to deter people from smoking. Increasing tobacco taxes is seen as a win-win option as it means more money in government coffers and a reduction in consumption of tobacco products. A World Bank study shows that a 10% increase in tobacco taxes was followed by an 8% reduction in consumption of tobacco products.

Uganda’s tax on tobacco products has been increasing marginally in the last three years but is still far below the threshold set by the WHO Framework Convention on Tobacco Control (FCTC).

Uganda consented to the FCTC in June 2007, which is a set of internationally-agreed strategies for tobacco control that has force of international law. The FCTC calls for a ban on advertising of tobacco products, the display of graphic warnings on cigarette packs, an increase in tobacco taxes and alternatives to tobacco farming. However, Uganda is yet to give full effect to FCTC guidelines such as using graphic warning on cigarette packs.

‘’The size of health warnings on cigarette packs, as a percentage of the surface area of the cigarette packs in Uganda is till small and below FCTC guidelines’’ says Gilbert Muyambi, Secretary General of Uganda National Tobacco Control Association.

An effective tobacco control regulatory regime in developed countries has constrained the operations and profits of big tobacco companies such as Phillip Morris and BAT which has made them consider Africa as a lucrative alternative – an untapped market with weak anti- tobacco laws and policies. Thus tobacco giants have set their sights on Africa as a ‘new’ marketing hope for the tobacco industry.

With multinational tobacco companies switching their attention to African countries, the non-communicable disease epidemic of heart diseases and cancers which, until now, have been more widespread in the west, are certain to shift to African countries which already have high burdens of infectious diseases such as AIDS, malaria and tuberculosis epidemics to contend with.

It is estimated that by 2030 tobacco-related illnesses will be the leading cause of death in the world and 70-80% of these deaths will occur in low and income countries.

“Be wary of multinational companies, which come here and sell you death in the name of freedom. These are merchants of death. The tobacco disease epidemic is already here,” warns Professor Peter Odhiambo.


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