For decades, smoking has been on the rise, driving more than 100m deaths in the 20th century alone and creating health and other costs of about $1,500bn a year that have hampering global growth. According to a report from the global health policy organisation Vital Strategies and the University of Illinois Chicago in the latest edition of the Tobacco Atlas, the era of big tobacco is coming to an end: there is an unequivocal drop in global smoking rates, to 19.6% in 2019 from 22.6% in 2007.
Concealed in the figures, however, is a plan to turn tobacco back into a growth industry by focusing on Africa.
Global progress against the “tobacco epidemic” is driven by large declines mostly in nations that have raised taxes on tobacco, limited marketing, mounted hard-hitting public information campaigns, and banned smoking in many public places. Our research shows that the decline in smoking in Africa has been small, and adult prevalence increased in 10 of the continent’s countries between 1990 and 2019.
Quick GuideA common condition
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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
As outlined in research from the University of Bath, a partner in the tobacco industry watchdog, Stopping Tobacco Organisations and Products (Stop): “To protect their profits, transnational tobacco companies (TTCs) began shifting their business to relatively untapped markets in parts of the world where the opportunity for growth is largely unrestricted … Nowhere is this underexploited prospect as ripe for the picking as Africa. TTCs are expanding into African countries, where, excluding South Africa, the tobacco market grew by almost 70% through the 1990s and the first decade of the 21st century.”
Taxation is the most effective way to control tobacco use but Africa has a poor record in this area. Tobacconomics’ cigarette tax scorecard rates nations on a scale of 0 to 5, with 5 indicating the best performance. Compared with leaders such as New Zealand or Ecuador (4.63), which are making rapid progress, countries such as Kenya (0.88), Zimbabwe (1.38), Chad and Central African Republic (both at 0.75) show that tobacco is lightly taxed across most of the continent.
Cheap cigarettes suit international tobacco multinationals. As profits are choked off in the west, big tobacco has homed in on African communities, and especially their young people, as incubators for deadly new initiatives. The Africa Centre for Tobacco reported in 2016 how shops and pushcarts peddling cigarettes alongside sweets were operating near schools in Cameroon and Burkina Faso. The Tobacco Atlas lays out stark data on the industry’s global youth focus, finding smoking rates among 13- to 15-year-olds increasing in 63 countries.
Ironically, keeping cigarettes affordable for poor people has been used by industry lobbyists as an argument against taxation. However, it ignores the fact that those groups are more sensitive to price, and the health, social and economic benefits of higher taxes – fewer people starting to smoke and more quitting – accrue much more to these groups. The positive impact can also be amplified by governments that use tobacco tax revenues for the benefit of those same groups, such as supporting programmes to help people stop smoking.
Another industry argument is that tobacco cultivation in many east and southern African countries is an important part of the economy. The tobacco industry lobbies governments to stall action for fear of hurting farmers, but the Tobacco Atlas identifies recent research that demonstrates that most tobacco growers are impoverished and governments would serve them better by helping them transition to more profitable crops.
We cannot let Africa be the world’s ashtray. Governments should act now to raise tobacco taxes to at least World Health Organization-recommended levels, restrict marketing to young people, create policies that control access to tobacco products, and protect policymaking from interference by the tobacco industry. Smoking rates on the continent are still relatively low, and the tobacco epidemic that has already scarred the US and Europewill not inevitably take off in Africa if we act now to protect the next generation.
African economies remain vulnerable; the vestiges of colonialism are still at play. We can work together to ensure that global corporations based in high-income countries don’t siphon profits out of lower-income countries at the cost of their people’s health. Less than 2% of all development aid is dedicated to non-communicable disease prevention and the figure is even more dismal for Africa – an oversight leading to preventable premature deaths and increased costs, as well as leaving populations more vulnerable to health shocks such as Covid. Financial and technical aid for tobacco control should be readily available to protect Africa’s one billion people from being the next growth market.
It is heartening to see tobacco’s influence on the wane anywhere in the world, but this edition of the Tobacco Atlas exposes an industry hard at work to make Africa the new frontier for smoking. It will take a concerted effort to implement established tobacco control measures to resist the powerful multinationals looking to profit at the expense of people’s health. As high-income countries act to ensure tobacco-free futures, we need to use those same policy measures to prevent tomorrow’s health crises across Africa.
Rachel Kitonyo is regional manager, based in Nairobi, for the Australia’s McCabe Centre for Law & Cancer. Jeffrey Drope is a research professor at the University of Illinois Chicago.
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