South Africa – The threat of Big Tobacco to CVD in children and adults
Tobacco Use and Disease
Tobacco is currently one of the greatest risks to global public health, causing approximately 8 million fatalities annually, with 50% of these deaths occurring in Africa. This amount exceeds the deaths from AIDS, cancer, and other chronic diseases combined (Organization, 2018). With 6% of the world’s adults smoking, around 77 million of these smokers residing in Africa, and the average monthly smoking rate of 31.4% among South Africans over the age of 15 (Organization, 2011), this represents a huge and exploitable business opportunity for tobacco companies (Abade, 2018). Approximately 44,000 South Africans die annually from tobacco-related diseases (Groenewald et al., 2007), with 18% of premature cardiovascular disease deaths attributable to tobacco use (Gaziano, 2007). Cigarette smoking is a major cause of CVD (Delobelle et al., 2016).
Age Group of Smokers
According to reports, smoking rates vary by race and age in South Africa. Smoking is viewed as a lifestyle among “coloured” individuals, whose prevalence is typically higher than that of other races, and whose adult smokers have higher arterial stiffness, indicating a stronger influence of tobacco use on cardiovascular dysfunction. In addition, the fact that South African children under the age of 15 are developing a smoking habit and that tobacco overt and electronic advertising on social media may have influenced the early onset of smoking in South Africa is a significant warning sign, as the entire business model of the tobacco industry becomes increasingly dependent on younger age groups. Despite knowing the hazards of nicotine, PMI Tobacco has actively created e-cigarettes, flavoured cigarettes, and hookahs to market cigarettes to children and teenagers worldwide since 1950. The introduction of new tobacco products, such as electronic nicotine delivery systems, has decreased the smoking age and increased the risk of CVD among adults and children in South Africa (Fagbamigbe et al., 2020). Premature mortality due to CVD in South African adults is projected to increase by 41% by 2030 (Gaziano, 2007).
Dominate the Tobacco Market
British American Tobacco South Africa (BATSA) is South Africa’s leading manufacturer and distributor of tobacco products (van Walbeek and Shai, 2015). Even though South Africa joined the WHO Framework Convention on Tobacco Control in 2015, the firm has employed various strategies to undermine tobacco control and public health to maintain its dominant market position. Between 2012 and 2016, BATSA secretly paid bribes and unlawfully monitored South African officials and lawmakers to sabotage the FCTC Act’s implementation (Burki, 2018). During the COVID-19 pandemic, the South African government announced a ban on the sale of all tobacco and e-cigarette products because evidence indicated that smokers accounted for a more significant proportion of severe COVID-19 cases and CVD than non-smokers, so limiting exposure to tobacco would likely improve the health of many individuals infected with COVID-19 and CVD. Even though the sale of their products is prohibited, they are exploiting a gap in the law to sell tobacco products as “harm reduction” via social media networks (Filby et al., 2022). This action will increase the prevalence of CVD and other smoking-related disorders, as well as children’s and adults’ exposure to tobacco advertising and the likelihood of nicotine addiction. It follows that Big Tobacco’s continued profitability is based on harming people’s health, and its ability to market itself is linked to the speed at which it exploits the relative lack of regulation in developing countries.
Exploration of strategies
According to studies, tobacco smoking is one of the top causes of CVD fatalities worldwide, and by 2100, 26% of the world’s smokers would reside in Africa (Kaai et al., 2019). The world is searching for a durable solution to end the tobacco industry’s trick and protect more children and adults from the dangers of nicotine products and CVD. For the government, there is a need for stricter regulation of policy. The development of framework legislation for NCDs beyond tobacco control, while it cannot replace detailed legislation on tobacco control, can accelerate progress in the country by raising the political profile of NCDs and clarifying who is responsible for the relevant sectoral responses. And at the primary care level, improving the diagnosis and management of CVD, simplifying procedures and increasing the availability of easily accessible medicines. For society, promote health education for the population, utilise health services and community mobilisation to monitor businesses that raise the risk of noncommunicable diseases, and conduct regular blood pressure testing for persons who use tobacco or are exposed to it at home. For individuals, smoking cessation, regular physical exercise, and cigarette avoidance have been found to reduce the risk of CVD (Buttar et al., 2005). In conclusion, South Africa still has a long way to go in the fight against the tobacco epidemic, despite the significant progress made on tobacco control concerns.
References
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