Smoking contributes to inequality in SA

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The manifesto period has already begun. The ANC kicked it off on January 8 with their manifesto launch. They spoke about all the improvements they’ve brought since the advent of democracy 25 years ago and provided an extensive list of  “if-we-win” promises. Next up was the EFF on February 2, again with grand declarations of what they will do post-elections if they win. And the DA took to the stage to launch theirs on February 23. Even Patricia De Lille’s new kid on the block GOOD took a seat at the table to engage ordinary citizens, as did the UDM.

Their manifestos have all been peppered with promises – and key in these long lists were how they would improve health care in South Africa. The ANC, for example, has promised to take immediate steps to improve the state of hospitals and clinics, to implement the National Health Insurance and to improve their test and treatment services for both HIV and TB. Over the next two months, as we edge towards South Africa’s sixth national general elections, we are likely to have more promises made by political parties.

Citizens will be centre stage as parties engage with issues and challenges that people face daily on the ground. As this all plays out, the National Council Against Smoking has been eager to understand how important an issue South Africa’s political parties think tobacco control is. We created an online survey to ask eight of the country’s most popular political parties to gauge how much they supported the Draft Tobacco Control Bill, set to go before the new Parliament later this year.

The Draft Tobacco Control Bill was tabled by Health Minister Aaron Motsoaledi for public comment in May last year. Now that submissions are being reviewed, the Bill is expected to come before Parliament for further deliberation. Although the Bill is yet to officially come before Parliament, the fact that the Bill has been in the public domain for the last 10 months  –with the tobacco industry actively lobbying against it — means that many people know about the Bill and the changes that it will bring to South Africa.

The Bill will introduce several new policies: 100% smoke-free indoor public places, the regulation of e-cigarettes, the removal of tobacco marketing and adverts at till points, the plain packaging of cigarettes and the ban of sale of cigarettes from vending machines. We sent our survey to the African National Congress, the Democratic Alliance, the Economic Freedom Fighters, the Inkatha Freedom Party, the United Democratic Movement, the African Christian Democratic Party, the Azanian People’s Organisation and newcomers to the political scene, Good.

They were asked about the Bill in general as well as each of the five key elements of the Bill. Our survey results were dismal. A month after receiving the survey, and receiving several follow up calls and reminders, only two of the eight parties responded: newcomers Good and the ACDP. Their responses show that they are serious about the health of the citizens they wish to serve. This shows that when it comes to tobacco control, South Africa’s political parties don’t prioritise the health of the citizens they want votes from.  

Asked about whether or not they support the Bill, Nthabiseng Lephoko, National Chairperson of Good said: “Illnesses caused by the tobacco like lung cancer, emphysema, asthma and bronchitis cost South Africa almost R60 billion per year. This cost is more than was allocated to fund higher education in 2018 or nearly three times what the increase in VAT to 15% raised for government. Each year, smoking results in more than 40,000 deaths in South Africa.”

ACDP Gauteng chair Lesiba Molokomme said that the benefits of the Bill would outweigh the jobs that could be lost. Molokomme has pointed out that the ACDP has been consistently supporting tobacco control in South Africa and that their Member of Parliament Cheryllyn Dudley was the one to propose a ban on smoking in cars when children under the age of 12 were present. But other parties simply failed to respond to the survey on the Bill and did not attend the launch of the report card.

The poor response to the survey shows that South Africa’s political parties do not take the health of voters or the prevention of illness to voters seriously. It’s disappointing to see that political parties are not thinking about the health of the nation at all. What many people don’t realise is that tobacco is a serious issue in South Africa. While only 20% — or about eight million people over the age of 15 in South Africa smoke, the harm that comes about from tobacco is significant.

As a start, the fiscus losses about R60 billion as a result of tobacco related illnesses and loss in productivity. And when it comes to health, smoking increases the harm from diseases such as diabetes, high blood pressure and cancer. Statistics SA reports that more than half of the estimated 460 000 deaths in 2015 were due to these non-communicable diseases. Aside from the suffering to the individual, an increase in the number of people with tobacco-related illnesses puts more pressure on the country’s public health system, which is already under severe pressure.

Research done by UCT shows that smoking contributes to inequality in South Africa because poor smokers spend more of their income on cigarettes and other tobacco products that those who are more well off. This means they have a higher opportunity cost. It therefore goes without saying that politicians who want the support of these people need to think about how they can help these people.  

If political parties were serious about our health, they would have made it a priority to understand the Draft Control of Tobacco and Electronic Delivery Systems Bill since it will play a major role in reducing the burden of tobacco-related diseases on our health system in the future.

Saveera Kalideen is the Executive Director of the National Council Against Smoking