Smoking, anti-smoking policies and the impact it all has on health
More than twenty years ago when South Africa first introduced designated smoking areas in restaurants and bars, there was vehement opposition from some sections of the hospitality industry. They argued that restaurants would lose significant revenue and even close down, jobs would be lost and the public would neither eat out anymore nor would they abide by the law.
But two decades later, smoking in non-smoking sections of a restaurant has become a complete taboo. Both ordinary South Africans and the hospitality sector have policed and implemented the legislation. And despite those initial concerns, research from the University of Cape Town shows that none of the 700 restaurants surveyed saw a drop in patrons or profits by marking off designated smoking areas.
Of the restaurants, only 1% allowed patrons to smoke wherever they wanted to while more than 40% followed a no-smoking policy and a little over 40% designated an area outside for smoking. Just 11% had a designated area for smoking inside the restaurant.
No-smoking areas within restaurants and other public spaces have now become the norm, and smokers and non-smokers have shown support for restricting smoking in public places.
The legislation, and the annual increase in the price of cigarettes, led to a consistent decrease in the prevalence of smokers from about 38% in 1998 to between 16% and 18% in 2012.
But South Africa has not seen a significant drop in consumption of tobacco products since 2012. And what’s more worrying is that there’s no reduction in the prevalence of smoking among young people. The Draft Control of Tobacco Products and Electronic Delivery Systems Bill – which is out for public comment until 9 August 2018 – will address this problem.
There are five main legislative shifts that will happen through the legislation. The first declares any enclosed public area 100% smoke-free, and proposes introducing outdoor public places smoke-free too. Anyone who wants to light up will have to go further away from the public space to do so. There is good reason for this.
Research has shown that second-hand smoke is as harmful as smoking. Non- smokers face the same risks that smokers do – even though they are not the ones lighting up. As soon as the smoker lights up in front of the non-smoker, the non-smoker develops a 30% higher chance of getting heart disease.
Smoke-free public spaces are a well-documented strategy to reduce the number of cigarettes that people smoke and to move them towards stopping completely. An Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) study last year found that about a third of non-smokers are exposed to second-hand smoke at restaurants.
The second major shift in the bill is around the regulation of e-cigarettes. When e-cigarettes were first introduced to the market they were described as a product to help people quit smoking. But this is not how they are being used and we see instead dual use of cigarettes and e-cigarettes. The kinds of flavouring used, such as chocolate doughnut, ice-cream and cream soda flavours encourage young people to start smoking as it makes the taste more palatable.
The vapour in e-cigarettes can cause serious harm to health as some contain nicotine and other toxins which can cause restriction of blood vessels, which has been linked to heart disease. Vapour can remain on the lungs and this could lead to lung disease. The Bill proposes that there be no indoor use of e-cigarettes, no advertising and sponsorship, no sale to children under the age of 18 and provides for health warnings on packaging. South Africa joins 83 other countries that regulate e-cigarettes, including Brazil and Singapore.
The packaging of tobacco products will change too. The ATIM study found that more than 50% of smokers notice text warnings, more than two thirds (73%) read the text warning but only 13% of smokers are motivated by the text warnings to quit. Change was needed to ensure that South Africans notice the health warnings on the package.
The Draft Bill introduces uniform packaging for all brands of cigarettes and pictorial warnings on all packages. This will remove all advertising on the tobacco package, and make it harder to ignore the health warning. Plain packaging, as this intervention is called, has resulted in a significant drop in consumption in Australia where it was introduced in 2012. In 2014, 5% of 12 to 17-year-olds were current smokers, down from 7% in both 2011 and 2008.
When the Draft Bill becomes law, vending machines will no longer sell cigarettes or any other tobacco product, and all advertising at the point of sale of cigarettes will be removed completely.
Tobacco use is one of the top five risk factors that contribute to South Africa’s burden of disease burden. It increases the risk of several chronic diseases including cancers, pneumonia, ischaemic heart disease and stroke. Smokers also face double the risk of developing tuberculosis than non-smokers.
South Africa’s smoking rates are the highest on the continent – and the current trends show that these figures will increase over the next 15 years. The introduction of new tobacco control legislation should be seen for what it is: South Africa’s response to the escalating increase in non-communicable diseases such as cancers, heart disease and strokes.
Savera Kalideen is the Executive Director of the National Council Against Smoking.