Minister of Health Aaron Motsoaledi has published a new tobacco control bill which, if passed into law, will further restrict how cigarettes and other tobacco products are sold, marketed and consumed in South Africa. Health and medicine editor Candice Bailey asked Catherine Egbe about what it means for tobacco control.
What's significant about South Africa's pending tobacco control legislation?
a smoke-free policy,
plain or standardised cigarette packaging,
points-ofsale marketing, and
removing cigarette vending machines.
Some are addressed in South Africa's current tobacco control law. But the country still doesn't fully comply with the standards set by the World Health Organisation's Framework Convention on Tobacco Control. South Africa signed the convention in 2005.
Smoke-free public places are one example. The current law bans smoking in public places but allows for designated smoking areas in places like bars, taverns and restaurants provided that they do not take up more than 25 percent of the venue.
The WHO's convention calls for 100 percent smoke-free public places to protect non-smokers fully.
In line with this, the new bill calls for a 100 percent ban on smoking in public places. It will also ban the advertising of cigarettes and other products at tills or the selling of them in vending machines.
The health warnings on cigarette boxes and other tobacco product packages is another example. The current law allows for text health warning on 20 percent of the package. But the convention calls for a minimum of 30 percent and encourages countries to have the more effective plain or standardised packaging with graphics and textual warnings in place.
So the new law mandates standardised packaging with graphic health warnings to make tobacco packages less attractive to new smokers and to discourage old smokers from continuing to smoke.
The bill is also significant because it attempts to regulate e-cigarettes for the first time in South Africa. To date, e-cigarettes have been freely marketed and sold anywhere to anyone, including children.
18 studies have shown that e-cigarettes do not reduce quit rates. Instead, the latest research shows that they do the reverse – they reduce the quit rates of smokers intending to quit by about 66 percent.
Is there evidence that the planned interventions will work?
There's a great deal of evidence from the rest of the world.
Let's start with smoke-free policies. In countries like South Korea and the U.S. where they are in place, research shows that they led to an overall improvement in health, particularly children's health. Incidents of smoking-related cancers went down, and there was a reduction in childhood smoking. There was also an increase in the number of smokers who say they want to quit.
E-cigarettes are still a relatively new factor. But research is already casting doubts on various claims made about them. First introduced in China in 2004, they were initially mooted as an aid to quit smoking. But research shows that they, in fact, encourage young people to start smoking cigarettes. And 18 studies have shown that e-cigarettes do not reduce quit rates. Instead, the latest research shows that they do the reverse — they reduce the quit rates of smokers intending to quit by about 66 percent.
There are 83 countries that regulate e-cigarettes and about 27 that have completely banned their sale. These include Brazil, Singapore, Uruguay, Seychelles and Uganda. The advertising, promotion and sponsorship of e-cigarettes are regulated or prohibited in 62 countries.
The tobacco industry views young people as replacement smokers. Strong legislation will prevent young people from being manipulated by the tobacco industry.
Why is it important to have a legislation like this?
Tobacco smoking is the single most preventable cause of death in the world. Smoking also worsens TB and HIV treatment outcomes. Yet 37 percent of South African men and 6.8 percent of South African women aged 15 years and older use tobacco.
Before the WHO Framework Convention on Tobacco Control, South Africa was a leader in tobacco control in Africa and across the world, because of strong tobacco control legislation it had put in place. But the laws weren't updated according to current WHO's standards, and the country now lags behind some other African countries.
The new legislation will place South Africa on the right path. Apart from saving millions of lives, it will ensure that South Africa fulfils its obligation as a party to the WHO convention. There are several benefits to having strong legislation.
Firstly, it will protect millions of South Africans who don't smoke but take in secondhand smoke from those who do. They face the same health risks as active smokers. Secondly, it will also help encourage people to quit and live healthier lives and discourage young people from starting. And thirdly, the tobacco industry views young people as replacement smokers. Strong legislation will prevent young people from being manipulated by the tobacco industry.
What are the next steps?
Once the bill becomes law, the health minister will have to draw up several regulations to guide its implementation. These will ensure that the law is interpreted correctly and not manipulated by the tobacco industry and that the potential gains of the legislation are not watered down.