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Challenges of Tobacco Control in Africa

By: Foluke Akinwalere. Freelance Health Writer. Medical review and editorial support provided by the DLHA Team

A black man smoking a cigarette. Image credit: Freepik

While there are many strategies available to reduce tobacco consumption, African countries, like those on other continents, face significant challenges in enforcing tobacco control measures.  Here are some of the challenges:

• The Influence of the Tobacco Industry in Africa

One of the biggest obstacles is the powerful tobacco industry, which exerts significant influence in Africa, particularly as the continent is seen as a growing market due to its young population and fewer stringent regulations compared to other regions.  Major tobacco companies actively target African countries with aggressive marketing campaigns that promote smoking as a symbol of modernity and success, especially among youth and women. These companies also lobby against tobacco control laws, seeking to prevent or weaken legislation that would restrict tobacco sales or advertising. [1]

• Lack of Enforcing Tobacco Control Laws

The lack of enforcement of existing tobacco control laws is another major barrier.  In many countries, tobacco control laws exist on paper, but weak enforcement allows the tobacco industry to continue its operations with minimal consequences.  Corruption and limited resources also hinder the effective implementation of tobacco control policies.

• Cultural and Social Factors that may Hinder Anti-Smoking Efforts

In some African societies, smoking is associated with social status, masculinity, or cultural identity, making it harder to challenge pro-smoking norms.  Additionally, myths about the health effects of smoking persist, and in many cases, smoking remains socially acceptable, especially among men.  These deeply ingrained attitudes can hinder the success of anti-smoking campaigns.

• Political and Economic Barriers to Implement Tobacco Control

Furthermore, many African governments, like other international countries, rely on tobacco revenue as an important source of income, creating resistance to implementing strong tobacco control measures.  However, the long-term health and economic costs of tobacco use far outweigh the short-term benefits of tobacco revenue.

Government officials in several Sub-Saharan African countries have been recruited by the industry to oppose the provisions and implementation of the FCTC.  For example, in Nigeria, certain policymakers were engaged to delay the progress of the National Tobacco Control Act 2015.  Also, in South Africa, officials from various government agencies, such as the “Hawks” and the South African Police Service, were implicated in promoting the interests of commercial enterprises, including the tobacco industry.  Reports also indicate that policymakers in some East African countries accepted bribes to support the tobacco industry’s agenda at both national and international levels. [8]

Similarly, in other parts of the world.  New Zealand made history in December 2022 by enacting pioneering tobacco control laws with the aims of achieving a ‘smokefree’ status by 2025.

The campaign was aimed to have fewer than 5% of New Zealanders smoking within two years. [9] This involved measures such as reducing nicotine in cigarettes, limiting tobacco sales outlets, and banning smoking across generations. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government repealed the law; a move expected to have negative consequences on public health and widen life expectancy gaps.  This decision, influenced by political and industry interests, not only hinders New Zealand’s progress but also undermines global tobacco control efforts. [10]

The Role of International Organisations and Donors in Tobacco Control in Africa

International organisations such as the WHO, World Bank, and NGOs play a critical role in supporting tobacco control efforts across Africa. [2] These entities provide technical expertise, funding, and advocacy support to help African countries implement comprehensive tobacco control strategies and reduce the growing public health and economic burdens associated with tobacco use.

Donor funding is essential for public health campaigns, tobacco control research, and the establishment of alternative livelihood programs for tobacco farmers. International collaboration can also help African countries resist the influence of the tobacco industry and adopt best practices from other regions.

By working collaboratively with African governments, civil society, and local communities, international organisations and donors play an essential role in reducing tobacco consumption, improving public health outcomes, and relieving the economic burden of tobacco use across the continent.

Conclusion

The public health burden and economic costs of tobacco use in Africa are significant, but they are not insurmountable.  By adopting comprehensive strategies that include tobacco taxation, strong legislation, public health campaigns, support for alternative livelihoods, and investment in healthcare, African countries can reduce tobacco consumption and its harmful effects. While challenges exist, particularly from the powerful tobacco industry, international support and strong political will can help African nations cut the tobacco-related public health burden and improve the well-being of their populations.

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References

1. Sreeramareddy CT, Acharya K., Trends in Prevalence of Tobacco Use by Sex and Socioeconomic Status in 22 Sub-Saharan African Countries. 2003-2019. JAMA Netw Open. 2021 Dec 1;4(12):e2137820. doi: 10.1001/jamanetworkopen.2021.37820. Available from here. 

2. World Health Organisation, Scaling Up Tobacco Control Measure in Africa. 31 May 2024 [Internet] Accessed September 21, 2024] Available from here.

3. Boua, P.R., Soo, C.C., Debpuur, C. et al. Prevalence and socio-demographic correlates of tobacco and alcohol use in four sub-Saharan African countries: a cross-sectional study of middle-aged adults. BMC Public Health 21, 1126 (2021). doi: 10.1186/s12889-021-11084-1. Available from here.

4. Adeniji FI. Economic burden of tobacco consumption in Nigeria, 2013–2020: A prevalence-based attributable-risk approach. Population Medicine. 2023;5(September):23. doi:10.18332/popmed/171806. Available from here.

5. Le, TTT, Jaffri, MA. The association between smoking behaviors and prices and taxes per cigarette pack in the United States from 2000 through 2019. BMC Public Health 22, 856 (2022). doi: 10.1186/s12889-022-13242-5. Available from here.

6. Kaai SC, Sansone G, Meng G, Ong'ang'o JR, Goma F, Ikamari L, Quah ACK, Fong GT. Quasi-experimental evaluation of Kenya's pictorial health warnings versus Zambia's single text-only warning: findings from the International Tobacco Control (ITC) Project. Tob Control. 2023 Mar;32(2):139-145. doi: 10.1136/tobaccocontrol-2020-056396. Available from here.

7. Hu TW, Lee AH. Tobacco control and tobacco farming in African countries. J Public Health Policy. 2015 Feb;36(1):41-51. doi: 10.1057/jphp.2014.47. Available from here.

8. Egbe CO, Magati P, Wanyonyi E, et al Landscape of tobacco control in sub-Saharan Africa Tobacco Control 2022;31:153-159. doi: 10.1136/tobaccocontrol-2021-056540. Available from here.

9. The Press NZ News, Devastation and celebration at binning of smokefree legislation, [Internet] November 27, 2023. Accessed September 20, 2024. Available from here.

10. Albert A., New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic, Health Policy, Volume 147, 2024, 105123, doi: 10.1016/j.healthpol.2024.105123. Available from here.

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Published: October 15, 2024

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