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Tobacco companies interfere with health regulations, WHO reports

Tobacco industry is interfering with government attempts to regulate products and aggressively pursuing new markets in Africa, World Health Organization says

https://www.theguardian.com/world/2017/jul/19/tobacco-industry-government-policy-interference-regulations

Cigarette manufacturers are attempting to thwart government tobacco controls wherever possible, even as governments make progress regulating the products, a new World Health Organization report has found.

World health officials also warn that tobacco companies have moved their fight to the developing world, such as Africa, where smoking rates are predicted to rise by double digits in the coming decades.

“Tobacco industry interference in government policymaking represents a deadly barrier to advancing health and development in many countries,” said Douglas Bettcher, director of the WHO’s department for the prevention of noncommunicable diseases. “But by monitoring and blocking such activities, we can save lives and sow the seeds for a sustainable future for all.”

Tobacco-related diseases are the leading preventable cause of death worldwide. The products kill more than 7 million people each year – more than HIV and Aids, tuberculosis and malaria combined. The effects of the substance are also costly. Researchers believe that tobacco-related harm costs the world $1.4tn in healthcare costs and lost productivity.

A recent investigation by the Guardian found that tobacco companies, including British American Tobacco, threatened African countries with domestic and trade lawsuits if certain anti-smoking measures were put in place. BAT says it is not against all regulations but needs to take action from “time to time”.

A Reuters investigation found that BAT’s arch-rival, Philip Morris International, developed a vast lobbying campaign to delay and prevent tobacco controls. PMI says there is nothing improper about its executives engaging with government officials.

Wednesday’s WHO report, which was funded by Bloomberg Philanthropies, comes on the same day as a shareholder vote on a $49bn merger between BAT and Reynolds American Incorporated, a deal that would make BAT the largest listed tobacco company in the world.

“The epicentre of this epidemic has moved to the developing world,” said Dr Vera Luiza da Costa e Silva, head of WHO’s convention secretariat. “Low- and middle-income countries struggle to combat a tobacco industry seeking to pursue new markets, often through shameless interference with public health policymaking.”

Currently, the World Health Organization recommends countries put in place six regulations health officials see as critical to reducing smoking: systems to monitor smoking rates; laws to protect people from secondhand smoke; tools to help people quit; warnings about the dangers of tobacco use; enforcement of advertising bans, and increased taxes on tobacco products.

Six in 10 countries have implemented at least one of the six protections, officials said, four times the population that was protected in 2007.

However, progress is lopsided. Some recommendations have been far more widely accepted than others. For example, 3.5 billion people in 78 countries are protected by graphic warnings on cigarette packs, but only 15% of the world’s population is protected by a comprehensive advertising ban, and high tobacco taxes, while very effective, are one of the least-implemented measures.

Even some wealthier nations have had trouble getting tobacco control measures in effect. In the United States, for example, there are no graphic warnings on cigarette packs because of industry lawsuits and regulatory delay, and tobacco taxes remain low.

Anti-tobacco lawmakers and campaigners in the US blame the slow progress on “pervasive” tobacco industry influence, which reaches all the way to top officials in the Trump White House.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness,” said Tedros Adhanom Ghebreyesus, the WHO director-general. “Governments around the world must waste no time”.

Bloomberg Philanthropies funds Vital Strategies, which part funds the Guardian’s Tobacco: a deadly business series, the content of which is editorially independent.

Big Tobacco Accused of ‘Dirty War’ Against Smoking Prevention in Africa

In the past, Big Tobacco has been accused of covering up the true extent of the health risks associated with smoking, as well as fighting government restrictions. Now, a new investigation suggests that Big Tobacco is using strong-arm tactics to resist regulations in many parts of Africa.

http://www.care2.com/causes/big-tobacco-accused-of-dirty-war-against-smoking-prevention-in-africa.html

The Guardian reports that after reviewing court documents and other materials, it has uncovered a systematic wave of bullying and intimidation by British American Tobacco. And BAT is soon to close a deal that would make it the world’s leading tobacco company.

The exposé highlights attempts made by BAT to defang, or resist outright, regulation and restriction. For example, the company used threats of economic damage to fight higher taxes on cigarettes, a plan that is standard in the U.S. and much of Europe.

The Guardian reports:

In one undisclosed court document in Kenya, seen by the Guardian, BAT’s lawyers demand the country’s high court “quash in its entirety” a package of anti-smoking regulations and rails against what it calls a “capricious” tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

But we have seen these tactics before.

Starting as early as the 1970s, health warnings about cigarettes began to grab national attention. At that time, tobacco companies used every advertising and legal mechanism they could to prevent further regulation and to avoid plain packaging. As a result, some 70 years after the health dangers of cigarettes came to light, we are only now restricting tobacco in a way that seems appropriate to its risks.

While tobacco companies are in retreat in the West, African, Latin American and now Asian markets have become key areas of interest. As well as exploiting labor in these regions, tobacco companies now want to ensure that their products last long after the West has rejected cigarettes.

For its part, British American Tobacco has always claimed to abide by strict codes of conduct. The company has defended its use of the courts as a means to clear up ambiguous interpretations in local regulation and to ensure international regulations are being followed where appropriate.

British American Tobacco maintains that it does not oppose regulation per se and believes that reasonable restrictions on tobacco are warranted as, tobacco is a harmful product.

However, campaigners have long said that BAT falls short of that standard. Many African nations have signed on to the World Health Organization’s treaty on tobacco control, but that status still needs to be ratified, meaning that no uniform policies exist. Sub-Saharan Africa in particular has shown its vulnerability to manipulation by outside businesses with money.

The Guardian exposé highlights this clearly in one extract regarding tobacco regulation in Kenya:

Extract – letter
“If these measures are brought into effect, the economic and social impact will be extremely negative. They could even threaten the continuation of our factory which has operated in Bobo Dioulasso for more than fifty years with more than 210 salaried employees.”

Excerpt from letter from Imperial Tobacco to the prime minister of Burkina Faso, 25 January 2016, concerning new regulations on plain cigarette packaging and large graphic health warnings.

The Sunday Times has previously reported on an investigation which found that BAT sold cheaper, highly addictive cigarettes to Africans in the 1990s. The company also allegedly marketed smoking without sufficient health warnings.

BAT may dispute such claims or suggest that these are simply past infractions. However, more recent reports claim that people affiliated with BAT have attempted to bribe African officials to advance tobacco products in sub-Saharan Africa and to avoid certain regulations.

As of 2016, these allegations — made both by former BAT employees and by outside investigators — even prompted lawmakers in the U.S. Congress to call for a full investigation to determine whether BAT breached any laws due to its involvement in Africa.

Overall, tobacco use remains low across Africa. A major “Lancet” study published in 2010 puts cigarette smokers at about 14 percent of the total population — far below that seen in the Americas. However, data suggests that the rate of smoking uptake is rising at an alarming rate — by as much as four percent per year.

Will the Guardian’s revelations prompt further action against British American Tobacco? That remains to be seen, but we must do everything we can to help African nations get the full facts on tobacco’s health impacts and resist Big Tobacco’s strong-arm tactics.

Nairobi’s smoking culture – in pictures

In east Africa, the tobacco industry, including British American Tobacco, has been putting pressure on local governments over some of the regulations attempting to curb smoking.

https://www.theguardian.com/world/gallery/2017/jul/12/on-the-tobacco-road-david-levene-in-kenya

BAT says it is not against all regulation, but from ‘time to time’ needs to challenge it. BAT Kenya is currently taking a legal case to the country’s supreme court over some regulations.

Every year, more than 6,000 Kenyans are killed by tobacco-linked diseases, part of what the WHO calls the ‘biggest public health threats the world has ever faced’.

Campaigners say the industry is developing its African market and sees new potential customers as populations and prosperity grow there.

David Levene spent some time documenting the country’s smoking culture in Nairobi, noticing the prevalence of cigarette brands in daily life. This collection is gathered from his walks through the city

Facts from Tobacco Atlas

Smoking in public areas in highly restricted in Kenya. These two men sit back in one of central Nairobi’s smoking zones, as designated by the country’s ministry of health. Photograph: David Levene for the Guardian

Smoking in public areas in highly restricted in Kenya. These two men sit back in one of central Nairobi’s smoking zones, as designated by the country’s ministry of health.
Photograph: David Levene for the Guardian

Meru, Kenya - Over the past 50 years, Africa has seen a significant increase in tobacco farming. Many farmers suffer from green tobacco sickness, which shares symptoms with nicotine addiction and withdrawal. It’s simply caused by being in consistent contact with the plant, as nicotine can be absorbed through the skin especially when wet. Tanzania, Kenya’s southern neighbor, earns $50 million per year from tobacco but spends $40 million for tobacco- related cancers alone. Photograph: David Levene for the Guardian

Meru, Kenya – Over the past 50 years, Africa has seen a significant increase in tobacco farming. Many farmers suffer from green tobacco sickness, which shares symptoms with nicotine addiction and withdrawal. It’s simply caused by being in consistent contact with the plant, as nicotine can be absorbed through the skin especially when wet. Tanzania, Kenya’s southern neighbor, earns $50 million per year from tobacco but spends $40 million for tobacco- related cancers alone.
Photograph: David Levene for the Guardian

Approximately 176 million adult women worldwide are daily smokers and 37 women die every week in Kenya due to tobacco related complications. Photograph: David Levene for the Guardian

Approximately 176 million adult women worldwide are daily smokers and 37 women die every week in Kenya due to tobacco related complications.
Photograph: David Levene for the Guardian

A vendor sells single sticks in central Nairobi’s Uhuru Park. Most Kenyan smokers prefer this to buying whole packs, given the cost.Manufacturers are not allowed to produce cigarettes in packs of less than 10, and they say they want customers to purchase full packs, and that they work with vendors to encourage them to sell them this way.The World Health Organization estimates that people in low-income countries can spend as much as 10% of household income on tobacco products.Uhuru Park is also a key spot for Nairobi’s bourgeoning skate scene. Photograph: David Levene for the Guardian

A vendor sells single sticks in central Nairobi’s Uhuru Park. Most Kenyan smokers prefer this to buying whole packs, given the cost.Manufacturers are not allowed to produce cigarettes in packs of less than 10, and they say they want customers to purchase full packs, and that they work with vendors to encourage them to sell them this way.The World Health Organization estimates that people in low-income countries can spend as much as 10% of household income on tobacco products.Uhuru Park is also a key spot for Nairobi’s bourgeoning skate scene.
Photograph: David Levene for the Guardian

Excises taxes are still the most effective controls against tobacco. In Kenya, they make up 35% of retail price, similar to the US’s 38%. One of the elements of government plans that BAT Kenya is fighting in the court is a new tobacco industry tax.Clear adverts may be outlawed, but still, Kenyans know what is being sold. These red boxes are instantly recognizable. Photograph: David Levene for the Guardian

Excises taxes are still the most effective controls against tobacco. In Kenya, they make up 35% of retail price, similar to the US’s 38%. One of the elements of government plans that BAT Kenya is fighting in the court is a new tobacco industry tax.Clear adverts may be outlawed, but still, Kenyans know what is being sold. These red boxes are instantly recognizable.
Photograph: David Levene for the Guardian

The afternoon sets on Enterprise Road in Nairobi’s industrial zone. Photograph: David Levene for the Guardian

The afternoon sets on Enterprise Road in Nairobi’s industrial zone.
Photograph: David Levene for the Guardian

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A smoker in a Nairobi smoking zone Photograph: David Levene for the Guardian

A Nairobi smoking zone Photograph: David Levene for the Guardian

A Nairobi smoking zone
Photograph: David Levene for the Guardian

Nairobi, Kenya Photograph: David Levene for the Guardian

Nairobi, Kenya
Photograph: David Levene for the Guardian

The combined revenues of the world’s 6 largest tobacco companies in 2013 was USD342 Billion, 85% larger than the Gross National Income of Kenya Photograph: David Levene for the Guardian

The combined revenues of the world’s 6 largest tobacco companies in 2013 was USD342 Billion, 85% larger than the Gross National Income of Kenya
Photograph: David Levene for the Guardian

Threats, bullying, lawsuits: tobacco industry’s dirty war for the African market

Revealed: In pursuit of growth in Africa, British American Tobacco and others use intimidatory tactics to attempt to suppress health warnings and regulation

https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market

British American Tobacco (BAT) and other multinational tobacco firms have threatened governments in at least eight countries in Africa demanding they axe or dilute the kind of protections that have saved millions of lives in the west, a Guardian investigation has found.

BAT, one of the world’s leading cigarette manufacturers, is fighting through the courts to try to block the Kenyan and Ugandan governments’ attempts to bring in regulations to limit the harm caused by smoking. The giant tobacco firms hope to boost their markets in Africa, which has a fast-growing young and increasingly prosperous population.

In one undisclosed court document in Kenya, seen by the Guardian, BAT’s lawyers demand the country’s high court “quash in its entirety” a package of anti-smoking regulations and rails against what it calls a “capricious” tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

BAT in Uganda asserts in another document that the government’s Tobacco Control Act is “inconsistent with and in contravention of the constitution”.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

Extract – court document

“The Regulations are unlawful in their entirety as a result of procedural impropriety … The warning requirements [on cigarette packets] constitute an unjustifiable barrier to international trade.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, 16 April 2015

BAT denies it is opposed to all tobacco regulation, but says it reserves the right to ask the courts to intervene where it believes regulations may not comply with the law.

Later this month, BAT is expected to become the world’s biggest listed tobacco firm as it completes its acquisition of the large US tobacco company Reynolds in a $49bn deal, and there are fears over the extent to which big tobacco can financially outmuscle health ministries in poorer nations. A vote on the deal by shareholders of both firms is due to take place next Wednesday, simultaneously in London at BAT and North Carolina at Reynolds.

Professor Peter Odhiambo, a former heart surgeon who is head of the government’s Tobacco Control Board in Kenya, told the Guardian: “BAT has done as much as they can to block us.”

Experts say Africa and southern Asia are urgent new battlegrounds in the global fight against smoking because of demographics and rising prosperity. Despite declining smoking and more controls in some richer countries, it still kills more than seven million people globally every year, according to the WHO, and there are fears the tactics of big tobacco will effectively succeed in “exporting the death and harm” to poorer nations.

There are an estimated 77 million smokers in Africa and those numbers are predicted to rise by nearly 40% from 2010 levels by 2030, which is the largest projected such increase in the world.

In Kenya, BAT has succeeded in delaying regulations to restrict the promotion and sale of cigarettes for 15 years, fighting through every level of the legal system. In February it launched a case in the supreme court that has already halted the imposition of tobacco controls until probably after the country’s general election in August, which are being contested by parliamentarians who have been linked to payments by the multinational company.

Extract – court document

“[A proposal for a new 2% tax on the industry in Kenya] … is arbitrary, capricious and inaccessible … it will have a significant effect on cigarette manufacturers and importers putting at risk further investment and direct and indirect employment opportunities in Kenya.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, April 16th 2015

In Uganda, BAT launched legal action against the government in November, arguing that the Tobacco Control Act, which became law in 2015, contravenes the constitution. It is fighting restrictions that are now commonplace in richer countries, including the expansion of health warnings on packets and point-of-sale displays, arguing that they unfairly restrict its trade.

The court actions are brought by BAT’s local affiliates, BAT Kenya and BAT Uganda, but approved at Globe House, the London headquarters of the multinational, which receives most of the profits from the African trade. In its 2016 annual report, BAT outlined the “risk” that “unreasonable litigation” would be brought in to control tobacco around the world. Its response was an “engagement and litigation strategy coordinated and aligned across the Group”.

‘Focus on emerging markets’

At its annual meeting in March, chairman Richard Burrows toasted a “vintage year” for BAT, as profits rose 4% to £5.2bn after investors took their cut – their dividend had increased by 10%. When asked about the legal actions in Africa, he said tobacco was an industry that “should be regulated … but we want to see that regulation is serving the correct interests of the health mission and human mission which should lie behind it”.

Extract – court document

“Your Petitioner alleges and shall demonstrate that the Tobacco Control Act, read as a whole, has the effect of unjustifiably singling out the tobacco industry for discriminative treatment.”

A petition of British American Tobacco Uganda in the constitutional court against the Ugandan government’s Tobacco Control Act

So, “from time to time it’s necessary for us to take legal action to challenge new regulation” which he said was led by “the local board”.

BAT says it is “simply not true that we oppose all tobacco regulation, particularly in developing countries”. Tobacco should be appropriately regulated as a product that has risks to health, it said, but “where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it”. It was opposed to only a handful of the issues in Kenya’s regulations, not the entirety, it said in a statement.

Although most countries in Africa have signed the World Health Organisation (WHO) treaty on tobacco control, none has yet fully implemented the smoking restrictions it endorses.

The WHO predicts that by 2025, smoking rates will go up in 17 of the 30 Africa-region countries from their 2010 level. In some countries a massive hike is expected – in Congo-Brazzaville, from 13.9% to nearly half the population (47.1%) and in Cameroon from 13.7% to 42.7%. In Sierra Leone it will be 41.2% (74% among men) and in Lesotho 36.9%.

In contrast, research showed last year that just 16.9% of adults smoke in the UK; and last month new figures showed UK heart disease deaths had fallen 20% since that country’s indoor smoking ban.

“The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continent’s patchwork tobacco control regulations and limited resources to combat industry marketing advances,” said Dr Emmanuela Gakidou and colleagues at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, publishing an analysis of smoking prevalence around the world in the Lancet in April.

Extract – letter

Uganda’s economy has “benefitted… significantly” from BAT’s tobacco business, employing 200 Ugandans and 1500 extra in the tobacco buying season. “This has helped to alleviate poverty and improve welfare in urban and rural areas …”

Extracts of a letter from Jonathan D’Souza, managing director of BAT Uganda to the chairperson of the Uganda Parliamentary committee on health, 14 April 2014

Africa’s growing numbers of children and young people, and its increasing wealth, represent a huge future market for the tobacco industry. The companies deny targeting children and cannot sell packs smaller than 10, but a new study carried out in Nairobi by the Johns Hopkins school of public health in the US and the Kenya-based Consumer Information Network found vendors selling cigarettes along the routes children take to walk to primary schools.

WHO-congo-smoke

Stalls sell single Dunhill, Embassy, Safari and other BAT cigarette sticks, costing around 4p (5 cents) each, alongside sweets, biscuits and fizzy drinks. The vendors split the packets of 20 manufactured by BAT. “They are targeting children,” said Samuel Ochieng, chief executive of the Consumer Information Network. “They mix cigarettes with candies and sell along the school paths.”

BAT said that its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, “given our investment in the brands and the fact there are clear health warnings on the packs.

“Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.”

Links with politicians

The Kenya case, expected to be heard after the elections on 8 August, is seen as critical for the continent. If the government loses, other countries will have less appetite for the long and expensive fight against the wealthy tobacco industry.

BAT has around 70% of the Kenyan market; its Kenyan competitor, Mastermind, has joined in the legal action against the government.

Extract – letter

“If these measures are brought into effect, the economic and social impact will be extremely negative. They could even threaten the continuation of our factory which has operated in Bobo Dioulasso for more than fifty years with more than 210 salaried employees.”

Excerpt from letter from Imperial Tobacco to the prime minister of Burkina Faso, 25 January 2016, concerning new regulations on plain cigarette packaging and large graphic health warnings.

Concerns have been raised about links between politicians and the tobacco companies. “There are allegations of some of them having been bribed in the past,” said Joel Gitali, chief executive of the Kenya Tobacco Control Alliance.

BAT whistleblower Paul Hopkins, who worked in Africa for BAT for 13 years, told a British newspaper he paid bribes on the company’s behalf to the Kenya Revenue Authority for access to information BAT could use against its Kenyan competitor, Mastermind. Hopkins has also alleged links between certain prominent opposition Kenyan politicians and two tobacco companies, BAT Kenya and Mastermind. Hopkins, who says he alerted BAT to the documents before the company made him redundant, claimed BAT Kenya paid bribes to government officials in Burundi, Rwanda and the Comoros Islands to undermine tobacco control regulations. Gitali is concerned about the outcome of the election: “If the opposition takes over government we shall be deeply in the hands of the tobacco companies.”

BAT denies any wrongdoing. A spokesperson said: “We will not tolerate improper conduct in our business anywhere in the world and take any allegations of misconduct extremely seriously. We are investigating, through external legal advisors, allegations of misconduct and are liaising with the Serious Fraud Office and other relevant authorities.”

Extract – letter

“Once the decision to smoke is taken by an adult smoker, the pack provides adult consumers with pertinent information”

British American Tobacco letter to the prime minister of Gabon, 1 January 2012

‘We grow up dreaming we can be one of them’

Tih Ntiabang, regional coordinator for Africa of the Framework Convention Alliance – NGOs that support the WHO treaty – said the tobacco companies had become bolder. “In the past it used to be invisible interference, but today it is so shameful that it is so visible and they are openly opposing public health treaties like the case in Kenya at the moment … Today they boldly go to court to oppose public health policy. Every single government is highly interested in economic growth. They [the tobacco companies] know they have this economic power. The budget of tobacco companies like BAT could be as much as the whole budget of the Africa region.

“Our health systems are not really well organised. Our policy makers can’t see clearly what are the health costs of inaction on tobacco control because our health system is not very good. It puts the tobacco industry at an advantage on public health.”

The sale across the whole of Africa of single cigarette sticks was a serious problem because it enabled children to buy them. “They are extremely affordable. Young teenagers are able to purchase a cigarette. You don’t need £1 for a pack of 20,” he said.

WHO-africa-deaths

BAT has a reputation in Africa as an employer offering steady and well-paid jobs, said Ntiabang, based in Cameroon. “When I was about 10, I was always dreaming I could work for BAT. They have always painted themselves as a responsible company – a dream company to work for. All the staff are well-off. The young people think ‘I want to work for BAT’. They promote a lot of events and make their name appear to young people. We grow up dreaming we can be one of them.”

In Uganda in 2014, BAT managing director, Jonathan D’Souza, sent a 13-page detailed attack on the tobacco control bill, then going through parliament, to the chair of the government’s health committee.

BAT was contracting with 18,000 farmers and paid them 61bn Ugandan shillings for 16.8m kg of tobacco in 2013, said the letter. The economy has “benefited significantly” from BAT Uganda’s investments, it said. “This has helped to alleviate poverty and improve welfare in urban and rural areas,” it says.

Extract – letter

“The draft regulations which you have published deal with a wide range of issues which will have a massive impact not only on the tobacco industry but also on a wider scale on the Namibian economy at large.”

Excerpt from a letter from the general manager of BAT in Namibia to the minister of health and social services, 17 November 2011

BAT Uganda (BATU) agreed tobacco should be regulated while “respecting the informed choices and rights of adults who choose to smoke and the legal rights of a legal industry”. But it cited 11 “areas of concern”, claiming there is no evidence to support a ban on tobacco displays in shops, that large graphic health warnings on packs are ineffective, that proposals on bans on smoking in public places were too broad and that prohibiting smoking under the age of 21 was unreasonable, since at 18 young people are adults and can make up their own mind.

Documents made public by the University of Bath show that BATU had another concern: the ban on the sale of cheap single cigarettes. Adults should be “free to purchase what they can afford”, says an internal leaked paper. BATU also took action against the MP who sponsored the bill. A letter informed him that the company would no longer be contracting with the 709 tobacco farmers in his region. There is evidence that the company also lobbied other MPs with tobacco farmers in their constituencies.

The Tobacco Control Act became law in 2015, and in November last year, BAT sued. Many people choose to smoke, said an affidavit to the court from managing director Dadson Mwaura and it was important to ensure regulation did not lead to “unintended consequences that risk an untaxed and unrestrained illegitimate trade in tobacco products”. BATU’s legal product contributed to the Ugandan economy “in many dimensions”.

The Guardian has seen letters showing that at least six other African governments have faced challenges from the multinational tobacco companies over their attempts to control smoking.

Democratic Republic of Congo: Letter to the president sent in April 2017 by the Fédération des Entreprises du Congo (chamber of commerce) on behalf of the tobacco industry, listing 29 concerns with the proposed tobacco control regulations, which they claim violate the constitution, international agreements and domestic law.

Burkina Faso: Letter sent in January 2016 to the minister of health from Imperial Tobacco, warning that restrictions on labeling and packaging cigarettes risks economic and social damage to the country. Previous letter sent to the prime minister from the US Chambers of Commerce in December 2013 warning that large health warnings and plain packaging could put Burkina Faso in breach of its obligations to the World Trade Organisation.

Ethiopia: Letter sent in February 2015 to the ministers of health and science and technology by Philip Morris International, claiming that the government’s tobacco directive banning trademarks, brands and added ingredients to tobacco breached existing laws and would penalise all consumer retailers.

Togo: Letter to the minister of commerce in June 2012 from Philip Morris International opposing plain packaging, which “risks having damaging consequences on Togo’s economy and business environment”.

Gabon: Letter from BAT arguing that there is no evidence that plain packaging reduces smoking, citing the Deloitte report of 2011, alleging its introduction would put Gabon in breach of trade agreements and promote smuggling.

Namibia: Letter to the minister of health from BAT, warning that planned tobacco controls will have “a massive impact … on the Namibian economy at large”.

Extract – memo

“As a country whose economy heavily relies on exports, Togo can ill afford to anger its international partners by introducing plain packaging.”

Excerpt from memo on plain packaging from chief executive of Philip Morris West Africa to the minister of commerce of Togo, to reiterate its concerns following a meeting, 21 June 2013

Bintou Camara, director of Africa programs at Campaign for Tobacco-Free Kids, said: “British American Tobacco, Philip Morris International and other multinational tobacco companies have set their sights on Africa as a ‘growth market’ for their deadly products”. Throughout Africa, tobacco companies have tried to intimidate countries from taking effective action to reduce tobacco use, the world’s leading cause of preventable death, he added.

“Governments in Africa should know that they can and should move forward with measures aimed at preventing and reducing tobacco use – and that they do so with the support of the many governments and leaders around the world that have taken strong action to protect public health.”

Cloe Franko, senior international organizer at Corporate Accountability International, said: “In Kenya, as in other parts of the world, the industry has resorted to frivolous litigation, aggressive interference … to thwart, block, and delay lifesaving policies. BAT’s actions are emblematic of a desperate industry grasping to maintain its hold over countries and continue to peddle its deadly product.”

Philip Morris said it is regularly engaged in discussions with governments. “We are approached by or approach public authorities to discuss a range of issues that are important for them and for us, such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best.” It said that it supports effective regulation, “including laws banning sales to minors, mandatory health warnings, and advertising restrictions”.

Imperial Tobacco said it sold its brands “where there’s a legitimate and existing demand for tobacco and take the same responsible approach in Africa as we do in any Western territory”. A spokesman said it supported “reasonable, proportionate and evidence-based regulation of tobacco”, including “health warnings that are consistent with global public health messages”. But, it said, Imperial would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

WHO urges government to control tobacco use

The World Health Organisation (WHO) has urged the government to introduce policies to control the use of tobacco because it is a leading risk factor for some serious non-communicable diseases.

The Country Representative of WHO, Dr Owen Kaluwa, who made the call suggested, for instance, the imposition of high taxes on tobacco companies to deter them from going into production.

http://www.graphic.com.gh/news/general-news/who-urges-government-to-control-tobacco-use.html

In the event of the companies paying such taxes, he said, the revenue generated should be used to finance health delivery.

He was speaking at a public forum to mark World No-Tobacco Day (WNTD) in Accra last Wednesday.

Avoid tobacco

Dr Kaluwa said globally, tobacco kills about 7.2 million people every year, over 80 per cent of whom are from low or middle-income countries.

“In Africa, about 146,000 adults aged 30 years and above die every year due to tobacco-related health diseases,” he added.

He said the use of tobacco was a leading preventable risk factor for non-communicable diseases such as cardiovascular diseases, cancer and chronic lung disease.

“Up to half of all tobacco users will die prematurely from tobacco-related causes, and on average, tobacco users lose 15 years of their lives,” he said.

Mr Kaluwa added that the growing of tobacco had affected agricultural lands in some areas.

Public education

At her turn, a Deputy Minister of Health, Mrs Tina Mensah, said adequate public education was important in dealing with the problem of tobacco use.

She reiterated the fact that tobacco use was dangerous to human health and damaging to national economic development.

“Tobacco-related illnesses and premature mortality impose direct and indirect cost to individuals and government,” she said.

She noted that tobacco production companies tried to influence the young generation to become addicted to smoking, which was a national threat.

She applauded the Food and Drugs Board (FDB) for its intervention in combating the use of tobacco by preventing tobacco companies from advertising their products.

Mrs Mensah said the ministry, for its part, would continue to support the fight against the use of tobacco in the country.

Preventive measures

Outlining some measures that had been put in place to check tobacco usage, the Chief Executive Officer (CEO) of the FDA, Mrs Delese A. Darko, mentioned the prohibition of smoking in public places, advertising prohibition and sponsorship as examples.

She added that packaging, labelling and health warnings on tobacco packages were other ways of preventing and discouraging tobacco consumers from patronising the product.

“These prohibitions have shown to be effective in reducing the demand for tobacco,” she said, adding that public sensitisation and education would, accordingly, be increased to meet the target groups.

“As we get funding, we will continue to do more to inform the public about the harmful effects of the use of tobacco,” Mrs Mensah said.

In connection with the celebration, Smoking Cessation Guidelines and a declaration on WNTD 2017 were launched.

Zimbabwe: Tobacco Farmers Wreak Havoc On Forests

By Problem Masau

As the vehicle negotiated Hurungwe District’s rugged terrain, weaving through countless tree stumps, it was difficult to imagine that once upon a time, the area was a dense forest.

http://allafrica.com/stories/201706020677.html

Years of deforestation by tobacco farmers seeking wood for their barns have taken a serious toll on the country’s indigenous forests.

The situation continues to get worse as few new trees are being grown where the old are being cut down by an increasing number of farmers turning to tobacco farming.

Most farmers in Hurungwe have since abandoned maize farming for tobacco, citing low prices and viability challenges they have faced in growing maize.

With more than 98 000 registered tobacco farmers, up from just 600 in 2000, Zimbabwe’s forests are indeed under siege.

According to the Forestry Commission, every year the southern African nation is losing more than 300 000 hectares of forests to deforestation.

At least 15 percent of the destruction is attributable to tobacco farmers.

Previously, tobacco farmers would mainly cure their crop using coal, but wood has become the cheapest and readily available fuel for the army of farmers who have migrated to tobacco.

Under these circumstances, finding a lasting solution to the increasing deforestation is near impossible.

But the solution could come from a most unusual source: Bees.

Arnold Guzha, who chairs the Mudzimu Bee Keeping Group, said bee-keeping was bringing double benefits to the Hurungwe community.

“As well as earning money from selling our honey, we have also started taking more care of our forests because this is where the bees live and build their natural hives,” he said.

“We have not used our forests wisely until now. Instead of cutting down trees, we are keeping them. If we had started our honey activities a few years ago, we would have known to make wiser use of this natural resource,” he added.

Guzha is among an estimated over 6 000 full-time beekeepers in Zimbabwe.

The beekeepers have support from farmers who are still growing maize.

“Our culture preserved forests by labelling them sacred. No one ever dared to cut down trees, but tobacco farmers in this area have wrecked havoc and if nothing is done to stop them our trees will become extinct,” said Vian Bhachi, a maize farmer who has watched Hurungwe forests vanish.

He added that herbalists in the area were now walking long distances in search of herbs.

“Indigenous trees are very helpful in many ways and parents are struggling to find certain trees for herbs when children experience stomach ache,” added Bhachi.

The Forestry Commission, which is responsible with preservation of forests, is now hoping that the enactment of a law through a Statutory Instrument (SI), could help force farmers to plant trees. The SI is currently being crafted, said Forestry Commission general manager, Darlington Duwa.

Duwa said: “The instrument will force farmers to set aside land for the growing of trees to be used during tobacco curing and these will be fast growing trees. Our research division is working on fast growing tree varieties and the law we are talking about is almost 80 percent complete and should come into effect very soon.”

Despite these efforts tobacco farmers says they have very little choice but to rely on the indigenous forest for fuel wood.

“Firewood is the only available source of fuel we can secure to cure our tobacco, we know the government policy on indiscriminate cutting down of trees but we are left with no choice. The advantage of indigenous trees is that they are flammable and last long,” said one farmer Forward Chigara.

 

Stamps mandated for tobacco products

The Tax Authoritiy (AT) has introduced a “control” stamp on tobacco products and plans the same for alcohol to reduce revenue loss from illicit trade, the AIM news agency reported.

http://www.tobaccojournal.com/Stamps_mandated_for_tobacco_products.54149.0.html

All imported and domestically manufactured products must bear the stamp to be sold legally, said AIM, the Agência de Informação de Moçambique. Amelia Nakhare, AT chairperson, said the new stamp would have a significant impact on government revenue and the country’s fiscal organisation, AIM said. She reportedly announced the new stamp during a visit to the British American Tobacco factory in Maputo, where cigarettes bearing the new seal were being manufactured.

Mozambique: Control Stamps Obligatory for Tobacco

Maputo — In an attempt to stamp out contraband, the Mozambican Tax Authority (AT) has banned the production, import and sale of tobacco products that do not carry an official control stamp.

http://allafrica.com/stories/201703200767.html

This measure has been in force since Friday, and was announced by AT chairperson, Amelia Nakhare, when she visited the Maputo factory of British American Tobacco (BAT), where she witnessed the production of packets of cigarettes bearing the stamp. The obligatory use of stamps will also be extended to alcoholic drinks.

According to Nakhare, a study undertaken in 2012, by exports of the Southern African Development Community (SADC), indicated that smuggling and contraband account for about 60 per cent of the alcoholic drinks consumed in Mozambique. (It was not clear how much of the tobacco smoked in Mozambique was contraband).

An earlier study, in 2009, showed that contraband alcohol cost the state about 2.8 million US dollars in lost revenue a year. 66 per cent of the drinks sold on the market came from illicit sources.

Nakhare said that no tobacco products without the stamp may be sold legally. She expected this move “to have a significant impact, not only on revenue, but also on the country’s fiscal organization”.

Sudan Scholars – ‘Tobacco Not Allowed in Islam’

Last week, the head of the Sudan Scholars Corporation issued a religious decree banning tobacco.

http://allafrica.com/stories/201701090127.html

Sheikh Mohamed Osman Saleh, head of the Sudanese Scholars Corporation told the state-owned Sudan News Agency (SUNA) last week that tobacco is forbidden in Islam.

The use of tobacco is no less dangerous and evil than the use of drugs, Saleh said.

He demanded the Sudanese security apparatus to combat the cultivation, sale, and use of tobacco in all parts of the country.

Asked about the donation of the North Darfur government of 10,000 tons of tobacco in support of the ruling National Congress Party, the sheikh said that the gift consisted of various in-kind materials. He accused the Sudanese media of highlighting the tobacco item, “for the purpose of creating sensation and chaos”.

In response, former North Darfur government adviser on economic affairs Rashid Ismail told reporters in Khartoum that “the fierce attack against tobacco trade in the country has led to the idea that it is something abnormal”.

According to Ismail, “the recent campaign against tobacco is probably intended to hit the Darfur economy. It will put the livelihoods of 900,000 Darfuris at stake”.

The price of Africa’s puff

It is still one of the biggest businesses in Africa despite all the efforts from the government trying to stamp it out. The tobacco industry makes over $700 billion a year and seems to survive advertising bans and restrictions. Part of this business is African children who work for a dollar a day. The article below first appeared in Forbes Africa and is republished with its permission. Subscribe today by contacting Shanna Jacobsen Shanna.Jacobsen@abn360.com

http://www.cnbcafrica.com/news/special-report/2017/01/05/africa-cigarettes-and-smoking/

It’s 5am in the northern hills of Malawi where its tobacco is grown. Chifundo Ndilowe is awake and ready for the day. Dressed in grey shorts and a blue NBA vest, still filthy from yesterday’s long day on the farm, Ndilowe has hours of hard labour ahead. He is just 15 years old and has been planting and picking tobacco since he was 10.

“I came here in 2011 because rural life is hard. We were battling at home and I had to start contributing for us to survive. I stopped going to school to work. It is very tough working under these conditions because it is hot and we easily get tired and I am often sick,” he says.

Ndilowe moved 567 kilometres from Mulanje to Mpherembe, 300 kilometres north of Malawi’s capital, Lilongwe, to work in a tobacco farm five years ago. It means long hours, missing school and breaking the law for little pay. He earns a little more than $140 and $280 a year depending on the harvest. That’s less than $1 a day.

“We work for the year and only get paid after harvest. During the year, we get 20 kilograms of maize for 12 days because we don’t grow crops for consumption. They also give us salt and then we have to figure out the rest ourselves. I get to eat once a day and I take whatever is there,” he says.

Ndilowe is just one of an estimated 800,000 youngsters in the tobacco fields; voices that are seldom heard. One of an army of children who sweat for millions of cigarettes lit all over Africa.

A study on child labour in the tobacco industry in two areas of Malawi, Suza in the Kasungu district and Katalima in the Dowa district, found 57% of all children were being used as child labour in the tobacco fields.

George Kube, an adult tobacco worker, works with Ndilowe and two other children.

“There is no money for the children to go to school and if they don’t work to help we wouldn’t survive. We farm on two acres of land and the produce is auctioned to tobacco companies. You have to be very strong if you are going to do this job because sometimes we have to cut down trees and look for water,” says Kube.

A study, published by the British Medical Association, says contract farmers, like Kube and Ndilowe, cultivating tobacco in Malawi, live below national poverty lines, while independent farmers operate at a loss.

“Even when labour is excluded from the calculation of income less costs, farmers’ gross margins place most households in the bottom income [groups] of the overall population. Tobacco farmers appear to contract principally as a means to obtain credit, which is consistently reported to be difficult to obtain,” says the study.

Tobacco farmers may struggle to make a living but tobacco manufacturers thrive. The world tobacco industry is worth billions of dollars. Cigarette retail values in 2014 were worth US$744 billion and over 5.6 trillion cigarettes were sold to more than one billion smokers according to the Campaign for Tobacco-Free Kids. But, very few farmers make money from it.

The market is controlled by a few international companies; China National Tobacco Corporation, Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Brands. They buy tobacco from cheap emerging markets, like Malawi, for profit.

For years, governments around the world have been trying to clamp down on smoking because of its health implications, through stringent laws and higher taxes, yet tobacco use is increasing in some countries, says Zambian economist Grieve Chelwa.

“African incomes have been rising over the last couple of years and we know that tobacco consumption responds to rising incomes. Further, tobacco companies have put in place strategies (subtle advertising) to take advantage of rising incomes.”

And they flourish.

In 2016, British American Tobacco (BAT) announced its revenue went up 8.1% at constant rates of exchange, cigarette volume from subsidiaries was 497 billion, up by 2.2%, cigarette market share in key markets increased by 40 basis points and its brands performed exceptionally well with cigarette volume up 9.8% year ending September 30.

BAT plans to merge with its US partner R.J. Reynolds Tobacco Company, the company behind the famous camel cigarette brand, in a deal valued at $47 billion. It hopes to create a stronger global presence and move into new ventures like e-cigarettes.

In its third quarter, Philip Morris International reported net revenues of $19.9 billion, up by 2.6%, net revenues, excluding excise taxes, of $7 billion, up by 0.8%, operating income of $3 billion, up by 0.6%, and operating company’s income of $3.1 billion, up by 1.2%. In Africa, companies thrive because of weak regulation.

The World Health Organization (WHO) has a 75% benchmark of tax on the retail price, yet the African average is way below. Nigeria taxes cigarettes at only 20% of the retail price. Chelwa says ideally increasing taxes to reduce tobacco use should work anywhere because of the law of demand, increasing price reduces demand.

“But, the important point is the increases have to be real-inflation adjusted increments,” he says.

In Africa, high tobacco taxes are rare. WHO says only 33 countries, with 10% of the world’s population, have introduced taxes on tobacco products of more than 75%.

Tobacco tax revenues are on average 269 times higher than spending on tobacco control.

Tobacco companies are also good at finding new markets, with new smokers and weak regulations. According to an article published by The Lancet, a UK medical journal, tobacco use is declining in higher income countries, but nearly 80% of the world’s smokers live in low and middle income countries.

“Tobacco control regulations are not strong across most of the continent. Countries have ratified the Framework Convention on Tobacco Control (FCTC) but that’s all they have done. And sadly the tobacco industry is an important player in the setting of tobacco control policy in most African countries,” says Chelwa.

For years, tobacco companies argue they market merely to convince smokers to switch brands, but evidence published by the National Center for Biotechnology Information shows advertising drives smoking.

According to a WHO study, smoking has increased in 27 countries over the past 15 years. Seventeen of these are in Africa. In Cameroon, smokers more than doubled from 7% in 2000 to 22% last year. Congo-Brazzaville has seen the biggest spike. Nearly half of Congolese men smoke. Last year, 22% of its people admitted to smoking regularly, up from 6% in 2000.

“Only 42 countries, representing 19% of the world’s population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs,” says WHO.

In South Africa, cigarette advertising is banned. There are also restrictions on point of sale product display, vending machines and sponsorship of events, activities, individuals, organizations or governments. Now, Health Minister Aaron Motsoaledi has pledged to take it further by strengthening the Tobacco Products Control Act.

Motsoaledi says there should be no branding, no logos and no colors on cigarettes to discourage smoking. If the law is introduced, all cigarettes will be in a brown package with graphics that show the damage they can cause.

This is worrying for the tobacco industry. Christo van Staden heads the only primary tobacco processing factory in South Africa, Limpopo Tobacco Processors, that processes 12 million kilograms of tobacco. He says the effects could be catastrophic.

“The biggest impact [of tougher regulations] is the increase in illicit cigarettes which is a huge dent in the business of BAT and in the whole market. About 20 to 30 percent of cigarettes in Gauteng are illicit and they are paid way below the price,” he says.

As we meet, in Rustenburg, a two-hour drive from Johannesburg, Van Staden’s farmers have lost 30 hectors of tobacco to a passing storm. On this day, the sun blazes down from a cloudless azure sky. A sprinkler keeps the glossy lawns and flowers alive. Inside the factory, it is dark and you can hear a pin drop. The silence is almost tangible. There is no bustle and machines that usually crackle stand still. It is not tobacco season. All employees are upstairs in the offices working. Dressed in khaki shorts and shirt, Van Staden says tobacco farming is hard.

“For every hector, you need two people to work there and pick it by hand, it is very expensive. One hector costs about R130,000 ($9,500) to plant and the farmer needs to make at least 20 to 25 percent profit. Last year was a very tough year. There were very tough conditions and an average farmer did not make any profit at all.”

“Now they are supporting the local market but if they don’t get any benefit out of that, they have to compete with everyone else in plain packaging, then there is no reason for them to buy South African tobacco, they will literally walk out of here overnight and source their product from Brazil, India and China where they can buy a lot cheaper.

We are not ready for that. We would close these doors,” he says.

For Van Staden, closing doors means 10,000 farmers lose their income. He thinks there should be more education about the dangers of tobacco and efforts to keep youngsters away from smoking.

“I am a non-smoker and will not advise anyone to smoke. Most of my staff members don’t smoke. Unfortunately, people smoke everyday but see the warning on the packets and turn a blind eye. Because it’s such an unhealthy product, the governments around the world will try and eradicate it but I don’t think it will happen in the next 20 years. There are laws in this country that allow people to smoke and to close down the primary sector is not going to stop smoking overnight,” adds Van Staden.

South Africa will follow the UK, Ireland, Australia and France in banning branded packaging.

In Uganda, 4,800 kilometres from South Africa, it’s even tougher. If you light up in bars, restaurants or hotels, you will be fined $60 or jailed for up to two months.

Smokers must be at least 50 meters away from public spaces, such as schools, hospitals and taxi ranks.

Uganda’s new laws also ban the sale of electronic cigarettes, flavoured tobacco for water pipes, the sale of single cigarettes and tightened rules on labelling, advertising and selling tobacco to under-21s.

“We are strongly opposed to plain packing as we feel that there hasn’t been enough consultation and research on it. Our concern is the serious adverse consequences that it will have on the economy, jobs and investment; as well as potentially making counterfeit easier. It trounces fundamental intellectual property rights and freedoms guaranteed by the constitution,” says Joe Heshu, Acting Head of External Affairs at BAT.

According to Heshu, counterfeit cigarettes are a bigger issue. In 2015, South Africa’s Treasury lost R5.1 billion ($373 million) due to illicit trade. The trade accounts for about 24% of the market.

South Africa has been increasing tobacco taxes since 1994 and the big impact has been the reduction in consumption and prevalence, but Chelwa agrees there has been a minimal impact of the taxes on illicit trade.

“Illicit trade often has to do with tax administration and not taxes. Even if taxes were a cent, you’d still have illicit trade showing that it is not a tax level or tax rate issue but a tax administration issue,” he says.

On jobs, Chelwa argues “there are very few tobacco manufacturing jobs, very few given how mechanized manufacturing of cigarettes is.”

The big worry he says is in the field.

“Governments have to consciously find ways of transitioning tobacco farmers into growing other types of crops. This will require a lot of work,” says Chelwa.

Asked if he thinks cigarettes are killers, Heshu argues his company has launched e-cigarettes, which are supposedly less harmful products, in the UK, France, Germany, Italy and Poland.

“We are committed to the research and development of Next Generation Products (NGPs) and globally have invested over half a billion pounds during the past five years.

There is a growing body of evidence that NGPs do pose significantly fewer risks than cigarettes.”

For now, tobacco companies continue to thrive. Only 29 countries, representing 12% of the world’s population, have completely banned all forms of tobacco advertising, promotion and sponsorship, according to WHO.

Some of Malawi’s tobacco, grown by the likes of Ndilowe and Kube, is shipped 2,000 kilometers south of Mpherembe. In South Africa, 19% of the population, over the age of 15, smokes according to the World Bank. That’s almost one in five people and it is dangerous.

Tobacco is responsible for six million deaths each year. Of those, 600,000 die from the effects of second-hand smoke. This number is expected to increase to eight million by 2030 if current trends continue, says WHO.

Alexandra chain smoker, Mpho Ndlovu, knows this, yet he goes through three packs of cigarettes a day.

“I have been smoking since I was 15. It started as just playing with friends at school because we knew we weren’t allowed to. It was a way of being cool. I got hooked and have been smoking for 40 years,” says Ndlovu.

What started as a game became a habit and then an addiction.

“Smoking helps me when I’m nervous and I just enjoy it. I have tried to stop many times but have failed. I know this might one day kill me but, at this point, there is nothing I can do.”

Ndlovu spends R110.50 ($8) per day on cigarettes. That’s R766.50 ($56) per week and R3,066 ($225) per month and R36,792 ($2,700) per year and R183,960 ($13,500) in five years. If he continues smoking the same number of cigarettes per day for another 40 years, at this current price, he will spend around $100,000 on cigarettes. If invested, he could buy a house.

Ndlovu spends close to half of his R7,000 ($500) salary he makes working as a driver for a logistics company in Sandton.

“By the last week of the month, I would be out of money and sometimes I have to ask people if I can borrow or take some on credit from the spaza shop,” he says.

“When I smoke, especially on weekends, I drink as well. So the money I earn is never enough. My children get angry because they think I should be using the money on them. I don’t know how to stop.”

Ndlovu buys his cigarettes from Ntando Debeza, a hundred metres from his home.

Debeza’s spaza shop sells cigarettes, pipe tobacco, snuff, chewing tobacco, hookah and shisha.

“I make about R6,000 ($440) a month from this small shop. Most of the money comes from tobacco sales but I also sell other day-to-day products like bread and milk.

People come to buy and sometimes on credit and I collect money at the end of the month,” says Debeza.

This means Ndlovu’s debt grows. But, that’s not all. Smoking does not only affect the smoker. High levels of nicotine exposure from handling tobacco leaves may cause nicotine poisoning called Green Tobacco Sickness, with symptoms including nausea and vomiting.

Back in Mpherembe in Malawi, Kube says he is aware of the dangers of working in a tobacco field without protective clothing, and mostly its effects on minors. “I know children can get sick but what can we do? We need a lot of hands on the farm because this isn’t an easy crop to plant and prepare. It needs three times more people than corn but we don’t make enough money at all,” says Kube.

He is one of the few rural farmers who know this. And it gets worse. A 2009 survey in China revealed that only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it can cause strokes.

“Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed. National comprehensive cessation services with full or partial cost coverage are available to assist tobacco users to quit in only 24 countries, representing 15% of the world’s population,” says WHO.

Cape Town-based entrepreneur Gareth Carter saw this crisis as an opportunity. He founded WeDoRecover, a company that helps patients who suffer from psychiatric and addiction problems.

“Finding the right addiction programme to meet someone’s specific needs is a complex process. The crisis and chaos synonymous with active addiction are overwhelming and the multitude of choices in the marketplace adds to the confusion,” says Carter.

According to Carter, people who smoke are more likely to drink alcohol and vice versa. He says alcoholics frequently present with a co-morbid nicotine addiction.

“As many as 80 percent of people addicted to alcohol and other drugs are frequent smokers, but the bulk will die of smoking-related disease rather than alcohol and drug-related disease…”

The damage doesn’t stop there. Carter adds that major depressive episodes among adults are highest in those addicted to nicotine and lowest in those who have quit or never started smoking.

“With nearly 80 percent of the world’s one billion smokers living in low- and middle-income countries, this is a very real public health care problem for us in Africa.

Making nicotine addiction prevention and treatment readily accessible to the youth counteracts a wide range of potential mental, physical and mood-disorder problems with far-reaching ramifications to families, communities and our economy,” he says.

Carter thinks if tobacco was “invented” today it would be classed with other illegal drugs. That’s not the case. The lucrative industry in Africa puffs on unfettered.