Rapid population growth, increasing advertising by the tobacco industry, and increasing tobacco use among young people in Africa all contribute to a huge tobacco-related disease burden. The World Health Organization (WHO) estimates that one in five African adolescents uses tobacco. WHO also predicts a doubling of tobacco-related deaths in low- and middle-income countries between 2002 and 2030.
Many efforts are made to prevent these unnecessary deaths. One of them is the establishment of the African Conference on Tobacco Control and Development (October 26-28, 2021). The aim of the conference is to connect researchers, policy makers, advocates, students and members of the public interested in tobacco control on the continent. It is a platform to share information on some of the tobacco control work being done in Africa, reflect on lessons learned and identify what needs special attention.
Our own contribution to the conference is work on the economic impacts of tobacco use on the continent and beyond.
Many African countries have indicated their interest in adopting tobacco control policies. Of the 54 countries in Africa, 51 have ratified the WHO Framework Convention on Tobacco Control – Malawi, South Sudan and Eritrea have not. By ratifying the convention, countries commit to adopting effective and evidence-based measures to reduce tobacco consumption.
One of the key interventions is to ban smoking in public spaces. The WHO suggests that globally between 1 million and 1.2 million deaths per year are linked to exposure to second-hand smoke. Thirteen African countries have banned smoking, joining more than 50 other countries around the world.
Sixteen African countries are requiring cigarette manufacturers to print graphic health warnings on cigarette packages. Studies have shown that images of risks, such as diseased lungs, reduce the attractiveness of the packaging and the appeal of smoking.
In 2018, the Protocol to Eliminate Illicit Trade in Tobacco Products entered into force. Countries that ratify the protocol commit to adopt various measures, such as the use of tracking and traceability systems to prevent and combat illegal trade. Currently, 27 African countries have ratified the protocol, the highest proportion of any continent. A number of countries have already implemented some of the measures suggested in the protocol.
Raising excise taxes is the most effective measure to reduce smoking. Studies around the world show that excise taxes that actually raise the price of tobacco products almost always lead to lower smoking. The structure of the excise tax is important. In general, a specific tax (an amount of tax per cigarette, regardless of its value) is preferable to an ad valorem tax (a percentage of the value of the product). Simpler tax systems are better than complex systems.
Save the achievements
Despite the progress made in many countries, many challenges remain. One is the slow adoption of recommended tobacco tax policies.
Most African countries have excise tax systems which are generally considered sub-optimal. This is because tax systems are generally ad valorem, tiered, or both. These factors mitigate the influence of excise taxes on the price of cigarettes. It is therefore not surprising that cigarettes are relatively inexpensive in most African countries. Indeed, the excise tax, expressed as a percentage of the average retail price, is lower in Africa than on any other continent in the world. On average, this figure rises to 28.6% in Africa, 35.4% in South America and 37.3% in Asia.
Excise tax systems in some countries have actually regressed. A classic example is Kenya. In the 1990s and early 2000s, Kenya had one of the most complex tax systems in Africa. This complexity has allowed the tobacco industry to profit from it at the expense of the tax authorities and public health. Targeted campaigns by tobacco control advocates resulted in the implementation of the specific uniform excise tax recommended by WHO in 2015. This achievement, however, was short-lived. In 2019, under pressure from the tobacco industry, the Kenyan government reintroduced a two tier system. The two-tier system allows tobacco companies to differentiate their products just enough to maximize their profits on high-end brands, while keeping low-end brands cheap enough that a large number of people continue to smoke.
The South African tax system has also regressed. Between 1994 and 2009, South Africa’s tobacco control efforts, anchored by sharp increases in the excise tax, received worldwide acclaim. Strict administrative controls by the South African tax administration have prevented illicit trade from increasing. Since 2010, there has been a rapid increase in illicit trade, although increases in excise duties over the past decade have been negligible. Since 2015, illicit trade in South Africa has increased significantly and now represents at least 35% of the total market. The main reason for this increase is the decline in the capacity of the South African tax administration to ensure the tax compliance of tobacco manufacturers. The tobacco industry has been at the forefront of undermining tax authority. Efforts to implement a tracking and tracing system have been unsuccessful.
The ethical practices of the tobacco industry have been questioned for decades. Recently, the BBC Panorama program featured a documentary on the tobacco industry. The documentary was the culmination of years of research by investigative journalists and researchers at the University of Bath. It details the ways in which British American Tobacco (BAT) has acted unethically in various African countries to keep its profits high, block or weaken tobacco control laws and maintain its market dominance.
This is not the first time that British American Tobacco has been accused of these practices and, unfortunately, it is unlikely to be the last.
Corné van Walbeek, Professor, School of Economics and Principal Investigator, Economics of Tobacco Control Project, University of Cape Town and Zunda Chisha, Research Officer, Excise Economics Research Unit, University of Cape Town
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