South Africa is battling a non-communicable disease (NCD) crisis that must be addressed through better tobacco control policy, say South Africa’s health organisations forming part of tobacco control advocacy partnership Protect our Next. The organisations, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC), the Heart and Stroke Foundation South Africa (HSFSA), the South African Tobacco Free Youth Forum (SATFYF) and The Africa Centre For Tobacco Industry Monitoring and Policy Research (ATIM) have welcomed news that the National Assembly has resumed proceedings on the Tobacco Products and Electronic Delivery Systems Control Bill as a vital step forward for public health, saying this legislation aimed at reducing tobacco use is central to addressing the NCD burden and will support sustainable implementation of South Africa’s National Health Insurance.

“As a major risk factor for NCDs, tobacco use adds enormously to the economic and human resources costs of the NHI,” says Prof Lekan Ayo-Yusuf, Director of the National Council Against Smoking and Chairperson: School of Health Systems and Public Health, University of Pretoria. “These NCDs are chronic diseases resulting in increased costs to the health system in the long term – not just short-term costs to treat a single illness. These costs are subsidised by the taxpayer while the tobacco industry reaps the profit.” 

Ayo-Yusuf says the fact that South Africans have a 50.9% chance of dying prematurely from NCDs, including cardiovascular disease, cancer, diabetes and chronic respiratory diseases (Statistics South Africa) points to an urgent need for better policies that support prevention and will reduce tobacco use. “Evidence from multiple countries shows that a reduction in tobacco use can rapidly decrease NCDs and related health-care costs,” says Ayo-Yusuf. “Strong tobacco control policy will keep the numbers of people needing healthcare for preventable NCDs down. For the NHI to be sustainable, numbers must be at a level where it is possible to provide good quality care to all that need it.”

About 84% of South Africans, equivalent to about 50 million, depend on the public health system. The 2021 Global Adult Tobacco Survey (GATS-SA) shows that over 12.7 (29.4%) million South Africans aged 15 years or older use tobacco. “This is the highest of any country in the region that has carried out a GATS survey, a critical alert for the government to prioritise addressing the tobacco use epidemic as a readily available solution to reducing heart disease, lung disease, cancer and other illnesses linked with tobacco use and exposure to tobacco smoke,” says Dr. Catherine Egbe, Senior Specialist Scientist of the Mental health, Alcohol, Substance use and Tobacco Research Unit at the South African Medical Research Council.

For example, lung cancer a major cause of cancer deaths in South Africa, and treatment is expensive, explains Lorraine Govender of CANSA. With global studies linking cigarette smoking to 80%-90% of lung cancer deaths, reducing smoking would have a major impact.   

Cardiovascular disease is responsible for almost 1 in 6 deaths, killing more South Africans than of all the cancers combined. “Smoking is a significant contributor to cardiovascular disease (CVD), accounting for nearly 50% of heart disease cases in South Africa. The detrimental effects of smoking do not only impact the smoker; second-hand smoke also poses serious health risks to those around them, further amplifying the public health crisis,” says Professor Pamela Naidoo of the Heart and Stroke Foundation of South Africa.

Tobacco-related premature deaths through these NCDs and other tobacco-related diseases stifle South Africa’s economic development. Families lose income and suffer crippling healthcare costs. As tobacco smoking is currently estimated to cost South Africa R42 billion per year in treating tobacco-related illnesses and in lost productivity, reducing these costs is essential.  Estimates show that the economic cost due to productivity losses arising from absenteeism, presenteeism and early retirement due to ill health in South Africa, largely from non-communicable diseases (NCDs), is expected to increase to 7.0% of GDP by 2030.  

The WHO’s global business case for NCDs shows that if low- and low-middle income countries put in place the most cost-effective interventions for NCDs (including for both prevention and management), they will see a return of $7 per person for every $1 invested by 2030. 

Ayo-Yusuf says the Tobacco Control Bill can make a vital contribution to curbing healthcare costs and improving standards of living, with benefits only increasing over time. ‘Investing in prevention and control of NCDs is essential for growth and development and, when carefully planned and implemented, is highly cost-effective. 

“Measures in the new Bill can prevent harm, death, and disability from NCDs by closing legislative gaps and properly regulating emerging products like e-cigarettes. Enacting the bill will decrease exposure, deter youth initiation, and bring South Africa closer to fully implementing the WHO Framework Convention on Tobacco Control (FCTC). It will be a win for public health, the NHI, and the national economy.”