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Tighter tobacco control central to reducing NCD burden and sustainable NHI implementation

Publish Date:

September 7, 2022

South Africa continues to battle a non-communicable disease (NCD) crisis that can be prevented through effective policy, say South Africa’s health organisations forming part of Protect our Next.  South Africans have a 50.9% chance of dying prematurely from selected NCDs, including cardiovascular disease, cancer, diabetes and chronic respiratory diseases, according to Statistics South Africa.  This points to an urgent need for policies that support prevention, according to Prof Lekan Ayo-Yusuf, Director of the National Council Against Smoking. “As the use of tobacco and related products is an entirely preventable risk factor for most of these NCDs, strong tobacco control policy is central to addressing the NCD burden and will support sustainable implementation of South Africa’s National Health Insurance.”

With over 70% of South Africans depending on the public health system according to Statistics South Africa, implementation of the National Health Insurance (NHI) aims to ensure access to quality healthcare for all, irrespective of family income. “Keeping numbers of people needing health care down is central to the sustainability of the NHI, so that numbers are kept at a level where it is possible to provide good quality care to all that need it,” says Ayo-Yusuf.  “Many diseases that we suffer from are entirely preventable with the right policies and screening, perhaps none more so than tobacco-related diseases, which claim the lives of nearly 26,000 people aged 35-74 in South Africa annually. 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.  Tobacco adds to the economic and human resources costs of the NHI, and these costs are subsidised by the taxpayer while the tobacco industry reaps the profit.”

Tobacco use is one of the top five major risk factors that must be addressed to reverse the growing burden of disease from NCDs, as identified by the WHO.  Evidence from multiple countries shows that a reduction in tobacco use can rapidly decrease NCDs and related health-care costs. 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. Investing in prevention and control of NCDs is essential for growth and development and, when carefully planned and implemented, is highly cost-effective.

The 2021 Global Adult Tobacco Survey (GATS-SA) shows that South Africans have a huge burden of tobacco use, with 12.7 (29.4%) million of the country’s adults aged 15 years or older using tobacco in one form or the other. “This is the highest of any country in the region that has carried out a GATS survey, a critical alert for the government to prioritize addressing the tobacco use epidemic as a readily available solution to reducing heart disease, lung disease, cancer and other illnesses linked with tobacco use,” says Dr Catherine Egbe of the South African Medical Research Council.

Smoking has negative impacts on all the major non-communicable diseases, including lung and other cancers, chronic obstructive pulmonary diseases (COPD), heart disease and diabetes.  Each year, over 86,000 South Africans are diagnosed with cancer as reported by the National Cancer Registry, and many go unreported. Treatment is expensive, according to Lorraine Govender of CANSA. “Lung cancer a major cause of cancer deaths in South Africa. 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 also has an impact on communicable diseases, worsening tuberculosis (TB) and HIV and AIDS. Smoking and exposure to second-hand smoke account for one in five cases of TB, triggering inactive TB and making treatment for TB less effective. In people living with HIV-AIDS (PLWH), tobacco use triples the risk of getting TB and makes antiretroviral therapies less effective.

Ayo-Yusuf says that the new Control of Tobacco Products and Electronic Delivery Systems Bill can contribute significantly to reducing heart diseases, cancer, diabetes and respiratory disease, reducing preventable harm, death and disability from NCDs.  “This bill is a strong updated piece of legislation that closes loopholes and aspects not covered by current legislation, such as the proper regulation of novel products including e-cigarettes. Proposals in the bill, in particular 100% smoke-free public places, health warnings and a complete ban on all marketing and advertising, come at low or no cost to the state. Together with tax increases on tobacco products, the evidence base used by the WHO shows that they contribute to the largest drop in tobacco consumption. Passing the bill will reduce exposure, delay initiation by young people and bring South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard.”

Ayo-Yussuf points out that the Bill is about more than health. Tobacco-related premature deaths through NCDs and other tobacco-related diseases stifle South Africa’s economic development. Families lose income and suffer crippling healthcare costs. As tobacco use is currently estimated to cost South Africa R42 billion per year in tobacco-related illnesses, reducing these costs is essential. (Boachie, M, K., Rossouw, L., & Ross, H. (2021). The economic cost of smoking in South Africa) 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.  Ayo-Yusuf says the Tobacco Control Bill can make a vital contribution to curbing health-care costs and improving standards of living, with benefits only increasing over time.

“Reducing tobacco use through effective tobacco control is a powerful way for to address a key risk factor,” says Ayo-Yusuf.  “Strong clean indoor air laws, graphic health warnings, the banning of point-of-sale advertising and promotion and vending machines are some of the aspects of the new Tobacco Control Bill that will better protect South Africans from NCDs. Passing the Tobacco Control Bill is a win for individual and family health, the NHI and the economy of South Africa.  We cannot lose any more time.”

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