Tobacco Kills: So what to do in Africa?


This page in:

The scientific evidence is overwhelming. As Robert Beaglehole and colleagues at the World Health Organization (WHO) pointed out years ago, tobacco is the only consumer product that eventually kills half of its regular users if they follow its manufacturers’ recommendations. 

Photo Credit: By AdamCohn, FlickrGiven this dire reality, it is clear that Africa is now at a crossroads. On one hand, the countries in this region have become an attractive and under-tapped market as tougher regulations, high taxes, and greater consumer awareness of the dangers of smoking in developed countries are “closing the door” to tobacco imports and leading to significant drops in consumption. And on the other hand, cigarettes are becoming increasingly affordable as incomes rise in several African countries due to the rapid economic growth of recent years. Indeed, African countries are experiencing the highest increase in the rate of tobacco use amongst developing countries--the number of smokers in sub-Saharan Africa is projected to increase 148 percent by 2030, to 208 million smokers or one-fifth of the total population. 

Should African governments and the international community be concerned with this development? 

I firmly believe, yes. If the current smoking patterns continue unabated, they will accelerate the growth of tobacco-related non-communicable chronic diseases (e.g., lung cancer, respiratory problems, heart attacks) compounding the already heavy burden imposed by communicable diseases (e.g., HIV/AIDS, tuberculosis, malaria). Besides undermining the health of the population and their productive potential and contributing to lives lost, Africa will be confronted with major health system and funding challenges to deal with these chronic diseases. The magnitude of these challenges is best illustrated by the United States, where cigarette smoking is estimated to cause annually more than 400,000 deaths and about US$200 billion in health-related economic losses, nearly half in direct medical costs. 

The good news is that Africa is fighting back. Some 42 African countries have already signed the 2003 WHO Framework Convention on Tobacco Control (FCTC) that binds them to a number of anti-tobacco measures, including high taxes on tobacco products and protecting people from exposure to tobacco smoke.

On June 3-5, 2012, the World Bank, in partnership with the Southern Africa Development Community (SADC), the Ministry of Finance of Botswana, the Bloomberg and Gates Foundations, and WHO, is convening in Gaborone, Botswana, a high level forum “The Economics of Tobacco Control:  Taxation and Illicit Trade.”  With the participation of delegations from Ministries of Finance, Trade, and Health of 14 SADC member countries and global and regional experts, the aim of the forum is to promote dialogue on best practices in effective design and administration of excise taxes on tobacco as an instrument to promote public health and to share knowledge on the dimensions, causes, and extent of illicit trade of tobacco and strategies to control it.

These topics are critical for helping create a “smoke-free” environment in Africa. Of all the demand-reduction strategies outlined in the FCTC, increasing the retail price of tobacco products through higher excise taxes to make tobacco products less affordable is the single most effective way to decrease consumption and encourage tobacco users to quit. And, contrary to tobacco industry claims, the forum will be geared to show that increased tobacco smuggling does not automatically follow tax increases if governments show committed and strengthened law enforcement to combat smuggling and counterfeiting.



Patricio V. Marquez

Senior Associate, Johns Hopkins University Bloomberg School of Public Health

Join the Conversation

May 16, 2012

My point of view to find the solution for this global, not only in Africa problem is very easy, but hard to implement:

Stop production - stop selling.
If they don't have they won't use (smoke), simple

High taxes won't work.

May 16, 2012

In a country where 47% of the population is 0-14 years of age--and stunting of growth is 50%----1.6 million kids labor in tobacco farms. Fertilzer subsidies are a major program in public expenditures as a "poverty reduction" intervention. However, a closer look and a serious analysis needs to take place to weigh the wisdom of such subsidies and where these subsidies go and who do they benefit and who do they harm.
Health outcomes are awful. See The Guardian article below

"Many of Malawi's estimated 80,000 child tobacco workers suffer from a disease called green tobacco sickness, or nicotine poisoning. Symptoms include severe headaches, abdominal cramps, muscle weakness, breathing difficulties, diarrhoea and vomiting, high blood pressure and fluctuations in heart rate, according to the World Health Organisation.

"Since the handling of the leaves is done largely without protective clothing, workers absorb up to 54 milligrams of dissolved nicotine daily through their skin, equal to the amount of 50 cigarettes, according to2005 research by Prof Robert McKnight, of the College of Public Health at the University of Kentucky, Lexington. Farm owners routinely plead ignorance of the health implications. "I never heard about touching tobacco leaves being dangerous," says Fraston Mkwantha, who plants 15 hectares of tobacco in Kasungu district."…

Patricio V Marquez
May 18, 2012

Interesting point put forward on “snus”. It illustrates an ongoing debate. However, both the National Cancer Institute at the US National Institutes of Health and the American Cancer Society, two respected scientific bodies, have concluded that “there is no safe form of tobacco. At least 28 chemicals in smokeless tobacco have been found to cause cancer.” And therefore, they advice that “smokeless tobacco is not a safe substitute for cigarettes.”

For more information:


Patricio V Marquez
May 18, 2012

The points raised by Commentators 1 and 2 highlight a critical challenge, particularly in resource-poor countries where tobacco cultivation is part of the farming system of large number of smallholder producers and the only income generating cash crop.

What to do?

As done under World Bank-funded agriculture projects and related policy dialogue, one option is to encourage/support agricultural diversification in alternative crops to move away from tobacco dependence--this option is consistent with the long-standing Operational Policy on Tobacco adopted by the World Bank in 1999 that precludes direct lending or investment or guarantee investments for tobacco production, processing or marketing.

Future Shock
May 17, 2012

As the entire pretense of this article was wrong, I didn't bother reading more than the two first paragraphs.

In Scandinavia, tax hungry and paniccing politicians have desperately try to label 'snus' as a health risk so that they can tax it or prohibit it. Thus legitimizing their own perverted 'jobs'.

But no matter how hard they have looked, they find no evidence of health risk of tobacco consumed by leaving it under your lip (snus). Norway even had to remove the cancer-warning on the snus-packages, as it was a blatant lie with no scientific base.

It seems that both WHO and the World Bank are just as ignorant and powerhungry as all beaurocrats and politicians. Get a real job. Produce something. Let me live my life.