Publications

In South Africa (SA), smoking results in 58% of lung cancer deaths, 37% of chronic obstructive pulmonary disease deaths, 20% of TB deaths, and 23% of cardiovascular deaths. Smoking-related TB deaths are especially prevalent in SA and Sub-Saharan Africa due to a higher vulnerability of HIV-positive individuals to TB. In SA, academic institutions and NG0s have provided country-specific data on the health burdens of tobacco and used them as effective evidence to advocate for tobacco regulation. Research, however, has not been limited solely to the health sector. The economics of tobacco played a significant role in tobacco legislation, and country-specific research and econometric models measured the costs and benefits of tobacco consumption. Public opinion polls complemented quantitative data and revealed a majority of SA citizens supported all forms of tobacco regulation. Public attitudes proved to be important in reflecting the interest of SA as a whole and not just its industries.

As a result of the multifaceted evidence and attention provided, the SA government passed the Tobacco Products Control Act in 1993.

However, the tobacco dilemma could not be solved with one legislative move. Following SA's political shift to the African National Congress (ANC) at the end of apartheid, strong anti-tobacco advocacy from President Nelson Mandela and his Minister of Health, Nkosazana Zuma, allowed the SA government to pass additional amendments to strengthen the Act and address the tobacco industry's exploitations of loopholes. Whereas her predecessor had consulted with the tobacco industry before drafting the 1993 Act, Minister of Health, Zuma held fewer consultations with the industry to prevent draft regulations from being watered down. After ratifying the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) treaty in 2005, the SA government continues to pass amendments to the 1993 Act, in order to comply with the international deadlines for specific regulations.

Monitoring smoking in SA has been key in tracking the overall trend in smoking prevalence rates and showing the effectiveness of legislation, education, and taxation against the tobacco industry. Local monitoring proved that initial fears about the negative impacts on the economy from tobacco regulations were not well founded. While about a third of SA smoked in 1993, the smoking population was reduced by half to about 16.4% in 2012. Tobacco regulations in SA have had the biggest impact on Black South Africans with respect to ethnic groups and on 16-24 year olds with respect to age. The large decrease in tobacco consumption in these two groups reflects their high price sensitivity to tobacco excise tax increases. However, since these large decreases in tobacco consumption were measured by official statistics, it is possible that smoking may have a higher-than-observed consumption rate in SA due to "roll-your-own" and illicit tobacco products. The tobacco industry has had a tendency to over-exaggerate the prevalence of these illicit sales in order to lobby against high taxation rates. In addition, SA has seen a simultaneous rise in the use of smokeless tobacco products, especially among youth. Nonetheless, taxation on tobacco has proven to be the most cost-effective method at a population level.