National Council Against Smoking
A submission to the Portfolio Committee on Health
19 October 1998

Chairperson, Honourable Members of Parliament, Ladies and Gentleman:

Thank you for the opportunity to make this submission to the Portfolio Committee on Health. The National Council Against Smoking is a non-governmental organization which was established in 1976 with the mandate of promoting public health through encouraging nonsmoking as a societal norm.

The Council welcomes the Tobacco Products Control Amendment Bill as sound public health policy. The Bill will build on the important gains that have already been achieved in lowering tobacco consumption since 1994. It will promote the health and welfare of our citizens.

Tobacco poses a problem to legislators for two reasons - it is a major health hazard and it is an important economic commodity. If tobacco were not harmful there would be no reason to regulate its use. On the other hand. if the market for tobacco were small there would be little opposition to the regulation of this trade.

Given this conflict of interests between health and trade, public policy on tobacco has evolved in an ad hoc fashion. It has emerged as a product of different pressures, including those of the tobacco industry and the public health lobby.

Public policy decisions, however, have to be guided not by pressure groups but by the pubic interest. The curtailment of individual and corporate rights should not be undertaken lightly. There must be a compelling public interest before we take such steps. The World Health Organisation (WHO) and the World Bank believe the interest here is undeniable. They have both urged governments to legislate to control tobacco because tobacco is a threat to health and sustainable economic development. Thus far, more than 90 countries have, to a greater or lesser degree, done so.

This submission will briefly review the policy objectives that will be served and evaluate the likely effectiveness tobacco control measures proposed in the Bill.

Let us start with a factual description of the problem. in singling out tobacco products for special attention it is important that to recognise that they are a special case. Tobacco is unique among currently legal products because it is the only consumer product that kills the user when used exactly as the manufacturer intended. There is also no safe level of use.

Globally. there are only two causes of preventable death that are increasing substantially - HIV and tobacco. Experts at the WHO predict that unless smoking behaviour changes. then deaths from tobacco will increase from the current 3,5 million to 10 million annually by the year 2025. With 70% of these future deaths occurring in the poor nations of the world, where the already overburdened health services are unprepared for this coming epidemic.

The WHO estimates that by 2025, that is over the next 27 years, about 500 million people worldwide will die of tobacco-related disease. That is a numbing figure. It is too large to take in, so lets put it in other terms. That is the death toll from a World War II every three years for 27 years. That is a Bhopal every two hours for 27 years. That is a Titanic every 43 minutes for 27 years. That is a Sharpeville every minute for 27 years.

Bhopal and the Titanic were accidents. Tobacco deaths are not. They are the predictable result of tobacco use. The tobacco industry must know this. But they will stand in front of this Committee and tell you that their products are neither dangerous nor addictive and that they do not market to children.

Internal US tobacco industry documents tell a different story. They expose some of the most incriminating evidence of suppression of science ever. They show that the industry was marketing to children as young as 13, that it was manipulating nicotine levels to achieve greater addictiveness, and that it was covering up the truth about a range of diseases from infant mortality to cancer.

Confronted by documents from his own company's files during testimony in a tobacco trial, the chairman of Philip Morris, Geoffrey Bible, admitted that he was "ashamed" and "sorry" that the world's leading tobacco company studied children's smoking behaviour. He also owned to being "embarrassed" by, and "ashamed" of, memos which discussed ways to conceal internal industry research from health authorities and litigants.

Further, a "leaked" 1988 British American Tobacco Company memo revealed that the industry were spending "vast sums of money" to pay scientists to "produce research or stimulate controversy" on passive smoking that their public affairs people could exploit. They have also paid scientists thousands of dollars to write letters to the editors of scientific journals to question the link between passive smoking and lung cancer.

The clear intention was to "create doubt" about the dangers of tobacco in the public mind. If the public do not know what to believe, then this provides a reason for smokers to continue smoking and for governments not to regulate tobacco use.

Reacting to this health threat the South African Medical Journal in a far-sighted editorial offered the following advice to the Minister of Health:

"The educational campaign should be the main weapon in the fight against cigarette smoking, but some restrictive legislation will also be necessary. There should be no hesitation about banning smoking in public places and on public transport. Here the discomfort and disease of the non-smoker must be considered before the convenience of the smoker. The law about providing cigarettes to children must be more strictly enforced and automatic vending machines must be banned. Cigarette advertising should at first be restricted in quantity and content with a view to its eventual complete limitation. It might also be advisable to insist that each cigarette packet should carry a notice to the effect that the contents are potentially dangerous to health.

The Minister of Health may also attempt further restrictions of smoking by increasing the taxation on cigarettes.... The matter is important and urgent."

The remarkable thing about this editorial is that it was published in September, 1963. Thirty five years later the government is at last on the threshold of acting on this "important and urgent matter"

The basic reasons for enacting this type of legislation are to:
(a) to free young people from pressure to smoke;
(b) to reduce tobacco consumption in the population.

Most people begin smoking as children. Teenagers do not worry overmuch about their health but they are very sensitive about their image. They pay great attention to their hair, their clothes and to being part of the in-group.

Advertising tries to exploit these social insecurities to get them to smoke. As a US marketing memo said: Camel advertising must show that Camel smokers "have a cool attitude" which is admired by their friends. In other words, advertising must exploit peer pressure to get teenagers to smoke.

In sports crazy South Africa, tobacco is associated with the drama and excitement of football, rugby, surfing and motor racing. Children's sporting heroes have become walking billboards for the cigarette companies. Not surprisingly, the brands most popular among kids are the brands which are most heavily promoted.

The result is that kids are being pushed into a life-long addiction - the results of which they do not understand and will not understand until it is too late. Within a year of starting most teens will try to quit smoking and most will fail to do so. Addiction starts early. In the US, over 60% of teenage smokers say that if they could start afresh, they would not smoke.

Regrettably, children observe very little evidence that society regards their smoking as a problem. To reduce tobacco consumption among the young we need to both limit supply and decrease demand. Education, the elimination of tobacco promotion, reducing illegal sales and making cigarettes less affordable are all vital.

There is ample evidence to show that advertising increases tobacco consumption and that bans reduce consumption below that which it would otherwise have been. Two recent major reviews of the evidence were conducted in the US and the UK.

1. In 1993, the Chief Economic Adviser to the Department of Health in the UK concluded:

"The balance of evidence thus supports the conclusion that advertising does have a positive effect on consumption."

The report also reviewed trends in smoking in four countries (Norway, Finland, Canada, New Zealand) that banned tobacco advertising and found:

"In each case the banning of advertising was followed by a fall in smoking on a scale which cannot be reasonably attributed to other factors."

2. In 1996, the US Food and Drug Administration concluded:

"[R]estrictions on tobacco advertising.. will reduce cigarette and smokeless tobacco use among children and adolescents under the age of 18."

3. In May 1998, the Health Minister of Norway wrote:

"[T]he ban on advertising of tobacco products has had a marked and beneficial effect upon tobacco consumption and young people's smoking rates in Norway."

SUMMARY: The majority of smokers begin their habit before the age of 20 years. Youthful experimentation can lead to quickly to dependency. Tobacco advertising bans reduce tobacco consumption below that which it would otherwise have been, A ban on tobacco advertising and promotion is an essential part of a comprehensive tobacco control programme.

The reasons for enacting legislation to control smoking in public places are to:
(a) ensure that a clean and healthy environment is maintained;
(b) ensure that the health of nonsmokers is not impaired by the smoking of others;
(c) prevent the nuisance which smoking may cause to nonsmokers

* Most South Africans have decided not to smoke - 70% of adults are non-smokers. They have chosen to avoid the risks associated with smoking. All to often, they are forced to re-assume risks they have chosen to avoid when others smoke in public places.
*In 1997, smokers burned 38 million kilograms of tobacco in our air making tobacco smoke one of our largest sources of indoor air pollution.
*People are more exposed to indoor pollution than to outdoor pollution, because on average they spend between 70% to 90% of their time indoors.
*Employees spend more time at work than at any other place except home. People have less choice about their exposure to smoke at work than they do in other places, such as restaurants.
* The smoke that drifts from a burning cigarette as it smoulders between puffs contains over 4000 chemicals, including over 200 known poisons. and 43 carcinogens. It contains three times the tar and nicotine. five times the carbon monoxide, 46 times the ammonia, and 100 times the nitrosamines as well as higher concentrations of many other toxic substances, than the smoke a smoker inhales.

*More than 90% of the particles in tobacco smoke cannot be removed by conventional filters in ventilation systems.

*Over 600 scientific studies have now linked passive smoking and ill health - it is a cause of lung cancer, heart disease and respiratory disease.

*Some tobacco control regulations are already in force in South Africa, e.g., in cinemas, theatres, public transport, workplaces. etc.
*Surveys show that 70% of smokers and 90% of non-smokers support a ban on smoking in public places.

Experience in both South Africa and internationally shows that once designated smoking areas are defined and clearly signposted, the law becomes self-enforcing. The vast majority of smokers will not smoke in areas where the law forbids it. However, clear rules help smokers and non-smokers know what "common courtesy" requires. Smokers know where they can smoke, and nonsmokers know where they can ask smokers to refrain.

The no-smoking regulations in cinemas, theatres, and airplanes are effective and largely self-policing.

Of all the tobacco control measures this has the firmest base in legal tradition. The law has always been used to protect individuals from harm resulting from the activities of other people.

SUMMARY: The majority of South Africans do not smoke. Passive smoking is both unpleasant and harmful to nonsmokers. Surveys show that the majority of smokers and nonsmokers are in favour of restrictions on smoking in public places. Clear rules defining where smoking is, or is not. permitted will avert needless conflict between smokers and nonsmokers. Both smokers and non-smokers can then be sure of their rights. Ventilation and air-cleaning devices are not the solution to the problem of passive smoking.

The reasons for this type of legislation are:
(a) to make cigarettes less harmful for those who are unable to stop smoking,
(b) to allow for the progressive lowering of the tar and nicotine in tobacco smoke.

* The health effects of tobacco are caused by its various constituents. The higher the exposure to these chemicals the greater the risk of ill effects.

* At least 2,500 chemical substances have been identified in unburnt tobacco.

*Over 4,000 chemicals have been identified in tobacco smoke.

*Many of these chemicals are harmful and they include irritants and carcinogens.

*Cigarette manufacturers have developed techniques that enable them to adjust the yields of nicotine, tar and other substances as required.

In 25 countries the tar and nicotine levels in cigarette smoke are controlled by legislation. There is some evidence that the switch from plain to filter cigarettes in the 1950's may have slightly reduced the risks of lung cancer. However, by inhaling more deeply or smoking more cigarettes smokers can undo the benefits of switching to "low tar" cigarettes.

SUMMARY: There is no such thing as a safe cigarette. The benefits of reducing tar and nicotine levels are very small compared to the benefits of stopping smoking. However, because of the large numbers of people involved even a small reduction in risk is worth pursuing.

This Council believes that the Bill will make a significant contribution to reducing the burden of cancer, heart disease and complications of pregnancy in South Africa. Further, since a healthy economy needs a healthy workforce it will be beneficial to the economy. It will also contribute to the development of a social environment in which the healthy choice - that is, the decision not to smoke - becomes the easy choice.

It is said that freedom from addiction to tobacco is a child's right and society's responsibility. I hope that every member of the Portfolio Committee will put the freedom of children to grow up healthily above the freedom of an industry to market a deadly drug. Please support the Bill

Thank you.

Yussuf Saloojee
Executive Director

19 October 1998