TOBACCO PRODUCTS CONTROL AMENDMENT BILL
SUBMISSION FROM THE HEART FOUNDATION
The mission statement of the Heart Foundation of South Africa is
"The Heart Foundation is a community based health organisation established to reduce the incidence of heart disease and stroke in the population of South Africa by providing education and supporting research."
There is a considerable time lag between starting to smoke and the appearance of tobacco-related deaths. This has meant that it is only within the last decade that the full extent of the health damage caused by tobacco has been properly documented. People have long been aware of the connection between lung cancer and tobacco smoke. Do you know that about 5 times as many people die from coronary heart disease due to smoking than do from lung cancer. We now know that 30% of tobacco -related deaths are due to CVD.
Cardiovascular diseases are diseases of the heart and blood vessels. South Africa has the third highest incidence of CVD in the world and in South Africa figures indicate that the percentage of all male deaths from CVD is 16.39% and the percentage of all female deaths from CVD is 22.98%. It is estimated that one out of four deaths from coronary heart disease (CHD) is smoking related.
The risk of developing CHD increases with the length and intensity of exposure to cigarette smoke. Overall, smokers have a 70% greater rate of mortality from CHD than non-smokers. Smokers consuming more than 40 cigarettes per day have mortality rates between two and three times greater than non-smokers.
With regard to smoking and CHD, the finding that current cigarette smokers have about an 80% increased risk has been consistently demonstrated over the last 30 years by different investigators in a large number of case-control and cohort studies involving millions of person-years of observation.
Among people less than 65 years of age, 45% of CHD in men and 40% in women is caused by cigarette smoking. Among people 65 years of age or older, 15% of CHD in men and 9% in women is caused by smoking.
In women who smoke and use the contraceptive pill there is a synergistic action, resulting in a substantial increase in risk of myocardial infarction.
Cigarette smoking is a cause of stroke (damage to the brain due either to interruption of blood flow or the escape of blood into brain tissue from a damaged artery). This may occur because of arterial blockage due to atherosclerosis. Frequently, the artery stretches at the site of weakness causing it to balloon out (an aneurysm). The bigger the aneurysm, the more likely it is to rupture, causing haemorrhage (bleeding) and a resultant stroke. A stroke may result in rapid death, or in varying degrees of disability, depending on the part of the brain which has been affected.
Children tend to take up smoking due to advertising promises and peer pressure. As they mature and are aware of the consequences of smoking their addiction makes it very difficult for them to stop.
In many countries tobacco use is rising among young people. At the same time the age of smoking initiation is declining. The majority of smokers begin while in their teenage years or earlier. If young people do not begin to use tobacco before the age of twenty they are unlikely to initiate use as adults.
Some trends from other parts of the world:
- Teen smoking rate in some Latin American cities is 50%.
- In Kenya, the smoking rate among primary school children was estimated at 40% in 1989 - a huge jump from the 10% level estimated a decade earlier.
- Smoking rates among male Korean teenagers rose from 18% to 30% in one year after the entry of USA tobacco companies. Among female teenagers rates increased from less than 2% to nearly 9%.
- Bach day, 3 000 children in the United States become regular smokers.
- Although there have been reductions in smoking prevalence among French youth since 1977, 35% of 12-18 year olds smoked in France in 1995.
- In Ukraine, 40% of 16-17 year olds were smoking in 1990.
- In recent years, an increase in the frequency of smoking among young people has been reported in Uzbekistan. In the capital, Tashkent, 22.5% of Uzbek boys and 0.6% of females smoked at lease one cigarette a week.
- In a number of countries, the highest rates of smoking in pregnant women and in new mothers are among adolescents."
Similar patterns are occurring in South Africa. Recent data from Reddy, et al indicate that 34% of adult South Africans smoke and this incidence has increased since 1992. It also shows that the number of 18-24 year olds smoking has increased by 5% (to 36%) from February 1995 to October 1996.
The South African population will benefit by the adoption of the bill as the incidence of cardiovascular and other smoking related diseases will decrease, children will have less exposure to advertising and less chance of becoming addicted to nicotine. Children need to be protected from having to make a decision about smoking until they are responsible and aware enough to make an educated choice. One of the major benefits of the bill will be to protect children and young adults from becoming addicted to nicotine.
The proposed bill could prolong the life of upcoming generations. These people are the future of South Africa. Few people start smoking as adults but occasionally peer pressure may have some influence. Give-aways of cigarettes should be discouraged as nicotine is addictive and these "freebies" may cause a physiological need for nicotine.
The bill represents sound public health policy Nicotine can kill and is the only product that has a detrimental possibly fatal effect when used as instructed.