NATIONAL COUNCIL AGAINST SMOKING
THE ”TOBACCO PRODUCTS CONTROL AMENDMENT BILL 2006”
A submission to the Portfolio Committee on Health
Tobacco is a
uniquely dangerous consumer product. It is the only legal product that kills
the user when used exactly as the manufacturer intends. In
Tobacco use is bad for business too – it makes workers sick, so reducing productivity in all sectors of the economy. Tobacco also keeps poor people poor.
The purpose of the Bill is to ensure that young people don't start smoking, to protect non-smokers from pollution by tobacco smoke, to help smokers quit and to reduce the risks for those who continue to smoke.
The NCAS is especially supportive of the Bill’s increased requirements regarding smoking in public places. The Bill seeks to better protect children from passive smoking and seeks to guarantee workers their constitutional right to an environment that is not harmful to their health.
The changes proposed to Section 2 of the Act include:
1. Restricting smoking near air inlets and entrances to public places. Many people now smoke near entrances and exits to buildings as an unintended consequence of the current law. As a result, high concentrations of tobacco smoke can be found near doorways through which the public must pass, and smoke enters buildings via general airflow. This can be particularly problematic for those with asthma or heart conditions, for whom even short exposures to smoke can trigger an attack.
2. The Bill seeks to protect children in two ways. It proposes not allowing smoking in private homes used commercially for childcare or educational purposes. It also proposes not allowing minors into the areas set aside for smoking. Young children are especially vulnerable to second-hand smoke because they breathe more air relative to body weight than adults and so absorb more tobacco smoke toxins. They are also less able to complain or remove themselves from smoke-filled rooms
3. Most people do not want to be exposed to tobacco smoke. However, many are afraid to assert their right to smoke-free air in the workplace because of the fear of upsetting their employers. The Bill proposes making it possible for people to safely voice their concerns without fear of repercussions. The Bill also requires employers to respect an employee’s right not to be forced to work in a smoking section. People should not be required to endanger their health for the opportunity to work.
4. Section 2(3) allows the Minister to prohibit smoking in certain outdoor areas, where smoking may constitute a fire or other risk. In crowded sports stadia exposure to tobacco smoke is likely to be sustained (from a few hours to the whole day for cricket lovers) and significant. Vulnerable people, who are very sensitive to smoke, can have their health put at risk.
There are two issues on which the Bill is silent but which merit special attention from the Portfolio Committee.
Firstly, the Act prohibits smoking in workplaces, but allow it in private homes. Private homes are often a workplace for domestic workers. These workers are therefore not protected from tobacco smoke in smoker’s homes. The Act has created the discriminatory situation where domestic workers are given less protection than other workers. This is not fair. All workers, including domestic workers, must be protected from tobacco smoke pollution.
Secondly, there is strong public support for a ban on smoking in cars while children are passengers. Smoking in cars can produce high concentrations of smoke which can harm young children.
The amendments to Section 3A of the Act addresses regulation of the tobacco product itself. Manufactured tobacco products are more toxic, carcinogenic, and hazardous to health than they need to be to deliver nicotine.
Cigarettes are the deadliest form of nicotine delivery available on the market. Yet, cigarette manufacturing is barely regulated. By contrast, pharmaceutical smoking cessation products (such as nicotine gum and inhalers) are subject to a lengthy and expensive government approval process before they can be marketed.
A cigarette manufacturer can add anything it wishes to cigarettes without any regulatory oversight. On the other hand, if a pharmaceutical company wants to add mint flavouring to nicotine gum to improve the taste, it must endure years of regulatory hurdles.
The Bill allows for the regulation of the substances that the manufacturer can put into tobacco products (its constituents) and the chemicals that may be produced when tobacco products are used (its emissions).
The purpose of Section 3A is to reduce the harmfulness of tobacco products. It requires tobacco manufacturers to produce the least dangerous product technically possible.
The WHO has recommended that countries establish manufacturing standards for tobacco products so as to reduce their appeal to children, decrease their addictive qualities, and decrease potential harm to users.
The Bill also proposes
that manufactured cigarettes be manufactured in a way that reduces the
likelihood of a cigarette causing fires.
In 2004, cigarettes caused 1400 (or 4% of the total) fires in SA. Over
R45 million worth of property was destroyed. The devastating fire in 2005 at
Finally the Bill increases the penalties so that they are a real deterrent to contraventions of the Act. A fine of R200 for allowing smoking in a restaurant is miniscule and has no impact on restaurant owners.
The National Council Against Smoking (NCAS) welcomes the draft Tobacco Products Control Amendment Bill (B24-2006). We thank the Portfolio Committee for the opportunity to comment on the Bill.
1. The National Council Against Smoking (NCAS) welcomes the draft Tobacco Products Control Amendment Bill (B24-2006). We thank the Portfolio Committee for the opportunity to comment on the Bill.
2. The NCAS is a non-profit organization established in 1976 with the mandate of promoting public health through encouraging nonsmoking as a societal norm.
3. Tobacco harms both public health and the economy. The World Health Organization and the World Bank have both urged governments to control tobacco because it is a threat to health and sustainable economic development.
4. The NCAS has consistently supported the country’s tobacco laws and is in favour of the proposed amendments. The Bill will build on the important gains that have already been achieved in lowering tobacco consumption since 1994.
5. This submission will briefly review the policy objectives that will be served and evaluate the likely effectiveness of tobacco control measures proposed in the Bill.
Unique treatment for a unique product
6. Tobacco is the only legal consumer product that kills the user when used exactly as the manufacturer intended. There is also no safe level of use.
7. All forms of tobacco are harmful but cigarettes are more dangerous than cigars, snuff and snus.
8. Tobacco use causes, or worsens, over 40 diseases including cancer, heart attacks, lung disease, complications of pregnancy and TB.
9. Tobacco use kills about 30 000 South Africans each year or about 80 people a day. This is more than double the number of deaths on our roads every year
10. A smoker is more likely to die from tuberculosis (TB) than a non-smoker. Every day about 16 avoidable deaths from TB occur amongst smokers.
11. Globally, only two major causes of death are increasing rapidly - HIV and tobacco. The WHO predicts that, unless urgent action is taken worldwide deaths from tobacco will double from the current 5 million to 10 million annually by the year 2025.
12. Approximately 70% of these future deaths will occur in the poor nations of the world, where already overburdened health services are unprepared for this coming epidemic.
Tobacco use in
13. Fewer adults and children are smoking in
14. Since 1994, the number of adults who smoke has gone down by over a third. About 5 million or 23% of adults smoke. Snuff is used by about 10% of African women.
SECTION 2: CONTROLLING TOBACCO USE.
15. 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 smoking of others does not impair the health of non-smokers;
(c) prevent the nuisance which smoking may cause to non-smokers;
16. In 2004, smokers burned 25 million kilograms of tobacco in our air making tobacco smoke one of our largest sources of indoor air pollution.
17.Cigarette smoke contains over 4500 chemicals, including over 200 known poisons (arsenic, cadmium, cyanide, nicotine, etc) and 60 chemicals that cause cancer.
18. Over 600 scientific studies have now linked passive smoking and ill health. It is a cause of lung cancer and heart disease in adult non-smokers. In children it increases the risk of sudden infant death syndrome (SIDS), acute respiratory infections (croup and pneumonia), ear problems and asthma attacks.
19. There is no safe level of exposure to tobacco smoke and both short-term and long-term exposure can cause harm. As little as 30 minutes of exposure to secondhand smoke can significantly increase the risk of a heart attack in those with heart problems.
20. A number of countries have now banned smoking
completely in indoor public areas, including
21. A total ban on smoking in indoor public places has several advantages. It would:
• be more effective than a partial ban in decreasing tobacco smoke pollution and in improving health;
• be fairer as it would protect all workers. Currently, those who work in areas set aside for smoking are still exposed to harm;
• generate considerable cost savings to society; and
• be simpler, more consistent and easier to enforce.
22. Surveys show
that 80% of smokers and non-smokers support a ban on smoking in public places
23. The Tobacco Products Control Amendment Act of 1999 took significant steps toward protecting the public by prohibiting smoking in all enclosed public places and workplaces, except for designated areas set aside for smokers.
24. Almost overnight, the social norms regarding secondhand smoking changed. Whereas previously people smoked anywhere and everywhere including in hospitals, now the ashtray and smoky haze has almost disappeared.
25. Clear rules defining where smoking is, or is not, permitted has averted needless conflict between smokers and non-smokers. Both smokers and non-smokers can then
be sure of their rights. The public has embraced the law and shopping malls, public transport and workplaces rapidly became smoke-free. With the exception of some in the hospitality industry, the law is working well.
27. The law is self-enforcing. The police did not have to sit in every cinema, café, and office waiting to arrest offenders. Instead, ordinary citizens stood up for their right to clean-air.
The Proposed Amendments.
28. The NCAS is especially supportive of the Bill’s increased requirements regarding smoking in public places. The Bill seeks to better protect children from passive smoking and seeks to guarantee workers there constitutional right to an environment that is not harmful to their health.
Restrictions on smoking near entrances to enclosed public places:
29. The NCAS supports moving smokers away from the entrances and air inlets to buildings. Tobacco smoke can enter and pollute buildings though open doors, windows and ventilation inlets. People entering and exiting the building are also exposed to this pollution. This can be particularly problematic for those with asthma or heart conditions, for whom even short exposures to smoke can trigger an attack.
30. Significant numbers of people now smoke near entrances and exits to buildings as an unintended consequence of the current law. As a result, high concentrations of tobacco smoke can be found near entrances and exits through which the public must go, and smoke enters buildings via general airflow.
31. The NCAS has received numerous complaints from the public on this issue. For example, many indoor diners complain that in coffee shops and restaurants they are exposed to smoke from those smoking outside in the alfresco area.
32. The problem can be fairly easily resolved by prohibiting smoking within 3 metres of any non-domestic building. Experience in other countries shows that the policy can be enforced through signage at entrances and moving ashtrays away from doorways.
Smoking in day care centres and the entry of minors into smoking sections.
34. The Bill seeks to protect children in two ways. It proposes not allowing smoking in private homes used commercially for childcare or educational purposes. It also proposes not allowing minors into the areas set aside for smoking.
35. Young children are especially vulnerable to second-hand smoke because they breathe more air relative to body weight than adults and so absorb more tobacco smoke toxins. They are also less able to complain or remove themselves from smoke-filled rooms.
36. It is vital that facilities for children be smoke-free. Children of non-smoking parents should not be exposed to harm while in day care. For children of parents who smoke
exposure in the home plus in the day care will be additive and increase the harm.
37. In day care facilities, even if smoking is restricted to a single room in the house, smoke will still drift throughout the home. It is not possible to confine smoke to one area. The NCAS have received reports of caregivers walking from other parts of the house into the room where the children were with a lighted cigarette because he or she was not consciously mindful of his/her smoking.
38. Prohibiting smoking in day care and tutoring facilities only during times when children are actually on the premises will not work. This disregards the fact that many of the more volatile chemicals in smoke remain in the air for a long time following the smoking of a cigarette (from four hours to days). Some of the solid particles in smoke will settle on furniture, carpets and other surfaces in the room. These then slowly re-enter the atmosphere creating a hazard long after smoking has ceased. A simple test of how long smoking persists is that one can still smell cigarette smoke in a home, or on clothes, long after someone has smoked.
39. In relatively confined spaces, such as smoking areas, where many people smoke, high levels of tobacco smoke toxins can build up, To take children into these places is recklessly exposing them to harm.
40. Prohibitions on taking children into public smoking areas can have an educational effect for parents, who may be less inclined to smoke at home.
Smoking in sports stadia and other crowded facilities.
41. Section 2(3) allows the Minister to prohibit smoking in certain outdoor areas, where smoking may constitute a fire or other risk. In crowded sports stadia exposure to tobacco smoke is likely to be sustained (from a few hours to the whole day for cricket lovers) and significant. Vulnerable people, who are very sensitive to smoke, can have their health put at risk.
42. In addition, many communities ban nuisances like loud noise at night, public drunkenness, dogs defaecating on pavements, etc. So even when tobacco smoke may not harm health it is still a major nuisance which should be controlled in areas in which exposure cannot be easily avoided such as at railway platforms and entrances to buildings.
Protecting the constitutional rights of workers.
43. The Constitution guarantees everyone the right ‘to an environment that is not harmful to their health or well-being”. Sections 2(3) and (4) require employers to respect employees’ rights and protect them from the harms caused by tobacco smoke pollution.
44. Surveys find that most people do not want to be exposed to tobacco smoke. However, many are afraid to assert their right to smoke-free air in the workplace because of the fear of upsetting their employers. They instead phone local authorities, the health department and non-governmental organizations seeking help while wishing to remain anonymous. The Bill proposes making it possible for people to safely articulate their concerns without fear of repercussions.
45. The Bill also places an obligation on employers to respect an employees right not
to be forced to work in a smoking section against their wishes. People should not be required to pay with their health for the opportunity to work. The Bill proposes prohibiting employers from coercing people desperate for employment to work in the smoking section (section 2(5)(c)) and from seeking legal guarantees that employees will not to hold them responsible for harm caused by working in a smoking section.
46. Business owners cannot contract with their workers to relax workplace safety standards and the same rule should apply to tobacco smoke.
The special case of domestic workers.
47. The Act in general prohibits smoking in workplaces, but continues to allow it in private homes. Private homes can be a workplace for domestic workers. These workers are therefore not protected from tobacco smoke in smoker’s homes. The Act has created the discriminatory situation where domestic workers are given less protection than other workers. The NCAS urges that this anomaly be ended and that all workers, including domestic workers, be protected from pollution by tobacco smoke.
Smoking in cars
48. There is strong public support for a ban on smoking in cars while children are passengers. The Bill is silent on this issue. Smoking in cars can produce high concentrations of smoke. Even with all the windows open the particulate matter levels can be higher than what is considered ‘safe’ for sensitive groups like children and the elderly. When the windows are closed the smoke concentrations can reach levels considered hazardous for the general population.
49. The NCAS believes that a strong case can be made for banning smoking in any vehicle while driving. We have received reports of people throwing ‘stompies out of the window, only for the wind to blow the cigarette back into the driver’s lap. Frantic efforts to find the lit cigarette then follow to stop it burning clothes or the car upholstery. The lapse in concentration poses a road threat.
50. The NCAS urges the Portfolio Committee to prohibit smoking in cars while children are present. We believe that public support for the ban is sufficient to ensure that enforcement will not be a problem.
SECTON 3A: STANDARDS FOR MANUFACTURING AND EXPORT OF TOBACCO PRODUCTS
51. The purpose of Section 3A is to reduce the harmfulness of tobacco products. It requires tobacco manufacturers to produce the least dangerous product technically possible.
52. The way tobacco products are designed and manufactured affects their safety, appeal, and addictiveness. Manufactured tobacco products are more toxic, carcinogenic, and hazardous to health and the environment than they need to be to deliver nicotine.
53. The Bill allows for the regulation of the substances that the manufacturer’s can put into tobacco products (its constituents) and the chemicals that may be produced when tobacco products are used (its emissions).
54. The WHO has recommended that countries establish manufacturing standards for tobacco products so as to reduce their appeal to children, decrease their addictive qualities, and decrease potential harm to users.
55. Despite their toxicity, tobacco products are currently subject to little regulation regarding their content, design and manufacture. New tobacco products can be introduced and the design of currently available products can be changed on the whim of the manufacturers, and with almost no regulatory oversight.
56. Paradoxically, medications to help people quit smoking are strictly regulated by the Medicine’s Control Council. These have to meet the same safety and product standards as any other scheduled medicine and can only be sold through pharmacies.
57. A policy that barely regulates nicotine in its deadliest form (cigarettes), while strictly regulating it in its safest form (medications) is not rational. The WHO has recognized this is anomaly. The FCTC mandates that governments require tobacco companies to reveal what ingredients they use in producing cigarettes and that these are disclosed to the public.
58. The cigarette is more than just dried tobacco wrapped in paper, and snuff is not simply powdered tobacco leaf. Modern tobacco products are highly engineered. The manufacturers have spent enormous resources researching the design and manufacture of cigarettes. The key goal is to deliver nicotine rapidly and in sufficient quantities to feed a smokers craving.
59. Highly sophisticated technologies are used to fine-tune the addictiveness of the modern cigarette:
· Ventilated filters provide cooler and more dilute smoke. This enables the smoker to readily inhale larger quantities more deeply into the lungs.
· The physical size of smoke particles is carefully controlled – using the science of particle physics - to allow smoke particles to penetrate deep into the lungs.
· Chemical ingredients are added to the tobacco, filter, and paper during the manufacture of cigarettes or snuff. These ingredients are called ‘additives’ and serve many purposes.
60. Up to 1400 chemicals can be added to tobacco. These additives:
- Mask the irritating and harsh taste of smoke (sugars are added).
- Enhance nicotine delivery, so increasing the addictive “kick” of nicotine (ammonia).
- Keep the product fresh (anti-fungals);
- Control the rate at which cigarettes burn (nitrates).
- Produce a white ash (chalk).
- Give brands their special flavour (cocoa, chocolate).
Recognising that children often find the taste of
62. Chocolate, licorice, honey, sugars, menthol, and other flavourings help hide the unpleasant taste of tobacco and make it easier for children to start smoking. Menthol, for instance, numbs the throat and reduces coughing.
64. Additives, such as ammonia change the pH of smoke so increasing ‘freebase’ nicotine levels. Free nicotine, like crack cocaine, passes more rapidly and completely through the lungs into the bloodstream and has a faster effect on the brain.
67. The safety of many of the flavourings and other additives when burned and inhaled has not been established.
68. By engineering products to enhance addictiveness the industry makes it more difficult for smokers to quit, and is thus deliberately increasing the overall harm to the public.
69. The tobacco companies have over the years filed many patents for technology that would have removed some of the harmful components of tobacco smoke, but never made these ‘less toxic’ cigarettes available to the public. The problem, according to industry documents is that in order to market these changed cigarettes as ‘safer’, the industry would have had to admit that its existing products were dangerous.
70. When a cigarette is lit, the process of burning will produce over 4500 chemicals in the smoke – 200 of these are poisons (arsenic, cyanide, carbon monoxide, nicotine) while over 60 can cause cancer. The chemistry of smoke is influenced by many factors including the type of tobacco used, the length of the cigarette, the burn rate of the paper and how the cigarette is smoked.
Currently, the law in
72. The tar and nicotine numbers that appear on South African cigarette packs are meaningless. They convey no accurate information to smokers about what they are inhaling.
73. This is because the International Standards Organization (ISO) testing methods currently in use for measuring tar and nicotine are flawed. There is little relationship between the ISO machine-measured yields of cigarettes and what smokers actually absorb. Further, there are no methods for testing smokeless tobacco products.
74. Smokers can obtain as much nicotine and tar from smoking ‘low-tar’ cigarettes as they can from smoking regular cigarettes. This complicates the ability to regulate tobacco products. To date, no country has fully met the challenge of developing comprehensive product regulation standards.
75. A new regulatory framework is needed in which the manufacturer is obliged to demonstrate that no additional harm arises for tobacco product design decisions such as the use of additives. While it is impossible to make a cigarette safe, it is reasonable to prevent manufacturer’s doing anything that increases the harm caused by tobacco smoke.
76. A new framework should:
- Require manufacturers to disclose all additives used in tobacco products, by brand, to the government.
- Also require them to disclose the purpose of an additive and its biological effects, if any, when inhaled
- Enable government to order the removal of additives which increase harm.
- Only allow new additives if its safety can be demonstrated
- Permit additives necessary for the manufacturing and storage of tobacco products provided these are safe, but bar all additives that may influence smoking behavior.
- Not allow any health claim based on the levels of ingredients, or emissions, or whether the product meets regulatory standards.
77. The FCTC’s Conference of the Parties is developing guidelines for product regulation and testing. Such guidance should be forthcoming in the near future.
78. The Bill proposes providing broad legal authority to the Minister to develop standards for constituents, emissions, product design, and testing methods, once there are clear international guidelines for doing so.
79. While there is no such thing as a safe cigarette, it remains the goal of public health to make cigarettes less harmful. The benefits of reducing the levels of toxic chemicals 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.
Reducing the fire-risks from cigarettes
80. The aim is to reduce deaths, injuries and property damages resulting from fires started by manufactured cigarettes.
81. Smokers’ materials
are a leading cause of residential fires and fire-related losses in
82. Cigarette fires typically result from lit cigarettes left unattended, falling asleep while smoking in bed, smoking while under the influence of alcohol, or the tossing away of a lit cigarette. When a lit cigarette comes into contact with flammable products such as mattresses, bedding or upholstered furniture, it can start a smouldering process that can continue undetected for some time before bursting into flame.
83. It is possible to reduce cigarette ignition propensity (that is the likelihood that a lit cigarette will start a fire) by altering certain design characteristics of manufactured cigarettes.
84. In July 2000, a major
American cigarette manufacturer released a reduced-ignition propensity version
of one of its cigarette brands in the
86. Reduced ignition propensity does not mean fire-safe. It is impossible to make a burning object completely fire-safe. However, the proposed regulations can save lives by significantly reducing the number of fires started by cigarettes.
87. The Bill allows the
Minister to set a ‘performance standard’ that all cigarettes sold in
88. The Bill increases the penalties for contraventions of the law so that they are a meaningful deterrent. The fine for the owner of a public place is increased from R200 to a maximum of R50 000, and for individual from R200 to a maximum of R500.
89. The proposed fines are reasonable and modest compared to those for other offences. For instance the maximum fine for selling liquor to a minor is R 1 million, and for poaching perlemoen it is R 800 000.
submission has provided a rationale for the amendments contained in the
Bill. The NCAS believes that the Bill is
fair, reasonable and workable. It will make a significant contribution to
reducing the health, economic and environmental harms caused by tobacco use in
91. Freedom from addiction is a child’s right and society’s responsibility. We trust that the Portfolio Committee on Health will put the freedom of children to grow up healthily above the freedom of an industry to sell a deadly drug.
Yussuf Saloojee PhD. Executive Director Peter Ucko CP Law. Director Mobile: 082 454-9889 e-mail: firstname.lastname@example.org
INCORPORATED ASSOCIATION NOT FOR GAIN. Reg. No. 76/00025/08 NONPROFIT Reg. No. 023-970-NPO