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Updated: July 19, 2011
South Africa
Overview
Prevalence of Tobacco Use
Common Forms of Tobacco Use
Cost of Tobacco Use
Tobacco-Related Health Information
Tobacco Use in the Workplace
Tobacco Cessation Treatment Options
Resources
Citations
Overview
South Africa has a variable history with tobacco. On one hand, it has one of the highest smoking rates in the world.1 In fact, South Africa's incidence of smoking ranks 20th in the world.2 On the other hand, South Africa should be considered a tobacco control success story. It is one of just a handful of developing countries with comprehensive tobacco control policies. In 2008, South Africa was considered highest among countries at enforcing bans on tobacco industry advertisements, promotions and sponsorship.3This country's experience proves that evidence-based tobacco control policies can positively impact tobacco use.2,4
South Africa's tobacco control measures have evolved over time. In 1993, the country enacted its first tobacco control legislation. In 2005, the country ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC). Some of South Africa's tobacco control efforts include:
- Encouraging smokers to quit. Between 1992 and 2001, when adjusted for inflation, the price of cigarettes increased by 111%.4
- Discouraging new smokers from starting the habit. South Africa has established broad bans on tobacco product advertising, promotion and sponsorship.5
- Protecting non-smokers from secondhand smoke. Smoking is prohibited in workplaces and public places, including health care facilities, schools, government facilities, restaurants, airports, hotels, bars and entertainment venues.5,6
In 2009, South Africa's President Zuma signed into law new anti-smoking regulations that strengthen limits on smoking in public places and regulate the manufacturing and marketing of tobacco products.7 The government:
- Increased fines for smoking or allowing smoking in non-smoking areas.
- Disallowed smoking in:
- 'Partially enclosed' public places (e.g., covered patios, verandas, balconies, walkways and parking areas).
- Cars when passengers under age 12 are present.
- Areas (including private homes) used for commercial childcare, schooling or tutoring.
- Restricted designated smoking areas to persons over 18 only.
- Outlawed tobacco industry-sponsored 'parties' that leverage social media and viral marketing.
- Prohibited the sale of tobacco products (or confectionary products/toys) to and by persons under 18.
- Required that vending machines sell either tobacco products or other products, not both.
As a result of its many tobacco control measures, South Africa's smoking rates have dropped significantly. Between 1995 and 2004, adult smoking rates fell by 20%.4
Approximately 2.5 million smokers have stopped smoking resulting in decreased annual cigarette consumption by about 40%.4,8
Prevalence of Tobacco Use
Smoking in South Africa is commonplace. More than 22% of adults (2002-2003) and 24% of youth (2008) smoke.3 Approximately 16% of adults report smoking daily. 3
Tobacco users in South Africa are generally older and less-educated than non-users.4 Men are more likely to smoke than women.5 Women are likely to continue smoking during pregnancy. In fact, 20% of women report doing so.4 Colored* people have the highest prevalence of smoking in the country (49%), followed by whites (37%), Indians (28%) and blacks (22.7%).9
| Prevalence of Tobacco Use (%)3 |
| Adult Males |
35.1% |
| Adult Females |
10.2% |
| Youth Males |
29.3% |
| Youth Females |
20.1% |
* The term 'colored' refers to an ethnic group of mixed-race people who possess some sub-Saharan African ancestry, but not enough to be considered black by South African law.
Common Forms of Tobacco Use
Manufactured cigarettes dominate the market. Hand-rolled cigarettes account for 21% of all sales.4 Approximately 6% of tobacco users use smokeless tobacco. Commercial snuff in South Africa delivers more nicotine than homemade snuff. A user of commercial snuff receives the nicotine concentration equivalent to smoking 20 cigarettes a day.4
Cost of Tobacco Use
Economic data about tobacco-related costs in South Africa is limited. Where it exists, it is dated. 1994 estimates of lost productivity costs as a direct result of tobacco-attributed hospitalizations were more than U.S.$300 million.1 The total economic cost of smoking-related disease in 1988 was projected at between R1,390 million and R2,453 million (U.S.$1 equivalent to R2.5 in 1988).10 These costs include direct health care and lost productivity due to hospital admissions and premature mortality.
Tobacco-Related Health Information
Tobacco use is a significant cause of death and disease in South Africa. Eight percent of all deaths, or almost 50,000 South African deaths per year, are a direct result of smoking.8,11 In South Africa, smoking is the third leading cause of death (after unsafe sex/sexually transmitted disease and high blood pressure).12 Out of 100 smoking-related deaths in South Africa:4
- 28 were from chronic obstructive pulmonary disease (COPD)
- 19 were from tuberculosis (TB)
- 13 were from lung cancer
- 12 were from ischaemic heart disease (IHD)
- 10 were from cancer of the lip, mouth, pharynx and esophagus
- 9 were from strokes and vascular disease
- 9 were from other conditions
If all smokers in South Africa suddenly quit smoking, 58% of all lung cancer deaths, 37% of all COPD deaths, 20% of all TB deaths and 23% of all vascular deaths could be avoided.4
Tobacco Use in the Workplace
Smoking has a significant impact on workplace productivity. Deaths from smoking-related diseases result in 110,856 potential years of life lost among those 35 to 64 years of age (1988).10
South Africa has passed extensive smoke-free workplace legislation. Smoking is banned in health care facilities, schools and universities, government facilities, indoor offices, restaurants, bars and entertainment venues.5,6 National standards fall short of FCTC requirements because the law permits the establishment of Separate Designated Smoking Rooms (DSR). 3
Tobacco Cessation Treatment Options
About 72% of adult South Africans say they want to quit smoking; 24% have tried to quit.4 In South Africa, there are many options for treating tobacco dependence, including:
- Available quitline(s).5
- The sale of Nicotine Replacement Therapy (NRT).5
- The sale of bupropion.5
- Available counseling in most health clinics, hospitals, provider offices and in the community.5
The South African government, however, provides no financial support to individuals seeking treatments. 3
Resources
Citations
1 Asare BE. Tobacco regulation in South Africa: interest groups and public policy. African Journal of Political Science and International Relationships. 2009;3(3):99-106.
2 Naurath N, Jones J. Smoking rates around the world - How do Americans compare? Gallup News Service. August 17, 2007. Accessed May 19, 2011.
3 World Health Organization. WHO report on the global tobacco epidemic, 2009: implementing smoke free environments. Accessed June 11, 2011.
4 Saloojee Y. Tobacco control in South Africa. In: Steyn K, Fourie J, Temple N, eds. Chronic Diseases of Lifestyle in South Africa: 1995-2005. Cape Town, South Africa: South African Medical Research Council; 2006.
5 World Health Organization. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva, Switzerland 2008. Accessed June 11, 2011.
6 Global Smokefree Partnership. Global voices: working for smokefree air 2008 status report. American Cancer Society & Framework Convention Alliance; 2008. Accessed June 11, 2011.
7 Langa L. South Africa: govt tightens tobacco laws further. September 1, 2009. Accessed June 11, 2011.
8 Burki T. Special report: national smoking in South Africa. The Lancet. December 2008;9:1127.
9 Walbeek CV. Recent trends in smoking prevalence in South Africa - some evidence from AMPS data, South African Medical Journal 2002;92(6):468-472.
10 Yach D, McIntyre D, Saloojee Y. Smoking in South Africa: the health and economic impact. Tob Control. December 1,1992;1(4):272-280.
11 Henderson A. Law catches up with smokers. Cancer Association of South Africa, 2008.
12 Groenewald P, Vos T, Norman R, et al. Estimating the burden of disease attributable to smoking in South Africa in 2000. South African Medical Journal. 2007;97(8 Pt 2):674-681.
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