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If you fear AIDS, fear tobacco even more

“The tobacco diseases epidemic is already with us in Africa,” says Prof Peter Odhiambo, chairman of the Kenya Tobacco Control Board.

“I treat the victims of tobacco everyday.”

Prof Odhiambo was speaking at Kampala Serena hotel on November 1, 2011, at a public lecture titled, ‘The Journey from the Farm to the Lungs: Who gains from Tobacco in Africa?’

Tobacco use is the single most preventable cause of death in the world today. Tobacco use claims more lives globally than HIV/AIDS, tuberculosis and malaria combined. According to the World Health Organization (WHO), unless urgent action is taken, tobacco could kill one billion people during this century. WHO data also shows that in comparison to HIV/AIDS which claimed three million lives globally last year, tobacco deaths were nearly six million cases.

It is estimated that by 2030 tobacco-related illnesses will be the leading cause of death in the world and 70-80% of these deaths will occur in low-income countries.

“Tobacco is the only legal product in the world which, when used as intended by the manufacturer, kills half of all the people who use it,’’ says Dr Sheila Ndyanabangi, the tobacco control focal person in the ministry of Health.

In a study conducted at Mulago hospital, 75% of patients with oral cancer had a history of smoking, with the number of years of smoking ranging from 2-33 years, according to a 2008 study report by Fredrick Musoke of Makerere University.

“Tobacco use is the only risk factor associated with all major non-communicable diseases (NCDs) such as lung cancer and  heart diseases. It is a risk factor for six out of eight leading causes of death, globally,” said Dr Douglas Bettcher, Head of WHO’s Tobacco-Free Initiative. Dr Bettcher also said that tobacco use in women causes infertility and leads to low birth weight of babies born to tobacco-using mothers. For men, tobacco use can cause low sperm count.

However, the threat posed by second-hand smoking  is said to affect almost a half of all youths in Uganda and is a much more mainstream public health threat in Uganda. Exposure to second-hand smoke increases the risk of heart disease by 25-30% and the lung cancer risk by 20-30%.

Smoking has been banned in public places, including  in bars and restaurants, in Uganda since 2004,  although enforcement is still a challenge. The Ugandan tobacco industry argues that tobacco is economically important to Uganda given that the industry is a leading taxpayer.

“It is not the tobacco companies which pay tobacco taxes; it is the smokers,’’ counters Dr Sheila Ndyanabangi, who argues that taxes on tobacco are simply passed on to consumers and that the healthcare costs of treating tobacco-related diseases far outweigh the economic benefits of the tobacco industry.

According to Rachel Kitonyo of The Africa Tobacco Control Consortium, Uganda is out of step with other East African countries such as Tanzania and Kenya which passed a tobacco control law in 2007. Uganda is yet to pass a tobacco control law although a bill has been in the works for the past few years with a draft announced in 2010.

The Ugandan Parliament is now set to discuss the bill after being dogged by delays. The resurrection of the bill was disclosed on November 1, 2011 by Rebecca Kadaga, the Speaker of Parliament, while opening the new regional Centre for Tobacco Control in Africa (CTCA).

According to Kadaga, the bill will have its first reading in Parliament soon and will be tabled in the house as a private member’s bill moved by Dr Chris Baryomunsi. An effective tobacco control regulatory regime in developed countries has constrained the operations and profits of big tobacco companies such as Phillip Morris and BAT which has made them consider Africa as a lucrative alternative – an untapped market with weak anti-tobacco laws and policies.

With multinational tobacco companies switching their attention to African countries, the non-communicable disease epidemic of heart diseases and cancers which, until now, have been more widespread in the west, are certain to shift to African countries which already have high burdens of infectious diseases such as AIDS, malaria and tuberculosis to contend with.

“Be wary of multinational companies, which come here and sell you death in the name of freedom. These are merchants of death. The tobacco disease epidemic is already here,” warns Professor Peter Odhiambo.

The author works with Makerere University and is a Tobacco control advocate.


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