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A Focus on India and South Africa See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/305635219 Controlling the use of Tobacco for Sustainable Development: A Focus on India and South Africa Article in INDIAN JOURNAL OF PHARMACY PRACTICE · June 2016 DOI: 10.5530/ijopp.9.2.5 CITATIONS READS 0 159 1 author: Theodore Duxbury Rhodes University 5 PUBLICATIONS 2 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: health Promotion Research View project All content following this page was uploaded by Theodore Duxbury on 25 October 2016. The user has requested enhancement of the downloaded file. Special Edition Controlling the use of Tobacco for Sustainable Development: A Focus on India and South Africa Theodore Duxbury1, Seema Rath2, Paayal Maraj1, Sean James Bosman3, Sunitha Srinivas1* 1Faculty of Pharmacy, Rhodes University PO Box 94, Grahamstown, SOUTH AFRICA. 2Hugh Kelly Fellow, Faculty of Pharmacy, Rhodes University, SOUTH AFRICA /Department of Economics, Government College, Khandola-Goa, INDIA. 3Department of English, Rhodes University, Grahamstown, SOUTH AFRICA. ABSTRACT The use of tobacco containing products is a global health and economic burden adversely affecting sustainable development, particularly in the developing world. This article focuses on the impact of population growth, aging, gender, culture, and the ascendancy of transnational tobacco companies on the tobacco epidemic in India and South Africa. There is a distinctive manifestation of the tobacco epidemic in India and South Africa based on the stated impacting factors. Successful implementation and execution of tobacco control policies are required to promote sustainable human development. These must act in conjunction with strengthened World Health Organization tobacco control measures and improved understandings of tobacco industry strategies, as well as take population attitudes and practices towards tobacco consumption into consideration. One of the most effective contributions to controlling the tobacco epidemic is seen in health promotion initiatives. Key words: Tobacco, Health, Health Promotion, Sustainable Development Goals, Tobacco control polices. INTRODUCTION Tobacco use has become a global epidemic, due to tobacco related diseases. Tobacco use with dire consequences on health and devel- poses one of the leading preventable public opment.1,2 It is estimated that the number of health threats in the world.4 tobacco smokers will increase to 1.6 billion This manuscript focuses on tobacco use within the next 25 years. It is also estimated prevalence and its influence on the Sustain- that there are close to 1 billion male and able Development Goals (SDGs) under 0.25 billion female tobacco smokers globally, existing tobacco control policies and legis- DOI: 10.5530/ijopp.9.2.5 with 99000 young individuals starting to lation in India and South Africa. The smoke their first tobacco product annually. Address for literature is based on policy measures set out correspondence: It is indicated that the majority of this youth by the World Health Organization (WHO) Sunitha Chandrasekhar group are children under the age of ten, which includes the Framework Convention Srinivas, residing in low- and middle-income coun- Faculty of Pharmacy, on Tobacco Control policies and the Rhodes University tries (LMICs). This epidemic is shifting MPOWER measures. PO Box 94, from high-income countries to LMICs with Grahamstown, SOUTH AFRICA. the industry’s activities specifically targeted Phone no: + 27 46 603 8496 3 TOBACCO USE PREVELANCE at youth and women. It is reported that E-mail: [email protected] nearly 80% of the world’s 1 billion smokers Certain factors which influence the use of reside in LMICs and it is within these coun- tobacco include age, gender, culture and tries that tobacco-related illnesses are most economic characteristics. Smoking tobacco common.3 Reports suggest that one of the in men and women is historically most reasons transnational tobacco companies common in high-income countries (HICs) aim their marketing at women and children in higher socio-economic groups, but is is to compensate for those who quit or die now shifting towards lower socio-economic www.ijopp.org 86 Indian Journal of Pharmacy Practice, Vol 9, Issue 2, Apr-Jun, 2016 Duxbury et al.: Controlling the use of Tobacco groups and LMICs. The major contributor to this shift require much more attention in many countries if it has is the expansion of transnational tobacco companies to result in demographic dividend.10 Even in India and marketing 70% of their cigarettes in Asia, Africa, Eastern South Africa, a larger proportion of population belongs Europe and Latin America.5,6 Global statistics indicate to the age group of 15 to 69 years, the ‘most produc- that tobacco use is more widespread amongst men than tive age group’, which is predicted to increase further women, and that age-standardized smoking prevalence (Table 1). This demonstrates that if the available human is gradually decreasing across all continents. High levels resource is used efficiently, in a non-exploitative and of smoking can be associated with those below 20 years non-capitalistic way by all parties involved, it will result of age, and evidence states that health warnings tend to in sustainable development. However, ill health is a key be ignored by those who are starting to smoke.5 There factor that disrupts this critical growth and development is a gradual decline in tobacco users in some HICs and cycle, and contributes to the drop in life expectancy,10,11 upper middle-income countries (UMICs), but a disturb- especially healthy life expectancy. A study reports that ingly high increase amongst LMICs, resulting in a global tobacco smoking habits reduce the life expectancy of increase in the consumption of tobacco products. Rapid smokers by 12 years.5 population growth can also have an effect on tobacco use, further influencing the youth and women, and Tobacco use prevalence in India and South Africa strengthening the tobacco industries’ economic hold on In India and South Africa, smoking initiation typically them, especially in South Africa, with a projected popu- occurs during the late teenage years and the early twenties, lation of 60 million by 2030 (Table 1). and has a much higher prevalence amongst males than 12,13 The United Nations predicts that by 2050 the population females. In South Africa, it is reported that females over 60 years of age will account for approximately half who lost their mothers before they had turned 15 years of the world population.8,9 This geriatric population is of age are more likely to start smoking than those who projected to increase for both India and South Africa by had not. Males and females who currently drink alcohol 2030 (Table 1), leading to increasing demand for health- once or twice a week are also more likely to start smoking 14 care due to a higher prevalence of non-communicable than those who do not. The tobacco market within 15 diseases (NCDs). This will have negative implications on South Africa consists of 7.7 million tobacco users. the proposed healthcare budget for the government as Smoking tobacco is the most common method of 16 well as on the health expenditure of patients. tobacco consumption amongst South Africans. The use of other tobacco products is significantly higher Demographics in rural, informal settings (83.2%) than in urban, formal Increases in the size of a population can be regarded settings (56.2%).16 Furthermore, current smokers in as a contributing factor to economic development as informal urban settings smoke 6.5 cigarettes per day as they enhance the demand for goods and services, and opposed to the national average of 7.4 cigarettes per increase the supply of workforce, in turn encouraging day. The report indicates that previous exposure to envi- an increase in production, employment and income. The ronmental tobacco smoke (ETS), also known as passive African Region has over 30% of its population between smoking, has an influence on the likelihood of future the ages of 10 and 24, with these figures predicted to tobacco use. Around 17.7% of the population is exposed remain consistent over the next 15 years. The promi- to ETS on a daily basis in their home environment. The nence of youth in the population and the importance of contribution of ETS is significantly higher for males improving health behaviours and services for adolescents than for females, especially for Coloured males, and this Table 1: Age-wise Composition of Population in India and South Africa (in millions) Age Group 2010 2015 2030 2010 2015 2030 Projected Projected 0-14 30.89 28.79 23.90 30.93 29.25 25.40 15-29 27.57 27.03 24.24 29.65 29.16 25.80 30-69 38.43 40.77 46.64 36.07 38.42 44.52 70 and above 3.10 3.41 5.22 3.34 3.18 4.30 Total 100.00 100.00 100.00 100.00 100.00 100.00 (in millions) 1230.99 1311.05 1527.66 51.62 54.49 60.03 Source: The United Nations, 2015. 7 Indian Journal of Pharmacy Practice, Vol 9, Issue 2, Apr-Jun, 2016 87 Duxbury et al.: Controlling the use of Tobacco 88 Table 2: summarises the progress made by India and South Africa based on the WHO FCTC, MPOWER policies. Year Report MPOWER Measures Outcomes SOUTH INDIA AFRICA 2015 WHO Report on the Monitoring tobacco use Current tobacco use 14.6 21.5 Global Tobacco Epidemic and prevention policies % Youth: Current Cigarette smoking 4.4 12.7 Current Smokeless tobacco use 9.0 7.9 Current Cigarette smoking 5.7 18.2 % Adult: Daily Cigarette smoking 3.6 16.2 Current smokeless tobacco use 25.9 6.5 Protecting people from Healthcare facilities, Educational facilities, tobacco smoke Public places with smoke Universities.
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