Enforcing laws against tobacco use in Nigeria

To prevent millions of people falling ill and dying from tobacco-related disease, several attempts have been made in Nigeria to stop the sales, marketing and consumption of tobacco products.

The Lagos State government in 2014 enacted a law banning smoking in public places.

The Lagos State House of Assembly on January 21, 2014 passed a bill to prohibit smoking in designated places and vehicles in the state.

The law places a fine of N10, 000 or three months imprisonment, or both for first offenders.

The law prohibits residents of the state from smoking in public places such as schools, day-care centres, libraries, museums, hospitals, public transportation, restaurants, and public toilets among others.

The law also mandates owners of public places to place signs with the inscription; “No Smoking” or symbols as part of enlightenment for smokers and would-be violators of the law.

At the national level, the National Tobacco Control Bill, NTCB 2009 is a comprehensive law to regulate the manufacturing, advertising distribution and consumption of tobacco products in Nigeria.

Despite all these laws and decrees, Nigerians still smoke at public places and there is not yet any court convictions and sentencing to deter the practice.

Advocates say Nigeria still operates a 23-year-old tobacco control decree because the failed National Tobacco Control Bill 2009 is an upgrade of the Tobacco Control Act of 1990.

Despite these efforts made by governments all over the world to stop smoking, the World Health Organisation (WHO) said tobacco use kills more than seven million people every year and costs households and governments over US$ 1.4 trillion (about N504 trillion) through healthcare expenditure and lost productivity.

According to a first-ever WHO report, released yesterday ahead of the World No Tobacco Day (WNTD), May 31, action to stamp out tobacco use can help countries prevent millions of people falling ill and dying from tobacco-related disease, combat poverty and, reduce large-scale environmental degradation.

The theme of WNTD 2017 is “Tobacco – a threat to development.”

To address the menace in Nigeria, Minister of Health, Prof. Isaac Adewole, last November, indicated the Federal Government’s interest to increase taxation on tobacco to discourage people from smoking as it endangers their health. This is as tobacco-manufacturing companies have described Nigeria as an untapped market to invest in tobacco products.

Also, a non-governmental group, Environmental Right Action, Friends of the Earth Nigeria, Environmental Rights Action (ERA)/Friends of the Earth International, Nigeria charter (FoEN), has accused Philip Morris International, PMI, of illegal importation of cigarettes into the country, and that if not checked, the country might witness tobacco epidemic worse than any epidemic ravaging the country.

Adewale said he had “personal and official reason for fighting tobacco.”

He made it known that the government had contemplated increasing taxation on tobacco products to discourage people from smoking tobacco because of the inherent health danger and also use the proceeds to fund healthcare.

Meanwhile, The Guardian investigation revealed that tobacco in Nigeria (particularly cigarettes, which account for most volume sales) recorded a slightly stronger increase in current value sales, as illicit trade growth slowed slightly. The steady rise in demand follows a mild increase in consumption, primarily due to Nigeria’s growing population and the ongoing urbanisation and Westernisation trends. In addition, the fact that smokers are increasingly choosing higher-priced cigarette brands is also helping to drive value sales.

The Guardian learnt that the volume growth in cigarettes was boosted by a slowdown in growth of illicit trade, which grew over the review period due to the fact more and more brands are being imported legally (paying customs duties) but failing to fulfill all legal requirements, such as having Standards Organisation of Nigeria (SON) certification.

A Global Adult Tobacco Survey (GATS) conducted in 2012, which is Nigeria’s first official data documenting the prevalence and pattern of adult tobacco use in the country estimates that the bulk of Nigeria’s 4.5 million adult smokers are male. While 10 per cent of adult men in Nigeria consume tobacco, only 1.1 per cent of the women do.

The 4.5 million smoking adults, exposes 27 million others to harmful second smoke, the report added, with government buildings and restaurants the most likely places none-smokers get exposure to tobacco.

The survey also estimates that an average smoker in Nigeria spends N1, 202.5 on tobacco products monthly. On the whole, Nigerians spend an average of N7.45 billion on tobacco monthly, and N89.5 billion yearly.

While at least one in every five adults polled saw a cigarette advert outside stores and sporting events, two in five adults admitted noticing an anti tobacco warning on TV and radios.

Four out of every five adult polled believe tobacco causes serious illness, the report said.

The survey polled 9,765 respondents across the 36 states of Nigeria – and the capital territory.

The GATS showed South Easterners in Nigeria are the highest consumers of tobacco, with about nine per cent of its adult population currently smoking.

Closely following the South East is the North Central – Middle Belt – where at least 8.5 per cent of its adult population is hooked on tobacco.

North West states, including Kano, Kaduna, Sokoto and Katsina, are the least smokers in Nigeria, with only three per cent of its adult population indulging in tobacco.

The North East, South-South and Southwest regions come between that range.

It is believed that the failed National Tobacco Control Bill 2009 is an upgrade of the Tobacco Control Act of 1990 and a replica of the World Health Organization’s Framework Convention on Tobacco Control (FCTC). Nigeria ratified the FCTC treaty in October 2005.

Anti-tobacco advocates argue that Nigeria needs to fully adopt the more comprehensive provision of FCTC. Nigeria is planning a new tobacco bill that is believed to have stiffer anti-tobacco laws.

Executive Director, Nigerian Heart Foundation (NHF), Dr. Kingsley Akinroye, said: “Tobacco-related illness is one of the biggest public health threats the world faces, killing more than seven million people a year. But tobacco use is one of the largest preventable causes of non-communicable diseases.

“Tobacco control represents a powerful tool in improving health in communities and in achieving the Sustainable Development Goals (SDGs). SDG target 3.4 is to reduce premature deaths from NCDs by one third by 2030, including cardiovascular and chronic respiratory diseases, cancers, and diabetes.

“Another SDG target, 3.a, calls for implementation of the WHO Framework Convention for Tobacco Control (WHO FCTC). The WHO FCTC entered into force in 2005, and its Parties are obliged to take a number of steps to reduce demand and supply for tobacco products. Actions addressed in the Convention include protecting people from exposure to tobacco smoke; banning tobacco advertising, promotion and sponsorship; banning sales to minors; requiring health warnings on tobacco packaging; promoting tobacco cessation; increasing tobacco taxes; and creating a national coordinating mechanism for tobacco control. There are 180 Parties to the Convention.”

Meanwhile, the first-ever WHO report, “Tobacco and its environmental impact: an overview,” yesterday, also showed the impact of this product on nature, including:
*Tobacco waste contains over 7000 toxic chemicals that poison the environment, including human carcinogens.
*Tobacco smoke emissions contribute thousands of tons of human carcinogens, toxicants, and greenhouse gases to the environment. And tobacco waste is the largest type of litter by count globally.
*Up to 10 billion of the 15 billion cigarettes sold daily are disposed in the environment.
*Cigarette butts account for 30–40 per cent of all items collected in coastal and urban clean-ups.

Tobacco threatens all people, and national and regional development, in many ways, including:
*Poverty: Around 860 million adult smokers live in low- and middle-income countries. Many studies have shown that in the poorest households, spending on tobacco products often represents more than 10 per cent of total household expenditure – meaning less money for food, education and healthcare.
*Children and education: Tobacco farming stops children attending school. 10 per cent–14 per cent of children from tobacco-growing families miss class because of working in tobacco fields.
*Women: 60 per cent–70 per cent of tobacco farm workers are women, putting them in close contact with often hazardous chemicals.
*Health: Tobacco contributes to 16 per cent of all non-communicable diseases deaths.

WHO’s Assistant Director-General for NCDs and Mental Health, Dr. Oleg Chestnov, said: “Many governments are taking action against tobacco, from banning advertising and marketing, to introducing plain packaging for tobacco products, and smoke-free work and public places.

“But one of the least used, but most effective, tobacco control measures to help countries address development needs is through increasing tobacco tax and prices.”

Governments collect nearly US$ 270 billion in tobacco excise tax revenues each year, but this could increase by over 50 per cent, generating an additional US$ 141 billion, simply from raising taxes on cigarettes by just US$ 0.80 per pack (equivalent to one international dollar) in all countries. Increased tobacco taxation revenues will strengthen domestic resource mobilization, creating the fiscal space needed for countries to meet development priorities under the 2030 Agenda.

Director of WHO’s Department for the Prevention on NCDs, Dr. Douglas Bettcher, said: “Tobacco is a major barrier to development globally. Tobacco-related death and illness are drivers of poverty, leaving households without breadwinners, diverting limited household resources to purchase tobacco products rather than food and school materials, and forcing many people to pay for medical expenses.

“But action to control it will provide countries with a powerful tool to protect their citizens and futures.”

According to the latest estimates from the Global Burden of Disease study published in The Lancet, worldwide, nearly one billion people smoked daily in 2015, including one in four men and one in 20 women – a reduction from one in three men and one in 12 women, respectively, since 1990.

While smoking prevalence has decreased, deaths attributable to smoking have gone up by 4.7 per cent globally – with more than one in 10 deaths worldwide caused by smoking.

More countries achieved significant reductions in daily smoking prevalence between 1990 and 2005, than between 2005 and 2015.

Although tobacco control programmes are effective, population growth has led to an increased number of smokers worldwide.

According to The Lancet, more than one in 10 deaths worldwide (equivalent to 6.4 million deaths) are caused by smoking and half of these occur in just four countries – China, India, US, and Russia.

The new estimates are based on smoking habits in 195 countries and territories between 1990 and 2015, and illustrate that smoking remains a leading risk factor for death and disability. With growing and ageing populations already heightening the burden of tobacco, it will be crucial to support more smokers to quit and stop people from starting smoking.

Since the implementation of the WHO Framework Convention on Tobacco Control in 2005, many countries have applied tobacco policies resulting in reductions in smoking prevalence, but the authors of the study warn that the war against tobacco is far from won, and argue that policy makers need renewed and sustained efforts to tackle the epidemic.

Worldwide, between 1990 and 2015, smoking prevalence decreased by almost a third (29.4 per cent) to 15.3 per cent in 2015, and today, one in four men (25 per cent) worldwide smoke, as do one in 20 women (5.4 per cent). Despite these improvements, population growth has led to an increase in the overall number of smokers, increasing from 870.4 million in 1990 to 933.1 million in 2015.

Deaths attributable to smoking increased by 4.7 per cent in 2015 compared with 2005 and smoking was rated as a bigger burden on health – moving from third to second highest cause of disability.

Senior author and lead researcher at Institute for Health Metrics and Evaluation at the University of Washington, US, Dr. Emmanuela Gakidou, said: “Despite more than half a century of unequivocal evidence of the harmful effects of tobacco on health, today, one in every four men in the world is a daily smoker,” said “Smoking remains the second largest risk factor for early death and disability, and so to further reduce its impact we must intensify tobacco control to further reduce smoking prevalence and attributable burden.”

The 10 countries with the largest number of smokers in 2015 were China, India, Indonesia, USA, Russia, Bangladesh, Japan, Brazil, Germany and the Philippines – who together accounted for almost two-thirds of the world’s smokers (63.6 per cent).

High smoking prevalence levels and worrying trends persist. For instance, Indonesia, Bangladesh and the Philippines saw no significant reductions in male smoking prevalence between 1990 and 2015 (2015 smoking rates were 46.7 per cent, 38.0 per cent and 34.5 per cent, respectively), and in Russia, female smoking prevalence has increased (from 7.9 per cent in 1990 to 12.3 per cent in 2015) and comprehensive tobacco control policies were only implemented in 2014.

The authors note that Indonesia has very high smoking levels and has not yet ratified the WHO Framework Convention on Tobacco Control.

In contrast, Brazil, which has been a leader in tobacco control, showed one of the largest reductions in smoking prevalence for men and women between 1990 and 2015 – halving from 28.9 per cent to 12.6 per cent in men and 18.6 per cent to 8.2 per cent in women.

In addition, the researchers link increases in female smoking prevalence since 1990 and consistently high levels of male smokers in Eastern Europe with the tobacco industry’s targeting of the area in the 1990s – for instance, Russia experienced a 56.2 per cent increase in female smoking prevalence between 1990 and 2015 while male smoking prevalence in Latvia remained at a persistently high level, 37.3 per cent in 1990 and 38.3 per cent in 2015.

They warn that a similar result could happen in sub-Saharan Africa, as the tobacco industry now seeks to expand its market by exploiting the region’s patchwork tobacco control regulations and its limited resources to combat the industry’s marketing tactics.

For this reason, the authors note that while the WHO tobacco convention is necessary for creating policy, each country must ensure that tobacco control is tailored to their own context and needs, and that compliance and enforcement work together.

“There have been some success stories, but smoking remains the leading cause of death and disability in 100 countries in 2015,” said Gakidou. “Its toll will remain substantial without more concerted policy initiatives, policy compliance and enforcement, and sustained political will to offset commercial interests. Despite progress in some settings, the war against tobacco is far from won, especially in countries with the highest numbers of smokers.

“The staggering toll of smoking on health echoes well beyond the individual, especially as tobacco threatens to exact long-term financial and operational burdens on already resource-constrained health systems. To markedly bend the global tobacco epidemic’s trajectory, a renewed and sustained focus is needed on comprehensive tobacco control policies around the world. Success is possible, but requires effective and aggressively enforced policies and laws.”

The study estimates were based on the number of people who smoked every day, rather than occasional or former smokers, and did not take into account how many cigarettes a person smoked in a day nor people who used smokeless tobacco products or e-cigarettes.