Toothless laws, policies fuel rise in tobacco smoking-related deaths

Despite efforts by successive governments in making legislation against tobacco smoking in public places and the associated dangers, more Nigerians especially the youths are taking up the bad habit.

Tobacco is a product prepared from the leaves of the tobacco plant by curing them. The plant is part of the genus Nicotiana and of the Solanaceae (nightshade) family. While more than 70 species of tobacco are known, the chief commercial crop is N. tabacum. The more potent variant N. rustica is also used around the world.

Tobacco contains the alkaloid nicotine, which is a stimulant, and harmala alkaloids. Dried tobacco leaves are mainly used for smoking in cigarettes, cigars, pipe tobacco, and flavored shisha tobacco. They can also be consumed as snuff, chewing tobacco, dipping tobacco and snus.

Snus is a type of moist powdered tobacco, typically held in the mouth between the lips and gums.

Tobacco use is a risk factor for many diseases; especially those affecting the heart, liver, and lungs, as well as many cancers. In 2008, the World Health Organisation (WHO) named tobacco as the world’s single greatest preventable cause of death.

Why do some Nigerians still smoke despite the negative health and economic implications? Several studies have identified poor implementation and enforcement of policies and legislations against smoking in public places, and advertising of tobacco products.

Also, producers are not giving up. They are developing newer versions and are still raking in huge profits with estimated 20 billion sticks of cigarettes valued at over N200 billion being consumed annually in Nigeria.

According to “A systemic review of tobacco use in Nigerian youth” published in the journal Plos One, peer influence was the most common risk factor described. The researchers said this is consistent with one study among South African adolescents that showed that peer smoking had the strongest influence on smoking lifestyle.

Also, family conditions, such as low parental education, polygamy, not living with parents; having a parent who smokes and having divorced or separated parents, were additional risk factors.

Stress, loneliness and depressive symptoms were the most common psychosocial risk factors for tobacco smoking, consistent in one study that focused on tobacco smoking among adolescents in seven African countries.

The Plos One review identified that young people who abuse other substances, such as alcohol and marijuana, or who consume other forms of tobacco, excluding smoking, were at risk of tobacco smoking. Since psychosocial problems among young people are usually due to physical, emotional and sexual abuse and neglect, they usually resort to tobacco smoking or other forms of substance abuse as a coping mechanism to ameliorate their condition.

Also, media advertisements and increasing age were identified as risk factors for tobacco smoking.

Similar findings among rural South African adolescents revealed that increasing age and seeing actors smoke on television had significant associations with smoking. Television actors usually serve as role models for young people, and they may subtly motivate adolescents to consider smoking as a socially desirable activity.

Consequences
Smoking cigarettes can have many adverse effects on the body. Some of these can lead to life-threatening complications.

In fact, according to studies, smoking cigarettes increases the risk of dying from all causes, not just those linked to tobacco use.

Smoking cigarettes affects the respiratory system, the circulatory system, the reproductive system, the skin, and the eyes, and it increases the risk of many different cancers.

According to a study published in the journal Elixir International Journal, as at December 31, 2016, the prevalence of tobacco use in Nigeria by youths was 15.4 per cent while adult tobacco smoking and smokeless tobacco use stood at 5.6 per cent and 1.9 per cent respectively.

The study titled “Tobacco Control Legislation and Policy in Nigeria: Much Barking Without Biting” was conducted by Festus Ukwueze, Chukwunweike Ogbuabor and Ebele Okiche of the Faculty of Law, University of Nigeria, Enugu Campus, Enugu State.

The Plos One study noted that the lowest prevalence values of tobacco smoking in Nigeria was 0.2 per cent, in a rural setting across Osun State, and the highest prevalence was 32.5 per cent in an urban population in Lagos.

According to the WHO, smoking is responsible for over two thirds of lung cancer deaths globally, and second-hand smoke increases the risk of developing lung cancer for non-smokers.

Director-General, WHO, Dr. Tedros Adhanom Ghebreyesus said: Every year, tobacco kills at least eight million people. Millions more live with lung cancer, tuberculosis, asthma or chronic lung disease caused by tobacco.

“Healthy lungs are essential to living a healthy life. Today – and everyday – you can protect your lungs and those of your friends and family by saying no to tobacco.”

In 2017, tobacco killed 3.3 million users and people exposed to second-hand smoke from lung-related conditions, including: 1.5 million people dying from chronic respiratory diseases; 1.2 million deaths from cancer (tracheal, bronchus and lung); and 600,000 deaths from respiratory infections and tuberculosis

More than 60,000 children aged under-five die of lower respiratory infections caused by second-hand smoke. Those who live on into adulthood are more likely to develop chronic obstructive pulmonary disease (COPD) later in life.

Legislation against tobacco
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.

Lagos is one of the states that have passed into law legislation against smoking in public places. The 7th Lagos State House passed the law, tagged “A law to provide for the regulation of smoking in public places in Lagos state and for connected purposes” in 2014.

According to the law, any person who smokes contrary to the provisions commits an offence and shall be liable on conviction to a fine of not less than N10,000 and not exceeding N15,000 or to imprisonment for a term not less than one month and not exceeding three months or both, or other non custodial punishment that the judge may deem fit.

Also, the law stipulates that the owners of properties on conviction will pay fine of between N100,000 and N250,000 or to imprisonment for a term of six months or both.

There is also the National Tobacco Control Bill 2009 repeals the Tobacco (Control) Act 1990 CAP. It completely domesticates the Framework Convention on Tobacco Control (FCTC) and establishes the National Tobacco Control Committee.

The National Tobacco Control Bill, NTCB 2009 is a comprehensive law, which will regulate the manufacturing, advertising distribution and consumption of tobacco products in Nigeria. It is a bill that is aimed at domesticating the FCTC because Nigeria is a party to that international convention.

According to the NTCB 2009, smoking in Nigeria is prohibited in public places and is punishable by a fine of not less than N200 and not exceeding N1000 or to imprisonment to a term of not less than one month and not exceeding two years or to both a fine and imprisonment.

The key highlights of the bill are prohibition of smoking in public places to include restaurant and bars, public transportation, schools, hospitals among others. A ban on all forms of direct and indirect advertising, prohibition of sales of cigarette 1000-metre radius of areas designated as non-smoking, mass awareness about the danger of smoking as well as the formation of committee that will guide government on the issue of tobacco control in the country.

The 7th National Assembly had enacted National Tobacco Control Act 2015, which called for National Tobacco Control Regulations.

The Draft National Tobacco Control Regulations could not be passed into law before the expiration of the 8th National Assembly on June 6, 2019, despite the fact that the Federal Executive Council had approved and transmitted the draft regulations to the National Assembly in June 2018.

The bill is expected to address tobacco advertisement and promotion as well as ensuring tobacco free environment.

However, advocates and public health professionals have charged President Muhammadu Buhari to give priority to the enforcement of the National Tobacco Act, 2015 (NTC Act 2015) in his second tenure.

The groups include the Nigeria Tobacco Control Alliance (NTCA), Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN), Cedars Foundation, Civil Society Legislative Advocacy Center (CISLAC), and University of Abuja Smoke-free Club among others.

The approved regulations are as follow: Health warnings on tobacco packs will now constitute 50 percent of the principal display surfaces, this will increase to 60 percent in four years; prescribed price list of tobacco products at Point of Sale, this will not contain images, symbols, colors, signs or other contents including trade mark or branding images among other. Also are licensing of tobacco products -N10m each as prescribed fee before issuance of license to manufacture, import or distribute tobacco products.

How far with the implementation of the ban in smoking in public places?
It is still business as usual on Lagos streets and indeed on other major cities in Nigeria. People still smoke in public places.

The Guardian investigation revealed that about 70 per cent of the lawmakers, both at state and national level and over 80 per cent of law enforcement agents, smoke.

The Governors and other politicians are no saints. In fact The Guardian found that some Governors and their aides even smoke in the Government House. A past President of Nigeria was believed to have died of smoking related illness.

Can a chain smoker enforce any legislation against smoking? Has anybody being fined or jailed for any smoking offence in Nigeria?

A consultant family health physician and former President, Nigerian Medical Association (NMA), Dr. Osahon Enabulele, told The Guardian: “While the legislative and executive efforts are commendable, it is evident that not much has happened in the area of implementation of the ban on smoking in public places or even its replication in most states of Nigeria, aside from Lagos and few other states. There is need for greater public sensitization on the provisions of the law and the important benefits to be derived from it. There is also need for strict enforcement of the law.”

A pharmacists and President, Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, told The Guardian: “From my own observation, it seems that the Ban is working fairly well. These days, I hardly notice people smoke openly in public spaces. But I am aware that at lower socioeconomic levels, the ban is not as effective. Therefore sustained enlightenment must continue at those levels to get more people convinced about the dangers of smoking cigarettes.”

The fact is that nothing has changed since August 17, 2014 when the law was to take full effect in Lagos. Smokers are still having a filled day in all the 18 public places where the law prohibits smoking including libraries, museum, public toilets, schools, hospital, day care centres, public transportation and restaurants among others.

While the state government blames law enforcement officers for failing to clamp down on offenders, the officers themselves alleged that the state government made no provision whatsoever to help them enforce the new laws.

Environmental rights activist, Bamgboye Soetan, had told The Guardian that the state government actually showed a lack of political would to enforce the provisions.

“Ordinarily, one would have expected a mass awareness campaign to begin with and equip law enforcement agencies to commence a subtle arrest of offenders to serve as deterrence for others.

“But what do we have? It is just a complete lull around the very good law. And for me, that is to be the case in an administration populated my smokers — the actual culprits of the law,” Soetan said.

Efforts
World No Tobacco Day is celebrated around the world every year on May 31. This yearly celebration informs the public on the dangers of using tobacco, the business practices of tobacco companies, what WHO is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations.

WHO designed 31st May of each year as the annual World No Tobacco Day (WNTD). The theme of WNTD 2019 is “Tobacco and lung health”.

A surgeon and President, National Association of Resident Doctors (NARD), Dr. Segun Olaopa, told The Guardian said the exposure to tobacco would affect the health of people’s lungs and induce various related diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), tuberculosis, asthma, pneumonia, bronchitis and lower respiratory infections among others. He said the most effective measure to improve lung health is to reduce tobacco use and second-hand smoke exposure. However, Olaopa said the potential of tobacco control for improving lung health is underestimated.

The surgeon said: “Tobacco is used almost universally by people throughout the world. Tobacco is rewarding for their manufacturing concerns and to the government because it brings in huge financial benefits. However, because of the danger associated with cigarette smoking, such as cancer of the lung, coronary heart disease, which leads to premature death, the federal government made it compulsory that every advertisement on any branch of cigarette must carry warning example ‘cigarette is dangerous to health and smokers are liable to die young’.

“By adopting ‘Tobacco and lung health’ as the theme of WNTD 2019, WHO encourages parties to organize campaign to increase the awareness on the negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease, and on the fundamental role lungs play for the health and well-being of all people. It also aims to advocate for effective policies to reduce tobacco consumption and engage stakeholders across multiple sectors in the fight for tobacco control.”

Challenges
The WHO has condemned efforts by the world’s biggest cigarette vendor to rebrand the WNTD, a day dedicated to raising awareness about the dangers of tobacco use.

The United Nations health agency launched a campaign to highlight the devastating impact smoking continues to have on human health and urged countries to step up the fight against the dangerous habit that causes some eight million deaths annually.

But it also voiced concern at attempts by Philip Morris International (PMI) to co-opt international efforts for its own campaign this week promoting new vaping and heated tobacco products as part of the solution to the world’s smoking epidemic.

“We regard the PMI campaign as little more than a cynical attempt by the company to promote its deadly products,” Vinayak Prasad, head of WHO’s Tobacco Free Initiative, told AFP in an email.

PMI, the maker of Marlboro, insisted that WNTD should be renamed World No Smoking Day, and it launched its own campaign dubbed It’s Time to Unsmoke.

The company has been working to promote its new so-called “smoke-free” products as far less harmful alternatives to traditional cigarettes, insisting its science shows they release far fewer dangerous toxins than conventional cigarettes.

PMI maintains that it is the combustion in regular cigarettes that is the main problem, and that other forms of tobacco-use and nicotine consumption are far less harmful, and is striving to convince governments to slap fewer restrictions and taxes on its new products.

But the WHO stressed that there was no independent science backing up PMI’s “harm-reduction” claims, flatly rejecting that the new products could be used as a tool to help people quit smoking.

“The claim that these are cessation aids is not substantiated,” Prasad said.

Anti-tobacco campaigners also voiced outrage at PMI’s campaign this week.

“This is the latest attempt by PMI to insinuate itself into the public health world under false pretenses, and its attempts to co-opt the day are disrespectful to the millions who have and will die from using PMI’s products,” Michel Legendre of Corporate Accountability said in a statement.

He slammed the company’s attempt “to draw some arbitrary distinction between smoking and tobacco, as if smoking is bad for your health but tobacco is not”.

“Nicotine is addictive and tobacco use is deadly, period,” he insisted.

Recommendations
The passage of a bill to ban the smoking and marketing of tobacco in Nigeria will have huge positive implications on the health of Nigerians. It means there will be reduction in lung cancer cases. It is believed that the bill and other tobacco control measures will improve population health and well-being, and save lives.

The WHO FCTC encourages measures such as raising tobacco taxes, implementing smoke-free policies, supporting people to quit, raising awareness through mass media and enforcing bans on all forms of promotion.

Senior Programme Officer, Civil Society Legislative Advocacy Centre (CISLAC), Mr. Okeke Anya, said that beyond the approval of the regulations, the government should be mindful that the tobacco industry was particular about getting replacement smokers through kids being initiated into smoking. He therefore urged the Federal Government to mainstream tobacco control into the education curriculum at all levels.

Olaopa recommends:
*Government and communities worldwide should prioritize tobacco control in order to achieve the Sustainable Development Goal (SDG) target of a one-third reduction in non-communicable diseases premature mortality by 2030

*Countries should fully implement MPOWER tobacco control measures contained in the WHO FCTC
*Parents and other members of the community should also take measures to promote their own health, and that of their children, by protecting them from the harms caused by tobacco

The Plos One study recommends that the health hazards of smoking and the impact on quality of life should be the primary focus on tobacco control initiatives for in-school and out-of-school youths.

According to the International Centre for Tax Development, Nigeria needs a huge tobacco tax hike to curb smoking. Last year Nigeria increased the excise tax on cigarettes. Although a step in the right direction, the tax change fell short of bringing meaningful change: it fell way below the excise tax burden of 70 per cent recommended by the WHO.

The Nigerian Tobacco Control Alliance – a tobacco control advocacy group consisting of several civil society organisations – argues that, even after the increase, the tobacco excise taxes are still too low. And it called for an increase in rates that amount to the WHO’s recommendation.