CURBING TOBACCO EPIDEMIC

Tobacco is the world’s leading cause of preve

ntable deaths and non-communicable diseases such as cancer, stroke, cardiovascular, chronic respiratory diseases among others. The World Health Organization attributes more than 8,000,000 deaths globally to tobacco use and exposure to tobacco smoke. It projects that 80% of these deaths will by 2030 be in the developing economies. According to the Ministry of Health, approximately 2.5 Million Kenyans use tobacco products, two-thirds of whom smoke cigarettes. ?Consumption of these products and exposure to tobacco smoke account for more than 8,000 deaths annually. Non-communicable diseases, which are partly fueled by tobacco, account for 50% of all hospital admissions. It is estimated that for every dollar collected as tobacco revenue, three dollars are spent on treatment of tobacco related illness. This means that out of the estimated 5 Billion shillings which the country collects as tobacco revenue, 15 Billion shillings are spent on treatment of tobacco related diseases. A clear indication that tobacco-caused diseases strain countries already overburdened health sector.

The Ministry of Health has further estimated the economic effect of cigarette smoking to be at the range of Kshs. 40 Billion annually. These costs are likely to be higher if smokeless and novel tobacco products such as snus, juul, heated tobacco products, oral nicotine pouches, electronic cigarettes among others, are factored into the equation. Resources which should be spent on basic needs are either spent on purchasing tobacco products to appease nicotine cravings or treating tobacco related ailments. This in turn result to impoverishment of households occasioning inability to meet basic needs and children dropping out of school due to lack of school related expenses and or to engage in tobacco production activities such as farming. There is also loss of income as the productivity of tobacco users is either affected by social and health complications arising from the effects of tobacco consumption or succumb to tobacco related illnesses thus robbing the family a reliable bread winner. In the alternative productive family members may become active caregivers of the tobacco victims hence losing out on job opportunities.

The devastating effect of tobacco is also being felt by the environment. Tobacco smoke contain toxic substances which not only result to environmental pollution but also affect the health of both the smokers and non-smokers. Cigarette butts made up of non-biodegradable materials have been found to contain toxic chemicals which usually find their way to rivers and eventually to oceans thus posing danger to the marine environment. Further the clearing of vegetation to make way for tobacco crops and use of pesticides contribute to environmental degradation.

The unprecedented impact of tobacco forced the international community under the auspice of the World Health Organization (WHO) to develop and adopt on the 21st of May 2003 an evidence based Framework Convention on Tobacco Control (FCTC), to protect the present and future generations from the devastating health, social, economic and environmental consequences of tobacco consumption and exposure to tobacco smoke. The treaty came into force on 27th of February 2005 and has so far been ratified by 182 Parties which according to WHO covers approximately 90 % of the world population. State Parties have also adopted a Protocol on Elimination of illicit Trade in Tobacco Products and Guidelines to aid in the implementation of the provisions of the Convention at the national level. Kenya signed and ratified the Convention in 2004 and is implementing its obligations under the Convention through The Tobacco Control Act No. 4 of 2007, The Tobacco Control Regulations of 2014, The Kenya Tobacco Control Policy of 2012, Customs and Excise Act, Food, Drugs and chemical Substances Act, Standards Act, Environmental Management and Coordination Act, No.8 of 1999, Public Health Act among others.

The Convention call upon State Parties to adopt and implement, in accordance with their national laws, comprehensive and effective legislative, executive and administrative measures, to prevent and reduce tobacco consumption, nicotine addiction and exposure to tobacco smoke. The Convention contemplate policy measures aimed at reducing demand and supply of tobacco products. These measures include; first, increase of prices and taxes on tobacco products, to make them unaffordable thus reducing consumption of tobacco. Second, ban on smoking indoor and public places, to protect all persons from exposure to tobacco smoke. Third, ban on tobacco advertisement, promotion and sponsorships, to protect the public from misleading, false and deceptive information on the health effect of tobacco products. Fourth, labelling of tobacco products with pictorial and text health warnings, to warn the public on the dangers of consumption of tobacco products and exposure to tobacco smoke. Fifth, regulation of contents of tobacco products and tobacco products disclosure, to reduce attractiveness, addictiveness and toxicity of tobacco products-however this does not mean tobacco products complying with these measures are less harmful to human health. Sixth, creation of public awareness on the health, social, economic and environmental effect of tobacco products. Seventh, prohibition of sale of tobacco products to and by minors to prevent their initiation to tobacco use. Eighth, tobacco dependence and cessation, to offer help to quit tobacco use. ?Ninth, offer support for economically viable alternative activities to prevent possible adverse social and economic impacts on those dependent on tobacco production and protect the environment and health of those involved in the cultivation and manufacturing of tobacco. Lastly is on limiting of interaction between the tobacco regulatory agencies and tobacco industry, to protect public health policies with respect to tobacco control from commercial and vested interests of the tobacco industry.

Surveys on the impact of WHO FCTC key policies conducted by the International Tobacco Control Policy Evaluation Project (ITC Kenya Survey) in 2012 and 2018 and released in May 2021 found that; the implementation of pictorial health warnings in 2016, increased the perception of smokers on the health risks of smoking from 28% in 2012 to 43% in 2018 and those who thought quitting smoking from 24% to 38% in the same period. ?Less than 10% of the respondents noticed advertisement, promotion and sponsorship of tobacco products within a period of 6 months. Increase of prices on tobacco products during the period under study saw 55% of smokers reduce consumption of tobacco products while 49% considered quitting tobacco use as a measure for saving costs. Further, only 7% noticed smoking in restaurants in 2018 while 86% reported a ban on smoking at their homes. These findings demonstrate that the efforts in implementing and enforcing tobacco control measures are bearing fruits.

However the affordability of tobacco products, flavoured cigarettes, sale of cigarettes by single stick, smoking in public places particularly in bars, and indoor workplaces and unawareness on tobacco harm and available tobacco cessation services are derailing efforts to curb the tobacco epidemic. ITC recommends in this regard improvement of enforcement of the Tobacco Control Laws and imposing of stricter requirements, as envisioned under Article 2.1 of WHO FCTC. Some of the measures proposed by ITC include ban on smoking in all public and indoor work places to create a 100% smoke free environment and ban on cigarettes with flavoured substances, such as menthol, which are known to mask the harshness of the tobacco smoke and increase the palatability of tobacco products. ?Another timely recommendation is the introduction of plain packaging and enlarging pictorial health warnings to at least 50% on both sides of the pack from 30% of the front and 50% of the back of the pack, to limit tobacco industries’ avenues for advertisement and misleading the public on the social and health effects of tobacco consumption. The implementation of these recommendations will go a long way to reduce consumption of tobacco products, prevent initiation and promote cessation of tobacco use in Kenya.

It should however not be lost that there are irreconcilable conflicts between public health policies related to tobacco control and commercial interests of the tobacco industry. The tobacco industry has over time employed tactics and strategies meant to undermine and delay the development, implementation and enforcement of tobacco control laws and policies.?One of the main strategy the industry has employed globally to subvert policies, measures and laws for tobacco control, is mounting litigation against tobacco control laws as witnessed in the case of British American Tobacco (Kenya) Ltd v. Cabinet Secretary of the Ministry of Health & 4 others, where the Petitioner unsuccessfully challenged the constitutionality of Tobacco control regulations of 2014. Apart from litigation the tobacco industry fund and deploy research and front groups to denounce the health effects of tobacco products, engage in corporate social responsibility activities, promote weak laws and engineer studies

on the contribution of tobacco industry to the economy to mask the health consequences attributed to consumption of tobacco products and exposure to tobacco smoke.

To win the tobacco war it is imperative for enforcement agencies, as advised under the Preamble to WHO FCTC ‘to be alert to any efforts by the tobacco industry, to undermine or subvert tobacco control efforts?and the need to be informed of activities of the tobacco industry that have a negative impact on tobacco control efforts.’ Article 5.3 of WHO FCTC, the attendant Implementation Guidelines and Part V of The Tobacco Control regulations of 2014, provide measures geared towards the protection of the tobacco control laws and policies from the interference of the tobacco industry. These measures include; limited interaction between the Tobacco Control enforcement agencies and the tobacco industry ‘to the extent strictly necessary for effective tobacco control and enforcement of relevant laws’, public officers’ disclosure of conflicts of interest, prohibition of grant of gifts by the tobacco industry to public officers, non-preferential treatment of the tobacco industry and above all prohibition of tobacco industry’s promotion or sponsorship of educational, social and commercial activities.?Strict observance of these measures will not only insulate the tobacco control laws and policies from the interference of the Tobacco industry but also guarantee their effectiveness in addressing the global tobacco epidemic.