Have you ever wondered why the state through the provisions of the Road Traffic Act force road users to obey road signs and forces them to behave in a certain way while driving such as putting on a seat belt, driving at a certain speed and not driving through a red traffic light? Well the answer is simply because ignoring most of the provisions of the road traffic Act is most probably likely to put a person’s life and that of other road users at risk. Government has a responsibility to protect individuals from unhealthy environments whether the source of risk is natural or from another individual or corporations. Now imagine if all actions by any person which pose a risk to their lives and that of others could be regulated one way or the other, no doubt life could be way better or simply different. This school of though is at the core of local anti-tobacco activists’ call for the regulation of tobacco trade in Botswana. Although Tobacco is the single most preventable cause of death in the world today and kills up to nearly 50% of people who use it, countries are still reluctant to impose stringent regulations against its trade and use. In Botswana for example, despite long calls to adhere to provisions of the Framework Convention on Tobacco Control (FCTC) which regulate trade and use especially protecting users and non-users who continue to fall victim to harmful tobacco smoke, little progress has been made. The Control of Smoking Act of 1992 with its amendment of 2004 has provisions that address smoking in public places. The provisions that address smoking in public or private places are on Part II, Section 3 & 4 however these provisions are not adequate;
Nonetheless, word is The Minister of Health and Wellness Dorcas Makgato is expected to table the amended bill in Parliament soon. The bill is said to have reached cabinet where some members had reservations about its contents and had to be returned back for corrections.
Effects of Tobacco (Second hand Tobacco smoke)
Research shows that inhaling even a little secondhand smoke can be dangerous damages your cells and sets the cancer process in motion. Brief exposures can have immediate effects on cardiovascular system similar to that of active smokers and Secondhand smoke contains many chemicals that can quickly irritate and damage the lining of your throat and lungs. In her presentation during the National Tobacco Control Conference, The Permanent Secretary in the Ministry of Health and Wellness Shenaaz El. Halabi underscored the importance of having smoke-free public places particularly pointing out the dangers of second hand smoking. According to her, smoke breathed out by a smoker and smoke from the burning end of cigarettes, cigars, pipes composed of 7,000+ different chemicals and over 150 toxins including carbon monoxide. And that just 30 minutes of exposure to tobacco smoke changes the way in which blood flows and clots, increasing the risk of heart attack and stroke. Second-hand smoke she said kills more than 600,000 people each year in many countries, and causes more than 10% of all tobacco-related deaths. Some of the dangers of second hand smoke that she outlined include the effects it has on children, which includes Sudden Infant Death Syndrome (SIDS), acute respiratory infections, Middle ear disease, more severe asthma and Slowed lung growth. Dangers of second hand smoke has also been recorded in pregnant women, this according to the Permanent Secretary includes passing carcinogens to the blood of unborn baby, risk of low birth weight, miscarriage, prematurity and Sudden Infant Death Syndrome. Workplaces are also said to be some other public places where dangers of second hand smoke are on the rise. According to El Halabi the workplace is a major source of exposure for adults, with nonsmoker exposure in the workplace linked to increased lung cancer and heart disease risk. Quoting the U.S. Surgeon-General and National Research Council, El Halabi said in restaurants, second-hand smoke levels are twice as high as in other workplaces without smoke bans while in bars and casinos are 3-6 times as high hence food service workers have 50% higher rate of lung cancer than general population. She pointed out that “Simple separation of smokers and non-smokers within the same air space, does not eliminate exposure of non-smokers to environmental tobacco smoke.”
Bottlenecks – The Good and the bad of Tobacco Control
The tobacco industry argues that smoking is an individual choice and government should not be allowed to dictate when and where people smoke. The industry has used these arguments in an attempt to rally public opinion against laws establishing smoke-free environments, and other similar restrictions. As mentioned earlier, the tobacco industry ‘s main premise is that individuals have a right to decide whether they want to smoke or not and governments should not interfere but at the same time tobacco smoking especially not regulated can expose non-smokers to the harsh effects of inhaling tobacco smoke. With that said even the Universal Declaration of Human Rights, 1948 states that “Everyone has the right to a standard of living adequate for the health, and wellbeing of himself and his family…?” All people have a fundamental right to breathe clean air. Completely smoke-free indoor environments – with no exceptions – are the only proven way to protect people. 100% smoke-free environments require the elimination of all smoking and tobacco smoke indoors. Ventilation cannot protect against the health risks of tobacco smoke. It is against this backdrop that anti-tobacco activists argue that government should introduce stringent regulations against tobacco trade and use. However one cannot totally ignore the ‘alleged trade’ benefits tobacco brings to those doing business in the industry. Luckily Botswana does not have any tobacco farmers and tobacco products manufacturers but at the end of the production chain, that is only have wholesale and retail dealers in tobacco products such as cigarettes and cigars. Those against stringent controls argue that these local traders, especially small scale retailers have tobacco (cigarettes) as their biggest source of income and imposing regulations may mean totally closing shop or reduced earnings. But those who are for the regulations and tobacco control argue that finding an alternative source of living for those affected and winning their buy in always work wonders. In fact Dr Yusuf Saloojee of the National Council Against Smoking in South Africa argues that when the South African government imposed bans on Tobacco trade which among others included advertising regulations, the tobacco industry motivated and sponsored the idea that a large number of people were going to lose jobs but on the contrary scientific research conducted by the University of Cape Town later showed otherwise.
Sharing Uganda’s experience on developing and implementation of a FCTC complaint Tobacco Control Legislation during the National Tobacco Control Conference, Dr Jim Arinaitwe stated that in their experience it was established that if anything, the contribution of Tobacco to government revenue was low. Explaining that although government got revenue from tobacco trade through levies and taxes it was established that government lost three folds the amount through treatment of tobacco related diseases and infections. Dr Arinaitwe encouraged his counterparts in Botswana to take leaf from Uganda especially if they wanted to succeed in pushing for an amendment of tobacco control legislation. He stated that as transpired in Uganda it is important to forge relationship with Members of parliament especially those with capabilities of winning the buy in of the powers that be. “Identify a strong committed champion in parliament,” he said. Political will, relationship with the media, emphasising public health debate as a key driver are according to the expert some of the key factors in winning the war in Tobacco control. Be that as it may, experts warn that it won’t be an easy task for both governments and anti-tobacco activists. According to Dr Saloojee, the basis of tobacco industry’s future is in Africa and Asia hence they will always fight tooth and nail to keep this status quo. To fight this he says legislation is important but warns that the tobacco industry and its tactics of stalling progress must be noted and guarded against. “Countries need to be careful when they sign trade agreements and note whose interests they serve,” he said. He said that more often when the tobacco industry realise that a government is starting to wage war against tobacco trade , the industry devise tactics of staying in business, which includes partnering with government ministries through sponsorship and other engagement in order to stay relevant. And if this does not work enough for them they will even bribe politicians in order to win their support and be the industry’s mouth pieces in parliament. If a government proves to be resolute in its decisions, Dr Saloojee warns that large multinational tobacco companies can even resort to suing governments for tampering with its way of doing business. He cited a case where Marlboro sued the Australian government for imposing plain packaging regulations in Tobacco products.
Anti-Tobacco Network calls for Change
The Anti-Tobacco Network has waged war against tobacco trade and tobacco industry in their quest for a tobacco-free Botswana. According to ATN Executive Director Dr Bontle Mbongwe, Batswana need to adopt a holistic approach of understanding tobacco as a threat to health and development and she says people need to understand that tobacco control is bigger than just tobacco use, that it requires a bigger and more holistic solution. “Tobacco use we know is prevalent among certain sub population such as the poor, therefore special focus must be on those groups as well. And we need to demonstrate an understanding and ability to apply a health equity approach to tobacco control. From policy development to resource allocation trough to service delivery,” Some of the regulations that Dr Mbongwe says Botswana needs to adopt include: The total ban of smoking in public places as they feel the current provisions which allows for designated smoking areas in public spaces like restaurants put some people such as workers at risk. She also stated that they believe government should license tobacco products they same way they do to alcohol products. “Government should limit access to tobacco products to protect vulnerable groups such as children and the poor. This can be as simple as stopping the sales of tobacco on the streets,” she said. The ATN is also calling for a total ban on advertising, promotion and sponsorship of tobacco and by the tobacco industry and imposing large pictorial and health warnings on cigarettes packages. Dr Mbongwe also pointed out that they want Botswana to go the same direction other countries are going by raising the minimum sales age from 18 to 21. “Remember that there is no safe level for tobacco use, even one cigarette can harm a person. We need to create a smoke free generation,” she said. According to Dr Mbongwe, Botswana can longer afford to ignore tobacco controls.