Abstract

PIP: In Africa the issue of smoking and health is complicated by the fact that in many countries tobacco is grown commercially and is relied upon to bring in foreign exchange through export, of revenue for the government if sold on the home market. Consequently, in some nations the ministries of health and of agriculture are working at cross purposes. This contradiction is recognized in the report issued recently of a World Health Organization (WHO) seminar on smoking and health organized for English-speaking Member States of the WHO African Region, and held in Zambia. In opening the seminar, the prime minister of Zambia, Mr. N. Mundia, stated that governments had an obligation to educate people on the risks involved in the use of tobacco but that this could pose a moral dilemma where tobacco production made an apparently significant contribution to the economy. Additionally, he warned that developing countries are considered valuable markets by tobacco companies and stressed that if the promotion of tobacco products by such companies represented a threat "to the health of our people, we cannot let it happen." This point was endorsed by Mr. W.C. Mwambazi, the National WHO Program Coordinator who stated that smoking was on the increase in many developing countries as a result of unscrupulous marketing practices by cigarette manufacturers and that smoking was a major threat to the realization of health for all by the year 2000. Aspects of smoking and health that have special relevance for Africa are emphasized in the report. The few studies carried out in Africa tend to confirm findings from the developed world that smoking increases the risk of cancer and coronary heart disease. Not only is tobacco smoked in Africa, but it is chewed and taken as snuff, and these uses also entail a risk to health. Case studies included in the report show that transnational tobacco companies take full advantage of the present lack of legislation in most African countries on the promotion and use of tobacco. Health hazards are the primary reason why smoking controls are needed, but there are also economic arguments. Tobacco cultivation requires land that could otherwise be used for the production of much needed food. Curing tobacco leaves requires vast amounts of heat that is generated by burning either expensive (and usually imported) oil or timber, the consumption of which ultimately leads to deforestation, soil erosion, and desertification. Although tobacco may be cultivated primarily as an export crop, the country of origin rarely escapes the health hazards of smoking and their economic consequences, including increased cost of health care and absenteeism from work. According to the report, control measures should include the following: data collection; public information and education; and legislation. The report proposes that a functional committee on smoking control be established in the ministry of health to work especially within the primary health care machinery.