Health-e (Cape Town)

South Africa: Nothing Good About Tobacco

Across the world and more recently in South Africa, the tobacco industry and its allies continuously push to weaken or repeal smoke-free laws. Two common tactics used to weaken laws are to allow business to create designated smoking rooms or areas, or to build complex and expensive ventilation systems.

The tobacco industry usually argues that these accommodations are needed because smoke-free laws hurt business.

In reality, and contrary to industry arguments, bars and restaurants have thrived in smoke-free countries and cities across the world. Studies repeatedly have found smoke-free laws do not harm business and may even have a positive impact.

However, some of the biggest spin-offs of this legislation have been in the health arena and no matter how much smoke and mirrors tactics the tobacco industry apply, the facts are clear and cannot be disputed.

The health benefits of smoke-free legislation are well documented in for example Scotland.

Here, bar workers have reported significantly fewer respiratory (such as wheezing and breathlessness) and sensory symptoms (such as red/irritated eyes) one year after their working places went smoke-free.

Admissions for acute coronary syndrome to Scottish hospitals decreased by 17% over the 10 months following implementation.

Admissions for asthma before the implementation of the smoke-free legislation increased at an average rate of 4.4% per year. After implementation there was an average reduction in admission rates of 15.1% per year. The reduction in childhood asthma hospitalisation admissions occurred for both preschool and school age children as well.

Norway is a cold climate country, where socialising is predominantly indoors, but it was one of the first to implement smoke-free legislation. Norwegian bars and restaurants went 100% smoke-free in June 2004. One year after the ban, studies found that workers reported better respiratory health; patrons reported better air quality, increased well being and higher support for the law; and there was no significant change in frequency of visits to restaurants and bars.

More recently, a 2010 study in Norway found that three years after implementing a 100% smoke-free law, there was no significant impact on restaurant or pub revenues.

Colombia was one of the first countries in Latin America to implement strong smoke-free legislation. In December 2008, all indoor public places including restaurants and bars went smoke-free.

The president of the bar owners and tenders association in Colombia has been a enthusiastic supporter of the legislation and reports that among the benefits they have seen employees are taking sick leave less frequently. One opinion poll found that 90% of people in Colombia agree with the 100% smoke-free environments.

California was the first state in the US to implement smoke-free restaurant and bar laws, in 1995 and 1998, respectively. The 1995 smoke-free restaurant law is associated with an increase in restaurant revenues, while the 1998 smoke-free bar law is associated with an increase in bar revenues.

Countless research studies have shown that tobacco is a drain on health-care systems and in South Africa where the country is struggling to find enough money to overhaul the overburdened health system, it is a no-brainer that controlling the use of tobacco is one area there the state can save money.

As an example between 2003 and 2008 11.3% of Egypt’s health-care expenditure was used to treat tobacco-related illnesses, while Mexico spent 10.5%, the US 4.9%, China and the UK 4.6%, Germany 3.2%.

The Tobacco Atlas has quantified the direct costs of smoking to South Africa at U$127-million.

This figure reflects estimates of both private and public direct medical costs of treating tobacco-related illnesses, which are only a portion of the total cost of tobacco to society.

Indirect costs such as losses in labor productivity, cigarette butt littering, fire damage, environmental harm from destructive farming practices, and the intangible suffering of the victims and their families are not included. These losses further strengthen the argument that tobacco consumption has serious economic consequences.

Tobacco companies insist that their business is essential for global and local economies, ignoring the enormous resource drain that the use of tobacco products has on society as a whole.

The tobacco industry has even commissioned studies that claim early mortality from tobacco use eases the financial burden on public pension funds—an argument never advanced to combat prevention efforts against HIV/AIDS, tuberculosis, or diabetes. This grim conclusion is not only immoral, but also incorrect.

The direct cost of tobacco-related illnesses is determined by both the number of persons being treated and the cost of treatment. The number of patients depends on a country’s population and stage in the tobacco epidemic, whereas cost of treatment depends on the country’s health system. Estimates may also vary depending on the research method used. Tobacco-related health-care costs have only been calculated in a few nations, primarily due to limited or poor-quality data, dearth of research funding, and absence of research capacity. As health systems of low- and middle-income countries develop along with their economies, the medical costs of tobacco-related diseases will continue to grow, and so will the need to evaluate these costs.

However, there can be no doubt that the burden of death, disease and disability caused by the use of tobacco products more than outweighs any economic benefit from their manufacture and sale.

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