As tobacco companies reap the benefits of weak tobacco controls across many African countries, illnesses and economic burdens are rapidly shifting to low and middle-income countries. Ethiopia must continue to toughen legislation to protect citizens and nip the epidemic in the bud or pay the price of complacency, writes Dereje Shimeles (firstname.lastname@example.org), a public health lawyer.
Powerful tobacco companies are thriving in Africa due to the weak anti-tobacco and tax laws in many of the continent's countries, according to a study on trends in the supply and demand of cigarettes by the University of Cape Town's Economics of Tobacco Control Project (ETCP).
The ETCP study examined cigarette consumption in 22 countries, including Ethiopia, which are home to 80pc of the continent's population. While cigarette consumption is decreasing in most developed countries, it is increasing in many developing countries, where markets are often unregulated, cigarette prices are low, and tobacco control laws are weak or not enforced.
Ethiopia was set to be a potential industry hub in Africa after Japan Tobacco International (JTI), one of the big companies dominating tobacco in Africa, acquired over 70pc of Ethiopia's National Tobacco Enterprise at the end of December 2017. Fortunately, the nation continues to make great strides in tobacco control to curtail the impact of the tobacco epidemic and remain less vulnerable to its economic cost, estimated at 1.391 million Br a year, according to Tobacco Atlas, a partnership between American Cancer Society and Vital Strategies.
While Ethiopia has relatively low numbers of smokers compared to its African counterparts, more must be done to make proven tobacco control tools work for the health and well being of citizens. Tobacco Atlas shows that more than 16,874 Ethiopians die from tobacco-related diseases every year.
Still, over 18,000 children between the ages of 10 and 14 and over two million adults aged above 15 years old continue to use tobacco each day. Around a third of adults are exposed to second-hand smoke in indoor workplaces and restaurants, increasing to over 60pc in bars or nightclubs.
Worryingly, 41pc of 13 to 15-year-olds are exposed to second-hand smoke in public places, which has dire health consequences. Over 460,000 people use smokeless tobacco - the use of tobacco products in means other than smoking - indicating an ongoing public health challenge, including heightened levels of oral cancer.
A new bill recently tabled in parliament proposes further measures designed to align Ethiopia with the World Health Organisation's (WHO) Framework Convention on Tobacco Control goals it committed to in 2004 and ratified in 2014. It joined continental tobacco control leaders such as South Africa and Ghana in implementing the next phase of legislation to more effectively protect citizens.
The proposals in the new bill include a 100pc ban on indoor public smoking, as well as new distance limits when smoking near entrances. This is in keeping with the WHO guidelines that state effective protection from exposure to second-hand smoke requires total elimination of smoking in enclosed public spaces. Evidence shows designated smoking areas, whether separately ventilated or not, are ineffective and do not protect from exposure to second-hand smoke.
The bill further clamps down on all forms of cigarette advertising and display - including a proposal that cigarettes may no longer be publicly displayed by retailers at points of sale due to proven promotional effects, particularly among young people. Importantly, the bill also regulates new smoking technologies, with strong enforcement mechanisms.
While guided by international WHO requirements, the new bill has benefited from a lengthy legislative study and drafting process, including engagement with thousands of local stakeholders to ensure applicability for Ethiopia. The most crucial aspect of the bill, different from the existing proclamation, is its enforcement mechanisms and strong administrative and legal measures that are carefully crafted to be comprehensive and transparent. Inspection powers, administrative and criminal provisions are set to deter violations.
These enforcement mechanisms must extend to reducing the illicit trade of tobacco products - particularly along Ethiopia's long and porous border with Somalia. Tobacco control measures do not increase the demand for illicit products but rather reduce the overall demand for tobacco.
Studies have consistently found that levels of illegal trade can be reduced with vigorous law enforcement and criminal prosecution, heightened penalties for smuggling crimes and robust tax administration systems that include monitoring and enforcement.
Through Addis Abeba University, Ethiopia is one of eight countries, including South Africa, Uganda, Ghana, the Gambia, India and Bangladesh, participating in a multinational study led by Stirling University in the UK. It will produce research that will inform tobacco taxation, tackle the black-market trade in tobacco and target tobacco companies' efforts to undermine government attempts to reduce smoking in their countries.
Tobacco epidemic was created in the developed world, where smoking rates skyrocketed in the first six decades of the previous century. It then took many years to bring these rates down, through research, advocacy, communicating health risks and introducing evidence-based policies. The new study is working with the low and middle-income countries now at the forefront of efforts to combat the world's most significant preventable disease. These countries have an opportunity to stop the epidemic in a much shorter time frame through informed leadership in tobacco control.
Complacency in the face of the tobacco epidemic will encourage the tobacco industry in Ethiopia and ensure that tobacco's death toll will grow every year. Tobacco control advocates should continue to reach out to communities and resources to strengthen efforts and ensure that Ethiopia remains on the front line in the war against tobacco.