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Wednesday, February 25, 2009


Written by Dr Olusegun Fakoya
Saturday, 04 October 2008

From available information, it appears as if the Federal Capital Territory remains the only part of Nigeria conscious of the harmful effects of smoking. The recent prohibition of smoking in public places remains a commendable step but actions are still necessary to combat the monster called smoking. The Third World is further impoverished by the harmful effects of smoking on the health of the populace. The undeveloped economies of these nations can also not cope with the surge on the insufficient health facilities occasioned by the myriad of health-related problems induced by smoking. While the recent efforts of the Nigerian government, especially in recent times, remain commendable as regards some appreciation of the menace of smoking, however, all hands must be on deck to counter the resurgent ability of the super-rich tobacco industry. The ability of the tobacco industry to stage a come back was buttressed by the statement credited to the Minister of the Federal Capital Territory, that as a reaction to the recent ban on public smoking in the FCT, tobacco companies made unsolicited overtures to his office. There is no doubt that more concerted efforts are needed on the parts of the Federal and State governments to ensure that Nigeria becomes a smoke-free country. This is a position devoid of religious or other parochial overtones. It is simply borne out of the need to create a healthy nation that can aggressively tackle its myriad of socio-economic problems.

Epidemiological and Health Implications of Smoking
A habit, which at one time was considered fashionable and acceptable has been proven after many years of study and linkages with many ailments to be as deadly as the scorpion sting. Smoking is a universal problem, which though may have peculiar geographical approaches in terms of solutions, but yet remain one with universal determination in tackling. To date, no nation has ever admitted benefiting economically from smoking and hence the numerous efforts by nations in tackling this man-made monster. The United States Centre for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide”. To further reinforce this view, let us consider the following facts about smoking:

- About 93 million sticks of cigarette are produced yearly in the country and every one of those cigarettes is consumed here in Nigeria.

- World Health Organisation (WHO) estimates that about 1.3 billion people in the world are currently smoking and most of them are in developing countries.

- Tobacco kills close to five million people yearly worldwide with over 70 percent occurring in developing countries including Nigeria. It is the cause of death of 17.7 per cent of all deaths in developed countries.

- By 2020, the World Health Organisation (WHO) expects the worldwide death toll from smoking to reach 10 million.

- Tobacco is responsible for over 25 diseases in man, including hypertension, heart attack, cancer and other conditions such as asthma, emphysema. It is also responsible for some pregnancy-related problems and other conditions such as tuberculosis, blindness, deafness and nutritional and psychological disorders.

- Tobacco kills 50 per cent of lifetime smokers and half of these deaths occur among people in their middle age (35-69years).

The extremely high tar content of the Nigerian tobacco was highlighted by the trio of Awotedu, Higenbottam and Onadeko in a study conducted in 1983 (J Epidemiology Community Health 1983; 37:218-20). It should be emphasised here that the dangers of smoking are directly proportional to the tar content of cigarettes. Tobacco smoke pollution has been classified as a known human carcinogen in the USA. Smoking harms nearly every organ of the body, causing many diseases and affecting the health of smokers in general. Smoking also harms people of all ages. For instance, toxic ingredients in cigarette smoke travel throughout the body, causing damages in several ways. Nicotine reaches the brain within 10 seconds after smoke is inhaled and it has been found in every part of the body, breast milk inclusive.

Smoking has been implicated in the following disease conditions or states:

Tooth Loss
Stomach Ulcers
Ocular Histoplasmosis (Fungal Eye Infection)
Acute Necrotising Ulcerative Gingivitis (Gum Disease)
Hearing Loss
Duodenal Ulcer
Reduced Sperm Count
Dysmenorrhoea (Painful periods)
Early Menopause
Colon polyps
Reduced Fertility
Buerger’s Disease
Optic Neuropathy (Vision loss)
Premature wrinkling
Crohn’s Disease

This month (October 2008), Dr Julie Pasco of the University Of Australia, Melbourne published the outcome of a research that showed that smoking increases the risk of major depressive disorder by 93% in women who smoke, compared to those who do not smoke. The odds are said to more than double for those who smoke in excess of more than 20 cigarettes a day. Dr Pasco concluded: “It is becoming increasingly clear that smoking is not innocuous to mental health and may in fact aggravate mental illness or contribute to its onset”.

It is common practice for cigarette packets to carry warnings approved by health authorities but none ever lists the diseases caused by smoking. In appreciation of this significant deficiency, Reuters reported on Saturday 27 September, 2008 the efforts of the British authorities to further inform its populace on the dangers of smoking via warnings on packets. This report states as follows: “Gruesome pictures of rotting teeth and throat cancer tumours will appear on all tobacco products in Britain from next month as the government steps up its campaign to encourage the country's 10 million smokers to quit. The images will be printed on the back of cigarette packs to illustrate written health warnings introduced in 2003, the Department of Health said on Saturday. The photos also include a flaccid cigarette to depict male impotence and a comparison of healthy and tar-filled lungs”. The concerns of the British authorities are justified considering that
smoking is Britain's single killer, causing the premature death each year of 87,000 people in England alone.

The introduction of photo warnings was a desperate action by concerned governments over a habit that refused to abate despite numerous interventions. Canada was the first country to put photo warnings on cigarettes in 2001. In Europe, Belgium and Romania followed suit but Britain will be the first in the European Union. Britain intends to put photo warnings not only on cigarette packs, but also hand-rolling tobaccos and cigars. Britain is taking this extra step despite the ban on smoking in enclosed places imposed in July 2007.

Another positive action to combat the menace of smoking was the recent effort by the leaders of one of the most populous nations on earth. On the 2nd of October 2008, India became the latest country to take measured actions at combating smoking. A ban on public smoking came into effect nation-wide. The law aimed at fighting tobacco use which has been responsible for a fifth of all deaths in the world’s third-largest consumer of tobacco. India has nearly 240 million of tobacco users (more than the entire population of Nigeria). A fine of £2.00 was also imposed on those caught breaking the fan. A token penalty may be, but significant nevertheless.

The Nigerian Situation

In spite of the worldwide concerted efforts by concerned governments, Nigeria remains amongst nations that have expressed concerns but done precious little to tackle the blooming epidemic of smoking. As a nation, our indulgent attitude coupled with prevalent illiteracy has not really helped the situation. The smoking culture in Nigeria seems to be waxing stronger instead of waning. Our men still smoke blissfully, totally ignorant of the potential dangers. Another significant fact is the now prevalent attitude of our female folks to smoking. Without sounding chauvinistic, gone were the days when no decent woman dares smokes in the streets of Nigeria. These days, this is now a common place thing. Not on this, the disservice inherent in the attitude of the female actresses in our home made videos to smoke on the screen is frighteningly appalling. This is an antisocial act that calls for urgent curbing. This unwanted attitude gives erroneous glamorous air to the habit of smoking. It negates the efforts of the governments and concerned peoples of Nigeria to nip smoking in the bud.

Sam Olukoya’s report in one of the national dailies in January this year highlighted the enormity of the battle to contain smoking faced by the Nigerian society. It is a chilling reminder of the little impact of government’s efforts so far. He told the story of two Nigerian youths and their attitude to smoking vis-à-vis the warnings on cigarette packets relating the danger of this dreaded habit: “Taju Olaide (17) says that he was unaware of the warning because he is uneducated and therefore cannot read what is printed on the cigarette packs he buys. “I don't care about what they write on the cigarette packs because I cannot read. What is important to me is the cigarette inside the pack." Similarly, another

youngster, Uche Okeke, says that even though he has read the warning, he is not bothered by it. "I don't believe smoking cigarettes makes me liable to die young. Many old people who smoke are alive and well." These statements smacks of defiance and ignorance and no doubt, reflects the non-impact of the much orchestrated warnings on tobacco cigarettes in the country. Positions like this have forced the government to admit that the warning on cigarette packets have achieved nothing in fighting the tobacco surge.

The youth market gives Nigeria the unenviable tag of a veritable tobacco market in Africa. Statistics show that youths form over 40% of the Nigerian population and 18% of the youths smoke. This figure is actually on an upward spiral. Unless drastic steps are taken. Students in the Universities and Secondary schools are addicted to smoking while the primary schools are gradually being infiltrated. This development is of significant social concern and also portends dire economic consequences.

A strong determinant of the success of tobacco control in Africa is the need to have baseline information on tobacco on the continent. Anne-Maria Schryer-Roy, a Consultant with the African Tobacco Situational Analysis (ATSA) recently stated that little or no information exists on the continent to track progress on tobacco control activities in many sub-Saharan countries. This has led to dearth of sound information and evidence to assist policy makers in their efforts to effectively address country-level needs and implement a targeted tobacco control program. The two-year ATSA initiative is a partnership between IDRC (the International Development Research Centre) and the Bill and Melinda Gates Foundation.

Equally, Nigeria lacks baseline information on tobacco smoking pattern and attributes consequently making formulation and implementation of a national policy on tobacco difficult. To redress this situation, the Nigerian Heart Foundation (NHF) and the Nigeria Tobacco Control Alliance (NTCA) are to conduct a Nigerian Tobacco Situational Analysis (NTSA). The Executive Director of NHF, Dr. Kingsley Akinroye, said the situational analysis project was to Identify opportunities (short and long-term) to avert a tobacco epidemic in Nigeria, provide opportunities for support, provide information to support national and regional efforts for evidence-informed tobacco control and explore opportunities for strengthening collaboration among actors involved in tobacco control in Nigeria. The NTSA would also address presence of existing research, health policies and systems, infrastructure for tobacco control, the stakeholders for the tobacco control, government positions and the existence of tobacco control legislation amongst other issues. This NTSA has been endorsed by various stakeholders in the struggle for tobacco control as a step in the right direction.

It is pertinent to state that tobacco companies carry on their business in Nigeria as if their mere presence in the country is a privilege to the citizens. It is however, the view of Mr. Akinbode Oluwafemi, programme manager of ERA (Environmental Rights Action), that the product harms the national economy as costs far outweigh whatever benefits accrue to tobacco transnationals who are the beneficiaries of the tobacco trade. According to him, tobacco destroys national manpower, destroys the environment and also ruins social relationships. Although Nigeria has the Tobacco Smoking (Control) Act, Decree 20 of 1990, the Code of Advertising Practice (APCON), 1993 and APCON Resolution at its 89th meeting held on July 11, 2001, all these have not proved to be effective control mechanisms for tobacco control in Nigeria. A laudable development is the Framework Convention for Tobacco Control (FCTC) which was signed by Nigeria in June 2004 and ratified in October 2005.

The Nigerian Tobacco Market

British American Tobacco Nigeria (BAT) merged with the Nigerian Tobacco Company (NTC) in November 2000 to form the single largest tobacco company in Nigeria; it held a massive share of retail volume sales of cigarettes in 2005. The rest of the market is currently fragmented. Its dominance can be largely attributed to the popularity of its brands, which enjoy a long history in Nigeria, and its new factory, which has ensured a steady supply of its products to the market. Also, the company has embarked upon vigorous and creative marketing campaigns that have strengthened brand awareness and improved sales.

The Nigerian government welcomed tobacco investment and showed an active support for tobacco multinationals. BAT was granted a concessionary import duty that lasted until the end of 2003. Upon completion of the ultra-modern cigarette plant built by BAT in 2003, ex-President Olusegun Obasanjo described the US$150 million investment in Nigeria as a significant and trail-blazing initiative, which other investors should emulate. Perhaps to heed this call, in 2005, the Gallaher Group Plc and Japan Tobacco International (JTI) were registered to operate in Nigeria.

A significant portion of British American Tobacco is owned by the Swiss luxury group, Richemont, the family business empire of the South African billionaire Anton Rupert, who died in 2006.

The Enemy of the Nigerian nation

Mr. Lanre Oginni, Executive director, All-Nigerian Consumer Movement, stated that the tobacco industry has violated practically every article of the eight consumer rights, which were incorporated in the 1985 United Nations Guidelines for consumer protection and which were amended in 1999 to include sustainable consumption. He maintained that the tobacco business is a huge consumer fraud. He stated that those employed in tobacco factories or selling tobacco on the streets often earn starvation wages. Far from being rich from their vocation, many of those working in tobacco-related environment are facing multi-generational poverty compounded by illiteracy and poor health.
To illustrate the overtly conducive atmosphere for tobacco market in Nigeria which remains out of tune with global reality, the British American Tobacco (BAT) recently demanded tax waivers from the federal government. Additionally, BAT continues to explore areas not covered by the APCON directive or existing laws to advertise its products. Those areas include delivery vans, point of sale, traffic signs and umbrellas. It has continued to associate tobacco with arts, music, fashion, etc. It has also colour-coded all its brands in Nigeria that the colours speak for the products.
BAT has continued to demonstrate its willingness to exploit further loopholes (in its battle for survival) to continue to market its deadly products to identified target customers, especially the youths and the poor, further creating a vicious cycle of preventable deaths, diseases and poverty. It has continued to use its corporate social responsibility projects to hypnotise the public, creating confusion about the needs for tighter tobacco control.
Nigeria is in a race against a heartless and powerful tobacco conglomerate which admitted at the FCTC hearing in 2000 that: “‘we agree that smoking is addictive and causes diseases in smokers, but we do not have legal responsibility for those that claim they have been injured. We should not be responsible for their choices”. The onus thus lies on the federal government of Nigeria to be proactive in instituting measures aimed at protecting the populace.
Suggestions for Control
The situation calls for concerted and measured actions on the part of all Nigerians. The need for continued and sustained public health education on the dangers of smoking cannot be over-emphasised, especially with the prevalent ignorance exhibited by the critical segment of the Nigerian population. Other practical measures could include:
- Complete ban of advertisement, including points of sale.
- High taxes on cigarettes to discourage more people going into the venture.
- Protection of non-smokers from the often underestimated harmful effects of second-hand smoking.
- Expansion of smoke-free public places.
- Assistance to tobacco farmers to discourage the planting of tobacco.
- Assistance to pro-tobacco victims to ameliorate the resultant harmful effects of smoking.
- Provision of adequate support to states instituting litigations for damages.
- The domestication of the FCTC and passage of the draft National Tobacco Control Bill by the National Assembly. Effective enforcement of the said bill when passed into law is also imperative.

- Introduction of bold warnings that would up take no less than 30% of the space on cigarette wrappings. In particular, the introduction of photographic warnings showing cancerous growths caused by cigarettes as obtained in countries like Thailand, Brazil, Canada and lately Britain, will go a long way in making an informed decision on the part of (potential) smokers.

It is important to state that litigation remains the cornerstone of efforts to checkmate the tobacco industry excesses but this could only be achieved once necessary legislation framework is in place

It is also pertinent to state here that in 1998, 46 American states instituted a law suit against tobacco companies to recoup healthcare spending on tobacco-related illnesses. In a settlement, four tobacco companies agreed to pay $206-billion to the 46 states over 25 years and to cease advertising targeting youth. Since then, United States juries have awarded millions of dollars in damages against tobacco companies in compensation to Americans affected by smoking through death and disease. Since then, suits have followed in other countries, Nigeria being one.

The lawsuit filed by the Nigerian government was in conjunction with the civil society group Environmental Rights Action, the Nigerian affiliate of the environmental group Friends of the Earth. The suit, filed at a federal court in the capital, Abuja, is against big tobacco companies International Tobacco, Philip Morris, British American Tobacco, its Nigerian subsidiary British American Tobacco ( Nigeria) and the lobby group the Tobacco Institute. The suit seeks relief to regulate tobacco smoking, given the high number of under-aged children in what is Africa's most populous country. The government is also claiming $44-billion in compensation from the tobacco companies.

For Nigeria, the implication of unrestricted smoking environment is ominous as tobacco-related ailments take about 20 years to manifest. Thus the government should anticipate a huge epidemic of tobacco-related diseases in the coming years. The resultant strain on public healthcare would be enormous as the majority of these smokers are poor people who have no means to access treatment themselves. They will depend on the government to bear the cost. With the current pathetic state of our healthcare system, the impending chaos is best imagined. Perhaps, it is thus appropriate to suggest that at this juncture, an outright ban on smoking would be most relevant. This is probably the only effective way of forestalling the inevitable doom associated with our current kid-glove approach to the unimaginable disaster that smoking is.

This treatise is essentially a contribution in support of the numerous efforts by individuals and non-governmental organisations at achieving a smoke-free environment in Nigeria. It is principally directed at the general public, researchers and healthcare providers in Nigeria. Its goal is to touch on the health and socio-economic implications of smoking in Nigeria and efforts geared at achieving a smoke-free environment. I fully accept any shortcoming in this write-up.