Tobacco use and child health in Africa

1
Tobacco use and child health in Africa

• Dr. Joy de Beyer
• Africa Child Health Meeting,
• World Bank, July 2000

2
Cigarette Consumption in Africa
Disease and death caused by tobacco is an
emerging problem in Africa. The age for
smoking initiation is getting younger and
younger Smoking by mothers and other adults
has serious health consequences for children,
beginning in utero. In 1999, Africa smoked 4
of world cigarette consumption.
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The health consequences of smoking and second
hand smoke evolve over a lifetime.
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Pregnancy, Infant Health and Smoking
A woman who smokes during pregnancy not only
risks her own health but also changes the
conditions under which her baby develops Fetal
growth is retarded Spontaneous abortions
Fetal and neonatal deaths Pregnancy
complications Long term effects on surviving
children
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Second Hand Smoking, Birth Weight, and Fetal
Growth
Reduced Birth Weight Babies of women who
smoke during pregnancy are on average 200 grams
lighter Fetal Growth Retardation body length,
chest and head circumference The childs long
term growth, intellectual development,
behavioral characteristics are affected
Increased risk of sudden infant death syndrome
6
Second Hand Smoking during Childhood
700 million children- almost half of children
worldwide- live in a home with a smoker.
Children whose mothers smoke have an estimated
70 more respiratory problems. The prevalence is
30 higher if the father smokes. Infants of
mothers who smoke have almost five times the risk
of sudden infant death syndrome. Annual
health costs attributed to environmental tobacco
smoke are signifincant.
7
Tobacco addiction starts early in life

• Every day 80,000 to 100,000 youths become regular
  smokers

Source Chinese Academy of Medicine 1997, Gupta
1996, US Surgeon General Reports, 1989 and 1994,
Authors calculations
8
Adolescent Smoking
Males Females Senegal
(Dakar) (10-20 year old) 1989
70 52 Niger (15-35 years old)
1991 41 11 Ethiopia (18-20 years old)
1980 38 3.4 Benin (400 students) 1986
12 2 Ghana (secondary school)
1994 6 1

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Adult Smoking Prevalence in Africa
Cigarette consumption and prevalence rates have
been increasing in Africa. Males
Females Namibia 1994 65
35 Algeria 1980-1995 53 -77
10 - 14 Zaire 1980-1992 20 - 40 10
- 25 Swaziland 1989 33 8

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Tobacco, 21st Centurys Increasing Risk Factor in
Africa
In Mali, during 1989-1993, hospital admissions
for tobacco related causes have increased. Of
those, 82 of ischaemic heart disease, 89 of
emphysema, and 66 of lung cancer patients were
smokers. In South Africa, 25,450 smoking
related deaths were reported in 1988 and 110,856
potential years of life lost in the age group
35-64 years. In Mauritius, tobacco attributable
age standardized death rate per 100,000 were 1583
for males and 918 for females in 1990s.
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Government roles in intervening

• To deter children from smoking
• To protect non-smokers from others smoke
• To provide adults the needed information to make
  an informed choice
• First-best instrument, such as youth
  restrictions, are usually ineffective. Thus, tax
  increases are justified, and are effective.
• Tax increases are blunt instruments.

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Taxation is the most effective measure

• Higher taxes induce quitting and prevent starting
• A 10 price increase reduces demand by
• 4 in high-income countries
• 8 in low or middle-income countries
• Young people and the poor are the most price
  responsive

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Non-price measures to reduce demand

• Increase consumer information dissemination of
  research findings, warning labels,
  counter-advertising
• Comprehensive ban on advertising and promotion
• Bans or restrictions on smoking in public and
  work places

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What are the costs of tobacco control?

• Revenue loss likely to have revenue gains
• a 10 tax increase would raise revenue by 7
• Job loss temporary, minimal and gradual
• Possible smuggling crack down on criminal
  activity, not lower taxes
• Cost to individuals, especially the poor
  partially offset by lower consumption

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Summary

• Tobacco deaths worldwide are large and growing,
  and have higher burdens on poor people
• Specific market failures support government
  intervention
• Demand measures, chiefly tax increases,
  information, and regulation are most effective to
  reduce consumption
• Control of smuggling is the major supply-side
  intervention
• Tobacco control is cost-effective