Unfortunately, public health issues rarely make headline news in Nigeria. Very few people know that there is an important bill – the NIGERIA TOBACCO CONTROL BILL currently going through the Senate. It has just gone through its second reading. The Bill seeks to regulate the manufacturing, advertising, distribution and consumption of tobacco products in Nigeria
One of the great public health victories of recent times has been the battle against the cigarette industry, forcing them to admit to the harmful and addictive properties of their products. The health benefits of reducing access to cigarettes are now irrefutable. Over the last few years, almost every Western country has also banned smoking in public places, making significant measurable impact on the health of their citizens. As a similar bill makes its way through the Nigerian Senate the economic argument is being brought to the fore. Senator Victor Ndoma-Egba has argued that “…we have to deal with the use of tobacco in such a regulated manner that it doesn’t create any economic distortion.” In addition to any direct impact on tobacco farmers, reviewing the economic case must include the costs of tobacco-related illnesses such as lung cancer, chronic obstructive pulmonary disease and other illnesses, and evidence from other countries suggests that the harms far outweigh the benefits.
In the mid-2000s, the prospect of a smoking ban in public places ignited fierce public debate in England leading up to 2006 when the UK parliament voted to ban smoking in all workplaces in England and Wales. Why then have we not seen a similar vigorous debate in Nigeria? Why are a lot of health professional voices not being heard?
The journey of tobacco control in Nigeria started over 60 years ago. Solomon Nwathor in an interesting article he published in 2012 titled “Nigeria’s costly complacency and the global tobacco epidemic” describes the history of the Nigerian Tobacco Control Policy, which starts in 1951, when the bill was first mentioned. In 1990, the Tobacco Smoking (Control) Decree No. 20 forbade smoking in ‘public spaces’ (cinemas, stadia, offices, public transport, lifts, medical establishments, schools and nursery institutions), prohibited use of print and electronic media, including television, to advertise tobacco and mandated the display of the tar and nicotine content and a health warning from the Federal Ministry of health on each pack. In 2004, Nigeria signed the WHO Framework Convention on Tobacco Control (FCTC), which was ratified in 2005. Tobacco billboards were taken down by 2005 and radio / television cigarette advertisement before 10pm banned. In 2007, the Federal Government sued three international tobacco firms, accusing them of “putting unacceptable pressure on the country’s health services, and companies are targeting younger and younger people in an attempt to replace former smokers in Europe and America” but the lawsuit was eventually withdrawn. In 2008, WHO reported an almost complete absence of tobacco control implementation in Nigeria. A 2009 Tobacco Control Bill by the House of Representatives and Senate was enacted in 2011 but still awaited the President’s signature in 2012. In 2012, a study review showed “rising smoking prevalence in all age groups” in Nigeria over the past 25 years.Monitoring of tobacco use is very limited in Nigeria. The National Demographic and Health Survey (NDHS) in 2003 started asking about tobacco use, initially from pregnant women only. In 2008 and 2013, this aspect of the survey was expanded to all people aged 15-49 but still missed other age groups. Also, since the NDHS only asks about current smoking status, it does not provide information on former smokers. Nevertheless, as Nwathor points out, the limited data on the monitoring of tobacco use suggests that educated people are less likely to smoke. Thus education, in general and on the dangers of smoking, is an important tool in reducing the number of smokers.
Another study by Olowookere et al (2014) shows “poor awareness and attitude to the law banning cigarette smoking in public places” in Osun State. In addition, most people (about 3 out of 4 respondents) did not perceive tobacco as damaging to health. The same number of people did not think a tobacco control bill is needed. Furthermore, less than a third of respondents were aware of the existence of the Tobacco Control Bill and none had actually seen it. Thus, the authors of the study recommend that the general public be sensitized and the Tobacco Control Law be enforced.
Given this lack of knowledge, what will it take to get the public aware of the risk of smoking enough for them to push our senate to get this law passed? Learning from the examples in other countries, this would be a perfect advocacy agenda for health workers and health organizations in Nigeria.
The “Association of Public Health Physicians of Nigeria” (APHPN) has taken up this challenge. It recently constituted an expert committee on Tobacco control to provide technical expertise to the various committees set up by government to domesticate the Framework Convention on Tobacco Control. On May 31 2014 – the “World No Tobacco Day” the organisation led a series of activities across the country to raise the profile of this issue with the aim of making the problem of tobacco use, its dangers to health and the weak regulation of the industry more visible in the public arena.
It will not be an easy battle. It has never been. In this article, Philip Jakpor describes how British American Tobacco (BATN) undermines these efforts in Nigeria through “agricultural initiatives”. He describes how through a Corporate Social Responsibility programme, BATN presents itself as a stakeholder in Nigeria’s agriculture sector, targeting rural farm communities that make up 70% of Nigeria’s population. Their position is a canny one – using the argument that the ban will hurt the Nigerian economy, but saying little about the harms of tobacco use. Similar tactics were used in western countries, mounting a powerful public relations and sponsored scientific campaign. Economic arguments are very powerful in Nigeria, but a proper economic assessment will need to include the cost of the cancers and respiratory illness and the impacts on productivity.
A country’s development is not only determined by the size of its Gross Domestic Product, but how its society engages with issues like this. How great it would be if health professionals could find a rallying point in this cause.
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