Is tobacco smoking being ignored in favour of other substance abuse?

Whenever there is media attention, especially international media attention and a public outcry over any sensitive public issue, the government’s is usually forced to respond, and in the best-case scenario is spurred to action. We have seen this pattern with one of the most talked about issues in the Nigerian health sector today, the codeine crisis and the government’s reaction to the issue. Not as much talked about, though just as deadly, is tobacco smoking, which is yet to receive such huge attention and criticism, at least in Nigeria.

According to the World Health Organisation (WHO), the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 7 million people worldwide each  year. In Nigeria, WHO estimated that about 5.6% of adults and 15.4% of youths currently use tobacco as at December 2016. In addition, as at 2016, Tobacco Atlas estimated that about 16,100 Nigerians die every year from tobacco-related diseases.

Image credit: Nigeria Health Watch

Tobacco smoking not only negatively affects health, but also takes a heavy toll on the economy and the environment. It is estimated that smoking costs the global economy more than 1 trillion dollars every year. In Nigeria, close to 90 billion Naira is spent annually on tobacco products. On an individual level, a smoker in Nigeria spends 7.18% of his annual average income to buy 10 sticks daily. Tobacco smoking is associated with almost every non-communicable disease, and is the leading cause of death in the world. It is responsible for about 90% of lung cancer in the United States; it is also a leading cause of oesophageal cancer, pancreatic cancer, liver cancer, cancer of the bladder, kidney cancer and others. It also contributes to worsening diabetic and hypertensive cases and is a major cause of many cardiovascular diseases such as hypertension. Tobacco also leads to infertility in both males and females, causes preterm and stillbirths and other birth defects. Apart from releasing carbon monoxide into the atmosphere, cigarette butts are the most commonly discarded pieces of waste worldwide. It is estimated that 8,004 tonnes of butts and packs of cigarettes wind up as toxic trash in Nigeria each year. This is roughly equivalent to the weight of 1,601 endangered African elephants. The impact of this on the ecology of the country cannot be estimated, but is sure to be detrimental.

Image credit: Nigeria Health Watch

Perhaps nothing contributes to the high prevalence of tobacco use in Nigeria than its easy accessibility and affordability. One stick of cigarette can be sold for as low as N20 and it can easily be bought by anyone, irrespective of their age at any small kiosk in any neighborhood, shop, supermarket and mall. Growing in popularity among Nigerian youths, is the smoking of shisha, also called hookah. It is freely smoked at open joints, restaurants and hotels across major cities in Nigeria. Many people think that smoking shisha is less harmful than smoking cigarettes, but it has many of the same health risks as cigarette smoking.

Many tobacco smokers know the health risks associated with smoking. We must counsel and encourage them and provide them with the support they need to quit. Photo credit: Nigeria Health Watch

In addition, using a hookah to smoke tobacco poses serious health risks not just to the smokers but also to others exposed to the smoke from the hookah as a result of the dangers of second-hand smoking, or passive smoking when bystanders inhale the smoke which usually fills the air when tobacco is being smoked. According to WHO, second-hand smoke in adults causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.

In 2015, the then Nigerian president signed the National Tobacco Control Act into law. The law aimed at overall control of tobacco smoking in Nigeria with clear regulations on the importation, distribution and sale of tobacco products and penalties for violating the law. Three years on, its implementation has not received the necessary impetus. In 2017, the Minister of Health, Prof. Isaac Adewole, announced nine regulations that would limit the use of tobacco in the country. The regulations if fully implemented, would result in significant reduction of tobacco smoking in Nigeria. As with the Act, the regulations are yet to receive meaningful actions from stakeholders. In many Western countries, public health campaigns have helped to change the law, reduce advertising and banned smoking in public places, resulting in a decline in smoking rates and the resultant health effects. As a result, the tobacco companies are increasingly focusing on targeting developing countries.

Tobacco threatens us all. Say no to tobacco. Protect health, reduce poverty and promote development. Photo credit: Nigeria Health Watch

As the world marks this year’s No Tobacco day, it is another opportunity for all stakeholders, from the general public to health professionals, media organisations and government to raise the bar on regulations of tobacco smoking in the country. More action needs to be taken by organisations to sensitize the public about the hazardous effects of tobacco smoking. Media organisations need to do more in creating awareness and making it a major topic of concern.

A comprehensive ban on all tobacco advertising, promotion and sponsorship, especially those that might target young people should be put in place as evidence suggests that this will help decrease tobacco consumption. The Nigerian government should employ the use of graphic warnings that will dissuade smokers. Many tobacco smokers know the health risks associated with smoking. We must counsel and encourage them and provide them with the support they need to quit. Above all, government agencies need to prioritise the enforcement of existing laws and regulations that were aimed at discouraging the smoking of tobacco in the country.