Professor Rotimi A K Jaiyesimi – Smoking is the primary cause of preventable illness and premature death, accounting for approximately 100,000 deaths a year in the United Kingdom. There is undisputed evidence that smoking damages one’s health. Smoking causes lung cancer, throat cancer, breathing problems and death. Smoking in pregnancy reduces the growth of the baby.
It is for these reasons that smoking is banned in public places in the United Kingdom and people are encouraged to stop smoking. Recently, brand names were removed from packages, cigarettes are not on display in shops and government has increased tax payable on cigarettes.
With these restrictions in Western countries, Tobacco companies turned to Africa and Asia to promote their dangerous products. In 2015, global cigarettes leader, Philip Morris International Inc, Black Horse Tobacco Co, and Japan Tobacco Inc. made an entry into Nigeria. The country opened its doors to these companies even granting them Standards Organisation of Nigeria certification in spite of the 2015 National Tobacco Control (NTC) Act.
Smoking kills and the Nigerian government must stop the entry of imported cigarettes or the local manufacture of cigarettes. The cost of the profit made from sales of cigarettes pales in significance to the health burden and health cost of smoking. Over 4.5 million Nigerian adults are addicted to smoking tobacco substances. Smoking does not improve your public profile or ego. It is not hip or cool to smoke. It does not make you more acceptable in social circles. It is an addiction – a disease.
In July 1988, Nigeria’s then Health Minister, Late Professor Olikoye Ransome-Kuti, stated that by the end of 1988 cigarette advertising will be banned in all newspaper, radio, television and billboards. Smoking was going to be banned in all public places and transport. That year, the Nigerian Tobacco Company sponsored a fishing festival and a jazz festival!
There was an outcry from society against the move to ban smoking in public places – Lewis Obi wrote in The African Concord, a Nigerian weekly, ”As for smokers, they really deserve some peace from self-righteous, hypocritical busybodies.” It was considered that there would be objections from popular smoke-filled restaurants and nightclubs.
The tobacco companies went on its own campaign. The British-American Tobacco Company Limited flaunted tobacco as an important source of foreign currency. It stated that in Nigeria, 1.7 million people earned their livelihood from growing tobacco and from manufacturing and selling cigarettes. Cigarette sales generated the equivalent of $50 million in tax revenue in 1985. (In 2017, $43 million was found in a residential flat in Lagos!). The tobacco companies stated that ”Taxes on tobacco products make a significant contribution to government revenues.” A Nigerian newspaper, The Republic, warned in an editorial in April in 1988 that ”In this hard period of widespread unemployment, dwindling revenue and inflation, the tobacco companies, if forced out of business, will accentuate the economic plight,”
The 1988 government plan to ban smoking in public did not succeed. In 1990 the government attempted to legislate against tobacco with the establishment of the Tobacco Smoking (Control) Decree 20, 1990. With the transition from military to democratic governance in 2001, the decree was converted to an Act titled “Tobacco (Control) Act 1990 CAP, T 16”.
A result of the Act was the warning message – “The Federal Ministry of Health warns that smokers are liable to die young,” on all tobacco and sponsorship advertisement. Under the provisions of the Act, smoking in specific places such as schools and Stadia was banned. The warning was not enforced and was ineffective.
THE POLITICS OF THE TOBACCO INDUSTRY
The election of the 1999 civilian administration brought a renewed focus on Foreign Direct Investment (FDI) and this created a window for the declining Nigerian Tobacco Company (NTC) which led to the incorporation of British American Tobacco (Nigeria) Limited and later merger with the in 2000. On September 24, 2001, the Group signed a Memorandum of Understanding (MoU) with the Federal Government of Nigeria for an investment of $150 million to build a state-of-the-art-factory in Ibadan, Oyo State. Dr Timothy Menakaya was the then Health Minister. The investment started a process that has impacted all aspects of the tobacco industry, from leaf growing, through to the manufacture and distribution of tobacco products. Under the terms of the MoU, British American Tobacco Nigeria made a commitment to work with the Nigerian government in the following areas;
Regularising the tobacco sector, Building potential for regional exports, Significantly increasing both the quality and quantity of tobacco grown, Establishing an independent Foundation to address rural socio- economic development
The MoU made no reference to the effects of smoking on health, a problem that was widespread knowledge in the western world at this time. On June 17 2003, British American Tobacco, Nigeria completed and commissioned its state-of-the-art factory in Ibadan. The company prided itself in its product being of the highest international quality. It was silent of the hazards of smoking and the financial burden of the medical treatment and the economic loss of the effects of smoking. Both the Federal Government and the British American Tobacco were accomplices in the damage caused to the health of Nigerians. Its reasoning that it will generate employment and earnings was inexcusable and unacceptable. Really? Employment for an unhealthy workforce with a potentially short lifespan?
There were a number of government initiatives to control the use of tobacco but again there was no serious commitment – National Smoking Cessation Committee, 1990; In June 2006, the Honourable Minister of Health inaugurated a multi-sectorial/inter-ministerial committee on tobacco control in Nigeria. State governments have not been left out of the tobacco control initiatives. For example, Cross River state, in the South-South region of the country, passed a law prohibiting advertisement of tobacco products in the media, while the Federal Capital Territory (FCT) has implemented a ban on smoking in public places since May 31st, 2008. Again, these initiatives were ineffective. There was no political will to see this succeed. Government paid lip service to the task at hand.
A renewed government initiative
Over 4.5 million Nigerian adults are addicted to smoking tobacco substances. Reducing the number of people who smoke is therefore a key priority in improving the health of the population.
Nigeria now has a legislative basis for making smoking in public spaces an offence. Section 9 of the Nigeria Tobacco Control Act 2015, stipulates that offenders, once convicted, are liable to a fine of not less than N50,000 or not less than six months’ improvement, or both.
On 31 May 2017, the Minister of Health, Professor Isaac Adewole, announced steps to reduce smoking in Nigeria. These measures include
- The enforcement of ban on sale of cigarettes to persons under 18 years in Nigeria in single sticks
- Cigarettes must be sold in packs of 20 sticks only
- Smokeless tobacco shall be sold in a minimum of a pack of 30 grams
- Ban of sale or offer for sale or distribution of tobacco or tobacco products through mail, internet or other online device
- Prohibition of interference of tobacco industry in public health and related issues
● Prohibition of smoking in anywhere on the premises of a child care facility; educational facility; and health care facility. - Prohibition of smoking in playgrounds, amusement parks, plazas, public parks, stadia, public transports, restaurants, bars, or other public gathering spaces
It is expected that the tobacco companies will fight back and that traders will make attempts to circumvent these prohibitions. While the steps taken by the Nigerian government are welcome there is a need to establish a structure that will ensure that organisations or persons that breach the law are prosecuted. The choice to smoke in public spaces is not a fundamental human right and the argument that an individual has the freedom to do what they want to their body has no mileage when such act, when done in public affects others. Governments should set up a number of designated smoking places and these may become eventually obsolete with continuing education of the hazards of smoking.
Enforcement
Smoking does no one any good. It is an addictive drug. Prosecution and the pittance fine of 50,000 Naira are unlikely to serve as a deterrent or to change people’s attitude to smoking. The Minister of Health has sought the collaboration and active participation of the Attorney General of the Federation, the Nigeria Police Force and the National Drug Law Enforcement Agency (NDLEA) over the enforcement of National Tobacco Control Act. It will be impossible to ‘police’ smoking in a country as large as Nigeria. No smoking signs must be placed in the public areas. Consideration should be given to designated smoking areas in certain places. The responsibility of enforcement must be placed on the owners of the public facilities where smoking is prohibited as they would incur the fines if the laws are breached in their premises.
Education
The key to the success of the smoking cessation campaign is the realisation of its hazards by the public. Smoking in public pollutes the air and harms the health of other people in the area. There is a need for sustained public education on the harmful effect of smoking and of second-hand smoke. This will be achieved through education of the public. Education comes in the form of awareness campaigns in the print and electronic media, and schools. Government must be commended for the enlisting of people the public recognise as Ambassadors of the Smoke Free campaign. Social media handles and hashtags in currently in use to educate the public include @tobaccofreeng, #CleanTheAir and #SecondHandSmokeKills.
The Department of Public Health in Federal Ministry of Health should produce a policy and educational material to promote smoking cessation. The National Orientation Agency of Nigeria is also well placed to assist in communicating government policy on smoking. Professional bodies such as Nigerian Medical Association, National Association of Nigeria Nurses and Midwives, Nigerian Thoracic Society, Asthma Campaign Non-Governmental Organisations, the Music and the Nollywood film industry are best placed to act as agents of behavioural change in educating the public of the harmful effects of smoking. Recent days have seen the use of social media to spread the message. The message has to be taken to schools, workplaces and public arenas.
Effective Services
Public and private health facilities should set up smoking cessation services and health promotion activities to help smokers. Professionals and counsellors require training to assist those addicted to smoking and those willing to stop smoking.
CLEAN THE AIR
Exposure to tobacco smoke is hazardous and concerted efforts by the government, professional associations, the media, music and film industries will help Nigeria win its renewed initiative against smoking. The production of a national framework that takes these components into consideration has been shown to be successful in other countries. This framework will provide a template for organizing national media campaigns, providing counselling training, publishing pamphlets for smokers and non-smokers, holding press conferences and working together with other preventive projects and programmes. Individuals should come on board in the quest to create a smoke-free Nigeria and a healthier society.
Professor Rotimi Jaiyesimi is Associate Medical Director for Patient Safety and Consultant Obstetrician and Gynaecologist, Basildon and Thurrock University Hospital, Basildon, UK. He is Visiting Professor, Faculty of Health Sciences and Wellness, University of Sunderland and with a master’s degree in medical law, he is Visiting Professor, Faculty of Law, University of Ibadan, Nigeria. He has a keen interest in public health issues and is a fellow of the Royal Society of Public Health. He is a member of the editorial board of the journal, Perspectives in Public Health.
