Tobacco control: Stiff regulation or public sensitisation?

Whether you belong to the pro- or anti-tobacco group, one undeniable fact that you must admit is that tobacco smoking is dangerous to health. This is one clear point of convergence in the raging tobacco debate, and key players in the tobacco industry admit this as well, which is why the inscription ‘THE FEDERAL MINISTRY OF HEALTH WARNS THAT SMOKERS ARE LIABLE TO DIE YOUNG’ appears boldly on packs of cigarettes.

Furthermore, all sides to the ongoing debate are agreed on the urgent need to properly regulate the tobacco industry in order to safeguard the health of the citizens and protect non-smokers, especially young people below the age of 18 who are often exposed to smoke mostly out of no fault of theirs. The major point of divergence in the whole argument is perhaps in the best approach to take in order to achieve the best result. While anti-tobacco groups favour stringent regulation – such as ban on all forms of promotion/advertisement/public display of tobacco products, heavier taxation, ban on Corporate Social Responsibility (CSR) by tobacco firms, among others – pro-tobacco groups argue that stiff regulation of the of the tobacco industry will not achieve any positive result. Instead, they argue, stiff laws will end up driving the legal tobacco industry out of existence and pushing the business into the hands of illicit traders.

For instance, British American Tobacco Nigeria (BATN), a key industry player, in a submission it made at the recent public hearing on the National Tobacco Control Bill (NTCB) held by the Senate Health Committee in Abuja, while agreeing that “there are health risks associated with smoking”, argued, however, that harsh, draconian laws will not achieve any positive result whatsoever.

“Some people hold the view that very harsh and draconian tobacco laws will help address the health concerns around smoking, but they do not also share the fact that in countries where very harsh tobacco laws have been introduced, people have not stopped smoking and that in many instances, the laws have encouraged smuggling of cheaper tobacco products into those countries,” BATN said in its submission.

“The results are that cigarettes are still widely sold and consumed in those countries, but the trade is controlled by criminal gangs. Consequently, the health concerns are not addressed. Instead, the governments only lost the revenue that would have accrued from law-abiding businesses,” it added.

To buttress this point, BATN cited the example of the United States of America which, it said, banned the manufacture, sale, distribution and transportation of alcohol in the 1920s only to discover, 13 years later, that the ban had driven the business underground and created the rise of the mafia, which continues to dominate criminal activities in all facets of the American society.

As such, BATN and other industry players as well as some stakeholders have called for the passage of a balanced, unambiguous and evidence-based law that can be enforced, not regulation based on emotions or sentiments. This, not draconian laws, they argue, will mitigate the impact of tobacco on public health. They explain that if the legal tobacco industry is unable to operate under very harsh tobacco laws, they will inevitably close shop and the criminal smuggling gangs would take over, because there would still be a demand for tobacco products and this demand would be met by the faceless criminal gangs that would not comply with any laws, further exposing smokers and non-smokers to greater peril. Plus the government will lose revenue that would have accrued from the legal tobacco industry.

But some anti-tobacco campaigners counter the argument by saying that illicit traders and smugglers have been, and will always be there regardless of whether the laws are stiff or lax.

In the face of these arguments, the critical question that arises is: if the intention of the NTCB, as stated by the Health Committees of both the Senate and the House of Representatives, is not to ban smoking or chase away the tobacco firms but to safeguard the health of Nigerians, especially underage people, how best do we achieve this result?

From a critical analysis of the whole scenario, one thinks that the best approach would be to enact a balanced, workable, evidence-based legislation. But even beyond that, there is need for public sensitisation and education. In this regard, Action Health Incorporated (AHI), a non-governmental organisation dedicated to promoting young people’s health and development to ensure their successful transition to healthy and productive adulthood, gives us a clue.

In a submission it made at the Senate Health Committee public hearing, AHI said considering the high prevalence of smoking among the youth in the country, it in 2010 started a Youth Smoking Prevention Campaign among in-school adolescents in the selected cities of Lagos, Abuja and Calabar to prevent underage smoking. This it did in partnership with various implementing partners in project states such as ministries and NGOs, the lead partner being the Ministry of Education.

The campaign, according to the NGO, involved training of students as peer educators/anti-smoking ambassadors (and training teachers as coordinating teachers) to promote their skills to share smoking-prevention messages among their peers. The programme also integrated smoking-prevention activities into existing school clubs in all project schools, including inter-school debates, and in 2014, Facebook and 2Go were used in disseminating smoking prevention messages.

At the end of the intervention which was completed this year, AHI said it recorded an increase in the number of students who knew the main cause of diseases associated with smoking. During the end line survey, it said, 23.7 percent of the students were able to mention tar as the main cause of tobacco-associated diseases as against 8.7 percent at the beginning of the intervention; 92.9 percent of the students were able to affirm correctly that inhaling smoke from other people’s cigarette is harmful to the health as against 79.8 percent before the intervention; and there was a reduction by 3 percent in the number of students that reported they tried cigarette smoking and also smoked in the last one month at the end of the campaign.

So, rather than risk stifling the legal tobacco industry and conversely creating a thriving illicit trade, indirectly funding terrorism through promulgation of draconian laws, the National Assembly should consider the creation of a coordinated multi-stakeholder National Youth Smoking Prevention programme involving the ministries, government agencies, faith-based organisations, civil society organisations, parents, young people, community, traditional leaders and the private sector, as suggested by AHI. Who knows, this approach may be more effective than stiff laws that may at the end of the day not be practicable.

Frank Odumodu