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Zambia facing tobacco threat

DR JEFFREY Drope Vice-President of Economic and Health Policy Research at the American Cancer Society (left), Dr Fastone Goma President of Zambia Heart and Stroke Foundation (middle) and Professor Geoffrey Fong of the University of Waterloo in Canada (right) at the launch of the dissemination of the International Tobacco Control survey wave 1 and 2 at the Taj Pamodzi Hotel in Lusaka.

ZAMBIA lags far behind other countries in implementing effective policies to protect the public from the growing threat of tobacco harms to health.
Despite strong public support, Zambia’s continued inaction is promoted by incorrect beliefs that tobacco leaf growing is an economic boom to Zambian farmers.
This is according to the International Tobacco Control (ITC) Zambia National Wave one and two report released in Lusaka by international research teams at the University of Zambia, the University of Waterloo, and the American Cancer Society.
Zambia is a Party to the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC), a global health treaty that has been ratified by 180 countries.
As a party to the FCTC since 2008, Zambia is obligated to implement comprehensive tobacco control laws to control the threat of a tobacco epidemic, including large pictorial health warnings, bans on smoking in public places and tobacco advertising, and increases in tobacco taxes and prices.
The first report presents the findings of the International Tobacco Control (ITC) policy evaluation project in Zambia.
Approximately 1,500 tobacco users and 600 non-users were surveyed in 2012 and re-contacted in 2014 to identify strengths and weaknesses in Zambia’s efforts to protect the public from the harms of tobacco.
The ITC Zambia report released the second country data in two years by the research teams.
Findings show that over the past two years, Zambia has made little progress towards meeting its FCTC obligations and addressing the policy shortcomings that were identified in the first report.
The ITC project, centered at the University of Waterloo in Canada, has since 2002 conducted large-scale studies to assess the impact of FCTC policies.
In all, ITC impact assessment studies have been conducted in 23 countries, covering over half of the world’s population and over two-thirds of the world’s tobacco users.
The ITC Zambia survey shows that smokers in Zambia have low awareness of the specific harms of smoking.
In Zambia smokers are least likely among 12 ITC countries to be aware that smoking causes lung cancer among 12 ITC countries (79 percent compared to Brazil at 93 percent).
Zambian smokers have the third lowest level of awareness among 14 ITC countries that smoking causes heart disease (74 percent compared to Mauritius at 86 percent), and the third lowest level of awareness among nine low- and middle-income ITC countries that second-hand smoke causes heart attacks in non-smokers (64percent compared to Thailand at 85 percent).
In another disturbing finding, only 15 percent of smokeless tobacco users (the vast majority of which are women) were aware that smokeless tobacco causes mouth cancer.
Health warnings are a proven no-cost measure to increase tobacco users’ awareness of the risks associated with smoking.
Large, pictorial warnings are most effective in motivating smokers to quit, discouraging non-smokers from starting, and keeping ex-smokers from starting again.
Seven years have passed since Zambia ratified the FCTC and the government has yet to introduce large pictorial warnings.
Therefore, Zambia continues to have just one single text warning in English on the front and back of the pack with no minimum size specified.
The ITC Zambia survey shows alarming evidence of the weak impact of the single text warning.
Forty percent of Zambian smokers were unable to read the health warning at all and 14 percent read it with difficulty.
Zambia ranked the lowest (22 percent) of 11 low- and middle-income ITC countries on the percentage of male smokers and quitters who noticed the warnings.
The lack of action on health warnings contrasts with smokers’ own desire for stronger health warnings.
Over three-quarters (77 percent) of smokers in Zambia want more health information on cigarette packs, the highest percentage of 20 ITC countries.
Taxation is another area where Zambia has shown little progress. The World Health Organisation (WHO) concludes that increasing tobacco taxes is the single most effective strategy for reducing tobacco use.
But the ITC report shows that cigarettes continue to be highly affordable in Zambia, and as a result, unlike other countries where prices are high enough to motivate quitting, in Zambia cigarette prices are too low to motivate smokers to quit.
In addition, the easy availability of hand- rolled cigarettes, which are taxed at a lower rate, and of single cigarettes, which allow the poor and youth to obtain cigarettes contribute to missed opportunities by Zambia to use strong price/tax policies to reduce tobacco use.
And yet even smokers in Zambia support tax increases on tobacco, and the support has increased from 56 percent of smokers in 2012 to 74 percent in 2014.
About three-quarters (73 percent) of smokers supported a tax increase on hand-rolled tobacco in 2014.
Professor Geoffrey Fong of the University of Waterloo in Canada, chief principal investigator of the ITC project said: “The ITC survey findings clearly show that Zambia needs to move forward urgently on many different tobacco control policy fronts.
If the growing tobacco epidemic is not effectively countered through stronger policies, Zambia and other countries are certain to experience an unprecedented health and economic crisis.
The second report from the American Cancer Society provides evidence countering tobacco industry claims that tobacco farming is an economic benefit for farmers.
The report is based on an extensive survey of 497 small-scale tobacco farmers across the three largest tobacco-growing provinces in Zambia.
The survey found that most small-scale tobacco farmers are in fact losing money each year.
And according to Dr Jeffrey Drope , vice-president of Economic and Health Policy Research at the American Cancer Society (the lead investigator of the tobacco farming survey), tobacco farmers with contracts experience a net loss of about K2,700 (about US$250) per acre. The independent farmers report a slight profit of about K2,200 (about US$200) per acre.
Dr Drope says these perceptions of profit are an illusion because they do not take into account the costs of labour, which are substantial, requiring 1,200 to 1,500 hours of labour to produce just one acre, with the most intensive tasks such as harvesting adding to the total hours required.
“When labour costs are factored in, then the net loss for contract farmers becomes about K18,500 (about US$1,700) per acre, and the independent farmers now experience a net loss of about K4,900 (about US$450),” he said.
In other words, both contract and independent small-scale tobacco farmers in Zambia operate at a net loss.
But then why do farmers continue to grow tobacco? Dr Drope cites several reasons for this.
Contract farmers, who make up nearly three-quarters of small-scale tobacco farmers are attracted by the fact that they have a buyer for tobacco leaf, they have access to credit through their contract, and most importantly, many contracts provide for cash payments up-front.
This is very attractive for farmers who for other crops would need to pay up-front for their inputs and would need to wait many months for an uncertain return on their investment.
The combination of cash up-front and certainty in having a buyer for their crops, compels many farmers to enter and to continue farming tobacco.
However, the contracts plunge these farmers into an increasing and deepening cycle of debt because the cash payments plus their revenue at harvest are not sufficient: they must grow tobacco again to pay back the leaf-buying companies, Dr Drope says.
Their contracts keep them at subsistence levels from year to year while their total debt increases year after year.
“The tobacco industry promotes a narrative that growing tobacco leaf provides a good living for many thousands of farmers in Zambia. The results of our research clearly show that the opposite is really true: the vast majority of small-scale tobacco farmers have very bleak economic livelihoods, and many are firmly stuck in vicious and increasing cycles of debt,” said Dr. Jeffrey Drope.
During the launch of the reports Ministry of Health Director for disease surveillance, control and research Dr Elizabeth Chizema said Tobacco is the only product which, when used as intended causes widespread addiction, disease and death.
“Zambia remains committed to the protection of its citizens from the harms of tobacco smoking and consumption. In 2014, the Zambian government spent US$37,257 on tobacco control programmes,” she said.
Following the signing of the 2008 treaty, Government came up with legislation banning smoking in public places to protect the public from harms caused by exposure to tobacco smoke among others.
Regardless of the foregoing, Government recognises that more needs to be done especially in the domestication of the WHO-FCTC.

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