Tobacco control in South Africa
The case study shows the difficulties that South African government had experienced when it implemented an anti-tobacco program in a new post apartheid South Africa. The difficulties arose from politico-economic changes in a society that was predominated by a long and enduring system of racial segregation. Tackling the tobacco problem the new government of Nelson Mandela had to face the reactions of diverse institutions that supported the apartheid system. The tobacco industry represented by Rembrandt Company existed since 1942 and supported the apartheid regime in South Africa. In term of health the situation was not bright for the South Africa. There were enormous health inequities among different group of the population. White people were doing well in term of health outcome whereas black people were at the very bottom level in term of health outcome. The new post apartheid government tried to implement new regulations in order to control the use of tobacco, but the tobacco industry allied with local and international industry to stop the vote at the regulation in the parliament. Finally after many discussions between government and tobacco industry, between lobbyists, the new regulation passed into legislation. Tobacco companies were required to stop any advertising about the product in TV and sport event. They were required to put health warning on their product labels. There was prohibition to sell tobacco product to 16 year- age adolescents. Most importantly taxes were imposed on the selling of the products.
There are several lessons that can be drawn from the case. Some of the most important are the need for a strong legislation in order to tackle social phenomenon that impact population and play important roles in the determinant of health of the population. Vera da Costa in the book Tobacco Control: An Introductory Guide noted an act passed in 1993 allowed the ministry of health to issue regulations. Immediately after the 1993 Act the minister of health began to initiate the health reform. Reddy, who participated in the drafting of the tobacco control regulation, said: “they had money, we did not have money, but we knew we had to legislate”(case). Legislation is a powerful tool and a help when it comes to implement health system regulation at a national level. The second lesson from the case is the use of an aggressive taxation on tobacco product. This mechanism proves its effectiveness by decreasing dramatically the consumption of tobacco in South Africa nearly it was estimated that the taxation policy would result in 400,000 fewer smokers in South Africa (case). On the other hand the taxation generates sufficient revenue for the government to finance the health system. The coverage of a large part of the population through health services became possible.
Tobacco companies are now less powerful than before. The health system has been implemented. On a broad prospective government has to create other incentives in order for the health system to keep functioning. It cannot rely on a long run on the tobacco taxation as this product is affected by its price elasticity. In order to continue with the health promotion it would be helpful now to build a program in collaboration with healthcare professionals (primary care professionals, nurses, and health workers) to encourage people to quit smoking. The program will be at very low costs for people who attend it. A powerful educational campaign through media should accompany the program. An introduction of incentives in order to encourage healthcare professionals to enroll patients who smoke into the program is also to consider. Ultimately the government will need to focus on cases of smuggling resulting from the increased price of tobacco.
Anne Emmanuel Birn : Textbook of International Health: global health in a dynamic world third edition, Oxford University press ed, print 2009.
Tobacco control in South Africa cases in global health delivery
Vera da Costa : Tobacco control : An introductory guide ,WHO