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Tobacco Control in Africa

Tobacco Control in Africa

Jeffrey Drope

(2011)

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Abstract

This volume presents the work initiated and executed under the African Tobacco Situational Analyses (ATSA), a recent major public health initiative sponsored by the Canadian government’s International Development Research Centre (IDRC). Conceived to illuminate the factors that will facilitate the reform of Africa’s major public health policies, this program focused particularly (but not exclusively) on policies concerning tobacco. The results, presented in this book, are an important contribution to the literature on global public health and international development, and comprise the most comprehensive evidence-based analysis of tobacco policy in the African region.

The country-level analyses of this study examine topics such as smoking prevalence, the status of relevant smoking-related policies, and the politics of public health policy reform – as well as the role played by the tobacco industry in each of these key areas. Sitting above these case studies is an overarching conceptual framework, operating with the expressed goal of creating generalizable lessons for the continent as a whole. Thus, ultimately this book permits the reader not only to grasp the depth and complexity of the tobacco situation in each country, but also to draw meaningful conclusions regarding what sort of public health policy reforms have been broadly successful across Africa – and how these successes might be replicated in the future.


Jeffrey Drope is Assistant Professor of Political Science, Marquette University, Milwaukee, Wisconsin, USA.


This volume utilizes the work initiated and executed under a recent major public health initiative, the African Tobacco Situational Analyses (ATSA), which was sponsored by the Canadian government's International Development Research Centre (IDRC) with funds from the Bill and Melinda Gates Foundation. The program was conceived to illuminate the factors that will facilitate the reform of major public health policies, particularly, but not limited to, tobacco. The results, presented in this volume, are an important contribution to the literature on global public health and international development, and comprise the most comprehensive evidence-based analysis of tobacco policy in the African region.


‘Tobacco use in Sub-Saharan Africa is growing rapidly as a result of strong economic growth and the aggressive marketing tactics of tobacco multinationals. Although the policy interventions are well understood, the political economy of tobacco control in Sub-Saharan Africa is not, and this volume is a timely addition to the literature, offering the most comprehensive review of the political economy of tobacco control in Sub-Saharan Africa yet. The attention to detail in the 12 country case studies – representing diverse linguistic, geographic, political, legal and developmental environments – sets new standards for tobacco control research on the continent.’ —Dr Evan Blecher, International Tobacco Control Research Program, American Cancer Society


Table of Contents

Section Title Page Action Price
Front Matter i
Half Title i
Title iii
Copyright\r iv
Contents v
LIST OF FIGURES AND TABLES vii
FOREWORD ix
PREFACE xi
ACKNOWLEDGMENTS xv
LIST OF ABBREVIATIONS AND ACRONYMS xix
Main Matter\r 1
Chapter 1 INTRODUCTION 1
Knowing and Articulating Your Context 3
The ATSA Narratives 4
Overview of the Book 6
Notes 12
Chapter 2 THE POLITICAL MAPPING PROCESS 13
Domestic Institutions 14
Domestic Interests 22
The International – Institutions and Interests 24
Conclusion – A Dynamic Interaction 26
Notes 27
Chapter 3 PROGRESS ON SMOKE-FREE POLICIES 29
The Path of National Comprehensive Tobacco Control Policy 32
Working with Existing Policies 33
Creative Alternative – Or Complementary – Solutions 36
Post-legislative Challenges: Implementation and Enforcement 38
A Final Key Component: Public Awareness 39
Conclusion 40
Notes 41
Chapter 4 TAXATION AS A TOBACCO CONTROL STRATEGY 43
Review of Key Tax-Related Terms 44
Cigarette Affordability 46
Strategies for Tobacco Taxation 47
State of Tobacco Taxation in the ATSA Countries 48
The Political Challenges of Tobacco Taxation 54
A New International Dimension 58
Conclusion 60
Notes 61
Chapter 5 THE CHALLENGES OF IMPLEMENTING BANS ON ADVERTISING, PROMOTION AND SPONSORSHIP 63
FCTC Defi nitions and Article 13 63
ATSA Country Overview and Model Laws 64
The Central Challenge of Enforcement 72
Youths and Advertising: Empirical Findings 73
The Continued Cunning Ways of the Tobacco Industry 75
Conclusion 77
Notes 78
Chapter 6 THE PURSUIT OF PACKAGING AND LABELING REQUIREMENTS 79
The Ultimate Goal – Graphic Pictorial Warnings 82
Size and Placement are Essential 83
Font and Color Requirements of Warnings 85
Language of the Warning 87
Content and Rotation of Warnings 88
Inclusion of Constituents and Emissions 89
Opportunities for Enforcement 90
Conclusions 91
Notes 93
Appendix A – South Africa Health Warnings 95
Chapter 7 BURKINA FASO 97
Executive Summary 97
Brief Description of Political System 98
Scope of Tobacco Problem 99
Politics 101
Tobacco Industry 104
ATSA Review 105
Notes 105
Chapter 8 CAMEROON 107
Executive Summary 107
Brief Description of Political System 108
Scope of Tobacco Problem 109
Politics of Tobacco 110
Tobacco Industry 115
ATSA Review 120
Notes 120
Chapter 9 ERITREA 123
Executive Summary 123
Brief Description of Political System 124
Scope of Tobacco Problem 125
Politics of Tobacco 126
Tobacco Industry Monitoring 130
ATSA Review 133
Notes 133
Chapter 10 GHANA 135
Executive Summary 135
Brief Description of Political System 137
Scope of Tobacco Problem 137
Politics of Tobacco 139
Tobacco Industry 144
ATSA Review 146
Notes 146
Chapter 11 KENYA 149
Executive Summary 149
Brief Description of Political System 150
Scope of Tobacco Problem 151
The Politics of Tobacco Control 153
Tobacco Industry 162
ATSA Review 165
Notes 166
Chapter 12 MALAWI 167
Executive Summary 167
Brief Description of Political System 169
Scope of Tobacco Problem 169
Politics of Tobacco Control 170
Tobacco Industry Monitoring 180
ATSA Review 182
Notes 182
Chapter 13 MAURITIUS 185
Executive Summary 185
Brief Description of Political System 186
Scope of Tobacco Problem 187
Politics of Tobacco 190
Tobacco Industry 199
ATSA Review 200
Notes 200
Chapter 14 NIGERIA 201
Executive Summary 201
Brief Description of Political System 203
Scope of the Tobacco Problem 203
Politics of Tobacco 204
Tobacco Industry Monitoring 216
ATSA Review 217
Notes 218
Chapter 15 SENEGAL 219
Executive Summary 219
Brief Description of Political System 220
Scope of Tobacco Problem 221
Politics 222
Tobacco Industry 225
ATSA Review 225
Notes 226
Chapter 16 SOUTH AFRICA 227
Executive Summary 227
Description of Political System 228
Scope of Tobacco Problem 229
Tobacco Control Policies 231
Tobacco Industry 240
ATSA Review 243
Notes 244
Chapter 17 TANZANIA 247
Executive Summary 247
Brief Description of Political System 248
Scope of Tobacco Problem 249
Politics of Tobacco 251
Tobacco Industry 256
ATSA Review 258
Notes 258
Chapter 18 ZAMBIA 261
Executive Summary 261
Brief Description of Political System 263
Scope of Tobacco Problem 263
Politics of Tobacco Control 266
ATSA Action – Enforcement of a Smoke-free Lusaka (Capital City) 272
ATSA Action – Tobacco Cessation 276
Tobacco Industry Monitoring 277
ATSA Review 280
Notes 281
Chapter 19 CONCLUSION: TOBACCO CONTROL IN AFRICA – PEOPLE, POLITICS AND POLICIES 283
Thinking Systemically: Policy Change 284
The Underestimated Role of the Bureaucracy 284
Thinking Smartly: Exploiting Opportunities 285
The Next Frontier: Implementation and Enforcement 286
The Legacy of Bad Rules 288
The Central Role for Civil Society 288
Promoting Government Will 289
Early Interventions 291
Tobacco Cultivation 291
The Continuing International Component 292
Emphasizing the “Whole” 293
Notes 293
End Matter 295
NOTES ON CONTRIBUTORS 295
Country Chapter Authors 296
INDEX 299