BURNING HOPES: Anti-tobacco advocacy groups peg Africa as a region of high concern due to its residents' growing habit. A man, pictured here, smokes a cigarette rolled in newsprint.
ISTOCKPHOTO/MANOAFRICA

Africa is already beleaguered by infectious diseases, such as AIDS and malaria, but now the continent's residents face growing health threats from preventable illnesses brought on by lifestyle changes, such as from poor diets and smoking.

In an effort to stave off these maladies, advocates have turned their sights on tobacco use, which is on the rise throughout Africa and projected to double by 2021. Of the approximately one billion people across the world who use tobacco, 60 million to 80 million live in Africa.

Along with lobbying for higher tobacco taxes and broader public health messages, advocates are hoping to eliminate smoking in public places in an effort to protect people from both first- and second-hand smoke.

About a billion people worldwide live in municipalities where smoking is outlawed in public places, according to a report published Tuesday by Global Smokefree Partnership (a joint initiative backed by the American Cancer Society, Johns Hopkins Bloomberg School of Public Health, Johnson & Johnson, Pfizer and 14 other entities) and announced in time for the African Organization for Research and Training in Cancer's (AORTIC) "Cancer in Africa" conference taking place this week in Dar es Salaam, Tanzania. Reducing secondhand smoke exposure can reduce the rates of lung cancer, heart attacks and breathing trouble in populations.

"It's one of the most frustrating things," Thomas Glynn, director of International Cancer Control for the American Cancer Society (ACS) and acting head of the Global Smokefree Partnership says, about knowing that many nicotine-related illnesses can be prevented—especially among those who do not smoke—with the right laws and education.

A few countries in Africa have taken a firm stance on public smoking. the Indian Ocean nation, Mauritius, and South Africa have passed strong national smoke-free laws, and Nigeria's capital, Abuja, has a local ordinance in effect. But in many areas throughout the continent, politically connected and economically strong tobacco companies—and their addictive products—are shaping up to be a substantial opponent (British American Tobacco, a member of the industry group the Tobacco Institute of Southern Africa, did not repond to request for comment).

A hit on health
Tobacco causes about 5.4 million deaths worldwide each year, according to the World Health Organization (WHO), a number that is set to rise in the coming decades even as use decreases in many developed countries. But it is not just the smokers who suffer from the ill effects of their habits.

Since 1986 secondhand smoke has been recognized internationally as a contributor to lung cancer and, in 2006, the U.S. Surgeon General went so far as to say "there is no safe level of exposure to secondhand smoke." These findings, however, have not widely been put into regulatory action, leaving some 90 percent of Africans without local or national smoke-free laws, the new report notes. For example, in Tunisia, where tobacco use is especially high, even teachers and doctors smoke at work, according to a report issued earlier this year by the Economist Intelligence Unit, a London-based firm that provides business and market research, and backed by Pfizer.

Aside from the millions of tobacco-related deaths annually, the range of long-term disability that tobacco smoke exposure can induce also takes a toll on health and productivity. "We focus on lung cancer deaths, but more people are disabled by emphysema and heart disease and can't provide for their families," Glynn says.

In developed countries, heart attacks in areas with smoke-free laws dropped by 36 percent three years after laws went into effect, according to a report released in September by the American Heart Association. California, one of the first states in the U.S. to institute substantial local laws banning public smoking, has seen a reduction in lung cancer, Glynn notes. "From a biological plausibility standpoint, there's no reason we wouldn't see a similar decrease" in African countries, he says.

"The science is established," Glynn says. "It's now the legal and regulatory issues that are being dealt with." But in cities such as Abuja, where more than half of school students do not know that secondhand smoke can be hazardous, creating public support for laws and enforcement can be challenging. And in countries that grow tobacco, such as Tanzania, where about 6 percent of the country's income is tied to the crop, limiting the product's range can be met with formidable financial resistance.