1. Tobacco use and child health in Africa Dr. Joy de Beyer Africa Child Health Meeting, World Bank, July 2000

2. Cigarette Consumption in Africa Disease and death caused by tobacco is an emerging problem in Africa. The age for smoking initiation is getting younger and younger Smoking by mothers and other adults has serious health consequences for children, beginning in utero. In 1999, Africa smoked 4% of world cigarette consumption.

3. The health consequences of smoking and second hand smoke evolve over a lifetime. Pregnancy Infant health Adolescence Adulthood Child Health and Smoking Fetal growth Birth weight Abortions Premature Birth Fetal Death SIDS Physical Growth Behavior and cognitive development Respiratory infections More hospitalization Small airway dysfunction Cough Wheezing Phlegm production other respiratory symptoms Chronic bronchitis Emphysema Lung cancer Coronary heart disease Stroke COPD

4. Pregnancy, Infant Health and Smoking A woman who smokes during pregnancy not only risks her own health but also changes the conditions under which her baby develops Fetal growth is retarded Spontaneous abortions Fetal and neonatal deaths Pregnancy complications Long term effects on surviving children

5. Second Hand Smoking, Birth Weight, and Fetal Growth Reduced Birth Weight Babies of women who smoke during pregnancy are on average 200 grams lighter Fetal Growth Retardation body length, chest and head circumference The childs long term growth, intellectual development, behavioral characteristics are affected Increased risk of sudden infant death syndrome

6. Second Hand Smoking during Childhood 700 million children- almost half of children worldwide- live in a home with a smoker. Children whose mothers smoke have an estimated 70% more respiratory problems. The prevalence is 30% higher if the father smokes. Infants of mothers who smoke have almost five times the risk of sudden infant death syndrome. Annual health costs attributed to environmental tobacco smoke are signifincant.

7. Tobacco addiction starts early in life Source: Chinese Academy of Medicine 1997, Gupta 1996, US Surgeon General Reports, 1989 and 1994, Authors calculations Every day 80,000 to 100,000 youths become regular smokers

8. Adolescent Smoking Males Females Senegal (Dakar) (10-20 year old) 1989 70%52% Niger (15-35 years old) 1991 41%11% Ethiopia (18-20 years old) 1980 38% 3.4% Benin (400 students) 1986 12% 2% Ghana ( secondary school ) 1994 6% 1%

9. Adult Smoking Prevalence in Africa Cigarette consumption and prevalence rates have been increasing in Africa. Males Females Namibia 199465% 35% Algeria 1980-1995 53 -77% 10 - 14% Zaire 1980-199220 - 40%10 - 25% Swaziland198933%8%

10. Tobacco, 21st Centurys Increasing Risk Factor in Africa In Mali, during 1989-1993, hospital admissions for tobacco related causes have increased. Of those, 82% of ischaemic heart disease, 89% of emphysema, and 66% of lung cancer patients were smokers. In South Africa, 25,450 smoking related deaths were reported in 1988 and 110,856 potential years of life lost in the age group 35-64 years. In Mauritius, tobacco attributable age standardized death rate per 100,000 were 1583 for males and 918 for females in 1990s.

11. Government roles in intervening To deter children from smoking To protect non-smokers from others smoke To provide adults the needed information to make an informed choice uFirst-best instrument, such as youth restrictions, are usually ineffective. Thus, tax increases are justified, and are effective. uTax increases are blunt instruments.

12. Taxation is the most effective measure Higher taxes induce quitting and prevent starting A 10% price increase reduces demand by: –4% in high-income countries –8% in low or middle-income countries Young people and the poor are the most price responsive

13. Non-price measures to reduce demand Increase consumer information: dissemination of research findings, warning labels, counter-advertising Comprehensive ban on advertising and promotion Bans or restrictions on smoking in public and work places

14. What are the costs of tobacco control? Revenue loss: likely to have revenue gains –a 10% tax increase would raise revenue by 7% Job loss: temporary, minimal and gradual Possible smuggling: crack down on criminal activity, not lower taxes Cost to individuals, especially the poor: partially offset by lower consumption

15. Summary Tobacco deaths worldwide are large and growing, and have higher burdens on poor people Specific market failures support government intervention Demand measures, chiefly tax increases, information, and regulation are most effective to reduce consumption Control of smuggling is the major supply-side intervention Tobacco control is cost-effective