Nigeria: 17,500 Deaths Yearly Linked to Smoking-Related Diseases

With 17,500 deaths recorded each year in Nigeria on account of smoking-related diseases, and prevalence rising at four per cent yearly, Kasim Sumaina writes on the need for effective implementation of control measures in the country

Though, the Minister of Health, Prof. Isaac Adewole, has inaugurated the National Tobacco Control Committee (NATOCC). The issue of poor regulation, lack of enforcement of provisions of the Nigerian Tobacco Control Act (NTC), inadequate funding of National Tobacco Control Committee, poor regulation, lack of enforcement of provisions of the NTC Act, insufficient coordination and collaboration between government ministries, departments, agencies and strong tobacco industry interference at all levels have been deduced to be hindrances to effective tobacco control in Nigeria.

A recent survey reveals that tobacco-related deaths in sub-Saharan Africa which accounts for 25 per cent of all deaths was proportionate to the deaths caused by HIV/AIDS (12 per cent) and malaria (13 per cent) combined according to a 2012 survey. Globally, countries are putting in stringent measures to control tobacco and tobacco companies are responding innovatively.

Nigeria became party to the World Health Organisation (WHO)’s Framework Convention on Tobacco Control in January 18, 2006. Over nine years later, the Nigerian Tobacco Control Act was passed at the House of Representatives and Senate on April 23, 2015 and May 12, 2015, respectively. Yet, more than 175, 000 deaths are recorded each year on account of smoking-related diseases in Nigeria; this translates to about 207 men and 130 women weekly (Tobacco Atlas, 2015).

In addition to the serious health consequences, tobacco usage also has significant economic cost estimated at US$591 million. Nigerian tobacco market is dominated by local production which accounts for 12.2 billion cigarette sticks out of 18.4 billion sticks consumed in Nigeria in 2015 (NCS, 2017).

Communique issued at the end of a one day Policy Dialogue on the Economics on Tobacco Control in Nigeria, held in Abuja by the Centre for the Study of the Economies of Africa (CSEA), with support from the African Capacity Building Foundation (ACBF) and the University of Cape Town (UCT)’s Economics of Tobacco Control Project, estimates the impact of changes in the excise tax structure and level on cigarette consumption, government revenue, smoking prevalence, net-of-tax revenue, and excise tax burden.

The Executive Director, Centre for the Study of the Economies of Africa (CSEA), Dr. Chukwuka Onyekwena, stated that, while tobacco control had been gaining traction in the policy circle, there was still very little evidence to support advocacy efforts.

He explained that tobacco remained the single greatest preventable cause of death worldwide with 17,500 deaths recorded each year in Nigeria on account of smoking-related diseases.

He argued that while there is a perception of relatively low smoking prevalence in Nigeria, prevalence is rising at four per cent yearly necessitating the need for the effective implementation of tobacco control measures.

Chukwuka added that tobacco taxation had proven to be the most effective tobacco measure and that CSEA’s study on the Economics of Tobacco Control which is the first of such study in Nigeria was aimed at strengthening advocacy efforts for tobacco control.

Similarly, Research Associate, CSEA, Mr. Joseph Ishaku, noted that, an average pack of cigarette costs approximately ₦183.50 in 2017 (CSEA Survey, 2017).

According to him, “In Nigeria, there is no specific tax regime on tobacco products, but a general excise tax on domestically produced items which currently stands at 20 per cent ad valorem on Unit cost of production (UCA). UCA is reported to be around ₦60 per pack of cigarette (NCS, 2017).

“Thus, excise burden amounts to 6.49 per cent, whereas, the WHO recommended an excise tax burden of 75 per cent on tobacco products. Imported cigarettes are excluded from excise tax; an imported tax levy of 40 per cent of all CIF in addition to other levies such as ETLS, CISS, import duty and surcharge.”

He explained that, there is a need to implement an effective tobacco control programme to curb the epidemic.”Tobacco taxation has proven to be the best tobacco control measure as it can reduce smoking prevalence and generate revenue.

He said, “CSEA modeled four different changes to the Nigerian tobacco tax structure and level under 12 different scenarios of economic/income growth (slow, medium and high growth) and industry price response to an increase in excise taxes (either a full pass-through, or under-shift or over-shift of the tax onto the retail price).

“The policy interventions are as follows: Policy Intervention 1 (PI.1): Keep 20 per cent ad valorem tax, which includes ₦20 specific tax, and increase import levy to 50 per cent of Cost of Production (CIF) per pack. Policy Intervention 2 (PI.2): Change to specific tax system, set the excise tax burden to ₦30 per pack, and increase import levy to 50 per cent of CIF per pack. Policy Intervention 3 (PI.3): Change to specific tax system, set the excise tax burden to ₦60 per pack, and increase import levy to 50 per cent of CIF per pack. Policy Intervention 4 (PI.4): Change to specific tax system, set the excise tax burden to the equivalent of 75 per cent of current retail price, and increase import levy to 50 per cent of CIF per pack, as recommended by the WHO.”

He added that, the effects of the proposed policy changes are;”On Cigarette Consumption and Smoking Prevalence: Cigarette consumption and smoking prevalence decrease in all twelve scenarios of possible economic/income growth and industry price changes under PI.3 and PI.4 – which impose higher tax levels and specific tax systems relative to PI.1 and P1.2. Thus, changesin tax policy need to be significant to have the desired effect on smoking prevalence under all scenarios considered.

“On Government Revenue: Under all policy interventions and in all scenarios considered, government excise tax revenues from cigarette sales increase significantly. Excise tax revenues are most significant under specific tax system (as in PI.3 and PI.4) relative to ad valorem tax system.

“On Net-of-Tax Revenue: Under all policy interventions, the best response to maximise not revenue for the tobacco industry is to increase industry price. On Excise Tax Burden: Under all policy interventions and in all scenarios considered, the excise tax burden to the consumer will at least double. In terms of setting policy target and monitoring impact, tracking excise tax burden is the most useful indicator relative to the excise tax rate. The excise tax burden shows the impact of policy interventions after the industry response, whereas simply focusing on the excise tax rate will mask the pass-through effect on retail prices.”

Sub-Regional Coordinator, West Africa, Campaign for Tobacco-Free Kids, Hilda Ochefu, during her presentation on “Background on Tobacco Control in Nigeria: Successes and Challenges”, revealed that 5.6 per cent of Nigerians totaling six million people use tobacco products while about one-third of adults are regularly exposed to second-hand smoking (SHS) which is responsible for about 600, 000 premature deaths per year globally. Of all the deaths attributable to SHS, 31 per cent occur among children and 64 per cent occur among women.

She outlined stroke, lung cancer, asthma, induction and exacerbation, low birth-weight, pre-term delivery as some of the attendant consequences of exposure to SHS.

She added that foreign tobacco companies were migrating into the African continent because of poorly implemented Tobacco control laws.

“Although what tobacco control advocates and governments would love a completely ban on the tobacco products, tobacco is a legal product and there had been a call on a total ban on tobacco products in some policy circles, but the legality of the products made it impossible. The only viable and available option was to enforce effective tobacco control measures,” Ochefu said.

Advocacy and Awareness on the Dangers of Tobacco Smoking Contributor, Babatunde Oladapo (WATAX) stated that the level of awareness and publicity on the dangers on tobacco smoking was paltry when compared to awareness on communicable diseases like HIV/AIDS.

“According to statistics, HIV/AIDS is responsible for 12 per cent of deaths in sub-Saharan Africa, while tobacco-related diseases are responsible for 25 per cent of deaths.”

He recalled that the advocacy and awareness of HIV/AIDS was taken even to the grassroots level. Adding that, the social media has the ability to reach millions of people and suggested that social media be incorporated into advocacy and awareness campaigns on tobacco smoking. He further suggested that advocacy organisations think towards the establishment of Tobacco Awareness Clubs in secondary schools. Also, he opined that the lack of coordination and synergy between CSO’s was an area available for exploitation by tobacco companies. He therefore called for a more cordial relationship between CSO’s, “so there is no discordance” in advocacy.

Babatunde added that, the ECOWAS was heavily vested in tobacco control advocacy under the ECOWAS Fiscal Transition Programme with an aim to harmonise tariff across borders.

Assistant Comptroller-General, Nigerian Custom Service, Mr. Michael Ugbagu, stated that, there was a recommendation before the House of Assembly on a 20 per cent ad valorem and an additional 1 naira per cigarette specific tax on tobacco products.

He stated that an increase in tobacco excise tax will result in reduction in consumption. Adding that, one of the expected implications of an increase in excise tax burden would be an attempt by tobacco companies to engage in illegal trading through the borders.

ACG Michael suggested that, “Nigerian adopts the ‘track and trace’ tobacco control measure enforced by the Kenyan Government which makes tracking smuggled and illegal goods easier.”

On his part, Dr. Noel Arua- Asokoro District Hospital stated that according to statistics, 45 per cent of children exposed to tobacco smoking through their parents, end up smoking.

He encouraged advocates of tobacco control to educate smokers and non-smokers alike on the dangers of tobacco smoke to public health. For the smokers, Noel suggested models of change such as lifestyle modification and behavioural change modification.

Dr. Adedeji Adeniran, Senior Research Fellow, CSEA, opined that tobacco companies over publicise their benefits, and added that policy makers as well as activists have to look at the cost-benefit for example, the impact on public death. He urged the policy makers to look at innovative ways of administering tobacco revenue such as education, awareness and publicity, public health and others rather than looking at it as an avenue to increase government revenue.

Experts at the event recommended that, “there is an urgent need to raise taxes on tobacco products given the currently low tobacco tax levels, its dangers to public health and benefit for public finance. Based on the study presented, a substantial upward review of excise tax levels on cigarettes alongside a change from ad valorem to the specific tax system yields the most significant gains in public health (measured by reductions in cigarette consumption and smoking prevalence) as well as fiscal revenue (measured by increase in excise tax and other government revenues).

“An effective tobacco control tax policy will require that: the tax system is changed from ad valorem to specific tax system; excise tax burden on tobacco products is continuously increased until it at least reaches 75 per cent excise tax burden; and tax administration and revenue-collecting agencies are strengthened. There is a need for strong and consistent political will for tobacco control policies in order to continuously raise excise tax burden (thereby raising the retail price of tobacco products) annually to meet up with the WHO benchmark. Improvements in border control, monitoring and tracking systems, enforcement measures and international cooperation must accompany a tobacco tax policy to ensure optimal results.

“The Ministry of Finance, Ministry of Industry, Trade and Investment, Ministry of Health, Federal Inland Revenue Service, and the Nigerian Customs Service have to efficiently synergise resources in order to create a successful and effective tobacco tax policy in Nigeria. There is also need for synergy between Civil Society Organisations interested in public health and tobacco control, among others.”