It has been 14 years since Tanzania enacted the 2003 Tobacco Products Regulatory Act but for Daria Tarimo*, a resident of Buguruni in Dar es Salaam, it’s about seven years since she smoked her first cigarette—and this has changed her life— not for the better.
Daria, now 32, recalls her first cigarette smoking debut, as she speaks to Your Health two days ahead of this year’s ‘World No Tobacco Day’ (WNTD), which will be marked globally under the theme, “Tobacco – a threat to development.” It’s a day meant to highlight tobacco-related health risks and advocate effective policies to reduce tobacco consumption.
Daria is a petty trader and a mother of one. She earns an average daily income of about Sh7500 from selling tomatoes, beans and onions in Bugurni Market, but, she tells Your Health that she has to spend Sh3500 of her income on a packet of cigarettes each day, and this habit didn’t begin just of late.
The story of Daria continues
“I began smoking at 25, it was just on a normal day when I had gone out for an evening walk in Temeke with a friend. I had one cigarette, then the other day; I felt like I wanted another. Months later, I felt I couldn’t live without it. Here I am now, I can smoke a packet a day.”
Today, she says, “I don’t want to dwell on what I have been through but to be frank; smoking the cigarettes has robbed me of a good quality of life, family relationship and, of course, money.”
When asked whether she fears violating Tanzania’s anti-smoking laws, she laughs, shrugs off her shoulders and asks this reporter, “Where is that law? Or that police who will arrest me? Well, I smoke while at home but sometimes I can do it outside my home, especially if the people around where I smoke from won’t mind.”
And about her child? Daria says, “My daughter is now 6-years-old. She is already in school. She has gotten used to my smoking habits but I wouldn’t wish to see her live her life in the future like me.” Daria also smoked during pregnancy.
Prevention and management of tobacco use and exposure to second-hand smoke in pregnancy is crucial in protecting maternal and child health in low and middle-income countries, including Tanzania, says a 2014 study published in the Lancet Journal, titled “Tobacco use in pregnant women.” But Daria wasn’t aware of this.
Yet, at one moment, she admits that her smoking habits, especially when she did so in public, have come with consequences. “Not all people are okay with it. At times people scorn me. My boyfriend left me and it’s all about smoking,’’ she says and continues, “Warnings from doctors about cancer risk, heart attack and bad mouth odour haven’t worked for me,’’ she recalls when doctors told her that she had developed stomach ulcers because of her smocking habit.
A word from the activist
But Daria is not alone. In Tanzania, more and more people continue to smoke, yet the country lacks a comprehensive tobacco control system that conforms to the requirements of the World Health Organisation (WHO), says Tanzania’s anti-tobacco activist, Ms Lutgard Kagaruki.
“As such, anyone can smoke anywhere. There are still advertisements for cigarettes, and as a country, we have very low taxes imposed on cigarette businesses,’’ she points out as she explains how higher taxes could help reduce the availability of cigarettes and therefore reduce the number of smokers.
“The WHO recommends higher taxes on companies dealing in tobacco business. If the number of smokers goes down, so does the tobacco-related diseases,’’ says Ms Kagaruki who, over the years, has been very vocal against tobacco smoking through an organisation, Tanzania Tobacco Control Forum (TTCF).
“There is a need for strong political will in dealing with cigarette or tobacco smoking,’’ she says, citing an example from other countries which have made strides in tobacco control.
“In Tanzania, we still have a situation where the government is a stakeholder in the tobacco business. In other countries, such as Australia, it’s in the law that no government leader can have business interests with tobacco companies,’’ she says.
Data from World Health Organisation (WHO) show that through increasing cigarette taxes worldwide by USD1, an extra USD190 billion could be raised for development.
“High tobacco taxes contribute to revenue generation for governments, reduce demand for tobacco, and offer an important revenue stream to finance development activities,’’ reads a WHO fact sheet released ahead of this year’s World No Tobacco Day.
Reports show that Australia has among the toughest antismoking legislation in the world.
Smoking is banned inside all airports, government offices, health clinics and workplaces in Australia. Restaurants and shopping centres in most states and territories are also smoke-free zones.
The anti-tobacco law in Tanzania requires that warning signs be printed on each cigarette advertisement, on the sticks and on packets. It also bans smoking in public places. However, there is an apparent reluctance to implement most aspects of the law.
The health risks absorbed by passive smokers
Mr Loius Kavishe, 27, a cigarette smoker for the past four years tells Your Health that he has been in many public places in Dar es Salaam where warning signs say, “This is a No smoking Zone,” yet, he reveals, “ I have sat and smoked in those places many times and no one touched me.”
“I have been to places in neighbouring Uganda and Kenya. Those countries have very strict antismoking laws that are enforced. But here in Tanzania, I can smoke the way I want, as long as people around me don’t mind,’’ says Mr Kavishe.
“The government should build a specific area within the city centre where people can go and smoke,’’ suggests Mr Kavishe. “If some countries have done this and succeeded, we can also do it,” he adds.
Experts say the control of public smoking can help reduce the health impact of tobacco, especially on passive smokers, who studies say are more affected than the active smokers.
“If someone has a spouse who is a smoker, the risk of stroke and heart attack is increased in non-smoker. It has been shown that banning of public smoking can reduce up to 36 per cent of emergency admission due to heart attacks,’’ says Dr Heri Tungaraza, an Oncologist from Muhimbili National Hospital(MNH).
There are more than 7 million deaths from tobacco use every year, a figure that is predicted to grow to more than 8 million a year by 2030 without intensified action, says the WHO.
What effort has been made?
Early last year, when the government announced that it had totally banned public smoking of cigarettes and sheesha, and medics under the Tanzania Non-communicable Diseases Alliance (TANCDA) hailed the directive, but they went ahead to ask the government to reinforce it consistently.
“Smoking of cigarettes and sheesha has been blamed for a number of non-communicable diseases to users and non-users alike,’’ said the Chairperson of TANCDA, Dr Tatizo Waane.
“The government should act tough in enforcing the directive to protect Tanzanians from the health risks of smoking of cigarettes and sheesha,’’ said Dr Waane.
But, despite the directive was highly publicised in the media for a year, stories of smokers, such as that of Daria the petty trader in Buguruni and Mr Kavishe, are still being told in many corners of the city-and beyond.
And the proportion of smokers in the country, especially the youth, continues to increase because there is a favourable environment for them to take up smoking, studies show.
A study carried out in Tanzania in 2015, titled: “The Demand for Cigarettes in Tanzania and Implications for Tobacco Taxation Policy,’’ funded by United States National Institutes of Health – Fogarty International Center and National Cancer Institute, suggested that an increase in the excise tax on cigarettes in Tanzania would reduce cigarette consumption and increase government tax revenue.
Findings showed that the smoking prevalence for Tanzania is 15.35 per cent with low variability across income groups, warning that tobacco production and cigarette consumption were a major health issue in countries throughout the world, and Tanzania was no exception.
This year’s ‘World No Tobacco Day’ campaign, aims at, among other things to encourage countries to include tobacco control in their national responses to 2030 Sustainable Development Agenda.
Ms Kagaruki, the anti-tobacco activist, believes that if political leaders come out strongly against tobacco use, enforce laws that were already passed and impose huge taxes on tobacco business, the prevalence of tobacco smoking can be reduced greatly.
“This is an impetus in attaining the Sustainable Development Goals (SDGs) that call for efforts to deal with tobacco smoking as a development agenda,’’ she says.
During the campaign, the World Health Organisation, and other anti-tobacco agencies across the world are expected to support member states and civil society to combat tobacco industry interference in political processes, in turn leading to stronger national tobacco control action.
Tobacco control has been enshrined in the Sustainable Development Agenda. It is seen as one of the most effective means to help achieve the fourth target of the third SDG goal, which is one-third reduction globally, by 2030, of premature deaths from non-communicable diseases (NCDs), including cardiovascular disease, cancers and chronic obstructed pulmonary disease.
*Not her real name