National Progressive Primary Health Care Network (NPPHCN)
A Written Submission
By The National Progressive Primary Health Care Network
on the Proposed Tobacco Products Control Amendment Bill, 117 of 1997

Submitted to The National Assembly Portfolio Committee on Health
On 20 October 1998

1. Introduction and Background
The National Progressive Primary Health Care Network (NPPHCN) is a national non-government organisation founded in 1987 to advocate for the implementation of a national health system for South Africa based on the principles of the Primary Health Care (PHC) approach. NPPHCN has a membership of more than 1,100 health and development programmes, projects, and individuals. We have offices in eight of the nine provinces and our national office is based in Johannesburg.

NPPHCN welcomes this opportunity to present it's position on the Tobacco Products Control Amendment Bill [B 117 of 1998]. We view this legislation within the wider context of creating an environment which promotes health and healthy choices.

2. NPPHCN's Positions
2.1 The Constitutional and Legal Context
The Constitution of our country must be the benchmark against which all health policies, regulations, and legislation are measured. Chapter Two of the Constitution contains the Bill of Rights, by which all levels of government and other individuals, in some cases, are bound.

The proposed amendments contained in the Tobacco Products Control Amendment Bill relate to specific rights enshrined in the Bill of Rights. In the debate around the Bill thus far, much attention has been put on the infringement of the right to "freedom of expression"1. This section of the Bill of Rights protects the freedom of the press and other media, as well as the freedom to receive or impart information and ideas. Opponents to the Bill have argued that the clauses prohibiting advertising and sponsorship by tobacco companies place an infringement on the right to "freedom of expression".

The Constitution also provides for rights to be limited through legislation. In this regard, Section 36(1) of the Constitution stipulates that the "rights in the Bill of Rights may be limited...taking into account all relevant factors, including:-
(a) the nature of the right;
(b) the importance of the purpose of the limitation; ... and
(e) less restrictive means to achieve the purpose."

NPPHCN, is an ardent advocate for the rights contained in the Bill of Rights, as communities have struggled long and hard for a Constitution which promotes the rights of all. Thus, our analysis of legislation always begins with an evaluation of the effect of proposals on these rights. It is therefore of grave concern to NPPHCN that within the debate on this Bill there has not been much mention of another right contained within the Bill of Rights, namely, everyone's right to an "environment that is not harmful to their health or well-being"2. This is a right which also needs to be protected and promoted.

While the Constitutional right to "Freedom of Expression" is a right that we deeply value, its intention cannot be construed as meaning that all forms of public expression which intentionally promote harmful products should be allowed without any form of control or restriction. Tobacco has become a major pubic health hazard which some might argue requires more stringent controls than merely limiting its promotion.

Clearly this legislation calls for an evaluation of both the right to freedom of expression and the right to a healthy environment. NPPHCN believes that the right to a healthy environment should take precedence in this particular debate. Creating an environment which promotes healthy choices is a fundamental aspect of the Primary Health Care approach.

Smoking is known to be a cause, as well as a contributing factor, of heart disease, cancer of various types, and emphysema, amongst many other illnesses. In addition, smoking negatively affects the health of non-smokers. It is also important to note that the epidemiology of disease in developing countries, including South Africa, indicates that cardiovascular disease and cancer are increasingly accounting for more and more deaths. The World Bank has stated that "Unless smoking behaviour changes, three decades from now, premature deaths caused by tobacco in the developing world will exceed the expected deaths from Aids, tuberculosis, and complications of childbirth combined".3 Particularly, in South Africa it has been stated that the tobacco related epidemic will be second only to HIV in its negative effect on mortality".4

NPPHCN therefore supports this Bill as we believe that the right to an environment that is not harmful to one's health or well-being must be the most important consideration in evaluating this legislation. The need for restrictive legislation in the control of tobacco products in order to promote public health is necessary, given the impact of tobacco-related illnesses and diseases on the health status of our population. Further, the need to create an environment which encourages healthy choices is an integral part of our new endeavour to implement Primary Health Care in our country.

2.2 Advertising, sponsorship and promotion
The proposals in the Bill to ban advertising of tobacco products and restricting the nature of sponsorships have raised much debate. Indeed these proposals are directly related to the rights which have been identified above. The importance of advertising and sponsorship in promoting smoking cannot be denied. Advertising is a powerful medium which ties smoking to images of status. One cannot say that such advertising promotes only a specific brand of tobacco products and does not influence smoking itself especially given the impact that visual images have. In addition, the use of sponsorship as a means of advertising tobacco products is clear. Indeed sponsorship currently provides tobacco companies the opportunity to advertise without the need of including any health warnings about the dangers of smoking! What is more, tobacco company sponsorships of sporting activities, in particular, encourages the association of smoking with athletic prowess and provide powerful images to which the youth, especially are susceptible.

NPPHCN recognises the significant impact of tobacco advertising and sponsorship on promoting and encouraging smoking. NPPHCN believes that tobacco, as a substance which is addictive and which has such severe impacts on the health status of South Africans requires restrictive control in order to reduce it's use. We therefore support the proposal to ban advertising of tobacco products. In addition, we support the restriction of tobacco company sponsorship of events, as proposed by the legislation. The legislation does not ban sponsorship - it does allow for tobacco companies to sponsor events provided that such sponsorship does not involve the use of the tobacco company's name or logo in the event.

2.3 Restriction of smoking in public places
NPPHCN welcomes the widening of the definition of "public place" to include the workplace. The workplace provides an important context for health promotion. By restricting smoking in the workplace, the legislation promotes the creation of healthy environments. This proposal also enables non-smokers to demand the right to a smoke-free work environment. It is heartening to note that some employers have already begun to voluntarily implement "smoke-free" work environments. NPPHCN would like to encourage all employers and employees to use the opportunity created by this legislation as a means to participate in health promotion activities, and in creating healthy environments.

2.4 Economic impact
While supporting this legislation, we request government to be mindful of the possible job losses in industries within and peripheral to the tobacco industry. It is still unclear how agricultural workers and those in supporting services, such as packers for example, would be absorbed into other sectors in the event of retrenchments or job losses.

NPPHCN would therefore like to recommend that a continuous and comprehensive assessment of the economic impact of the legislation be carried out, including an evaluation of the impact on neighbouring tobacco-producing countries. South Africa's chairing of the health committee in SADC provides us with a valuable opportunity to mobilise neighbouring countries in joint efforts in addressing the impact of tobacco on the health status of the people of Southern Africa.

In considering the economic impacts of restricting tobacco advertising and promotion we must consider also the damage that it does to workers in industry and the reduction of income over their working lives. Given the their considerable skills in marketing and distribution, and given the will, tobacco companies could be shifting their production to more socially udrgul ptofuvyd. Similarly, tobacco growers could, by reading not only the market signals being sent out by the continuing rise in the costs of selling tobacco products due to taxation, start to grow other crops, particularly food crops, which this country and the world as a hole need to feed expanding populations.

It is not morally defensible for farmers, workers and trade unions to promote the growing of crops whose end products harm and damage the livelihoods of other people, including the workers themselves, particularly if there are alternative products in society which they could produce and are very much more needed.

Additionally, the impact of this legislation goes beyond a "health" issue. It was encouraging to hear that joint discussions were held between the Ministries of Trade and Industry, Agriculture, Labour, Sport and Health prior to the acceptance of this legislation by Cabinet. NPPHCN would like to encourage government to continue with such intersectoral endeavours. Indeed, any endeavour at health promotion requires the involvement of other sectors. Specifically, in this case intersectoral collaboration is needed in order to achieve the full objectives of the Bill. For example, farmers will need support if they are to be encouraged to grow alternative crops, and support will be required to enable organisers of sport and cultural activities to find alternative sources of sponsorship.

NPPHCN therefore supports a phased approach to implementation of the legislation, as we believe this will allow for the greatest benefit. It will allow for a deeper analysis of the impact of the legislation on different aspects of the economy, as well as allowing for phasing in of alternatives in farming and sponsorship, in particular.

3. Conclusion
NPPHCN would like to state its support for the Tobacco Products Control Amendment Bill, 117 of 1998. We believe that this legislation is required in order to try and reduce the impact of tobacco-related illnesses and diseases. We are encouraged by the Department's efforts at promoting a healthy lifestyle; and we hope that this legislation will be supported by other strategies to encourage healthy choices, particularly amongst the youth.

We would like to thank the Portfolio Committee for once again giving NPPHCN an opportunity to put across it's view. We hope that our comments will be useful in your evaluation of the current legislation.

For more information please contact Carnita Ernest at (021) 696-4954, or by fax at (021) 696-9308, or by e-mail at [email protected].