NATIONAL COUNCIL AGAINST SMOKING
SUSTAINING SUCCESS
THE ”TOBACCO PRODUCTS CONTROL AMENDMENT
BILL 2006”
A submission to the Portfolio Committee on Health
SUMMARY:
Tobacco is a
uniquely dangerous consumer product. It is the only legal product that kills
the user when used exactly as the manufacturer intends. In
Tobacco use is bad
for business too – it makes workers sick, so reducing productivity in all
sectors of the economy. Tobacco also keeps poor people poor.
The purpose of the Bill is to
ensure that young people don't start smoking, to protect non-smokers from
pollution by tobacco smoke, to help smokers quit and to reduce the risks for
those who continue to smoke.
The
NCAS is especially supportive of the Bill’s increased requirements regarding
smoking in public places. The Bill seeks to better protect children from
passive smoking and seeks to guarantee workers their constitutional right to an
environment that is not harmful to their health.
The
changes proposed to Section 2 of the Act include:
1.
Restricting
smoking near air inlets and entrances to public places. Many people now smoke
near entrances and exits to buildings as an unintended consequence of the
current law. As a result, high concentrations of tobacco smoke can be found
near doorways through which the public must pass, and smoke enters buildings
via general airflow. This can be particularly problematic for those with asthma
or heart conditions, for whom even short exposures to
smoke can trigger an attack.
2.
The Bill seeks
to protect children in two ways. It proposes not allowing smoking in private
homes used commercially for childcare or educational purposes. It also proposes
not allowing minors into the areas set aside for smoking. Young children are especially vulnerable to
second-hand smoke because they breathe more air relative to body weight than
adults and so absorb more tobacco smoke toxins. They are also less able to
complain or remove themselves from smoke-filled rooms
3.
Most people do
not want to be exposed to tobacco smoke. However, many are afraid to assert
their right to smoke-free air in the workplace because of the fear of upsetting
their employers. The Bill proposes making it possible for people to safely
voice their concerns without fear of repercussions. The Bill also requires
employers to respect an employee’s right not to be forced to work in a smoking
section. People should not be required to endanger their health for the
opportunity to work.
4.
Section 2(3)
allows the Minister to prohibit smoking in certain outdoor areas, where smoking
may constitute a fire or other risk. In
crowded sports stadia exposure to tobacco smoke is
likely to be sustained (from a few hours to the whole day for cricket lovers)
and significant. Vulnerable people, who are very sensitive to smoke, can have
their health put at risk.
There are two
issues on which the Bill is silent but which merit special attention from the
Portfolio Committee.
Firstly, the Act
prohibits smoking in workplaces, but allow it in
private homes. Private homes are often a workplace for domestic workers. These
workers are therefore not protected from tobacco smoke in smoker’s homes. The
Act has created the discriminatory situation where domestic workers are given
less protection than other workers. This is not fair. All workers, including
domestic workers, must be protected from tobacco smoke pollution.
Secondly, there is
strong public support for a ban on smoking in cars while children are
passengers. Smoking in cars can produce high concentrations of smoke which can
harm young children.
The amendments
to Section 3A of the Act addresses regulation of the tobacco product
itself. Manufactured tobacco products are more toxic, carcinogenic, and
hazardous to health than they need to be to deliver nicotine.
Cigarettes are the
deadliest form of nicotine delivery available on the market. Yet, cigarette
manufacturing is barely regulated. By contrast, pharmaceutical smoking
cessation products (such
as nicotine gum and inhalers) are subject to a lengthy and expensive government
approval process before they can be marketed.
A cigarette manufacturer
can add anything it wishes to cigarettes without any regulatory oversight. On
the other hand, if a pharmaceutical company wants to add mint flavouring to nicotine gum to improve the taste, it must
endure years of regulatory hurdles.
The Bill allows for the
regulation of the substances that the manufacturer can put into tobacco
products (its constituents) and the chemicals that may be produced when tobacco
products are used (its emissions).
The
purpose of Section 3A is to reduce the harmfulness of tobacco products. It
requires tobacco manufacturers to produce the least dangerous product
technically possible.
The WHO has recommended
that countries establish manufacturing standards for tobacco products so as to reduce
their appeal to children, decrease their addictive qualities, and decrease
potential harm to users.
The Bill also proposes
that manufactured cigarettes be manufactured in a way that reduces the
likelihood of a cigarette causing fires.
In 2004, cigarettes caused 1400 (or 4% of the total) fires in SA. Over
R45 million worth of property was destroyed. The devastating fire in 2005 at
Finally the Bill
increases the penalties so that they are a real deterrent to contraventions of
the Act. A fine of R200 for allowing
smoking in a restaurant is miniscule and has no impact on restaurant owners.
The National
Council Against Smoking (NCAS) welcomes the draft Tobacco Products Control Amendment Bill
(B24-2006). We thank the Portfolio Committee for the opportunity to comment
on the Bill.
INTRODUCTION
1. The National
Council Against Smoking (NCAS) welcomes the draft Tobacco Products Control Amendment Bill
(B24-2006). We thank the Portfolio Committee for the opportunity to comment
on the Bill.
2. The NCAS is a non-profit
organization established in 1976 with the mandate of promoting public health
through encouraging nonsmoking as a societal norm.
3. Tobacco harms both public
health and the economy. The World Health Organization and the World Bank have
both urged governments to control tobacco because it is a threat to health and
sustainable economic development.
4. The NCAS has consistently supported the country’s tobacco laws
and is in favour of the proposed amendments. The Bill will build on the important gains
that have already been achieved in lowering tobacco consumption since 1994.
5. This submission will
briefly review the policy objectives that will be served and evaluate the
likely effectiveness of tobacco control measures proposed in the Bill.
Unique treatment for a unique
product
6. Tobacco is the only legal
consumer product that kills the user when used exactly as the manufacturer
intended. There is also no safe level of
use.
7. All forms of
tobacco are harmful but cigarettes are more dangerous than cigars, snuff and snus.
8. Tobacco use causes, or
worsens, over 40 diseases including cancer, heart attacks, lung disease,
complications of pregnancy and TB.
9. Tobacco use kills about 30
000 South Africans each year or about 80 people a day. This is more than double
the number of deaths on our roads every year
10. A smoker is more likely to die from
tuberculosis (TB) than a non-smoker. Every day about 16 avoidable deaths from
TB occur amongst smokers.
11. Globally, only two major
causes of death are increasing rapidly - HIV and tobacco. The WHO predicts
that, unless urgent action is taken worldwide deaths from tobacco will double
from the current 5 million to 10 million annually by the year 2025.
12. Approximately 70% of these future deaths will
occur in the poor nations of the world, where already overburdened health
services are unprepared for this coming epidemic.
Tobacco use in
13. Fewer adults and children are smoking in
14. Since 1994, the number of adults who smoke has
gone down by over a third. About 5 million or 23% of adults smoke. Snuff is
used by about 10% of African women.
SECTION 2:
CONTROLLING TOBACCO USE.
Policy
goals
15. The reasons
for enacting legislation to control smoking in public places are to:
(a) ensure that a clean and healthy environment is maintained;
(b) ensure that the smoking of others does not impair the health
of non-smokers;
(c) prevent the nuisance which smoking may cause to non-smokers;
Background
16. In 2004,
smokers burned 25 million kilograms of tobacco in our air making tobacco smoke
one of our largest sources of indoor air pollution.
17.Cigarette smoke contains over 4500 chemicals, including
over 200 known poisons (arsenic, cadmium, cyanide, nicotine, etc) and 60 chemicals
that cause cancer.
18. Over 600
scientific studies have now linked passive smoking and ill health. It is a
cause of lung cancer and heart disease in adult non-smokers. In children it increases the risk of sudden infant
death syndrome (SIDS), acute respiratory infections (croup and pneumonia), ear
problems and asthma attacks.
19. There is no safe level of exposure to tobacco smoke
and both short-term and long-term exposure can cause harm. As little as 30
minutes of exposure to secondhand smoke can significantly increase the risk of
a heart attack in those with heart problems.
20. A number of countries have now banned smoking
completely in indoor public areas, including
21.
A total ban on smoking in indoor public places has several advantages. It
would:
• be more effective than a partial ban in
decreasing tobacco smoke pollution and in improving health;
• be fairer as it would protect all
workers. Currently, those who work in areas set aside for smoking are still
exposed to harm;
• generate considerable cost savings to
society; and
• be simpler, more consistent and easier to
enforce.
22. Surveys show
that 80% of smokers and non-smokers support a ban on smoking in public places
in
23.
The Tobacco Products Control Amendment Act of 1999 took significant steps
toward protecting the public by prohibiting smoking in all enclosed public
places and workplaces, except for designated areas set aside for smokers.
24.
Almost overnight, the social norms regarding secondhand smoking changed.
Whereas previously people smoked anywhere and everywhere including in
hospitals, now the ashtray and smoky haze has almost disappeared.
25. Clear rules
defining where smoking is, or is not, permitted has averted needless conflict
between smokers and non-smokers. Both smokers and non-smokers can then
be sure of their
rights. The public has embraced the law and shopping
malls, public transport and workplaces rapidly became smoke-free. With the
exception of some in the hospitality industry, the law is working well.
27.
The law is self-enforcing. The police did not have to sit in every cinema,
café, and office waiting to arrest offenders. Instead, ordinary citizens stood
up for their right to clean-air.
The Proposed Amendments.
28.
The NCAS is especially supportive of the Bill’s increased requirements
regarding smoking in public places. The Bill seeks to better protect children
from passive smoking and seeks to guarantee workers there constitutional right
to an environment that is not harmful to their health.
Restrictions on smoking near entrances
to enclosed public places:
29.
The NCAS supports moving smokers away from the entrances and air inlets to
buildings. Tobacco smoke can enter and pollute buildings though open doors,
windows and ventilation inlets. People entering and exiting the building are
also exposed to this pollution. This can be particularly problematic for those
with asthma or heart conditions, for whom even short
exposures to smoke can trigger an attack.
30.
Significant numbers of people now smoke near entrances and exits to buildings
as an unintended consequence of the current law. As a result, high
concentrations of tobacco smoke can be found near entrances and exits through
which the public must go, and smoke enters buildings via general airflow.
31.
The NCAS has received numerous complaints from the public on this issue. For
example, many indoor diners complain that in coffee shops and restaurants they
are exposed to smoke from those smoking outside in the alfresco area.
32.
The problem can be fairly easily resolved by prohibiting smoking within 3 metres of any non-domestic building. Experience
in other countries shows that the policy can be enforced through signage at
entrances and moving ashtrays away from doorways.
33.
Since 1997,
Smoking in
day care centres and the entry of minors into smoking
sections.
34.
The Bill seeks to protect children in two ways. It proposes not allowing
smoking in private homes used commercially for childcare or educational
purposes. It also proposes not allowing minors into the areas set aside for
smoking.
35.
Young children are especially vulnerable to second-hand smoke because they
breathe more air relative to body weight than adults and so absorb more tobacco
smoke toxins. They are also less able to complain or remove themselves from
smoke-filled rooms.
36.
It is vital that facilities for children be smoke-free. Children of non-smoking
parents should not be exposed to harm while in day care. For children of parents who smoke
exposure
in the home plus in the day care will be additive and increase the harm.
37.
In day care facilities, even if smoking is restricted to a single room in the
house, smoke will still drift throughout the home. It is not possible to
confine smoke to one area. The NCAS have
received reports of caregivers walking from other parts of the house into the
room where the children were with a lighted cigarette because he or she was not
consciously mindful of his/her smoking.
38.
Prohibiting smoking in day care and tutoring facilities only during times when
children are actually on the premises will not work. This disregards the fact
that many of the more volatile chemicals in smoke remain in the air for a long
time following the smoking of a cigarette (from four hours to days). Some of
the solid particles in smoke will settle on furniture, carpets and other
surfaces in the room. These then slowly
re-enter the atmosphere creating a hazard long after smoking has ceased. A simple test of how long smoking persists is
that one can still smell cigarette smoke in a home, or on clothes, long after
someone has smoked.
39.
In relatively confined spaces, such as smoking areas, where many people smoke,
high levels of tobacco smoke toxins can build up, To take children into these
places is recklessly exposing them to harm.
40.
Prohibitions on taking children into public smoking areas can have an
educational effect for parents, who may be less inclined to smoke at home.
Smoking in
sports stadia and other crowded facilities.
41.
Section 2(3) allows the Minister to prohibit smoking in certain outdoor areas,
where smoking may constitute a fire or other risk. In crowded sports stadia
exposure to tobacco smoke is likely to be sustained (from a few hours to the
whole day for cricket lovers) and significant. Vulnerable people, who are very
sensitive to smoke, can have their health put at risk.
42.
In addition, many communities ban nuisances like loud noise at night, public
drunkenness, dogs defaecating
on pavements, etc. So even when tobacco smoke may not harm health it is still a
major nuisance which should be controlled in areas in which exposure cannot be
easily avoided such as at railway platforms and entrances to buildings.
Protecting
the constitutional rights of workers.
43.
The Constitution guarantees everyone the right ‘to an environment that is not
harmful to their health or well-being”. Sections 2(3) and (4) require employers
to respect employees’ rights and protect them from the harms caused by tobacco
smoke pollution.
44.
Surveys find that most people do not want to be exposed to tobacco smoke.
However, many are afraid to assert their right to smoke-free air in the
workplace because of the fear of upsetting their employers. They instead phone
local authorities, the health department and non-governmental organizations
seeking help while wishing to remain anonymous. The Bill proposes making it
possible for people to safely articulate their concerns without fear of
repercussions.
45.
The Bill also places an obligation on employers to respect an employees right
not
to be
forced to work in a smoking section against their wishes. People should not be
required to pay with their health for the opportunity to work. The Bill
proposes prohibiting employers from coercing people desperate for employment to
work in the smoking section (section 2(5)(c)) and from seeking legal guarantees
that employees will not to hold them responsible for harm caused by working in
a smoking section.
46.
Business owners cannot contract with their workers to relax workplace safety
standards and the same rule should apply to tobacco smoke.
The special case of domestic
workers.
47. The Act in
general prohibits smoking in workplaces, but continues to allow it in private
homes. Private homes can be a workplace for domestic workers. These workers are
therefore not protected from tobacco smoke in smoker’s homes. The Act has
created the discriminatory situation where domestic workers are given less
protection than other workers. The NCAS urges that this anomaly be ended and
that all workers, including domestic workers, be
protected from pollution by tobacco smoke.
Smoking in cars
48. There is
strong public support for a ban on smoking in cars while children are
passengers. The Bill is silent on this issue. Smoking in cars can produce high
concentrations of smoke. Even with all
the windows open the particulate matter levels can be higher than what is
considered ‘safe’ for sensitive groups like children and the elderly. When the windows are closed the smoke
concentrations can reach levels considered hazardous for the general
population.
49. The NCAS
believes that a strong case can be made for banning smoking in any vehicle
while driving. We have received reports
of people throwing ‘stompies out of the window, only
for the wind to blow the cigarette back into the driver’s lap. Frantic efforts
to find the lit cigarette then follow to stop it burning clothes or the car
upholstery. The lapse in concentration
poses a road threat.
50. The NCAS urges
the Portfolio Committee to prohibit smoking in cars while children are
present. We believe that public support
for the ban is sufficient to ensure that enforcement will not be a problem.
SECTON 3A:
STANDARDS FOR MANUFACTURING AND EXPORT OF TOBACCO PRODUCTS
Policy goals
51.
The purpose of Section 3A is to reduce the harmfulness of tobacco products. It
requires tobacco manufacturers to produce the least dangerous product
technically possible.
52. The way tobacco
products are designed and manufactured affects their safety, appeal, and
addictiveness. Manufactured tobacco products are more toxic, carcinogenic, and
hazardous to health and the environment than they need to be to deliver
nicotine.
53. The Bill allows for
the regulation of the substances that the manufacturer’s can put into tobacco
products (its constituents) and the chemicals that may be produced when tobacco
products are used (its emissions).
54. The WHO has
recommended that countries establish manufacturing standards for tobacco products
so as to reduce their appeal to children, decrease their addictive qualities,
and decrease potential harm to users.
Background
55.
Despite their toxicity, tobacco products are currently subject to little
regulation regarding their content, design and manufacture. New tobacco
products can be introduced and the design of currently available products can
be changed on the whim of the manufacturers, and with almost no regulatory
oversight.
56.
Paradoxically, medications to help people quit smoking are strictly regulated
by the Medicine’s Control Council. These have to meet the same safety and
product standards as any other scheduled medicine and can only be sold through
pharmacies.
57.
A policy that barely regulates nicotine in its deadliest form (cigarettes),
while strictly regulating it in its safest form (medications) is not rational.
The WHO has recognized this is anomaly. The FCTC mandates that
governments require tobacco companies to reveal what ingredients they use in
producing cigarettes and that these are disclosed to the public.
58.
The cigarette is more than just dried tobacco wrapped in paper, and snuff is
not simply powdered tobacco leaf. Modern
tobacco products are highly engineered.
The manufacturers have spent enormous resources researching the design
and manufacture of cigarettes. The key goal is to deliver nicotine rapidly and
in sufficient quantities to feed a smokers craving.
59.
Highly sophisticated technologies are used to fine-tune the addictiveness of
the modern cigarette:
·
Ventilated
filters provide cooler and more dilute smoke. This enables the smoker to
readily inhale larger quantities more deeply into the lungs.
·
The physical
size of smoke particles is carefully controlled – using the science of particle
physics - to allow smoke particles to penetrate deep into the lungs.
·
Chemical
ingredients are added to the tobacco, filter, and paper during the manufacture
of cigarettes or snuff. These ingredients are called ‘additives’ and serve many
purposes.
60.
Up to 1400 chemicals can be added to tobacco. These additives:
- Mask the irritating and harsh taste of smoke (sugars
are added).
- Enhance nicotine delivery, so increasing the
addictive “kick” of nicotine (ammonia).
- Keep the product fresh (anti-fungals);
- Control the rate at which cigarettes burn (nitrates).
- Produce a white ash (chalk).
- Give brands their special flavour
(cocoa, chocolate).
61.
Recognising that children often find the taste of
cigarettes unpleasant,
62.
Chocolate, licorice, honey, sugars, menthol, and other flavourings
help hide the unpleasant taste of tobacco and make it easier for children to
start smoking. Menthol, for instance, numbs the throat and reduces coughing.
63.
On
64.
Additives, such as ammonia change the pH of smoke so increasing ‘freebase’
nicotine levels. Free nicotine, like crack cocaine, passes
more rapidly and completely through the lungs into the bloodstream and has a
faster effect on the brain.
67.
The safety of many of the flavourings and other
additives when burned and inhaled has not been established.
68.
By engineering products to enhance addictiveness the industry makes it more
difficult for smokers to quit, and is thus deliberately increasing the overall
harm to the public.
69. The tobacco companies have over the years filed many patents
for technology that would have removed some of the harmful components of
tobacco smoke, but never made these ‘less toxic’ cigarettes available to the
public. The problem, according to industry documents is that in order to market
these changed cigarettes as ‘safer’, the industry would have had to admit that
its existing products were dangerous.
70. When a cigarette is
lit, the process of burning will produce over 4500 chemicals in the smoke – 200
of these are poisons (arsenic, cyanide, carbon monoxide, nicotine) while over
60 can cause cancer. The chemistry of
smoke is influenced by many factors including the type of tobacco used, the
length of the cigarette, the burn rate of the paper and how the cigarette is smoked.
71.
Currently, the law in
72. The tar and nicotine
numbers that appear on South African cigarette packs are meaningless. They
convey no accurate information to smokers about what they are inhaling.
73. This is because the
International Standards Organization (ISO) testing methods currently in use for
measuring tar and nicotine are flawed. There is little relationship between the
ISO machine-measured yields of cigarettes and what smokers actually absorb.
Further, there are no methods for testing smokeless tobacco products.
74. Smokers can obtain as
much nicotine and tar from smoking ‘low-tar’ cigarettes as they can from
smoking regular cigarettes. This complicates the ability to regulate tobacco
products. To date, no country has fully met the challenge of developing
comprehensive product regulation standards.
Regulatory
Approach
75.
A new regulatory framework is needed in which the manufacturer is obliged to
demonstrate that no additional harm arises for tobacco product design decisions
such as the use of additives. While it is impossible to make a cigarette safe,
it is reasonable to prevent manufacturer’s doing anything that increases the
harm caused by tobacco smoke.
76.
A new framework should:
- Require manufacturers to disclose all additives used
in tobacco products, by brand, to the government.
- Also require them to disclose the purpose of an
additive and its biological effects, if any, when inhaled
- Enable government to order the removal of additives
which increase harm.
- Only allow new additives if its safety can be
demonstrated
- Permit additives necessary for the manufacturing and
storage of tobacco products provided these are safe, but bar all additives that
may influence smoking behavior.
- Not allow any health claim based on the levels of
ingredients, or emissions, or whether the product meets regulatory standards.
77. The FCTC’s Conference of the Parties is developing guidelines
for product regulation and testing. Such guidance should be forthcoming in the
near future.
78. The Bill proposes
providing broad legal authority to the Minister to develop standards for
constituents, emissions, product design, and testing methods, once there are
clear international guidelines for doing so.
79. While there is no such thing as a safe cigarette,
it remains the goal of public health to make cigarettes less harmful. The benefits of
reducing the levels of toxic chemicals are very small compared to the benefits
of stopping smoking. However, because of the large numbers of people involved
even a small reduction in risk is worth pursuing.
Reducing the fire-risks from cigarettes
Policy goal
80. The aim is to reduce
deaths, injuries and property damages resulting from fires started by
manufactured cigarettes.
Background
81. Smokers’ materials
are a leading cause of residential fires and fire-related losses in
82. Cigarette fires
typically result from lit cigarettes left unattended, falling asleep while
smoking in bed, smoking while under the influence of alcohol, or the tossing
away of a lit cigarette. When a lit cigarette comes into contact with flammable
products such as mattresses, bedding or upholstered furniture, it can start a smouldering process that can continue undetected for some
time before bursting into flame.
83. It is possible to
reduce cigarette ignition propensity (that is the likelihood that a lit
cigarette will start a fire) by altering certain design characteristics of
manufactured cigarettes.
84. In July 2000, a major
American cigarette manufacturer released a reduced-ignition propensity version
of one of its cigarette brands in the
85. On
86. Reduced ignition
propensity does not mean fire-safe. It is impossible to make a burning object
completely fire-safe. However, the proposed regulations can save lives by
significantly reducing the number of fires started by cigarettes.
Regulatory
approach
87. The Bill allows the
Minister to set a ‘performance standard’ that all cigarettes sold in
PENALTIES.
88. The Bill increases the penalties for contraventions of the law so
that they are a meaningful deterrent.
The fine for the owner of a public place is increased from R200 to a
maximum of R50 000, and for individual from R200 to a maximum of R500.
89. The proposed fines are reasonable and modest compared to those for
other offences. For instance the maximum
fine for selling liquor to a minor is R 1 million, and for poaching perlemoen it is R 800 000.
CONCLUSION
90. This
submission has provided a rationale for the amendments contained in the
Bill. The NCAS believes that the Bill is
fair, reasonable and workable. It will make a significant contribution to
reducing the health, economic and environmental harms caused by tobacco use in
91. Freedom from
addiction is a child’s right and society’s responsibility. We trust that the
Portfolio Committee on Health will put the freedom of children to grow up
healthily above the freedom of an industry to sell a deadly drug.
NCAS
Yussuf Saloojee PhD. Executive Director Peter Ucko CP Law. Director Mobile: 082
454-9889 e-mail: [email protected]
INCORPORATED ASSOCIATION
NOT FOR GAIN. Reg. No.
76/00025/08 NONPROFIT Reg. No.
023-970-NPO