Peer N
Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa.
S Afr Med J. 2018 Jun 26;108(7):551-556. doi: 10.7196/SAMJ.2018.v108i7.12978.
Recently, there have been significant advances in the battle against tobacco use in Africa, with achievements including ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and the passing of tobacco control legislation in several countries. Many African countries have achieved measured success, while Uganda, South Africa and Mauritius have accomplished significantly more in their efforts to curb tobacco use. Nevertheless, few African countries meet the standards of the individual WHO FCTC articles with regard to comprehensive implementation. Africa has lower rates of tobacco taxation, weaker smoke-free policies and fewer restrictions on tobacco advertising compared with other world regions. These shortcomings have enabled the tobacco industry to expand its markets on the continent by capitalising on economic growth, changing social norms and population demographics. Consequently, tobacco use is increasing in Africa, with smoking prevalence having risen 57% between 1990 and 2009 compared with western Europe, where it decreased substantially during the same period. Rapid smoking uptake in Africa has led to tobacco-related conditions emerging as increasingly important public health problems. African nations are unlikely to meet the 2025 goal of a 30% relative reduction in tobacco use, as advocated by the World Health Assembly in 2013 and identified as the 'most urgent and immediate priority' intervention to reduce non-communicable diseases (NCDs). While there has been some progress, the current commitment of most African countries to the WHO FCTC has not translated into effective delivery of tobacco control policies and programmes. Strong tobacco control policies, which are among the most effective population-based strategies for NCD prevention, are needed. These include introducing higher tobacco excise taxes, stronger smoke-free policies, graphic warnings on cigarette packages, bans on tobacco advertising, promotion and sponsorship, and anti-smoking mass media campaigns. Furthermore, tobacco industry interference needs to be actively addressed by monitoring its activities and exposing misconducts, thereby changing attitudes to the industry. Technical support, capacity building and adequate financing are needed in Africa to enable countries to competently manage legal challenges to tobacco control and deal with the subversive tactics of the industry. Civil society and the media - major players in holding governments accountable for responsible stewardship - need to educate and pressurise African politicians and governments to implement and enforce effective tobacco control policies. Otherwise, if unchecked, the widespread uptake of tobacco use will be a threat not only to health but also to sustainable human development in Africa.
最近，非洲在抗击烟草使用方面取得了重大进展，成果包括批准《世界卫生组织烟草控制框架公约》（WHO FCTC）以及多个国家通过了烟草控制立法。许多非洲国家取得了一定成效，而乌干达、南非和毛里求斯在遏制烟草使用方面取得的成绩更为显著。然而，就全面实施而言，很少有非洲国家达到WHO FCTC各条款的标准。与世界其他地区相比，非洲的烟草税率较低，无烟政策较弱，对烟草广告的限制较少。这些不足使得烟草行业得以利用经济增长、不断变化的社会规范和人口结构在非洲大陆扩大市场。因此，非洲的烟草使用正在增加，与西欧相比，1990年至2009年间吸烟率上升了57%，而西欧同期吸烟率大幅下降。非洲吸烟率的迅速上升导致与烟草相关的疾病日益成为重要的公共卫生问题。非洲国家不太可能实现世界卫生大会在2013年倡导的到2025年将烟草使用相对减少30%的目标，该目标被确定为减少非传染性疾病（NCDs）的“最紧迫和直接优先”干预措施。虽然取得了一些进展，但大多数非洲国家目前对WHO FCTC的承诺尚未转化为有效的烟草控制政策和计划的实施。需要强有力的烟草控制政策，这是预防非传染性疾病最有效的基于人群的策略之一。这些政策包括提高烟草消费税、加强无烟政策、在香烟包装上印制图片警示、禁止烟草广告、促销和赞助以及开展反吸烟大众媒体宣传活动。此外，需要通过监测烟草行业的活动并揭露其不当行为来积极应对烟草行业的干扰，从而改变对该行业的态度。非洲需要技术支持、能力建设和充足的资金，以使各国能够妥善应对烟草控制方面的法律挑战并应对该行业的颠覆性策略。民间社会和媒体——让政府为负责任的管理负责的主要参与者——需要对非洲的政治家和政府进行教育并施加压力，促使其实施和执行有效的烟草控制政策。否则，如果不加以控制，烟草使用的广泛普及不仅会对健康构成威胁，还会对非洲的可持续人类发展构成威胁。
