RISK: South Africa is set to once again be the battlefield between big tobacco and public health authorities.
The big business of manufacturing cigarettes is under threat. Years of huge gains in tobacco control driven by the world’s only global health treaty, the World Health Organisation´s Framework Convention on Tobacco Control (FCTC) has seen growing enforcement of bans on advertising, smoke free spaces, the phasing in of graphic packet warnings and plain packaging legislation and point of sale restrictions.

All these measures are starting to hurt the big business of tobacco sales. It has led tobacco giants such as Philip Morris International (PMI) to litigate against Australia and Uruguay governments, not necessarily with the intention of winning a court battle over trade policy, but rather to deliberately slow down the legislative process.

This guarantees continuing sales under the status quo while the court process is under way.

We are also seeing a new push back by the tobacco industry to interfere in the progress made against smoking-related death and illness.

The announcement six months ago by PMI of its new $1billion (more than R11.8bn) Foundation for a Smoke Free World could be the tip of the iceberg of a twin strategy aimed at getting a new generation of non-smokers addicted in the developed world to novel nicotine products such as e-cigarettes and heat-not-burn products and, in parallel, maintain traditional cigarette markets in the developing world.

Tobacco control is at a crossroads. But so too is the fight against other non-communicable diseases such as cardiovascular diseases (heart attacks and stroke), cancer, chronic respiratory diseases (chronic obstructed pulmonary disease and asthma) and diabetes.

Nowhere are the battle lines between public health authorities and big tobacco, big food and big soda sharper than in South Africa; then on the African continent.

Let’s consider some of the facts:

Nearly a quarter of males in Africa smoke. About 32% of children aged 2-4 in South Africa are overweight.

The estimated prevalence of obesity in South Africa is about 27% and predicted to rise to the same level as children by 2025.

About 1.85million adults were diagnosed with diabetes in South Africa. More than 15.9million people in Africa have diabetes.

If we do not act now, this figure will increase by 162% by 2045.

Africa is the region with the highest percentage of undiagnosed people - 70% of people with diabetes do not know that they have it.

In 2015, there were about 17400 premature deaths from diabetes in people under the age of 70 in South Africa. Diabetes will cause 312000 deaths this year. The total health-care expenditure for diabetes across the continent is about $1.708.5bn.

A good chunk of Africa is sick but it is a chunk on junk that food and drink manufactures are keen to maintain. While the tobacco industry adheres to more restrictive rules in the developed world but exploits loopholes and exerts pressure on governments in the developing world, so too do the food and beverage manufacturers to ensure that cheaper, unhealthier options on supermarkets shelves are the norm rather than an exception

There is a perfect storm brewing on the continent of the collision of infectious diseases such as HIV/Aids and smoking and tuberculosis and diabetes.

Prevalence rates of smoking among HIV-positive people are considerably higher than the rest of the community.

The risk of contracting TB for people with diabetes is vastly higher than for those who don’t.

We are at a crossroads and some tough decisions confront public-health authorities.

This year there is a golden opportunity to do just that.

In September, the UN will hold a high-level meeting on non-communicable diseases as well as the first-ever high-level meeting on tuberculosis, now the biggest infectious diseases killer in the world, one that for most people curable but kills 1.8 million poor people every year.

World leaders have the opportunity to turn the tide on an infectious disease that needlessly kills the most vulnerable and avoid about 15million premature deaths from non-communicable diseases, 80% of which occur in low- and middle-income countries.

* Castro is executive director of the International Union Against Tuberculosis and Lung Disease and co-chair of the 17th World Conference on Tobacco or Health being held this week in Cape Town. See www.wctoh.org.

* Dain is chief executive of the global Non-Communicable Diseases Alliance.

** The views expressed here are not necessarily those of Independent Newspapers.

Cape Argus