Enforcement

Effective non-tax tobacco control policies include advertising bans, plain packaging, and smoke-free public places.

The adoption of policies from the WHO Framework Convention on Tobacco Control (FCTC) have contributed to the decrease in global smoking prevalence.

South Africa ranks 164 out of 206 countries that have implemented graphic health warning labels on cigarette packs, with a compliance score of only 21%.

This page discusses the WHO Framework Convention on Tobacco Control (FCTC), considers the various types of non-tax tobacco control measures used by governments around the world, and presents estimates of their effectiveness in reducing tobacco use. It presents data on the exposure to tobacco advertisements and warnings in South Africa and discusses the impact of the Covid-19 tobacco sales ban. Cessation policies and approaches are discussed and lessons from the global tobacco control movement are presented.

To learn more about the data and methods used in this page, click here.

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first international treaty negotiated under the auspices of WHO. It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It has since become one of the most rapidly and widely embraced treaties in United Nations history with 183 parties.. The Convention represents a milestone for the promotion of public health and provides new legal dimensions for international health cooperation. Over the last decade, the WHO FCTC has succeeded in keeping tobacco control high on the global agenda, while saving lives and improving global health. Measures outlined in the WHO FCTC emphasize the importance of using an approach that aims to minimize both tobacco demand and supply through a variety of measures. There is strong evidence that these measures effectively protect adults and children, equally, from smoking initiation, facilitate cessation and reduce tobacco-related harm. Read the WHO FCTC.

Key Aspects


Key Articles

of the FCTC


Map of Signatory Dates

to the WHO FCTC


  • Period|
  • less than 10 years
  • 10 to 14 years
  • 15 to 19 years
  • 20 years or more
  • No Data
    South Africa - Date: 19 Apr 2005
    Somaliland
    Ethiopia
    S. Sud.
    Malawi
    Rep. of Congo
    Somalia
    Tanzania
    Morocco
    Kenya
    W. Sah.
    DRC
    Namibia
    Libya
    Tunisia
    Zambia
    S.L.
    Guinea
    Liberia
    Djibouti
    Sudan
    C.A.R.
    Eritrea
    I.C.
    Mali
    Senegal
    Nigeria
    Benin
    Angola
    Botswana
    Zimbabwe
    Algeria
    Chad
    Mozambique
    Eswatini
    Burundi
    Rwanda
    Uganda
    Lesotho
    Cameroon
    Gabon
    Niger
    B.F.
    Togo
    Ghana
    GnB.
    Egypt
    Mauritania
    Eq. G.
    Gambia
    Madagascar
    Somaliland
    Ethiopia
    S. Sud.
    Malawi
    Rep. of Congo
    Somalia
    Tanzania
    Morocco
    Kenya
    W. Sah.
    DRC
    Namibia
    Libya
    Tunisia
    Zambia
    S.L.
    Guinea
    Liberia
    Djibouti
    Sudan
    C.A.R.
    Eritrea
    I.C.
    Mali
    Senegal
    Nigeria
    Benin
    Angola
    Botswana
    Zimbabwe
    Algeria
    Chad
    Mozambique
    Eswatini
    Burundi
    Rwanda
    Uganda
    Lesotho
    Cameroon
    Gabon
    Niger
    B.F.
    Togo
    Ghana
    GnB.
    Egypt
    Mauritania
    Eq. G.
    Gambia
    Madagascar
    S.Af.
    S.Af.

    Source: UN Treaty Treaty Collection


    Click on the images below to read more about the impact each measure has had on smoking prevalence in various countries around the world.

    Enforcement of Graphic

    Health Warnings


    South Africa lags behind most African countries in terms of the implementation of graphic health warnings (GHWs) on tobacco products. Currently, South Africa has eight rotating text-only health warnings on tobacco packages which have not been changed since 1995. Urgent changes are needed to meet the guidelines of the WHO Framework Convention on Tobacco Control.


    African countries that have implemented graphic health warnings

    NOTE: South Africa has not implemented graphic health warnings (GHWs) and lags behind most African countries in terms of implementation.

    Source : Canadian Cancer Society, 2023


    • About one third (30.5%) of South African adults have noticed anti-tobacco information on the television or radio.

    Among current smokers, intentions to quit smoking due to warning labels were higher among men (37%) than women (30.7%).

    Among smokeless tobacco users, intentions to quit were higher among women (27.1%) than men (16.5%).


    Quitting intentions and anti-tobacco warnings among adult tobacco users, South Africa


    OverallMenWomen0%5%10%15%20%25%30%35%40%Percentage of adults

    Source: Global Adult Tobacco Survey, 2021

    In 2020, as part of South Africa’s COVID-19 lockdown, the South African government imposed a ban on the sale of all tobacco products. While the ban was initially intended to last for three weeks, it was ultimately in place for 20 weeks (from March to August). South Africa was one of only three countries to ban the sale of tobacco during the pandemic, and its ban was the longest: Botswana banned tobacco sales for 12 weeks and India for six weeks.

    While not necessarily nationally representative, various studies assessed the impact of the sales ban:

    Smoking cessation can be encouraged with many different measures. Effective methods include nicotine replacement therapy, Champix, Zyban, training, counselling, quit-and-win schemes, and cognitive behavioural therapy.

    Combining measures improves their efficacy. Quit rates quadruple when behavioural therapy is combined with nicotine replacement therapy.

    In 2010, signatories of the WHO FCTC

    (which South Africa signed in 2003) adopted guidelines which encourage parties to implement tobacco cessation promotion activities, such as healthcare professionals screening for tobacco use, providing advice, and offering cessation treatments at clinics (all of which are shown to significantly increase the likelihood of smoking cessation).

    Although South Africa has made efforts to incorporate tobacco dependence treatment into the healthcare system, there was no evidence of an increase in the proportion of smokers receiving cessation advice between 2007 and 2017.

    There was, however, an association between receiving cessation advice and making a quit attempt in all survey years, which highlights the importance of scaling up cessation advice in South Africa.

    Evidence-based nicotine-dependence treatment is not included in South Africa’s Essential Drug list and must be paid out-of-pocket, a challenge for many South Africans.

    Including these treatments on the South African Essential Drugs list and adding coverage for smoking cessation treatment within the incoming National Health Insurance may increase access and utilisation of evidence-based cessation aids among smokers in South Africa.

    E-cigarettes have been promoted as a smoking cessation device, however, research is inconclusive on the effectiveness of e-cigarettes compared with nicotine replacement therapy (NRT) or non-NRT medication.

    Read more on e-cigarettes and smoking cessation.

    Considerations when designing

    cessation programs


    Combination nicotine replacement therapy (NRT), e-cigarettes, varenicline, and cytisine are effective cessation options.

    Bupropion may be as successful as single‐form NRT in helping people to quit smoking, but less effective than combination NRT.

    Consider both environmental and individual factors when developing smoking cessation programs for young persons.

    Digital and online cessation services appeal more to younger smokers, women, and smokers with greater nicotine dependence.

    For information on quitting smoking in South Africa, visit Go Smoke Free.

    Cessation Behaviour

    in South Africa


    Among South African adults:

    65.7% of current smokers planned to quit or were thinking about quitting smoking (Men = 66.5%; Women = 63.2%).

    40.5% made a quit attempt in the past 12 months (Men = 40.7%; Women = 39.7%).

    42.9% of smokers who visited a healthcare provider in the past 12 months were advised to quit smoking (Men = 42.5%; Women = 43.8%).


    Quitting behaviour among adult tobacco users in 2021, South Africa


    0%5%10%15%20%25%30%35%40%45%50%55%60%65%Percentage of adultsSmokers medically advised to quit in the last 12 monthsCurrent smokers planning or considering quittingSmokers who attempted to quit in the last 12 months

    Source: Global Adult Tobacco Survey, 2021

    Increasing numbers of countries are implementing tobacco control policies, ranging from graphic warnings and advertising bans to increases in excise taxes and the introduction of smoke-free laws.

    Policies and programs designed to reduce the demand for tobacco are cost-effective. These include significant tobacco tax and price increases (see Taxation page), comprehensive bans on tobacco marketing, graphic health warnings, smoke-free public places, and the provision of wide-scale tobacco cessation programs. Of these interventions, significant tobacco taxes and price increases are the most cost-effective.

    Control of the illicit trade in tobacco is a key supply-side policy to reduce the prevalence of smoking and its health and economic consequences. Other supply-side interventions, like restrictions on production, are generally not perceived as particularly successful or impactful. However, where there is a decrease in tobacco production, farmers should be helped to find other livelihoods.

    The tobacco industry uses a wide range of tactics to oppose any policies that might reduce sales. These include strategies such as political lobbying, financing research, attempting to influence regulation and policy, and using corporate social responsibility initiatives as part of their public relations campaigns.

    1
    Vital Strategies. Tobacco Atlas [Internet]. Vital Strategies. 2022 [cited 2022 Dec 8]. Available from:
    3
    Francis DB, Mason N, Ross JC, Noar SM. Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies. Tobacco Induced Diseases [Internet]. 2019 May 15;17:41. Available from:
    4
    Cunningham R. Tobacco package health warnings: a global success story. Tob Control [Internet]. 2022 Mar;31(2):272–83. Available from:
    5
    Tobacco Control Laws. South Africa Health Warnings/Messages Features [Internet]. Tobacco Control Laws. 2022 [cited 2022 Dec 8]. Available from:
    6
    Kennedy RD, Spafford MM, Behm I, Hammond D, Fong GT, Borland R. Positive impact of Australian “blindness” tobacco warning labels: findings from the ITC four country survey. Clin Exp Optom [Internet]. 2012 Nov;95(6):590–8. Available from:
    7
    Javed N, Saeed S, Shah SM, Ali R, Khan TK, Iqbal SP. Impact of Graphic Warning Labels on Cigarette Packs in Changing Smokers’ Views and Habits: An Opinion Survey. Addict Health [Internet]. 2020 Jan;12(1):40–5. Available from:
    8
    Pang B, Saleme P, Seydel T, Kim J, Knox K, Rundle-Thiele S. The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions. BMC Public Health [Internet]. 2021 May 20;21(1):884. Available from:
    9
    Strong DR, Pierce JP, Pulvers K, Stone MD, Villaseñor A, Pu M, et al. Effect of Graphic Warning Labels on Cigarette Packs on US Smokers’ Cognitions and Smoking Behavior After 3 Months: A Randomized Clinical Trial. JAMA Netw Open [Internet]. 2021 Aug 2;4(8):e2121387. Available from:
    10
    Fathelrahman AI, Omar M, Awang R, Borland R, Fong GT, Hammond D, et al. Smokers’ responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy. Nicotine Tob Res [Internet]. 2009 Mar;11(3):248–53. Available from:
    11
    Mia MT, Talukder MMA, Ali MM, Ismael M. Effects of Graphic Health Warning on Tobacco Packs: A Cross-Sectional Study among Low Socioeconomic Group in Bangladesh. J Smok Cessat [Internet]. 2021 Dec 13;2021:1354885. Available from:
    12
    Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Social Science & Medicine [Internet]. 2016 Sep;164:118–29. Available from:
    13
    Shadel WG, Martino SC, Setodji CM, Dunbar M, Scharf D, Creswell KG. Do graphic health warning labels on cigarette packages deter purchases at point-of-sale? An experiment with adult smokers. Health Educ Res [Internet]. 2019 Jun 1;34(3):321–31. Available from:
    14
    Hammond D. Health warning messages on tobacco products: a review. Tobacco Control [Internet]. 2011 Sep;20(5):327–37. Available from:
    15
    The South African Government. Tobacco Products Control Act 83 of 1993 [Internet]. The South African Government. 2022 [cited 2022 Dec 8]. Available from:
    16
    World Health Organisation. WHO Framework Convention on Tobacco Control [Internet]. World Health Organisation. 2003 [cited 2022 Dec 8]. Available from:
    17
    Saffer H, Chaloupka F. The effect of tobacco advertising bans on tobacco consumption. Journal of Health Economics [Internet]. 2000 Nov;19(6):1117–37. Available from:
    18
    Jackson KM, Janssen T, Gabrielli J. Media/Marketing Influences on Adolescent and Young Adult Substance Abuse. Current Addiction Reports [Internet]. 2018 Jun;5(2):146–57. Available from:
    19
    Venrick SJ, Kelley DE, O’Brien E, Margolis KA, Navarro MA, Alexander JP, et al. U.S. digital tobacco marketing and youth: A narrative review. Preventive Medicine Reports [Internet]. 2023 Feb 1;31:102094. Available from:
    20
    Escobedo P, Cruz TB, Tsai KY, Allem JP, Soto DW, Kirkpatrick MG, et al. Monitoring Tobacco Brand Websites to Understand Marketing Strategies Aimed at Tobacco Product Users and Potential Users. Nicotine and Tobacco Research [Internet]. 2018 Sep 25;20(11):1393–400. Available from:
    21
    Unger JB, Bartsch L. Exposure to tobacco websites: Associations with cigarette and e-cigarette use and susceptibility among adolescents. Addictive Behaviors [Internet]. 2018 Mar;78:120–3. Available from:
    22
    Ngqangashe Y. Influencers on the wrong side of public health laws [Internet]. Sowetan Live. 2023. Available from:
    23
    Dean B. How many people use Youtube? [Internet]. Backlinko. 2023. Available from:
    24
    Albarracin D, Romer D, Jones C, Hall Jamieson K, Jamieson P. Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes. Journal of Medical Internet Research [Internet]. 2018 Jun 29;20(6):e229. Available from:
    25
    Romer D, Reese Z, Jamieson PE. Misleading Tobacco Content is on the Rise on YouTube. HKS Misinfo Review [Internet]. 2020 Mar 9; Available from:
    26
    Ophir Y, Romer D, Jamieson PE, Jamieson KH. Counteracting Misleading Protobacco YouTube Videos: The Effects of Text-Based and Narrative Correction Interventions and the Role of Identification. Int J Commun Syst [Internet]. 2020 Sep 13 [cited 2024 Jul 2];14(0):16. Available from:
    27
    Little M, Van Walbeek C. Restaurant smoking sections in South Africa and the perceived impact of the proposed smoke-free laws: Evidence from a nationally representative survey. South African Medical Journal. 2018 Feb 27;108(3):240–4.
    28
    SAMRC. GATS (Global Adult Tobacco Survey) Fact Sheet, South Africa, 2021 [Internet]. National Department of Health South Africa. 2022 [cited 2023 Feb 23]. Available from:
    29
    Vander Weg MW, Rosenthal GE, Vaughan Sarrazin M. Smoking bans linked to lower hospitalizations for heart attacks and lung disease among medicare beneficiaries. Health Affairs [Internet]. 2012 Dec;31(12):2699–707. Available from:
    30
    Centers for Disease Control. Smoke-free Policies Reduce Smoking Fact Sheets [Internet]. Centers for Disease Control. 2021 [cited 2022 Dec 8]. Available from:
    31
    van Walbeek, C., Hill, R., Filby, S., van der Zee, K. Market impact of the COVID-19 national cigarette sales ban in South Africa. NIDS-CRAM Report [Internet]. 2021 [cited 2022 Dec 8]. Available from:
    32
    van Walbeek C, Hill R, Filby S. Quitting behavior during the tobacco sales ban in South Africa: Results from a broadly nationally representative survey. Tob Induc Dis [Internet]. 2023 Aug 7;21:102. Available from:
    33
    Mapanga W, Craig A, Mtintsilana A, Dlamini SN, Du Toit J, Ware LJ, et al. The Effects of COVID-19 Pandemic Lockdowns on Alcohol Consumption and Tobacco Smoking Behaviour in South Africa: A National Survey. Eur Addict Res [Internet]. 2023 Mar 17;29(2):127–40. Available from:
    34
    Filby S, van der Zee K, van Walbeek C. The temporary ban on tobacco sales in South Africa: lessons for endgame strategies. Tobacco Control [Internet]. 2021 Jan 20;31(6):694–700. Available from:
    35
    van der Zee K, Filby S, van Walbeek C. When Cigarette Sales Suddenly Become Illegal: Evidence From an Online Survey of South African Smokers During COVID-19 Lockdown. Nicotine and Tobacco Research [Internet]. 2022 May 2; Available from:
    36
    Vellios N. How big is the illicit cigarette market in South Africa? [Internet]. econ3x3. 2022 [cited 2022 Dec 8]. Available from:
    37
    Global Adult Tobacco Survey. Global Adult Tobacco Survey Factsheet South Africa 2021 [Internet]. Global Adult Tobacco Survey. 2021 [cited 2022 Dec 9]. Available from:
    38
    Agaku IT, Egbe CO, Ayo-Yusuf OA. Circumvention of COVID-19-related restrictions on tobacco sales by the e-cigarette industry in South Africa and comparative analyses of heated tobacco product vs combustible cigarette volume sales during 2018-2020. Preventive Medicine [Internet]. 2021 Jul;148:106526. Available from:
    39
    The National Treasury. Budget 2022, Budget Review The National Treasury [Internet]. The National Treasury. 2022 [cited 2022 Dec 8]. Available from: http://www.treasury.gov.za/documents/national budget/2022/review/FullBR.pdf 40. Heydari G, Masjedi M, Ahmady AE, Leischow SJ, Lando HA, Shadmehr MB, et al. A comparative study on tobacco cessation methods: a quantitative systematic review. International Journal of Preventive Medicine [Internet]. 2014 Jun;5(6):673–8. Available from:
    40
    Heydari G, Masjedi M, Ahmady AE, Leischow SJ, Lando HA, Shadmehr MB, et al. A comparative study on tobacco cessation methods: a quantitative systematic review. International Journal of Preventive Medicine [Internet]. 2014 Jun;5(6):673–8. Available from:
    41
    Rosen LJ, Galili T, Kott J, Rees V. Beyond “Safe and Effective”: The urgent need for high-impact smoking cessation medications. Prev Med [Internet]. 2021 Sep 1;150:106567. Available from:
    42
    Harris E. Systematic Review Finds the Most Effective Smoking Cessation Aids. JAMA [Internet]. 2023 Oct 17;330(15):1421–2. Available from:
    43
    Levy DT, Chaloupka F, Gitchell J. The effects of tobacco control policies on smoking rates: a tobacco control scorecard. Journal of Public Health Management and Practice [Internet]. 2004 Jul-Aug;10(4):338–53. Available from:
    44
    World Health Organization. Guidelines for implementation of Article 14 [Internet]. World Health Organisation; 2013 Jan [cited 2022 Dec 8]. Available from:
    45
    A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA [Internet]. 2000 Jun 28;283(24):3244–54. Available from:
    46
    Ayo-Yusuf OA, Omole OB. Smoking cessation advice and quit attempts in South Africa between 2007 and 2017: A cross-sectional study. Tobacco Induced Diseases [Internet]. 2021 Feb 11;19:11. Available from:
    47
    The South African National Department of Health. Standard Treatment Guidelines and Essential Medicines List for South Africa: Primary Healthcare Level [Internet]. The South African National Department of Health. 2022 [cited 2020]. Available from:
    48
    Agaku I, Egbe C, Ayo-Yusuf O. Utilisation of smoking cessation aids among South African adult smokers: findings from a national survey of 18 208 South African adults. Family Medicine and Community Health [Internet]. 2021 Jan;9(1). Available from:
    49
    Kaplan B, Galiatsatos P, Breland A, Eissenberg T, Cohen JE. Effectiveness of ENDS, NRT and medication for smoking cessation among cigarette-only users: a longitudinal analysis of PATH Study wave 3 (2015-2016) and 4 (2016-2017), adult data. Tob Control [Internet]. 2023 May;32(3):302–7. Available from:
    50
    et al. L. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses. Cochrane Database Syst Rev [Internet]. 2023 [cited 2024 Apr 3]; Available from:
    51
    Bitar S, Collonnaz M, O’Loughlin J, Kestens Y, Ricci L, Martini H, et al. A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults. Nicotine Tob Res [Internet]. 2024 Jan 1;26(1):2–11. Available from:
    52
    Grimes LM, Garg R, Weng O, Wolff JM, McQueen A, Carpenter KM, et al. Appeal of Tobacco Quitline Services Among Low-Income Smokers. Prev Chronic Dis [Internet]. 2023 Mar 2;20:E11. Available from:
    53
    World Health Organization. Global Youth Tobacco Survey (GYTS) South Africa (Ages 13--15) Fact Sheet. 2011; Available from:
    54
    World Health Organisation. WHO report on the global tobacco epidemic 2019: Offer help to quit tobacco use [Internet]. World Health Organisation ; 2019 Jul. Available from:
    55
    US National Cancer Institute & World Health Organization. Monograph Series 21: The Economics of Tobacco and Tobacco Control [Internet]. US National Cancer Institute & World Health Organization. 2016 [cited 2022 Dec 8]. Available from:
    56
    World Health Organization. Tobacco Industry Interference with Tobacco Control [Internet]. {World Health Organization}; 2008 Feb [cited 2022 Dec 8]. Available from: