Health Burden
Tobacco use harms nearly all systems in the human body, is associated with almost all types of cancer, and causes many other diseases.
Over 32 000 people died due to tobacco-related illnesses in South Africa in 2021.
The tobacco industry is promoting e-cigarettes as a “healthier” alternative to conventional cigarettes, but there are long-term negative health impacts.
Tobacco has negative health consequences—this page includes sections on the health impacts of tobacco use, ailments caused by cigarette smoking, the estimated annual deaths from tobacco-related causes, the impact of second- and third-hand smoke, health impacts associated with farming tobacco, and the health impact of using e-cigarettes.
To learn more about the data and methods used in this page, click here.
Health Impacts
of Tobacco Use
Tobacco use harms nearly all systems in the human body, is associated with almost all forms of cancer, and is responsible for many other diseases.
Estimates show tobacco use increases the risk of:
Coronary heart disease and stroke by 2 to 4 times
Lung cancer by 25 times
Source: US Department of Health and Human Services. (2014)
Smoking-Related
Diseases
Cardiovascular Disease
Cardiovascular Disease
Tobacco users are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease).
Tobacco use causes stroke and coronary heart disease, which are among the leading causes of death in South Africa.
Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.
Respiratory Disease
Respiratory Disease
If one has asthma, tobacco smoke can trigger an attack or make an attack worse.
Cancer
Cancer
Tobacco use can cause cancer almost anywhere in your body:
Bladder
Blood (acute myeloid leukaemia)
Cervix
Colon and rectum (colorectal)
Oesophagus
Kidney and ureter
Larynx
Liver
Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
Pancreas
Stomach
Trachea, bronchus, and lung
Mental Illness and Tobacco Use
Mental Illness and Tobacco Use
Mental illnesses such as attention-deficit hyperactivity disorder (ADHD) and schizophrenia are associated with the decision to smoke as well as smoking intensity.
Tobacco use in South Africa is associated with a higher incidence of depressive symptoms.
Smoking may reduce the effectiveness of medications, such as antidepressants and antipsychotics.
Ailments
Caused by Cigarette Smoking
Source: US Department of Health and Human Services. (2014)
Knowledge, Attitudes, and Perception
About the Harm of Smoking in South Africa
According to the GATS 2021 report:
An overwhelming majority of adults believed that smoking causes lung cancer (97%) and heart attacks (81.5%).
About two thirds believe smoking causes stroke (69%) and emphysema (68%).
About half (48%) believed that smoking causes diabetes.
Among current smokers, 92% believed that smoking causes serious illnesses.
Annual Deaths
from Smoking in South Africa
Over 32 000 South Africans died from tobacco-related diseases in 2021 (Males = 22 800; Females = 9600).
5.8% of male deaths and 2.9% of female deaths were caused by tobacco in 2021 (4,4% overall).
Over 13% of non-communicable disease-related deaths in South Africa, are attributable to tobacco use.
Smoking-Attributable Deaths as a Percentage of Total Deaths, 2021
Source: Global Disease Burden 2021
Economics
of Tobacco
Treatment Costs
of Tobacco-Related Illnesses in South Africa
209 275 South Africans
138 738 men
70 537 women
were admitted into hospital because of smoking-related diseases in 2016.
Tobacco-related illnesses cost the South African economy R42 billion in that year. R28 billion of this cost is due to illness-caused productivity losses and the losses in potential earnings for those who died prematurely, while the remaining R14 billion is due to direct healthcare costs.
However, the tobacco industry only paid R12 billion in excise taxes* in the same year.
* These figures were calculated using average earnings in South Africa, taking unemployment rates into account. The R14 billion reflects approximately 4.1% of overall healthcare expenditure.
The Economics
of Tobacco
R42 Billion
In South Africa, the economic cost of smoking was estimated at
R42 billion in 2016.
This includes total healthcare costs (R14 billion), the cost of productivity loss (R369 million), and the cost of premature death (R28.5 billion).
Conversely, over the 2016-2017 period, the tobacco industry generated just R12 billion in excise taxes, which is about 1% of total government revenue. This means that, in 2016, the economy loses R3.43 for every R1 raised from tobacco tax revenue.
The economic cost of tobacco (R42 billion in 2016) could:
Build approximately 250 000 Reconstruction and Development Programme (RDP) houses.
Pay approximately 215 000 high school teachers for a year.
Provide approximately 8.8 million children with the Child Support Grant for a year.
To see how the infographics were calculated, go to the Policies section of Data and Methods here.
Household Expenditure and Substitution Effects
Due to Tobacco Consumption
Data from the GATS 2021 report shows that:
South African adults who smoked manufactured cigarettes spent an average of R263 per month (Men = R273; Women = R207).
Nearly one third (29.3%) of current adult e-cigarette users reported spending more than R100 on e-cigarettes per month.
The three most common places people purchased cigarettes were spaza shops/kiosks (68%), grocery store/ supermarket (23%), and street vendors (4.2%).
Smoking harms household welfare directly and indirectly when household resources are channelled to tobacco expenditure
Substituting expenditure on essential goods for tobacco can have a negative impact on households, particularly low-income households. If low-income households buy tobacco products, they have less money to buy other goods. The low expenditure of low-income households on food relative to tobacco suggests they prefer tobacco more than essential goods such as food.
Low-income households who spend more on tobacco than other low-income households also spend more on the care of smoking problems and less on essentials for daily living. In South Africa, low-income households whose household head smokes tobacco invest less in their children’s education than other low-income households. In addition, Black household heads in South Africa who smoke spend less on their children’s education than their counterparts. Household head smoking behaviour also contributes to household food insecurity in South Africa. The need to address food insecurity at the household level is a compelling argument for tobacco smoking cessation or control in addition to health consequence concerns.
Secondhand Smoke
and its Impact on Health
Exposure to secondhand smoke is responsible for the deaths of 1.3 million individuals worldwide every year.
Secondhand smoke contains more than 7 000 chemicals, 70 of which can cause cancer, and hundreds more that are toxic. About half of secondhand smoke comes from the smouldering butt of a cigarette and the other half from exhaled smoke.
The scientific evidence is clear: There is no safe level of secondhand smoke.
Research on the effect of secondhand smoke is ongoing; the conditions that are causally linked to secondhand smoke are shown here.
Adults’ exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and can cause coronary heart disease and lung cancer.
Adults who live with a smoker have a 20%-30% increase in the risk of developing lung cancer.
Even brief exposure can trigger heart attacks.
There is a 25%-30% increase in the risk of coronary heart disease.
Myths
About Secondhand Smoke
Myth: Smoking out of a window or near an extractor fan will protect others in the room from secondhand smoke.
Fact: Smoke from one cigarette can linger in a room for up to two and a half hours, even with a window open.
Myth: If an inside space is ventilated after smokers have used it, there will be no health risks.
Fact: Residue from tobacco smoke can linger on surfaces, furniture, floors, curtains, and walls for several months. This is known as thirdhand smoke. Infants and young children are thought to be most at risk of this type of exposure.
Beliefs
Regarding the Health Impacts of Tobacco Use in South Africa
Most (93%) South African adults believe (1) smoking causes serious illness, and (2) breathing other people’s smoke causes serious illness in non-smokers.
Close to 80% of South African adults believe smokeless tobacco use causes serious illness.
South African adults’ beliefs regarding the health effects of tobacco use
Health Impacts
of Tobacco Agriculture
Tobacco is a labour-intensive crop.
Hand harvesting remains the preferred method, as tobacco leaves mature at different rates, machinery is expensive, and leaves picked mechanically are of lower quality. Farm workers can face risks from pesticides and other chemicals if safety protocols are not adhered to, and may also suffer from heat exhaustion during harvesting.Green Tobacco Sickness
Green tobacco sickness, which is a risk unique to tobacco farming, occurs when nicotine is absorbed through the skin as farm workers harvest tobacco. In principle, farm workers can protect themselves by wearing protective clothing, but can still be at risk if their clothing becomes saturated with rain, dew, or perspiration.
Some symptoms of green tobacco sickness are similar to those of heat exhaustion and pesticide poisoning. If healthcare workers are not familiar with this illness, it may be misdiagnosed. Read more on tobacco agriculture and its impacts.
Myths
about Green Tobacco Sickness
There is a lack of research on green tobacco sickness in Africa. Even when farmers and farm workers are aware of green tobacco sickness, there is misinformation about the causes and how to prevent it.
Myth: Smoking gives you protection from Green Tobacco Sickness.
Fact: Smoking provides no protection from green tobacco sickness, and smoking is harmful to your health.
Myth: Working with tobacco for some time allows you to develop a tolerance for Green Tobacco Sickness.
Fact: There is no evidence you can build up a tolerance to Green Tobacco Sickness.
Myth: Green Tobacco Sickness can be caused by compost, heat, the smell of the tobacco plants, or pesticide.
Fact: Nicotine from handling tobacco plants and products causes green tobacco sickness.
E-cigarettes’
Impact on Health
E-cigarettes (electronic cigarettes) are devices that produce an inhaled aerosol by heating a liquid that contains a solvent, one or more flavourings, and usually nicotine. Although e-cigarettes deliver nicotine differently to conventional cigarettes, they are still harmful to users’ health.
Aerosol
in E-Cigarettes
E-cigarette aerosol is NOT harmless “water vapour.”
The e-cigarette aerosol that users breathe from the device may contain harmful substances including: nicotine, ultrafine particles that can be inhaled deep into the lungs, flavourings such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.
The uptake of e-cigarettes by adolescents and young adults is a growing public health concern globally as they can lead to nicotine dependence and be harmful to brain development.
Although people may think that e-cigarettes are less harmful than combustible tobacco products, the emerging evidence shows that there are many known risks and harms for users (see here for more).
The sale or distribution of e-cigarettes is banned in 41 countries globally, including four African countries: Ethiopia, Gambia, Mauritius, and Uganda.
Animations
Illustrating the Harms of Tobacco Use
