Health Burden of Tobacco
In South Africa in 2016, there were almost 26,000 smoking-attributable deaths for smokers aged 35-75 years.
The tobacco industry is promoting e-cigarettes as a “healthier” alternative, but there are long-term negative health impacts.
Tobacco has negative health consequences—this page includes sections on the estimated annual deaths from tobacco-related causes, costs of treating tobacco-related diseases, impact of smoking cigarettes, the impact of second- and third-hand smoke, health conditions associated with farming tobacco, and the impact of using e-cigarettes.
Whilst research on the relationship between tobacco use and COVID-19 is still developing, and although some research has been reported in the news, many studies have not yet undergone peer review, and it is therefore difficult to assess their quality.
What is clear at this point is that current and former smokers are more likely to have severe COVID-19 symptoms if they contract the disease (results derived from an ongoing meta-analysis that pools results from studies judged to be of high quality).A one page fact sheet with the key information from this page is available here.
To learn more about the data and methods used in this page, click here.
Non-Communicable Diseases
and Tobacco Use
Smoking can harm nearly all systems in the human body and causes many diseases, including lung cancer, which is the leading cause of cancer deaths in South Africa.
Global studies show that cigarette smoking is linked to 80%-90% of lung cancer deaths.Ailments
Caused by Smoking Cigarettes
Mental Illness
and Tobacco Use
Mental illnesses such as ADHD, schizophrenia, personality disorders, and other substance abuse disorders influence individuals’ decisions on whether to start smoking and causes individuals to smoke more.
Smoking may also reduce the effectiveness of medication like antidepressants and antipsychotics.
Annual Deaths
from Smoking in South Africa
Using recent research published in South Africa,
the infographic above shows how smoking causes disease and death. A significant share of deaths were attributed to either heart Disease/hypertension, respiratory disease, or cancers (digestive/respiratory system). Most deaths were attributed to one of a variety of other smoking-related diseases, including vitamin deficiencies, thyroid issues, and rheumatic diseases. Higher smoking prevalence rates among men means that more men die as a result of smoking.Smoking Attributed Deaths by Gender and Disease in South Africa, 2016
Deaths due to smoking in South Africa were predominantly caused by respiratory problems, heart disease, issues related to blood pressure, and cancers.
Because only those who have died from tobacco-related illnesses are counted, these figures underestimate the direct health burden of smoking. Those who are sick but still alive, or those who have been exposed to secondhand smoke, are excluded.
Tobacco smoking caused an estimated 31,078 deaths (23,444 in males and 7,634 in females) in 2012 in South Africa and accounted for 6.9% of total deaths of all ages.
This represented a 10.5% decline overall from 2000. Note that the research methodology differs from that of the 2016 paper, thus the figures may not be directly comparable.Another study estimated the total annual deaths in South Africa attributable to smoking at 42,100 people in 2016. This research does not state the sampling and research methodology, making comparison more difficult.
Treatment Costs
of Tobacco-Related Illness 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.
This means the economy lost R3.43 for every R1 the government raised from tobacco tax.
* 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.
Secondhand Smoke
and its Impact on Health
Exposure to secondhand smoke is responsible for the deaths of more than 880,000 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.
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.
Research shows that there is a 25%-30% increase in the risk of coronary heart disease with exposure to secondhand smoke.
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, 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.
Tobacco Agriculture
and the Impact on Health
Tobacco is a labour-intensive crop.
Read more on tobacco agriculture in South Africa.
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. 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.Green Tobacco Sickness
Exposure Symptoms
Symptoms appear within one day of exposure and will last one to three days.
Common Symptoms:
• Nausea
• Vomiting
• Dizziness
• Headaches
Other Symptoms:
• Difficulty eating
• Difficulty sleeping
• Weakness
• Abdominal cramps
• Shortness of breath
• Fluctuations in blood pressure and heart rate
• Pallor (unhealthy/pale/ashy appearance)
• Diarrhoea
• Chills
• Increased perspiration and saliva
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.
