addiction healthcare international africa house believes ghanas ban smoking public

What those statistics mean could be questionable – did the ban make people stop, or only provide an extra incentive or assistance for those who already want to stop to do so? It could be suggested that this would simply lead to increased smoking within the home.  Even so, other measures could be more effective, if the goal is a simple reduction in smoking numbers.

Reduce smoking  A ban on smoking in public places would help reduce the rates of people smoking, by making it appear socially unusual – people will have to leave enclosed public places to smoke, each time they want to smoke. This is particularly important in Africa which is at an early stage of the tobacco epidemic where it can be prevented from ever coming to be seen as being normal.  The ban both through the new obstacle and the change in norms could reduce smoking rates. In England, nine months after such a ban, the fall in smoking rates (such as with much of the Global North) accelerated 1 - it has been claimed by up to 400,000.  1 Daily Mail Reporter, “Smoking ban spurs 400,000 people to quit the habit”, Daily Mail, 4 July 2008,

It would require a large amount of resources for law enforcement to go in to such public places occasionally to see that the ban is being enforced.  It would be easier to enforce conditions relating to the packaging and production of tobacco, which occurs on fewer sites, than ban an activity in certain places which is not so enforceable.

Nip the problem in the bud  Smoking rates in Africa are relatively low; a range of 8%-27% with an average of only 18% of the population smoking 1 (or, the tobacco epidemic is at an early stage 2 ). That’s good, but the challenge is to keep it that way and reduce it.  A ban on smoking in public places at this stage would stop tobacco gaining the widespread social acceptability that caused it to thrice in the 20th century in the Global North. The solution is to get the solutions in now, not later.  1 Kaloko, Mustapha, 'The Impact of Tobacco Use on Health and Socio-Economic Development in Africa', African Union Commission, 2013,  , p.4  2 Bill and Melinda Gates Foundation, “What we do: Tobacco control strategy overview”, Bill &amp; Melinda Gates Foundation, no date,

Lower healthcare costs  Smoking caused disease causes large expenses for healthcare systems, something which is particularly burdensome in countries without the rich well developed healthcare systems of the developed world. In the UK lung cancer, one of the diseases caused by smoking, costs £90 per person or £9071 per patient. 1 Even the cost per head of population is higher than Ghana’s entire healthcare budget of $83.4 (about £50) per person. 2  The reduction in smoking, which would be triggered by the ban, would lead to a drop in smoking related illness. A study in the US state of Arizona showed that hospital admissions for smoking related diseases dropped after a ban on smoking in public places 3 .  This would allow resources to be focused on the big killers other than tobacco – including HIV AIDS.  1 The National Cancer Research Institute, ‘Lung cancer UK price tag eclipses the cost of any other cancer’, Cancer Research UK, 7 November 2012,   2 Assuming Ghanaian health spending of 5.2% of GDP which is $40.71 billion split between a population of 25.37 million from World Bank Databank    3 Herman, Patricia M., and Walsh, Michele E. “Hospital Admissions for Acute Myocardial Infarction, Angina, Stroke, and Asthma After Implementation of Arizona’s Comprehensive Statewide Smoking Ban”, American Journal of Public Health, March 2011,

The argument that states will save money due to less people smoking based upon healthcare costs from treating smoking related diseases is over-simplistic. While smoking does cause medical costs, taxation can counterbalance this – in 2009, the South African government gained 9 billion Rand (€620 million) from excise duties on tobacco 1 . Paradoxically, less people smoking could lead to less money for other projects. Indeed, some countries in Europe raise the amount of health expenditure it causes from tobacco taxation 2 .  1 American Cancer Society, “Tobacco tax success story: South Africa”, tobaccofreekids.org, October 2012,   2 BBC News, “Smoking disease costs NHS £5Bn”, BBC News, 2009,

Is it really the job of African states to stop smoking? Africans have the same amount of personal responsibility to choose to smoke or not – policies should reflect that.

Yes, tobacco is harmful – but is it really a benefit to remove economic activity, which people choose to do? Labour abuses occur in other industries – but that’s an argument for increased labour protections and economic development, not economic self-inflicted wounds.

Easy to introduce  A ban on smoking in public places would be simple to enforce – it is an obvious activity, and does not require any form of complex equipment or other special techniques . It would largely be enforced by other users of public places and those working there. If it changes attitudes enough, it could be largely self-enforcing – by changing attitudes and creating peer pressure 1 .  1 See Hartocollis, Anemona, “Why Citizens (gasp) are the smoking police), New York Times, 16 September 2010,

Reduces growth of tobacco  Less people smoking means less tobacco being purchased – something that would contribute to the reduction in the tobacco industry. The industry is known for its exploitative labour practices, from child labour (80,000 children in Malawi work in tobacco farming, can result in nicotine poisoning – 90% of what is grown is sold to American Big Tobacco 1 ) to extortionate loans. 2 Reducing the size of such an industry can only be a good thing.  1 Palitza, Kristin, “Child labour: tobacco’s smoking gun”, The Guardian, 14 September 2011,   2 Action on Smoking and Health, p3

Even if such a link were true – the campaign against the ban on smoking in public places in the UK accept that it’s unlikely that it is the primary cause of closures in the UK 1 – the public health benefits would make it worth it. Reductions on spending in some areas of the economy is likely to be balanced by increases elsewhere; of course there will be losses in some industries – particularly tabacco itself but those who stop smoking will have the money to spend elsewhere.  Moreover the economic effects are likely to be different in Africa; smoking outside in the UK, bearing in mind the infamous British weather, is a far less attractive proposition than smoking outdoors in many African countries.  1 'Why we want government to amend the smoking ban', Save Our Pubs &amp; Clubs,

Personal autonomy arguments sound reasonable, but often ignore the wider consequences. Public health is a key issue – the state has a role in stopping people harming themselves – they may be harming themselves but the cost often falls on government through public healthcare, and therefore on all taxpayers. Moreover smoking also harms others through passive smoking, this is particularly true in public places that are enclosed.

Unenforceable  Smoking bans are often unenforceable in higher income countries. This is because they require expensive manpower or CCTV in order to stop those flouting the ban, with scarce resources a police force will almost always have other more important crimes to deal with. If Berlin 1 and New York City 2 cannot enforce them, most African cities won’t be able to either.  Ghana's advertising ban has been flouted in the past. When asked in a survey about advertising 35% of Ghanaians recalled hearing a tobacco advert on radio or television despite such ads being banned. 3  1 AFP, 'Smoking Ban not Enforced in Parts of Germany', Spiegel Online, 2 July 2008,   2 Huff Post New York, 'NYC Smoking Ban In Parks Will Not Be Enforced By NYPD: Mayor', Huffington Post, 2 November 2011,   3 Kaloko, Mustapha, 2013,  , p.18

Pack labelling or taxation a better alternative  If it’s not enforceable, enforceable solutions ought to be used instead. It would be easier to enforce pack labelling and branding requirements, from larger and clearer health warnings to even brand-free packs. Of course, American-style lawsuits by governments against tobacco manufacturers could be tried, as suggested in Nigeria 1 .  1 IRIN, “NIGERIA: Govt hits tobacco companies with whopping law suit”, irinnews.org, 9 November 2007,

Ban would harm the wider economy  A ban could harm the wider economy – from bars to clubs, if smokers are unable to smoke inside, they may be more likely to stay away. According to some critics, this lead to the closures of bars in the UK when such a ban was brought in 1 . Research in the United States has shown drops in employment in bars of between 4 and 16 percent. 2  1 BBC News, “MPs campaign to relax smoking ban in pubs”, BBC News, 2011,   2 Pakko, Michael R., 'Clearing the Haze? New Evidence on the Economic Impact of Smoking Bans', The Regional Economist, January 2008,

Paternalistic  Personal autonomy has to be the key to this debate. If people want to smoke – and the owner of the public place has no issue with that – it is not the role of the state to step in. While smoking is dangerous, people should be free in a society to take their own risks, and live with their decisions. All that is required is ensuring that smokers are educated about the risks so that they can make an informed decision.

Each has its own disadvantages. A growing form of tobacco sales in Africa – Nigeria in particular – is the “single stick” 1 . If retailers break packets of cigarettes apart, customers won’t see the packets containing health warnings or similar.  Cost increases can lead to increased use of rollups 2 , or even counterfeit cigarettes, 3 both of which have happened in South Africa as a result of taxation. At any rate, it’s not a zero sum game – more than one policy can be introduced at the same time.  1 Kluger, 2009,   2 Olitola, Bukola, “The use of roll-your-own cigarettes in South Africa”, Public Health Association of South Africa, 26 February 2014,   3 Miti, Siya, “Tobacco tax hikes 'boost illegal traders'”, Dispatch Live, 28 February 2014,

It often doesn’t require enforcement – it changes attitudes itself, making people not do so. In Scotland, within three months 99% of locations abided by the ban, without the need for excess heavy handed enforcement 1 . This is because non-smokers will ask a smoker to stub it out if they are smoking where they are not allowed to. There seems little reason why this wont happen in Ghana or elsewhere in Africa just as in the west.  Even so, a lot of laws are not enforceable in all cases – that doesn’t mean that they will be complete failures.  1 The Scottish Government, 'Smoking ban gets seal of public approval', scotland.gov.uk, 26 June 2006,