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KENYA: Hazards kept at bay with ruling on smoking

December 2019 theStar; “I saw several Spaniards on the island of Hispanola who were reproached because of their bad habits. They answered it was impossible for them to stop smoking.” Bartholome de las Casas

Other than ‘discovering’ America, the Italian explorer Christopher Columbus, influenced the growth and use of Nicotina tobacum what is commonly known as cultivated tobacco. This was after he was gifted dried tobacco leaves, believed to cure 36 health problems, including cancer, a narrative prompted by Spanish physicians.

The growth and use of tobacco since then kept growing, some chewed while others preferred snuffing. However, it is the invention of the cigarette that caused a rapid consumption of tobacco and current data shows that around 6.5 trillion cigarettes are sold globally each year translating to approximately 18 billion cigarettes each day. It is estimated that 8 million people die each year due to tobacco consumption and among these 1.2 million are second-hand smokers.

Of the many risks that cigarette consumers face is chronic kidney disease (CKD). This was first established by a study conducted in the year 1978 on a possible connection between cigarette smoking and kidney disease. CKD means that kidneys have been damaged and cannot filter blood in the body properly, and this happens gradually over time, thus the name chronic.

In the year 2015, it was estimated that 750 million people suffered from some form of kidney condition globally, making it the 12th leading cause of death, causing about 1.1 million deaths then. CKD is projected to become the 5th leading cause of death by 2040. Such a disease burden brings along an increase in health expenditure, for instance, in high-income countries, the cost of dialysis together with transplantation amount to about 2-3% of the healthcare budget annually. Here in Kenya, the National Health Insurance Fund (NHIF) reported that in the financial year 2017, it spent ksh.1.2 billion to cover for dialysis costs and this figure increased by 40% in the financial year 2018-2019 hitting ksh.1.7 billion translating to about ksh.9500 a week for every patient on dialysis.

Smoking qualifies as a cause of CKD as it increases blood pressure, which is one of the main causes of kidney disease. Smoking is also known to cause wall-thickening of arteries and arterioles in various organs including the kidneys, causing the kidneys to release hormones that result in blood pressure causing kidney failure over time. But even with such scary narratives, people are still smoking a fact that is attributed to the unforgiving addiction nature of nicotine found in cigarettes.

Over the years, different countries have come up with tobacco control measures as a way of discouraging the custom of smoking. In the year 1988, for instance, California increased cigarette tax by 25 cents and allocated some of the revenue collected to the creation of the first ever statewide tobacco control program in the state. In 2012, Australia through the Australian Tobacco Plain Packaging Act banned the display of brands and logos on cigarette packets by tobacco companies. This was done with an aim of reducing smoking prevalence, increasing thoughts about quitting, reducing brand awareness and increasing health warning among users.

Kenya records the highest number of smokers among the Sub-Saharan countries. In the year 2014, it was estimated that 11.6% of the adult population, 12.8% of boys and 6.7% of girls aged between 13-15 years used tobacco products.

The fight against the epidemic of tobacco use in Kenya began in the year 1992 as a way of celebrating the World No Tobacco Day. These campaigns led to the appointment of the National Tobacco Free Initiative Committee (NTFIC) which was tasked with coordinating tobacco control activities in the country. This led to successful negotiations that saw Kenya ratify the World Health Organization Framework Convention (WHO FCTC) on Tobacco Control in the year 2004. By ratifying this framework, Kenya joined the rest of the world in aiming to protect both present and future generations from devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.

TOBACCO CONTROL ACT

Three years after ratification of the WHO FCTC, Kenya enacted the Tobacco Control Act. This Act enabled designation of smoking areas as a way of limiting second-hand smoke exposure to non-smokers. The Act also banned cigarette companies from carrying out any form of advertisement, promotion or sponsorship of their products. However, the Act has faced a lot of implementation delays due to challenges from the tobacco industries including British American Tobacco (BAT) and the Kenyan tobacco manufacturer Mastermind Tobacco Kenya (MTK).

As a way of pushing forward with the agenda of curbing tobacco use in the country, the government through the Ministry of Health introduced the Tobacco Control Regulations in the year 2014, an effort that was again challenged by BAT through court under Petition No. 143 of 2015 to the High Court of Kenya on grounds that the regulations were unconstitutional. BAT however lost the case and appealed to the Court of Appeal (British American Tobacco Ltd v Cabinet Secretary for the Ministry of Health & 5 others [2017] eKL) but again lost after the Court of Appeal upheld the decision of the High Court. BAT again proceeded to the Supreme Court of Kenya, which is the highest court of the country, but lost as the court ruled in favour of the Tobacco Control Regulations of 2014 allowing the government to implement the same as a way of protecting Kenyans from the dire consequences of tobacco use.

As the world continues to curb the use of tobacco, we cannot fail to applaud our very own Supreme Court for upholding the Tobacco Control Regulations of 2014. Through such commendable efforts it is possible to prevent chronic kidney disease as this will eliminate one of its secondary causes- smoking cigarettes.

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