Rodgers Chisoni, 50, was bedridden at Thyolo District Hospital when a doctor advised him to quit smoking in 2004. The father of six, who usually consumed up to 17 cigarettes a day, was taken ill by Tuberculosis (TB), a tobacco-related disease which affects almost 17 000 people in Malawi, according to the National TB Control Programme. The ex-smoker clearly recounts how peer pressure put his health up in smoke.
“I used to smoke day and night,” he says. “At that time, I couldn’t drink, eat or sleep without smoking. But after a lengthy illness, I lost weight, appetite and hope. I wept in agony. I coughed hard, sweated profusely and struggled with chest pains. I thought I was going to join my wife in the grave.”
Chisoni’s 40-day battle with the lung disease left him without a doubt that tobacco kills.
“When I was diagnosed with TB, I realised that HIV had reduced my immunity and smoking made matters worse. From my sickbed, I saw some patients dying of the lung disease. When a doctor told me to stop smoking, I didn’t resist. I feel better now.”
Chisoni, from Chilembwe Village in the sprawling tea fields of Thyolo District, personifies the tragedy facing almost 5 000 children and 707 000 adult Malawians who use tobacco each day.
Smoking exposes them to TB and numerous tobacco-related diseases which killed 7.1 million people in 2016, according to World Health Organisation (WHO).
The Tobacco Atlas, released in March by Vital Strategies and American Cancer Society (ACS) at the World Conference on Tobacco or Health in Cape Town, South Africa, shows that about 5 700 of these deaths occur in Malawi.
The leaf is the country’s largest export, which is often marketed as “green gold”.
Minister of Health Atupele Muluzi terms this label “outdated thinking” as tobacco yields, demand and prices keep falling.
The new evidence highlights the need to do more to protect the population.
“The risks associated with smoking are clear and I do not condone smoking in any way,” says Muluzi. “Government is committed to supporting farmers move to an alternative high-value crop. Furthermore, we are looking at ways to reduce the number of smokers and resource burdens that they present to our health sector. This includes reviewing our public policy on issues such as tobacco advertising and taxation.”
He says government is working towards a comprehensive solution to ensure farmers and the economies no longer rely on a single crop.
However, widespread sights of people smoking in public places expose lack of smoke-free laws.
The tobacco-growing country has not ratified WHO Framework Convention on Tobacco Control (FCTC) to reduce the public health impacts of the leaf which accounts for almost two thirds of export earnings.
So far, 181 countries, including the neighbouring Mozambique, have signed FCTC.
“As the Tobacco Atlas highlights, we can and must do more. However, government guidance is that smoking in several public places, such as airports, is prohibited and all cigarettes manufacturers are required to indicate the harmful effects of smoking on their packaging,” says Muluzi.
But no one is safe from tobacco smoke. WHO estimates that second-hand causes one in eight tobacco-related deaths worldwide.
The Tobacco Atlas is funded by Bloomberg Philanthropies, founded by WHO global ambassador on non-communicable diseases Michael Bloomberg.
“Tobacco will kill one billion people this century, if we do nothing,” he says. “It is the world’s leading preventable killer, driving an epidemic of cancer, heart disease, stroke, chronic lung disease and other non-communicable diseases. But the good news is: we know the most effective strategies for stopping it.”
Creating smoke-free environments is vital to protect non-smokers from the harmful effects of second-hand smoke and to ingrain a sense that smoking is socially unacceptable behaviour, says the Tobacco Atlas co-editor Jeffrey Drope.
The ACS vice-president says most countries are not protected by strong smoke-free laws and regulations.
“Governments must be comprehensive and forceful in their smoke-free policies. Prohibit smoking in all public places, indoor workplaces and public transport without exception, including the elimination of designated smoking areas which leak smoke and make public smoking seem acceptable,” he says.
Malawi Health Equity Network executive director George Jobe calls for increased efforts to sensitise people to the dangers of smoking.
“The Tobacco Atlas show that smoking poses a heavy risk on people’s health. It appears the country does not adequately pay attention to tobacco, save for the disclaimers in adverts and on packets that ‘smoking can kill’.”
Jobe asks government to impose tax on tobacco products to make cigarettes unaffordable and improve healthcare funding.
“The tobacco industry is contributing to the disease burden in our healthcare system,” he says. “It needs to share the responsibility of healthcare financing in addition to taxes that are there.”