1.0. INTRODUCTION

Uganda's history on tobacco control has largely been one of concessions from the industry rather than deliberate legislative or policy effort by the Government.

Tobacco is our second largest cash crop, grown in over 16 of our 60 districts. The tobacco industry contributes approximately 8% of our revenue, approximately US. $35 million and employs approximately 600,000 people. These hard economic facts coupled with scarce local scientific data on tobacco disease and prevalence perhaps prevent a build up of public and political support for tobacco control.

Our President, while absolutely smitten by the apparent economic contributions of the tobacco industry to our economy remains by his own admission, unconvinced of the dangers of smoking. His Excellency has publicly expressed doubt on the links between cancer and smoking, a link that BAT itself now admit. Perhaps in typical African fashion, this thinking permeates through our political leadership and weakens the political will to address tobacco control.

2.0 DISEASE BURDEN AND PREVALENCE

Uganda is yet to conduct a nationwide prevalence study and the few studies done to-date have thrown up widely varying figures.

In some older studies smoking prevalence amongst adults was estimated at 52% for males, 17% for females and 58% among the 14-18 year olds. However the recent health and Demographic survey 2001-2002 places it at estimates 25% of the males and 3% for the females.

Our hope for reliable statistics lies in the Global Youth Tobacco Survey presently being conducted in Uganda by the Uganda Parliamentary Research Service in collaboration with the World Health Organization, Centre for Disease Control, Ministry of Health and the Ministry of Education and Sports. It will assess youth tobacco use and awareness of tobacco related illnesses.

The survey is being conducted in 10 districts (Arua, Mukono, Kampala, Mpigi, Sembabule, Kiboga, Masaka, Mubende, Luwero, Rakai) and will involve 85 private and government schools. We have cause to be apprehensive. One study by the Late Dr. Mathew Lukwiya found that the average age for initiation into smoking was 14 years with some starting as early as 6 years.

With regards to the burden of tobacco related disease, a study completed last year at the main referral hospital found that 75% of the victims of oral cancer had a history of smoking with some having smoked as little as 2 years. Acute respiratory infections is named as the second leading cause of infant visits to health units and third commonest cause of infant deaths accounting for 8.2% of the infant deaths. Cigarette smoke is identified as one of the causes of acute respiratory infections. Uganda is also seeing an increase in tobacco related diseases such as asthma, diabetes, cancers, heart and cardio-vascular diseases, stroke and hypertension

3.0 TOBACCO GROWING AND MANUFACTURE

Farmers contracted by the cigarette manufacturers presently grow tobacco on smallholdings. The tobacco companies provide crop finance to the farmers in the forms of loans and agricultural inputs. At the end of the season, the farmers are sell their product to that company.

This may all change if the Government efforts to attract commercial tobacco farmers fleeing Zimbabawe are successful.

The major market player in Uganda is British American Tobacco Uganda Ltd., with over 90% of the market share. In the last couple of years more players have been licensed to manufacture/import tobacco products in Uganda; Mastermind Tobacco Limited (was manufacturer of Supermatch now limited to leaf buying) Taaba Limited (importer of Boss), Amber Group Ltd. (importers of Amber), Leaf Tobacco & Commodities (U) Ltd. (now manufacturers of Supermatch).

The resultant competition in the purchase of raw leaf tobacco is said to have spurred Government to consider inviting yet another manufacturer as a strategy to alleviate poverty.

4.0 TOBACCO CONTROL MEASURES

In addition to the Ministry of Health, the tobacco control lobby comprises a mix of lawyers, journalists, students, Uganda Medical Association and NGOs. There is no full-time tobacco control person in Uganda, even within the Ministry of Health. The Ministry of Health runs the Tobacco or Health Forum, which is intended to serve as a clearinghouse for tobacco control activities. While a very loose alliance, it has achieved some significant progress.

The Ministry of Health has prepared draft legislation on tobacco control, but the road ahead promises to be anything but smooth. The key elements of the legislation include the setting up of an independent Tobacco Control Commission, a ban on advertising, promotion, sponsorships, prohibition of youth access to tobacco products, stronger warning labels with graphics, a ban on light and mild descriptors, protection of non-smokers, protection of the environment, liability provisions, penalties. We will be discussing this in the next session.

We turn to a review of Uganda's position on several key tobacco control issues;

A. Taxation

While Uganda has periodically raised its cigarette excise tax to 130% now, among the highest in the region, this has been driven by our revenue targets rather than public health priorities.

After an 8% increase in excise tax last year, BAT reported a decline in tax contributions of over 20%. However, Mastermind Tobacco Uganda Ltd. reported an increase of 30%. Funny maths??

B. Advertising / Sponsorship / Promotions

Tobacco advertising on state media (Uganda Television and Radio Uganda) was banned by the Minister of Information on World No Tobacco day in 1995. However, the more popular private FM radio stations and private television remain free to carry tobacco advertising.

As a result of the International Marketing Standards Agreement signed between the big three tobacco companies, BAT announced last year its withdrawal from all tobacco product advertising on electronic media. Early this year, BAT also announced that it would discontinue advertising on billboards.

What we have seen is not a reduction in advertising but rather a subtle shift from these forms of advertising to point of sale advertising in shops, bars, and nightclubs. As the billboards came down, posters on shop fronts went up to promote a campaign that offered mobile phones, radios and bicycles for purchase of cigarettes. The campaign run its course, the posters came down and up went branded umbrellas in places of entertainment.

The Benson & Hedges Street Bash, a mega musical concert is yet another form of advertising. This semi-annual event is held in a block off street outside a discotheque. The event is heavily advertised on radio and television. Patrons at these events tell of all forms of enticements to smoke.

Needless to say the new tobacco companies do not consider themselves bound by BAT's "concessions" and have launched aggressive advertising campaigns on radio.

One major victory of the tobacco control lobby in this area was forcing BAT to relinquish sponsorship of an annual sportsman gala that they had done for 10 years.

C. Package warnings & labels

In 1988, after negotiations with BAT, the Ministry of Health introduced a warning "cigarette smoking can be harmful to your health". BAT resisted suggestions for stronger warnings on the grounds that it did not believe that cigarette smoking was harmful to health. The warning is therefore attributed as "Ministry of Health Warning".

Amber, a new brand in the Ugandan market by a new market player carries the warning "cigarette smoking is harmful to your health" also attributed to the Ministry of Health. Two other brands Superkings and Gold seal carried "smoking is the main cause of cancer, lung diseases and of heart and artery diseases" and "The Director of Medical Services says smoking is harzardous to your health". Probably that is why these brands have since fallen out of the market.

The Uganda National Bureau of Standards working with other regional bureaus is proposing to adopt "cigarette smoking is harmful to your health" despite efforts to persuade them to adopt stronger language and graphics.

D. Smuggling

Smuggling of tobacco products is an issue of major concern in Uganda. BAT estimates that the Government loses approximately Ug. Shs. … in revenue due to tobacco smuggling.

According to media reports most of the activity is petty smuggling across the border with Kenya and Supermatch cigarettes are the favoured brand.

To counter smuggling, the Government created the Special Revenue Protection Service (SRPS). This is an armed group that tracks down smugglers and judging by media reports they have been successful in impounding large quantities of smuggled cigarettes. The impounded cigarettes are burnt and this has caused a lot of outcry. The leading independent daily recently run an editorial calling for the cigarettes to be donated to soldiers on the war fronts, after hearing that the desperate soldiers were smoking leaves to keep warm.

SRPS has recently tried to be creative in curbing smuggling. They recently donated 6 bicycles to smugglers as a way of inducing them to resort to other economic activities. The smugglers were warned not to use the bicycles for smuggling.

The Government also introduced tax stamps for cigarettes to help identify smuggled cigarettes. BAT was at the forefront of this campaign and was often in the company of tax officials at workshops to sensitise the industry on the use of tax stamps. One of the posters launching the tax stamps promised that the stamp was an indicator that the cigarettes were fresh and authentic.

E. Litigation

There have been two attempts at suing the tobacco industry for injury suffered by smokers. Both suits were dismissed in their very early stages on technical points.

TEAN has instituted two suits using a human rights angle to tackle tobacco control issues. The first action sought a declaration that smoking in public places was a violation of the rights of non-smokers to life and to a clean and healthy environment. The second action is for a declaration that the warning labels used by BAT infringe the right to life of smokers, as it does not give a true picture of the dangers of their product.

We will be discussing these actions in a later session.

F. Smoke free places

The Ministry of Health premises were declared smoke free in the year 2000. Those of us who work elsewhere are left wondering the Honourable Minister of Health will deem us fit for protection from the dangers of second-hand smoke.

On the eve of World No Tobacco day in 2000, BAT launched the Courtesy of Choice programme in prime hotels and restaurants in Uganda. This entails a simple separation of smoking and non-smoking areas in public places. Many of the hotels that run the programme have since abandoned it citing it as impractical.

G. Framework Convention on Tobacco Control

Uganda supports the development of the Framework Convention on Tobacco Control and has a representative on the Intergovernmental Negotiating Body. The Government's position is that because of the economic plight of many developing countries Uganda should be left to introduce a tobacco control regime suited to its realities and contexts. There is very little effort by the Government in creating local awareness on the FCTC.

5.0 CONCLUSION

While tobacco control in Uganda is still in its infancy, the tobacco industry is not. We still have a long way to go and it will be no easy task. Our best hopes lie in a strong Framework Convention on Tobacco Control, to which we pledge our every support.

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