Tobacco Products Control Amendment Bill: public hearings

HEALTH PORTFOLIO COMMITTEE
23 January 2007
TOBACCO PRODUCTS CONTROL AMENDMENT BILL: PUBLIC HEARINGS

Chairperson: Mr L V Ngculu (ANC)

Documents handed out:
National Department of Health PowerPoint Presentation
National Council Against Smoking PowerPoint Presentation
National Council Against Smoking Written Submission
Seventh-Day Adventist Church Submission
Soul City Institute for Health and Development Communication Submission
Goldfields PowerPoint Presentation
How to Fight the Tobacco Epidemic (Prof C T Bolliger)
South African Tobacco Industry PowerPoint Presentation
Tobacco Products Control Amendment Bill [B24-2006]

Audio Recording of the Meeting (Part 1) and (Part 2)

SUMMARY
The Committee heard submissions by the Department of Health, the National Council Against Smoking, the Seventh Day Adventist Church, Soul City, a doctor working within the mining industry, a pulmonary specialist and the South African Tobacco Industry. The Anti-Smoking lobbyists welcomed the proposed amendments and many suggested additional provisions, while the tobacco industry cautioned against regulations and taxation that were too stiff. Both groups raised concerns around illegal trade.

Members asked questions about the ability to implement of some of the proposed amendments, the health risks associated with cigarettes and tobacco products and the possibility of banning tobacco products. The Committee emphasised the need for cooperation between all stakeholders that would be affected by the legislation. The Department was urged to implement public education programmes that would effectively communicate the aims of the legislation as well as promote healthy habits.

MINUTES
The Chairperson welcomed everyone and wished them a prosperous 2007.

Department of Health Presentation
Chief Director, Mr Bennet Asia, led the delegation from the Department of Health (DOH) which included his deputy director, Mr Kgloiti Mahlako, and the legal representative, Mr Hennie Kleynhans. The Department presented the Committee with a condensed version of the presentation it had made towards the end of 2006. Mr Asia outlined the background to the legislation, tobacco control in South Africa and the Framework Convention on Tobacco Control (FCTC) to which South Africa was a co-signatory. The presentation also touched on the contents of the proposed amendments (see presentation document).

Discussion
Ms M Malumise (ANC) wondered what measures would be put in place to protect the health of children in homes where parents or care givers smoked.

Mr Asia reminded members that domestic activities could not be prescribed in legislation. The DOH did however feel that there needed to be increased awareness around the legislation and the health risks associated with smoking. Households thus were targeted from a health as well as a general point of view and the DOH aimed to promote good health practices and to ensure that people received the necessary support to live healthier lives.

A member wondered what measures would be put in place to deal with vendors or shops that sold tobacco products to children under the age of 18.

Ms M Manana (ANC) noted that the proposed legislation recommended a penalty of R500.00 for smoking in public areas. She wondered how the DOH would ensure that the provisions got implemented effectively.

Mr G Morgan (DA) presumed that in terms of enforcement the largest part of the proposed legislation would rely on self-regulation. He wondered how successful the enforcement of penalties imposed under the existing legislation had been and whether the proposed increase in penalties was aimed at promoting self-regulation. He questioned such an approach’s practicality, and wondered if the fines paid in such cases would be used to enhance policing.

Mr Kleynhans explained that the selling of tobacco products fell under trade and would be dealt with in the Section 76 bill. The DOH intended to raise the age limit from 16 to 18, to bring it in line with the provisions of the Constitution.

Mr Morgan pointed out that his question had been more detailed than the answer he had received. He was interested in how successful policing was under the existing legislation and wondered whether the increase in penalties was an admission that current policing was not effective.

Mr Asia said that the DOH did not have specific statistics related to the member’s concern. The decision to increase fines and thus “having a much better handle on offenders” was based on the number of complaints the DOH had received about people who contravened the current legislation.

Ms M Matsemela (ANC) said that the economies of a number of countries, such a Zimbabwe and Malawi, relied solely on their tobacco industries. She wondered what impact the FCTC, to which South Africa was a co-signatory would have on them.

Mr B Mashile (ANC) asked whether there were any health benefits to tobacco. He wondered whether the legislation was a move towards banning tobacco completely.

Mr Asia explained that the legislation was not aimed at banning the production of tobacco or the manufacturing of tobacco products. It was aimed at making communities aware of the risks associated with smoking. Individuals could not be prohibited from buying cigarettes either. The intention of the legislation was “to instill the practice of healthy behaviour” and to encourage smokers to decrease their smoking so as to improve their health status and to reduce the impact of tobacco products. The purpose of the legislation was not to “kill the tobacco industry” but to place a certain responsibility on the manufacturers and advertisers of tobacco products to be more responsible in their advertising of these products.

Mr Mashile wondered whether there was any scientifically supported evidence that certain levels of tobacco usage had no hazardous effect on one’s health.

The Chairperson responded that tobacco was a health hazard.

Mr Mashile wondered why, if this was the case, the DOH had no intention of banning smoking.

The Chairperson said that banning smoking could be discussed at a later stage. The Committee was approaching the legislation before them on the premise that, unlike the dagga industry for example, the tobacco industry was a legal industry that had certain economic activities attached to it. However the health fraternity recognized that tobacco was a health hazard. There must thus be certain regulations towards ensuring that, where possible, the number of smokers be reduced. This point might be arrived at as the DOH sensitised people around the health risks attached to smoking.

He added that while a sledge hammer approach as far as the tobacco industry would be a very bad policy to follow, he felt it necessary that it be categorically stated, that tobacco was a heath hazard.

Ms Matsemela wondered whether it was not necessary to also regulate advertising of tobacco products so that tobacco companies did not monopolise the industry. The DOH had during the previous year reported that there were 400 chemicals in a cigarette. She wondered whether like with many other products, cigarette packets could not also be labeled to indicate what it contained.

Mr Asia responded that it was not possible to list all the chemicals contained in a cigarette on its packaging. These needed to be listed and communicated to the public. He felt that while the main ones could be listed on a packaging, it would not be possible to list all of them.

The Chairperson said that issues around packaging might have to be revisited at a later stage to evaluate what other methods could be used so that the legislation supported the listing of the most dangerous chemicals.

Ms Matsemela wondered how the DOH would regulate the sale of single cigarettes at enterprises such as spaza shops etc, where children could access them easily.

Mr Asia said that the sale of loose cigarettes would also be addressed by the legislation. It would be the communication of the practical implications of the legislation that would determine its success. It required interpretation and understanding. Communicating this information to communities was part of the implementation strategy.

He added that legislation needed to be simplified so that people would understand what was required of them.

Ms Manana was pleased that the DOH would invest in public education around the legislation and heath risks associated with smoking. She urged them to ensure that programmes at the level of implementation had indicators whereby implementation could be monitored. Experience had shown that while programmes might be good, the absence of indicators within the implementing institutions, made it very difficult to monitor and fast track them.

Ms Malumise wondered whether there was any way of removing hazardous chemicals from cigarettes so that they did not pose a health risk.

Mr Mahlako said that the legislation contained a clause which allowed for the regulation of the chemicals in tobacco products. The current legislation regulated nicotine and tar only. He felt that in time the levels of nicotine and tar would be reduced as had happened in the past. The FCTC required that even other chemicals in tobacco products needed to be disclosed and regulated.

National Council Against Smoking Presentation
Dr Yusuf Saloojee, Executive Director of the National Council Against Smoking (NCAS) presented the submission. The submission focused on the dangers associated with smoking, and called for amongst others, greater control of what was added to tobacco products, for the protection of domestic workers from second hand smoke, and for a ban on smoking in stadia and crowded spaces. There was also a need to reduce the fire risk associated with cigarettes.

Discussion
Mr Morgan wondered how prevalent, according to the NCAS’s research, smoking was at the moment and what effect the current legislation had on the levels of smoking. He realised that there has been talk of a drop in the number of smokers and was curious about the methodology that had been used to arrive at the statistics. He asked whether statistics were determined at the point of sale (in which case he questioned whether they were accurate since they might not include illegal sales), or according to a representative sample of a survey. He also wondered whether the last amendment to the legislation had had any effect on the illegal (black market trade) sale of cigarettes.

Dr Saloojee explained that when measuring smoking two factors were taken into account: the number of people who used tobacco products particularly cigarettes as well as the amount of cigarettes that were being smoked. The figures for the amount of cigarettes smoked usually came from National Treasury and therefore normally underestimated the impact of smuggling. The data on the prevalence of tobacco usually came from two sources: the Medical Research Council (MRC) and the South African Advertising Research Foundation (SAARF). Both of these sources reported that the number of cigarettes legally sold has dropped by 30-40%, and the number of smokers has also dropped from about 30% in 1994 to about 23 % currently. In 1994 there were 8.5 million smokers in South Africa, at present there were 5 million smokers. Three quarters of a million to 1.5 million people have reduced the risk of contracting smoking related health problems. He felt that South Africa’s smoking control legislation worked very well – an MRC study showed that the number of children who had never attempted smoking has increased between 1999 and 2002.

Mr A Madella (ANC) noted that the presentation indicated that while Snus appeared to be less harmful this might in actual fact not be the case. He wondered if it had any impact on dental health.

Dr Saloojee said that most agreed that Snus was less dangerous than cigarettes, which was the most dangerous form of tobacco use. He said that it was not safe. Sufficient studies had not been done on it. The Scandinavian countries were the only ones that had been using it for long enough for some information to become available on it. While there was no risk of developing oral cancer, there was evidence that it contributed to dental diseases such as lucoplacea, which was a precursor for cancer.

A member wondered whether the NCAS had ever investigated the sniffing of glue. She wondered how the Government could address the problem.

Dr Saloojee said that he was often asked about the impact of glue sniffing. Though seeing children sniffing glue broke his heart, he had not studied it and thus could not respond to the question apart from agreeing that it was extremely dangerous. He was also often asked about the smoking of dagga. He said that the human lung was designed for the breathing of clean air - smoke from dagga, tobacco, or a braai was bad for the body.

Ms Malumise pointed out that some people felt that it was unnecessary to regulate smoking in stadia since these were huge venues that had much ventilation.

Dr Saloojee said that when the World Cup of Cricket was held in South Africa, the venues were smoke free zones. If one wanted to smoke one had to leave the spectator areas. It had worked very well. The majority of South Africans were law abiding and respected the law especially when they knew that it made sense. For healthy people second hand smoke is not dangerous – it is at most an inconvenience and a nuisance. If one suffered from heart disease however, even short term exposure to second hand smoke could bring about changes in the blood supply to the heart. It is also dangerous to asthmatics.

Ms Manana said that the presentation made clear that smoking was a health hazard and that it killed. She agreed fully with paragraph 87 of the submission but feared that the proposed freedom of manufacturers to use the manufacturing process or technical design of their choosing to create self extinguishing cigarettes might be abused. She suggested that that part of the proposal be deleted.

Dr Saloojee agreed with the observation and accepted the recommendation.

The Chairperson suggested that when recommendations were made they should also refer to the section of the legislation which would be affected.

Ms Matsemela felt that the NCAS’ contention that private homes, which are workplaces for domestic workers be included as prohibited areas could lead to a “dicey” situation. Citizens had a right to privacy as well as a right to a healthy work environment. These rights were provided for in the Constitution. She suggested that all stakeholders (the DOH, legislators, tobacco companies and anti-smoking lobbyists) had to look at the mater critically so that an agreed upon solution could be found.

Dr Saloojee agreed that the situation was a difficult one. He agreed that a person’s home was his or her private domain and that that could not be legislated. However domestic workers, just like any other workers, had rights. The Constitution provided that if rights stood in conflict to one another, one could take precedence. He believed that a person right to health was more important. He reminded members that while ones home was ones private domain, social services would step in to remove and protect a child who was being abused there. He agreed that one needed to consider the matter carefully. There was an anomaly in the law and - it would be dangerous to afford more protection to certain workers than to others. He believed that when Parliament in 1998 decided to exempt private homes it made a mistake. One could not tell people that if they wanted to earn a living they had to be willing to endanger their lives.

Ms F Batyi (ID) pointed out that if an employee did not want to work in an environment where there was smoking, they were free to seek other employment.

Ms Matsemela quipped that candidates could at interviews enquire whether their prospective employers smoked or not.

Dr Saloojee urged members to bear in mind that South Africa had high levels of unemployment and that domestic workers many times did not have a choice as far as where they worked. This was why the law was an important form of protection.

The Chairperson referred members to the definition of ‘public place’ as it appeared in the Bill. The definition included the workplace. He agreed that workers did not choose where or how they worked. He raised cautioned that the practical implementation of such a provision would be difficult to police.

Ms Matsemela reiterated that there was no point in stakeholders pointing fingers at each other, but that they should work together. She asked what role the NCAS would play as far as their social responsibility was concerned.

Dr Saloojee explained that the NCAS went beyond just lobbying. It provided services that assisted people who wanted to stop smoking. It also assisted people exposed to second hand smoke who felt that their rights were being violated to fight for their rights and ensure that their rights were being respected.

Ms Matsemela said that citizens had faith that legislators would make laws that protected them, irrespective of how popular those laws were.

Mr Madella was curious about how FIFA treated smoking during the Soccer World Cup in 2006. The information would serve as a guide as for South Africa who would be the host country in 2010. He added that he would be in favour of banning smoking in stadia.

Dr Saloojee said that the Olympic Games had always been smoke free. When the Cricket World Cup that was held in South Africa it was the first time the event was smoke free. Negotiations were underway for the next one, which would be held in the West Indies, to also be smoke free. FIFA was slightly inconsistent when it came to the matter. In Japan the Soccer World Cup was supposed to have been smoke free. Germany, the only country in Europe that strongly resisted tobacco control legislation, had however strongly opposed having a smoke free World Cup. FIFA relented and allowed smoking in the stadia during the 2006 event. He felt “absolutely sure”, that FIFA would not put pressure on South Africa to revert national legislation. He added that the South Africa Football Association (SAFA) had worked with the NCAS to issue anti-smoking information to young people.

Mr Mashile was convinced that the tobacco industry would take action to counter the provisions of the Bill, and efforts to conscientise around the dangers of smoking so as to sustain their businesses.

The Chairperson said that this question was related to the importance of having methods of effectively policing adherence to the laws.

Dr Saloojee agreed and said that it was unfortunate that “cigarette companies go as close to the edges of the law” as they possibly could. He admitted that it was a vicious cycle – people lobbied for laws to protected health, and that the industry repeatedly found loopholes. He equated anti smoking legislation with tax laws. Lobbyists had no choice however they had to keep closing loopholes that the industry exploited so that people could be protected from this exploitation. The tobacco industry could not be allowed to continue lying to and deceiving people.

Ms C Dudley (ACDP) agreed that loopholes had to be closed. She wondered whether any research had been done into other behaviour that replaced smoking when smokers kicked the habit. She recalled that Australia experienced that with stricter tobacco legislation, the use of other substances increased and wondered if any research had been done in this regard.

Dr Saloojee said that no such research had been done in South Africa. International experience was very clear that giving up smoking did not result in an increase in drug use, alcohol abuse or the abuse of other substances. Young people normally started smoking because they thought it to be smart. They then became addicted. Breaking the addiction did not mean that they replaced one addiction with another. The only addiction people replaced smoking with was exercise – there was no need why one had to replace a negative addiction with another negative one.

The Chairperson wondered whether the NCAS was satisfied that Snus was also listed under the definition of tobacco products.

Dr Saloojee recalled that the old definition defined a tobacco product as a product that could be sniffed, chewed or sucked. He believed that the tobacco industry wrongly maintained that Snus did not fit this definition as it was not sniffed, chewed or sucked. The new definition defined a tobacco product as a product made of tobacco and intended for human consumption. He was satisfied that that definition included Snus.


Seventh^-Day Adventist Church Presentation
The Executive Secretary, Pastor Ebrahim Ishmael and the Director, Ms Leonie Theda presented the submission to the Committee. The presentation touched on amongst others the need for greater tobacco control, the dangers associated with subversive advertising, the pollution caused by tobacco smoke and the need for packaging to reflect the chemical makeup of cigarettes and other tobacco products.

Discussion
Mr Morgan wondered whether the presenters could supply the Committee with information as to where over the last five years, it had seen examples of the subversive advertising the presentation spoke of.

Ms Theda explained that this was “emanating in the children’s minds”. When they were then urged to participate in non-smoking programmes they refrained because they were living up to the example set by the sport and other celebrities.

Mr Morgan was curious as to where the presenters saw evidence of this type of advertising in South Africa, considering that it had been banned. He did not doubt the power of subversive advertising. But he was not sure of examples of such advertising happening as far as sport was concerned.

Pastor Ishmael responded that although South Africa’s tobacco laws prohibited such advertising, pictures of “hero figures” smoking were evident on television and in magazines. Tobacco companies did not have to explicitly advertise cigarettes.

Mr Morgan wondered whether the presenters wanted images of cigarettes banned from television and the print media.

Ms Theda explained that they were presenting that anything that might influence a child to think that his or her heroes were involved in a lifestyle that was not in keeping with a healthy one should be banned.

Ms Dudley asked whether the presenters were in favour of the proposed legislation or whether they wanted to make further proposals. She suggested that they give the Committee greater clarity in terms of any further amendments they would like to see made.

Pastor Ishmael said that legislation was not strong enough to protect children from being exposed to cigarettes in reality or via the media, in their homes. The Seventh Day Adventist church wished that the legislation be strengthened to prosecute perpetrators in this regard. They also wished that workers who work in private homes be protected from the effects of smoking. Legislation should be strengthened in this regard.

Ms Matsemela said that one understood that the purpose of the FCTC was two pronged: to increase fines and to close loopholes. She felt that paragraph 2.8 of the submission appeared to indicate that South Africa had so far doned nothing to adhere to the principles of the framework.

The Chairperson pointed out that South Africa signed the FCTC towards the end of 2006. South Africa thus had to implement the provisions of the FCTC as soon as possible. The proposed amendment to the legislation was a step in that direction.

Ms Manana agreed that adverts were not necessarily the only way of advertising smoking cigarettes. Images in television programmes and films also contributed to its popularity.

Ms Theda said that one needed to realize that cell phones were also used to send messages that influenced young people.

The Chairperson commented that even though subversive advertising was banned the tobacco industry would find other ways of promoting their products i.e. promotional parties at special venues. The youth would attend these functions and thus get introduced to smoking.

He said that the presentation indicated that there would be greater education and communication around the implementation of the legislating was necessary.


How to Fight the Tobacco Epidemic
Prof C Bolliger was from the University of Stellenbosch and specialized in pulmonary disease. The NCAS had requested him to make a submission. The presentation touched on the history of tobacco and the advertising of its products, the heath risks associated with smoking as well as the difficulty of kicking of habit and the need for medical assistance when trying to do so.

Discussion
Mr Morgan wondered how effective the presenter thought warning images on cigarette packs were. He asked whether the presenter could comment on the effectiveness of this measure which was used in Canada. Should South Africa be looking into that?

Prof Bolliger admitted that he was not too knowledgeable as far as these images were concerned. He knew that many years ago they were used in Switzerland too. At that stage it had not been very effective. He commented on the fact that smokers would continue their bad habit even after having seen these images of the effect smoking had on their bodies. He did not believe that the images were extremely effective.

Measures such as legislation and pricing were much more effective. From his experience in Switzerland and Germany he pointed out that if legislation became stricter, the social acceptability if smoking would change. This meant that smoking would no longer be the norm. Changing the norm would be the most effective measure against smoking as far as he was concerned. He added that telling a thirteen year old that smoking would cause lung cancer by the time they were fifty had little if any effect. A sport superstar admitting to having smoked and stopped would provide a much more powerful image.

Mr Mashile noted that the presenter pointed out that smoking could be prevented in young people. He wondered how this could be done.

Prof Bolliger reiterated that smoking was the most preventable cause of disease. The only way to prevent smoke related illnesses was to not start smoking begin with. In the light of the fact that 70% those who wanted to quite would fail, he said that it was very important for medical practitioners to give smokers who wanted to stop all the assistance they needed.

Ms Malumise asked Prof Bolliger to elaborate on the assertion that tobacco companies should not be underestimated.

Prof Bolliger said that he was a doctor and not a specialist on what tobacco companies did. If one considered how they moved away from using celebrities to advertise their products directly to rather using images that portrayed a particular lifestyle thus adjusting to changes in the legislation. He thought that they used brilliant advertising mechanisms to adjust to any changes in legislation. This should not be underestimated. Some of the most popular actors and actresses still smoked in their films. This promoted smoking and the associated lifestyle and allowed tobacco companies to make huge amounts of money. There were very subtle indirect ways of advertising. He added that it was costly to edit out every single image of a cigarette in a movie, and tobacco companies knew and exploited this fact. He said that South Africa had had a very successful on going campaign against tobacco but agreed that the moment one released a bit of pressure, tobacco companies got back in the game.

Ms Manana said that the public hearings were giving the committee a holistic view of the medical, economic and social dangers around smoking. South Africa was fortunate in that its laws were entrenched in a Constitution that called for cooperative governance and enabled a holistic approach. The hearings so far had shown the need to for all stakeholders to work together. A cooperative approach would add value to the implementation of policies and strategies to combat the dangers associated with smoking – lives would be saved and communities would benefit. The legislation together with cooperation would at end of day add value because it would save lives.

A member wondered if there was any way that harmful chemicals were not used on tobacco plantations. She wondered if cigarette manufacturing would be harmed if no chemicals were used on plantations.

Prof Bolliger explained that because he did not have enough knowledge of tobacco plantations to answer the member’s question. He did not know whether the chemicals used on plantations were present in the final product. What he did know was that tobacco companies did not want to kill their customer base, but wanted addicts to live long lives so as to continue buying their products. The industry was always developing filter systems whereby toxic damages could be limited. It was not possible to change the composition and still have an attractive product. Ideally one would want a pure nicotine delivery device similar to pharmaceuticals but that would not be attractive to the buyer. The ratio of tar to nicotine was normally tenfold and it was not possible to reduce the toxins to the extent that all the carcinogens would be reduced since smokers would then merely stop using the product.

The Chairperson thanked Prof Bolliger for the submission, which also exposed similar weaknesses as far as communicating the implications of the legislation to communities, as identified by the previous presenters. Government’s responsibility to communicate these implications needed to be addressed.

Prof Bolliger said that it appeared as though the Government was spending very little on smoke prevention and smoker cessation. Switzerland that lagged far behind South Africa as far as tobacco control legislation, used to spend R 30 million on these programmes. The Swiss government ad finally agreed to quadruple this amount and now spent considerably more on information projects at schools, on education for doctors to become smoking cessation specialists. Tygerberg Hospital had the only smoking cessation clinic in the country and this was clearly not sufficient. He had no doubt that some funding for more such clinics would have to come from Government.

The Chairperson said that Prof Bolliger had raised an important issue that would have to be addressed. The Committee would have to emphasise the need for a general information campaign around the issue. The efficacy of anti smoking devices would have to be stressed since smokers who contract smoking related illnesses became a burden to the public health system and yet these devices and cessation programmes were not Government funded.


Soul City Institute for Health and Development Communication Presentation
Ms Loura Pollecut made the submission applauded the increase in the age limit, and called for the definition of ‘organized event’ to provide for underage events, graphic labeling and the confinement of vending outlets to areas inaccessible to children.

Discussion
Mr Mashile wondered what Ms Pollecut thought of the belief that tobacco companies will develop means of sustaining the market in spite of legislative attempts to curb smoking.

Ms Pollecut responded that any dangerous product should be regulated. If there were ways that one could see the integrity within the industry was lacking one could use legislation to represent the public and its health.

The Chairperson stated for the record that the proposed legislation was not aimed at eradicating the tobacco industry but that the aim was to better regulate it. Evidence showed that the impact of the legislation was positive and that many people have stopped smoking less or stopped smoking entirely. The more vigilant one became and the more one ensured proper monitoring and regulation, the more successes would be seen. Soul City’s message also highlighted the need for education. He urged the Department to note that in whatever course of action was taken education and information and enforcement should correlate. Returning to Ms Pollecut he sought clarity one her Soul City’s concerns around ‘underage events’.

Ms Pollecut thought it necessary that the legislation needed to include a definition of underage events and not only organized activities. Children attending these activities should be protected from being sold and exposed to tobacco products. She knew of other legislation that provided for fines to be levied against people who sold certain products to children at underage events.

The Chairperson wondered how practical it would be to use warning images on cigarette packages. Prof Bolliger had earlier indicated that in his experience these images were not that effective. He commented that in the AIDS debate too it has been found that scare tactics did not necessarily work.

Ms Pollecut admitted that it was a difficult question to comment on, partly because there were so many contradictory reports. Canadian experience seemed to suggest that images of the harmful effects of smoking did indeed impact on the prevalence of smoking. She added that in very many situations particularly when talking about whether one could regulate smoking in someone’s working environment she felt that there was room for public education to create a feeling of consideration so that even if one smoked one did not impose that on other people. Being considerate did not really affect the smoker’s life. She felt that one had a greater chance of creating considerate smokers than at succeeding in getting die-hard smokers to quit.

The Chairperson said that the Committee would also have to consider proposals in terms of vending machines that sold cigarettes. There might be some unforeseen consequences that needed to be provided for. Members would have to think about the situation seriously about the regulations that governed where such machines could be placed.

Ms Pollecut said that she had some international examples of regulations for the placement of vending machines. These regulations could be very specific in order to ensure that children would not have the opportunity to use the machines.

The Chairperson thanked Ms Pollecut for her contribution and requested her to provide the Committee with copies of the international regulations she had referred to.

Goldfields Presentation
Dr Vanessa Govender, occupational medical practitioner at the Goldfields mine presented a submission dealing with the effects of smoking on miners who, due to the health risks involved in their work, were a particularly vulnerable group. The presentation touched on how smoking was legislated in South Africa as well as on the burden smoking placed on smokers’ health as well as on their employers. The bulk of the presentation focused on the impact smoking had on miners and the mining industry. Dr Govender welcomed the proposed amendments to the legislation.

Discussion
Mr Morgan thanked Dr Govender for her interesting presentation. It had been interesting to see what impact smoking had on a specific industry. He wondered whether there was a network whereby she could share her research at Goldfields with other mines.

Dr Govender felt that sharing of information was a critical component of any research. She was very grateful to the Mine Health and Safety Council (MHSC) who funded her research. The Council was very instrumental and supportive of promoting education around the health risks of smoking in mine communities in particular. They represented all commodities such as coal mining and other diversified mining groups.

Mr Morgan wondered whether Dr Govender could elaborate on her statement that if one smoked there was an increased risk of acquiring an HIV infection.

Dr Govender explained that smoking puts one at risk of acquiring any infection not only HIV. This was due to the suppression of immune systems. Smoking diminishes immunity and made one vulnerable to acquiring any infection, not only HIV. She admitted that the evidence in this regard was not convincing at present. Out of the six studies, five showed that smoking might be contribute to contracting infections including HIV.

Ms Matsemela wondered how viable demand reduction measures were.

Ms Matsemela noted with concern that ever since the start of that day’s hearings none of the presenters spoke of forming relationships with the tobacco companies. She pointed out that at the end of day all stakeholders would need to work together to find common solutions.

Dr Govender explained that over the last two decades health care workers in all areas had been intensely busy with controlling HIV and tuberculosis. This utilised much of the resources and energy. In the last two years ARV programmes had taken off at work places and nationally, which now left a window of opportunity for more work as far as smoking was concerned. It was not possible to start a programme at the mine when it would not be possible to extend it to the communities miners returned to. She agreed that public private partnerships were of vital importance if one were to address the problem successfully. Members had raised an important point and she too hoped that all stakeholders would be able to work together.

Mr Mashile knew much about life on mines and knew that any miners started by smoking dagga and then progressed to tobacco. He wondered whether any research had been done into that.

Dr Govender informed the Committee she had not done any research into the smoking of dagga because that was her particular area of interest. She could however confirm that substance abuse was prevalent on mines. She added that often young people who entered the working world started smoking because many were now for the first time economically active and could afford cigarettes. It was important to target these young people.

Mr Mashile wondered whether Dr Govender had ever received research or any other funding from the tobacco industry.

Dr Govender explained that smoking research on mines had only just taken off. Outside of her study (whose results were not yet ready to be published) only one other study had been completed. She reiterated that it was critical to look at partnerships if one wanted to move forward with tobacco control.

Mr Madella wondered how often miners had to be medically boarded due to smoking related illnesses.

Dr Govender said that unfortunately data related to smoking history was not very well established in most work places. There was a study that had been done on a platinum mines because the mine had a database where they entered smoking history on employment and followed it up. She had no information on how many smoking related job changes or disabilities there was. Occupational health centres had programmes in place whereby if a miner became disabled and could not continue working he could be counseled regarding all the risks. They did however not offer further services as far as treatment was concerned and those needed to be established now.

Ms Matsemela wondered how mines controlled spaza shops on mines that sold loose cigarettes.

Dr Govender agreed that loose cigarettes were readily available on the mines. She was not sure whether there was a regulation related to their sale but said that if there were, Goldfields would have to look into the matter so as to comply with the regulations.

The Chairperson said that one also needed to look into the question of packaging to determine whether the provisions in this regard were adequate. He wondered whether Dr Govender were satisfied with the proposed legislation.

Dr Govender said that the legislation would strengthen her work and give it more credibility.

Mr Mashile sought clarity on what the latent tuberculosis that everyone apparently had was.

The Chairperson explained that everyone had the TB bacteria and that the contracting active TB depended on the body’s resistance.

Mr Morgan sought Dr Govender’s opinion on the impact of vending machines selling cigarettes to miners. He wondered if she thought it necessary to include provisions related to vending machines in the legislation.

Dr Govender admitted that she had not really thought about the impact of vending machines. She was not even aware of how many vending machines there were on the mines and would have to look into the matter. She said that a large part of the socialization on the mines took pace in the hostels where spaza shops selling loose cigarettes were common. While the mines had been very good at trying to improve living conditions more work needed to be done to incorporate social responsibility.

The Chairperson thanked her for her contribution and said that he Committee might invite her back and might even visit Goldfields for first hand experience of how things were progressing.


Tobacco Institute of South Africa Presentation
The Chief Executive Officer of the Tobacco Institute of South Africa (TISA), Mr Francois van der Merwe made the presentation. He thought that much had been said against the tobacco industry and that members needed to get the industry’s view. He gave a brief background as to what TISA was, the challenges the tobacco industry faced, as well as what the industry thought of the proposed tobacco control legislation. He also cautioned against taxation that was too high, and the over regulation of the industry. Issues related to illegal trade were also touched upon. TISA made specific recommendations which it hoped the Committee would carefully consider in its deliberations.

Discussion
Mr Morgan thanked Mr van der Merwe for the presentation which offered a different view on the legislation. He wondered how TISA had arrived at the percentage of illegal trade purchases.

Mr van der Merwe explained the different companies did independent research across the country. The statistics were contained from the independent research results. In some of the more informal areas in Gauteng illegal trade accounted for more than 70% of the cigarette and tobacco sales.

Mr Morgan wondered what TISA’s thoughts were as far as the tobacco industry’s claim that it did not have enough capacity to introduce self extinguishing cigarettes. These cigarettes were used extensively in a number of countries with very little objection from the tobacco companies there.

Mr van der Merwe said that he was not an expert on self extinguishing cigarettes but he new that they were not simple to produce. He explained that the concept was still new and that most successes were reported in laboratory type settings. He suggested that experts were consulted before taking a decision in this regard. He added that while one could make legislation providing for these cigarettes, testing would still need to be done and that that was costly, time consuming and would need capacity that the South African Bureau of Standards (SABS) did not have. The SABS was trying to facilitate a roundtable between the DOH, the industry and themselves to formalize and drive discussions. He cautioned against making legislation that could not be implemented and pointed out that even tar and nicotine testing was not properly controlled at the moment.

Mr Morgan wondered whether TISA was in agreement with the provisions related to designated areas where smoking would be not be allowed.

Mr van der Merwe said that TISA had little input to make in that regard. They were not really concerned about where people would be allowed to smoke. Once the legislation reached the regulation stage the industry would need to meet with the DOH to come up with reasonable and implementable regulations. He said that if the Committee paid serious attention to their recommendations they would be happy to support the legislation.

As time was running out, the Committee agreed with the Chairperson’s suggestion to, in the interest of doing justice to the TISA submission, continue the discussion the following morning.

The meeting was adjourned.