The Surveillance and Monitoring of Tobacco Control in South Africa

South Africa is situated at the southernmost tip of Africa and is divided into nine provinces: Western Cape, Eastern Cape, Northern Cape, KwaZulu-Natal, Free State, Gauteng, Mpumalanga, Limpopo Province and North West Province. It has a population of approximately 43 million, half of whom are under 19 years of age.(1) South Africa is considered a middle-income, developing country and has extremes of wealth and poverty due to 350 years of colonialism and apartheid1. Almost 78% of the population are “Black/African” (1) and they represent the majority of those living in poverty.(2) About 72% of the poor live in rural areas. (2) There are 11 official languages in South Africa. The history of tobacco control in SA dates back to the 1970s when tobacco use was banned in cinemas, followed by a ban on smoking on domestic flights.(3) In 1993 the first Tobacco Products Control Act (4) was passed and was implemented in 1995. It regulated smoking in public places, prohibited tobacco sales to minors under the age of 16 and regulated some aspects of advertising of tobacco products such as labelling. It was not a comprehensive act in that it had the following shortcomings: radio advertising was still allowed; smoking in public places was not banned completely; the definition of a public place was not specified, and no enforcement mechanism was built into the act. In 1995, health warnings were introduced for all tobacco packaging and tobacco advertising on billboards. Due to the shortfalls of the 1993 Act, the Tobacco Products Control Amendment Act was passed in 1999.(5) It primarily bans all advertising and promotion of tobacco products, including sponsorship and free distribution of tobacco products; it restricts smoking in public places, including the workplace and public transport; it stipulates penalties for transgressors of the law, and specifies the maximum permissible levels of tar and nicotine. The regulations were implemented in 2001.(6)