Implementation of WHO FCTC in Africa: Article 8 – “Protection from Exposure to Tobacco Smoke”

Globally, tobacco use causes 6 million deaths each year and estimated to reach over 8 million in the 2020s, over 80% of which will occur in low- and medium-income countries because of increasing usage rate and inadequate regulations. In the WHO African region (AFR), between 1970 and 2000, cigarette consumption increased from 91.2 billion to 212.8 billion sticks, which is mainly attributed to the tobacco industry's aggressive penetration. In 2003, the World Health Assembly adopted the WHO Framework Convention on Tobacco Control (FCTC) to deal with this problem of globalization of tobacco use. As of February 2012, 89% of AFR countries have ratified the FCTC, but majority of them do not have a comprehensive national law. As such, event history analysis was conducted to estimate the hazard and survival functions for adoption of components of Article 8 (smoking ban in public places, indoor or enclosed places, workplaces and public transportation) between 2003 and 2012. Additionally, multivariate logistic regression analysis was conducted to delineate key determinants of policy adoption. Although many AFR countries do not have comprehensive smokefree laws, different legal mechanisms were used to create smokefree environments, especially smokefree workplaces, public places and public transportation. While this study sheds light on implementation of Article 8 in AFR, it shows that in environments where comprehensive policies are difficult to enact, the public health community can champion the expansion of smokefree environments through different legal mechanisms, which in total can still achieve goals of all WHO FCTC articles.