/ 15 January 2025

Why South Africa’s smoking rate has declined in the 2020s

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In 2022, the South African Medical Research Council completed a landmark national survey of adult tobacco users. The survey found that 25.8 percent of South African adults – including a whopping 41.2 percent of men – are tobacco smokers. 

South Africa’s smoking rate is higher than the world average. That’s deeply concerning both for the smokers themselves and for their children, many of whom will likely become smokers as well.

Smoking also causes an incredible burden for the nation as a whole, with a 2016 estimate suggesting that smoking drains upwards of R42 billion from the economy – 0.97 percent of our entire gross domestic product. Moreover, 4.1 percent of South Africa’s total healthcare costs are spent on caring for people with avoidable smoking-related diseases.

The good news, though, is that things are getting better. South Africa’s adult smoking rate was 31 percent as recently as 1990, so the situation is definitely improving.

South Africa’s tobacco control efforts have produced particularly notable dividends in the 2020s, and this article will explain why.

Government intervention

South Africa was one of the first nations in the world in which the government implemented a tax on tobacco products to help curb smoking. South Africa implemented a value-added tax on tobacco in 1993 and a tobacco-specific excise tax in 1994. Taken together, the two taxes amounted to 50 percent of the retail price of cigarettes as of 1998. The tobacco excise tax has been periodically adjusted since then to keep it around that same level. 

The government has also enacted various tobacco control laws over the years in an attempt to curb smoking rates, including:

  • Establishing a national agency for tobacco control.
  • Banning smoking in many indoor environments, including schools, government buildings and healthcare facilities.
  • Mandating prominent health warnings on cigarette packs and preventing tobacco companies from using deceptive terms to market their products.
  • Implementing a ban on tobacco promotion and sponsorship.
  • Launching a free quit line that anyone can call for smoking cessation assistance (011 720 3145).

Traditional nicotine replacement products

Traditional nicotine replacement products are widely available in South Africa. These products have been available for decades, and while their success rates aren’t great, it’s been proven that using nicotine replacement therapy (NRT) – especially combined with professional counselling – increases one’s odds of quitting compared to attempting to quit cold turkey.

One drawback of NRT is that the drugs aren’t included on South Africa’s list of essential medications and therefore aren’t covered by the national public health system. Therefore, people need to pay for nicotine replacement products out of their own pockets, which can be difficult for those who already experience a significant financial burden due to high cigarette prices.

The three most common nicotine replacement products are:

  • Nicotine Gum: This was the first type of nicotine replacement product to be invented, and it essentially consists of a nicotine-impregnated chewing gum inside a sugar-free candy outer shell. You chew the gum a few times and place it between your gum and cheek when you begin to feel a tingle. When the tingle fades, you chew the gum again and continue the process for around a half hour. The nicotine absorbs through the soft tissue in your mouth.
  • Nicotine Lozenges: Nicotine lozenges are similar to nicotine gum in that the nicotine absorbs through your oral tissue. People who experience hiccups when using nicotine gum, however, may appreciate the fact that the nicotine in a full-sized lozenge is absorbed more slowly. Smaller fast-dissolving nicotine lozenges also exist for those who need them.
  • Nicotine Patches: A nicotine patch is a sticker that’s placed somewhere on your body – usually on the upper arm – and delivers nicotine to your bloodstream through your skin over several hours. Nicotine patches can cause bruising and yellowing on the skin, but the fact that they deliver a steady supply of nicotine all day makes them more effective for some people than oral nicotine replacement products.

Prescription medications also exist for smoking cessation, but they can have side effects and are best used only if traditional NRT has failed. You should only use a prescription drug for smoking cessation with monitoring by a physician.

Non-tobacco nicotine products

One of the biggest reasons why South Africa’s smoking rate has declined over the past several years is because alternative tobacco-free nicotine products now exist, and many people find those products more satisfying than traditional NRT. Those products are: 

  • E-Cigarettes and Vapes: An e-cigarette or vape is an electronic device that heats a liquid containing nicotine, turning it to vapour for inhalation. Because the vapour is inhaled, many people find vapes more satisfying than traditional nicotine replacement products. Using a vape also looks like smoking since the exhaled vapour resembles smoke. An additional benefit is that the nicotine liquid is available in a wide range of strengths, allowing you to reduce your nicotine intake as gradually as you wish. Nicotine-free vapes are also widely available. 
  • Nicotine Pouches: A nicotine pouch is a white pouch containing powdered nicotine along with flavours and vegetable-based fillers. You place the pouch between your gum and upper lip, and the nicotine absorbs through the tissue in your mouth. Nicotine pouches are similar to other oral nicotine replacement products in that way, but they differ from traditional NRT in that they’re available in a wider variety of flavours and strengths. Strong nicotine pouches may be useful for those trying to quit chewing tobacco.

A study published in the New England Journal of Medicine found that vapes – when combined with professional counselling – were about twice as effective as traditional NRT in helping people quit smoking. So far, the effectiveness of nicotine pouches for smoking cessation has not been studied. 

Heated tobacco products

Heated tobacco products (HTPs) are also available in South Africa. Unlike the products described above, HTPs do contain tobacco. That can be beneficial for some people because heated tobacco provides a flavour similar to smoking, but it can also be a drawback because although HTPs may be safer than smoking, they likely do not have the same safety profile as nicotine products that are tobacco free.

You use a HTP by inserting a stick of tobacco into a device with an electronically controlled heater. The device heats the tobacco until it releases the nicotine as vapour. Although using a HTP looks, feels and tastes similar to smoking, no actual smoke is released because the tobacco doesn’t combust. South Africa has implemented an excise tax on HTPs, but the tax is slightly lower than the tax on combustible cigarettes.

Conclusion: how South Africa can reach a smoke-free future

South Africa has made great progress in tobacco control since the 1990s, but we still have a long way to go in order to reach the goal of becoming smoke free. We hope that the government will use common-sense regulation to encourage existing smokers to adopt reduced-harm alternatives while simultaneously educating the public to help ensure that the youth of today never become nicotine users.