Smoking causes more than 1 in 10 cardiovascular deaths globally. Smoking is the leading preventable risk factor for cardiovascular diseases such as ischemic heart disease (IHD), which narrows heart arteries, and cerebrovascular diseases. However, awareness of links between smoking and cardiovascular disease remains low in many parts of the world, including Africa. Supporting better tobacco control policy design and execution, the Tobacco Control Data Initiative (TCDI) seeks to increase access to country-specific tobacco control data for governments, civil society, and academia. The six country-specific TCDI websites provide stakeholders with data that will inform better tobacco control policy design and implementation through comprehensive primary and secondary research.  
In this blog post, we discuss the heart-related implications of tobacco usage with emphasis on their health and economic impacts in South Africa, Zambia, Ethiopia, Kenya, the Democratic Republic of the Congo (DRC), and Nigeria.

South Africa
Health Impact: According to the Global Burden of Disease Study (2021), over 32,000 people in South Africa died from tobacco-related illnesses (TRIs), including cardiovascular disease (see Figure 1 below). Cardiovascular diseases, such as ischemic heart diseases, hypertensive diseases, and other forms of heart disease, account for 22% of the country's total TRI deaths. Additionally, tobacco use contributed to 13% of non-communicable disease (NCD) deaths in the country.

Figure 1

Economic Impact: In 2016, the cost of tobacco-related diseases in South Africa was estimated at 42 billion Rand (USD 2.88 billion). Of this, 28 billion Rand (USD 1.58 billion) was attributed to lost productivity, while 14 billion Rand (USD 790.07 million) went to direct healthcare expenses.

Zambia

Health Impact: According to a 2019 UNDP report, tobacco consumption in Zambia caused approximately 7,100 deaths annually . The top three causes of tobacco-related deaths were lower respiratory infections (1,839 deaths), ischemic heart disease (1,629 deaths), and tuberculosis (1,032 deaths). Other cardiovascular diseases contributed to 373 deaths.

Figure 2

Source: UNDP/Ministry of Health (Zambia). 

Source: UNDP/Ministry of Health (Zambia)

Economic Impact: In 2016, Zambia's health expenditure on tobacco-related illnesses amounted to ZMW 154.3 million (US$ 9 million). Out-of-pocket expenses stood at ZMW 42.5 million (US$ 2.5 million), while private insurance covered ZMW 37.6 million (US$ 2.2 million). Additionally, indirect costs, including productivity losses and premature death, were estimated at ZMW 1.4 billion (US$ 82 million).

Kenya

Health Impact: According to a TCDI study in Kenya, cardiovascular disease accounted for 9% of all deaths associated with tobacco use, while 33% of those who had myocardial infarction (heart attack) had a history of tobacco use.

Economic Impact: In 2021, tobacco-related illnesses, including myocardial infarction, led to economic losses between US$544.4 million and US$756.2 million. Myocardial infarction alone accounted for $171.43 to US$233.06 million, primarily due to healthcare costs and lost productivity.

Nigeria

Health Impact: The Global Burden of Disease report for 2021 attributed 29,605.1 deaths in Nigeria to tobacco-related illnesses. In the same year, smoking was associated with cardiovascular disease and ischemic heart disease deaths, resulting in approximately 4,806.55 and 2,794.32 deaths, respectively.

Economic Impact:  In Nigeria, tobacco-related CVDs cost approximately N273 million (US$ 890.1 thousand), and the National Tobacco Control Act has been implemented to reduce tobacco's impact on IHD, especially in light of rising shisha use among younger demographics.

Democratic Republic of Congo (DRC)

Health Impact: Noncommunicable diseases (NCDs) like cardiovascular disease, cancer, and diabetes are major health challenges in the DRC.  The GBD 2021 report estimated that there were 4725 deaths from tobacco-related cardiovascular diseases and 2579 deaths from ischemic heart diseases. In the DRC, the mortality rate due to smoking in 2019 was estimated at 4.05%. 

Economic Impact: Tobacco-related illnesses, such as cardiovascular diseases, have imposed significant economic burdens on the DRC. Between 2019 and 2021, budget allocations for the health sector reached 165.54% in 2020, yet households continue to bear a substantial portion of health costs. While tobacco taxes are collected, none are allocated to public health, violating the "polluter pays" principle and exacerbating economic strain on health systems.

Ethiopia

Health Impact: Tobacco use contributes to 5% of all non-communicable disease (NCD) deaths in Ethiopia, with 29% of these deaths attributed to cardiovascular diseases, as reported by the Global Burden of Disease (2021). Additionally, the estimate reveals that in 2021, tobacco was responsible for 1.14% of all deaths and accounted for 0.8% of years of life lost. According to Tobacco Atlas (2023), tobacco use is responsible for over 9,884 deaths annually in Ethiopia. 

Economic Impact: Tobacco places a heavy economic burden on Ethiopia, costing around 1.391 billion Ethiopian Birr (US$43.6 million) each year due to healthcare expenses and lost productivity (WHO, 2020). Additionally, smokers spend about 11.7% of their income on cigarettes, depriving them of resources that could otherwise help reduce poverty. 

The significant burden of non-communicable diseases, especially cardiovascular diseases, is evident across these nations, with tobacco-related deaths disproportionately affecting men. The economic costs, both direct and indirect, from healthcare expenses to lost productivity strain already fragile healthcare systems. Furthermore, environmental degradation linked to tobacco production exacerbates the long-term impacts on these emerging economies. Addressing the tobacco epidemic through stronger regulatory frameworks, public health campaigns, and sustainable alternatives is crucial to mitigating these multifaceted consequences and promoting healthier, more resilient societies.

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The educational landscape across sub-Saharan Africa is marred by daunting challenges, with persistently poor learning outcomes standing out as a cause for urgent concern. Despite decades of concerted interventions, evidence indicates a distressing regression in learning performance over the past half-century. Amidst these pervasive challenges, it is imperative to recognise and explore the modest, yet discernible progress achieved, that lay the groundwork for more transformative developments in education.

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This blog was first published by Education and Development Forum (UKFIET) .

The Finance for Development Lab and the Paris School of Economics hosted the 7^th edition of the Interdisciplinary Sovereign Debt Research and Management Conference (#DebtCon7), from May 29 to 31, 2024, at the Paris School of Economics. 

The conference brought together scholars, civil society representatives, and practitioners from the public and private sectors who work on sovereign debt, to help find creative solutions for urgent debt policy challenges.

Day one of the conference provided a platform for African think tanks to discuss new and emerging solutions to countries indebtedness.  CSEA’s Senior Research Fellow, Mma Amara Ekeruche, presented the Centre’s plan for a newly commissioned study on Debt Sustainability Analysis (DSA).

The study aims to improve the mechanisms of the current Lower-Income Countries’ Debt Sustainability Framework (LIC-DSF) andDebt Sustainability Analysis for Market-Access Countries (MAC DSA), by undertaking a historical examination of DSAs since 2005 and leveraging on insights from country officials. The overall outcome is to provide an alternative to the existing DSA framework.

Here are eight key takeaways from her participation in the conference:
1.        Bad fiscal policy is not the only reason for the rising indebtedness, the balance sheet effects of currency depreciations are also a key driver particularly in the context of high external loans.
2.        Improvements in restructuring whether nominal haircut restructuring or reprofiling is possible by adopting Collective Action Clauses (CACs) and/or engaging in Debt for Nature Swaps particularly before the high yielding debt becomes excessive. However, CACs cannot be integrated into some forms of loans such as syndicated loans and quasi debt. In such cases, legal reforms should be proposed and the best places to begin are countries that are well integrated into the international trade and financial systems.
3.        On climate-smart debt management, solutions include: (i) Climate-resilient clauses in official and commercial loans (ii) Catastrophe-Deferred Drawdown Options (CAT-DDO’s) (iii) Catastrophe bonds and (iv) KPI bonds whose interest rates reduce once emission targets are met.
4.        Issues with “new” innovations. State-Contingent Debt Instruments (SCDI) are value recovery instruments – creditors get higher yields when the state variable (e.g., oil price, GDP growth) improves. However, SCDIs have very low liquidity, are traded at low prices, and in most cases, their valuation is not backed by science. Another issue with new inventions is the proliferation of climate funds – there are now 70 of them!
5.      Debt gone wrong: Congo vs Commisimpex- Here, Congo took on an oil-backed supplier credit in 1986 and did not fulfil its debt obligations. Fast forward to nearly 4 decades after, the debt obligation has morphed into 675 million Euros and the International Court of Arbitration has mandated that Congo makes the payment.
6.     The European Bank for Reconstruction and Development (EBRD) is expanding its portfolio to emerging markets including Nigeria and a few other African countries. Their main aim is to lend to SMEs through African financial institutions.
7.     Debt is now being considered as “investment” by some courts which makes it possible for creditors to collect debt claims by leveraging on investment treaties.
8.  Trade is the most likely solution to the reoccurring debt problem in many African countries as exemplified by Mexico with North American Free Trade Agreement (NAFTA).

Tobacco smoking is a significant risk factor for noncommunicable diseases such as chronic respiratory disorders, cancer, diabetes, and heart disease and the leading cause of preventable deaths worldwide. Current estimates indicate that cigarettes alone are responsible for 8.7 million deaths annually, and 7.7 million of these fatalities are attributable to smoking, whereas 1.3 million are the consequence of secondhand smoke exposure among nonsmokers. Studies also reveal that many individuals begin smoking before the age of 18 as a result of  the tobacco industry frequently targeting youth in low-income countries with its marketing efforts (WHO report).  

CSEA, in its capacity as a sustainability partner  of the Tobacco Control Data Initiative (TCDI 2.0) established by Development Gateway, has compiled a factsheet commemorating World No Tobacco Day 2024. This document highlights facts about tobacco prevalence amongst children and the tobacco industry's interference in countries —Nigeria, South Africa, Kenya, the Democratic Republic of the Congo, Ethiopia, and Zambia

Afro beats have grown in popularity, both locally and globally, during the last decade. Its success extends beyond music, to the film and fashion industries. The widespread availability of internet access has given rise to a subgroup known as skit makers and influencers. Currently, the Nigerian entertainment sector has the second-largest position worldwide, after Hollywood (International Trade Administration, 2023). According to a report by PwC, this industry is expected to generate a revenue of USD 12.9 billion in sales by 2027, emphasising its huge untapped potential, primarily driven by the private sector.

According to the CBN statistical bulletin,  the arts and entertainment industry contributed no less than 0.20% from 2016 to 2021. However, in 2020, the industry growth rate fell to a record low of  -3%. In 2021, there was a substantial rebound, with a growth rate of 1.72%, suggesting an improvement in the sector's performance over the previous year. The downturn was mostly driven by the pandemic, which had an impact on industries all across the world. Hollywood, for example, suffered a $7 billion loss as a result of the pandemic. Despite these limitations, COVID-19 created a new revenue source through skits and reels, with local content creators building   sizable online followings during the pandemic.

Based on estimates from the United Nations Educational and Scientific Organisation (UNESCO) the creative economy generates $2.25 trillion in yearly income and contributes 30 million jobs globally, demonstrating  the vast economic prospects that await exploration. Nigeria is  in a unique position to effectively integrate its entertainment industry into the global creative economy, establishing itself as a key player in the international market. 

Despite the industry opportunities and potential for job creation, it is still hampered by several  challenges, including substandard technology and filmmaking equipment, copyright infringements, and piracy which impede potential investments, as well as limited access to funds and a lack of robust Foreign Direct Investments (FDI). The lack of a   well-defined industry structure as well as insufficient project development and business planning impede the sector’s ability to reach its full potential. 

To overcome  these challenges and increase the industry's contribution to the country's GDP, the Federal government can take strategic actions in the following ways:

1. Investment in Arts and Entertainment:

The Federal government should invest in infrastructure and training to encourage the expansion of the entertainment industry. This includes building and maintaining cutting-edge studios and production facilities, as well as  executing training programmes aimed at improving   the skills and knowledge of experts in the field. 

2. Access to Funding:

Allow for easier access to funding for both new and existing participant players in the entertainment industry. This can be achieved through government grants, partnerships with financial institutions, and the creation of investment incentives. 

3. Awareness and Enforcement of Intellectual Property Protection:

Nigerians intending to navigate the entertainment industry must be educated on intellectual property to maximise their opportunities and avoid copyright infringement and unauthorised use of their content. The government must strengthen intellectual property regulations to prevent copyright infringements and piracy. A safe intellectual property environment will encourage both local and foreign investment while also protecting the rights of content creators. 

4. Establish a collaborative Industry Task Force:

Establishing an industry task force comprising industry experts, government representatives, and key stakeholders. This task force will evaluate the current state of the sector and develop a strategic plan, working together to define and implement industry standards, guidelines, and best practices. This coordinated effort will strive to establish an organised and standard framework for operations, ensuring a comprehensive approach to industry development.

This blog was written by Ditep Nantep Rejoice, Research Intern at CSEA.