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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