A Deadly Trade-Off: Tobacco's Toll in Pakistan Echoes Warnings for South Africa
Each year, tobacco use kills approximately 164 000 people in Pakistan, according to the World Health Organization (WHO).
In Pakistan's power corridors, a troubling trade-off is quietly unfolding—one where human lives are weighed against financial returns.
Tobacco, despite its well-known links to disease and death, remains deeply embedded in the country's economy. Now, as death tolls rise and public hospitals overflow, the government faces a grim dilemma: protect public health or preserve a major source of national revenue. Each year, tobacco use kills approximately 164 000 people in Pakistan, according to the World Health Organization (WHO).
These aren't just statistics — they represent parents, workers, and teenagers lost to lung cancer, heart disease, and stroke. Tobacco-related illnesses have become a major part of the country's non-communicable disease burden, which is steadily increasing.
Yet, tobacco products remain widely accessible, lightly regulated, and marketed in subtle ways—especially to the youth. While cigarette packs carry graphic health warnings and anti-smoking campaigns exist, these efforts are undermined by lax enforcement and powerful industry influence. This paradox—acknowledging tobacco's harms while benefiting from its profits — is not unique to Pakistan.
The situation offers a cautionary tale for South Africa, where similar tensions exist. In 2023–24, Pakistan's tobacco industry contributed over 200 billion Pakistani rupees (roughly R13.5 billion) in taxes, according to the Federal Board of Revenue. This includes excise duties and sales tax, mostly from cigarettes. For an economy under pressure — facing budget deficits and IMF obligations — this income is difficult to ignore.
However, this revenue comes at a steep cost. A 2021 study by the Pakistan Institute of Development Economics (PIDE) found that tobacco-related illness and death cost the economy over 615 billion rupees annually — about R41 billion. In other words, for every rand (or rupee) gained from tobacco, three are lost managing its consequences. This economic burden is familiar to South Africans.
Our tobacco-related healthcare costs are estimated in the billions annually, with thousands of deaths attributed to smoking.
As in Pakistan, the presence of a strong tobacco lobby and a thriving illicit cigarette trade complicates reform. In both countries, lawmakers from tobacco-growing regions are reluctant to take action, often citing job losses and the risk of fuelling illegal trade. In Pakistan, illicit cigarettes are thought to make up over 30% of the market, though experts dispute the figure. South Africa, too, has struggled to control the spread of untaxed, unregulated cigarettes, especially during and after COVID-19 lockdowns.
Pakistan's youth smoking rate is another red flag. Around 10% of schoolchildren aged 13–15 use tobacco products.
Public health officials say this reflects a failure in education and regulation. The glamorisation of smoking, peer pressure, and the availability of single cigarettes all play a role, factors that South African schools and communities also grapple with. Meanwhile, newer nicotine products like e-cigarettes and heated tobacco devices are complicating efforts further.
Marketed as 'safer' alternatives, these products are growing in popularity among urban youth in both Pakistan and South Africa. But experts warn that their long-term health effects remain uncertain and that they often serve as a gateway to traditional smoking.
For now, Pakistan's healthcare system is straining under the pressure.
Overcrowded oncology wards and under-resourced rural clinics are unable to cope with the long-term fallout of tobacco use. South Africa's public health system, already stretched by TB, HIV, and NCDs, could face a similar crisis if tobacco regulation remains inconsistent.
Despite repeated calls from health advocates, bold political leadership on tobacco control remains absent in Pakistan.
Public health often takes a backseat to short-term economic concerns — a reality that rings true in South Africa as well. As both nations face growing, youthful populations and rising urbanisation, the choices made today will determine future health outcomes.
Pakistan's silent struggle with tobacco offers a clear warning: delaying action comes at a deadly price.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Daily Maverick
5 hours ago
- Daily Maverick
Newly planted indigenous trees rise against bark stripping in Cape Town
A new seedling planting initiative is revitalising Newlands Forest in Cape Town, bringing together traditional healers, SANParks and conservation groups to tackle illegal bark stripping. Thousands of centuries-old indigenous trees in the Newlands Forest have been dying from pervasive, illegal and unsustainable bark stripping. Stripped bark is typically used for rope, dyes and paints, canoes, and by traditional healers for cultural and medicinal purposes. On its ancient trees you can see the scars with patches of missing bark, sometimes circling the entire trunk, a practice known as ring-barking that serves as a death sentence. This illegal bark stripping, driven by a market where a single piece can sell for between R100 and R200, is killing 100-year-old, seed-bearing indigenous trees and disrupting the forest's natural regeneration. The problem has become so widespread that, according to Niel Williamson, co-founder of the Newlands Forest Conservation Group, 'there's actually no part of the forest that hasn't been affected'. Williamson told Daily Maverick they have been concerned about the bark stripping and the impact on the forest for years and that it seemed to increase around the Covid-19 pandemic. While acknowledging the need for traditional medicines and bark for cultural uses, Table Mountain National Park (TMNP) manager Megan Taplin told Daily Maverick that responsible harvesting was needed to prevent the demise of the trees and the long-term health of the forest. When too much bark is removed, particularly through 'ring barking,' the tree dies, impacting potentially hundred-year-old, seed-bearing trees and disrupting the forest's natural regeneration. For years, the response focused on enforcement, but the demand for bark for traditional medicine persisted. Now, SANParks is using an integrated strategy to try to heal the forest from the ground up, with those who might be using the bark. 'There is no point just doing the law enforcement actions when the demand is still going to be there,' explained Taplin. 'We have to make sure that we deal with it in an integrated way.' TMNP approached various stakeholders including the Sugarbird Trust, Newlands Forest Conservation Group and the City of Cape Town to begin conversations about collecting seeds, germinating those seeds and replanting them in areas that had been most affected by bark stripping. Now it's got to this point where seeds have been collected in the forest, which were propagated in nurseries, and planted in the areas which have been most affected by bark stripping. The first planting began on Friday, 20 June 2025 along the Woodcutter's Trail. Donovan Antonie, section ranger for Newlands Forest, told Daily Maverick: 'They remove up to 90% and in some cases 100% of the bark, stripping from the bottom up… That's the crucial part of the tree and kills the trees at the end of the day.' Antonie said they have been trying to put proactive measures in place to reduce the loss of these trees. This includes raising awareness of the problem, painting trees with watered-down PVA paint to deter bark strippers, and law enforcement to apprehend bark strippers. In the past three months there have been four arrests in Newlands. The seedling planting on Friday indicated a stronger shift in SANParks' multipronged approach that moves beyond mere law enforcement – including intelligence gathering and proactive solutions such as painting mature trees. Now they have begun seed collection and planting indigenous trees in affected areas and are working with traditional healers to create awareness and find sustainable solutions. Day of planting: A ritual of restoration The trek up to the Woodcutter's Trail in Newlands Forest on Friday for indigenous tree planting with traditional healers from the Traditional Healers Organisation (THO), SANParks and conservation organisations was a wet and muddy journey through a richly shaded forest. The trail began with a steady uphill climb, winding through indigenous forest on a well-worn path that can be rocky and uneven in places, especially after rain. The group gathered to begin the first phase of indigenous seedling planting. More than 50 seedlings were planted. But before the planting began, traditional healer Jongwa Mdumata performed a ritual to bless the day's activities. Mdumata said they came to appreciate the natural environment that surrounded them, with plants and trees that were designed to sustain humanity and the earth. 'Let us preserve the natural environment amongst us,' he said. Hipor Hlathana, coordinator of the Traditional Healers Organisation's Langa branch, was part of the tree-planting efforts and has been a traditional healer since 2008. She explained that they use tree leaves and roots to heal the nation, but that they looked forward to learning more about sustainable ways of harvesting these materials. 'Families have got trees that belong to them. Part of the trees that belong to families is the Umnquma (Wild Olive tree) at Table Mountain, you cannot do any cultural event without a branch of it. But we know it is very scarce, so they are now going to equip and empower us more on how to harvest it because from generation to generation, we are still going to do cultural ceremonies,' said Hlathana. Umnquma is still going to be needed by generations to come, so Hlathana said it was their duty to ensure that it is harvested sustainably. Hlathana said that they needed more knowledge and information on how to do the harvesting for their medicine, and that they needed to find a way to balance conservation with cultural practices. Workshops with traditional healers are planned to discuss challenges and explore sustainable harvesting methods, hopefully ensuring the forest's preservation while respecting traditional practices. The traditional healers from THO who helped in the planting with SANParks were not the ones coming to the forest to strip the bark, but Taplin said they might be using the products and not know that it was unsustainably harvested and harming the environment. Replanting and future-proofing the forest Trevor Adams, based at the Cape Research Centre, provided further insight into the seedling planting process. With a horticultural background, Adams and the Biodiversity Social Projects (BSP) team have been diligently collecting and germinating seeds. He clarified that the plants being introduced are seedlings, not mature trees, since they are taking 'baby steps' to see what works best. The seedlings, including Cape Beech, Wild Almond, Bladder Nut and Cape Olive, are strategically planted, with taller, slower-growing trees placed next to faster-growing 'pioneer trees' to provide support, structure and shade, mimicking natural forest growth patterns. Taplin said: 'This is just the first such initiative of replanting in areas where they have been affected by bark stripping, where trees have died off, and there will be more in future. 'We need to try and curb illegal activities in the park… It's not so easy to contact the bark-stripping groups, because they're aware that they're doing an illegal activity, and they'll try not to be found. 'But that's why we want to engage with more traditional healers, so that they can make sure that where they are buying the bark from, it was sustainably harvested or harvested with a permit, instead of illegally harvested.' Looking ahead, SANParks plans to initiate a 'cultural demands survey' within the park to identify the various groups using Table Mountain National Park and the purposes of their visits, encompassing cultural, religious and recreational activities. While recreational users are well understood, there is a recognised lack of information about cultural, religious or spiritual uses, and new groups are continually being identified. Taplin said that understanding these diverse uses, including specific needs such as the requirement for fire in ceremonies or the use of particular plants, was crucial. She said the gathered information will enable SANParks to develop strategies that allow these needs to be met safely and sustainably within the park, fostering a collaborative approach rather than relying solely on apprehension for illegal activities. DM
The South African
a day ago
- The South African
‘We have dreams': SA youth with intellectual disability seek jobs
Youth with intellectual disability face steep barriers to employment and support in South Africa. Yet, they are often forgotten in public discussions about unemployment. ADVERTISEMENT Having an intellectual disability (ID) limits a person's ability to learn and execute daily tasks. Roughly 4% of South Africans are affected by some level of ID, ranging from mild to profound. According to the South African Federation for Mental Health (SAFMH), ID continues to be one of the most overlooked disabilities in the country. While there are some opportunities available, people with ID want more support. Stigma makes having a disability 'not nice' Weekdays from 8am until 5pm, 28-year-old Zintle Sophangisa handles fabric that will become pants and jackets, and marks out where the pockets will be sewn. A fashionista from Nyanga in Cape Town, she is saving for a sewing machine, dreaming of starting her own clothing label. However, arriving at this period of hope was a gruelling journey. Zintle's mild intellectual disability means she struggles to read and write. She often forgets things, like her bank PIN. ADVERTISEMENT Situations where other people are impatient (like in the queue for the ATM) heighten her anxiety and depression. She tells The South African: 'It's not nice to have a disability because of the judgment.' South Africa has an Inclusive Education policy, but many children with disabilities are still not adequately supported in schools. Zintle recalls being endlessly teased at school because of her disability. Between that and struggling with academics, she left school during Grade 9. Overcoming isolation in protective workshops However, almost ten years later, Zintle was a mother, keen to earn a living. After hearing that local mental health organisation Cape Mental Health supported people with ID, she enrolled in their Training Unlimited Workshop (TWU) in early 2024. In this protective workshop, people with disabilities can earn an income through tasks like beading or recycling metal. Trainees also learn work skills and how to cope with their disabilities. Support measures for people with mild intellectual disability include: Easy-to-Read , a system of symbols and simplified text, assists Zintle in understanding documents. , a system of symbols and simplified text, assists Zintle in understanding documents. Voice-enabled apps help Zintle keep a diary and a to-do list. help Zintle keep a diary and a to-do list. Voice notes on messaging apps allow Zintle to communicate without reading or writing. Zintle now finds it easier to explain her disability and ask for support. She also feels a stronger sense of belonging. Supported employment: Hope for youth with intellectual disability? Persons with disabilities have a constitutional right to employment. However, a 2023 research paper indicates that most are jobless. Also, increased learnership enrollments have not improved employment outcomes for people with disabilities. Samantha Hendricks, Zintle's job coach at TWU Athlone, says employers are reluctant to hire people with disabilities. In 2024, 12 workshop trainees were placed in jobs. Of 171 trainees at TWU Athlone this year, she's placed eight so far by engaging with 12 employers. 'People think that we are lazy,' Zintle explains. However, with government funding, she completed a sewing course in 2024, which led to her current job in supported employment. The 2016 White Paper on Rights of Persons with Disabilities defines supported employment as ongoing support, including job coaching, in integrated work settings. For Zintle, it also means her supervisor encouraging her to take breaks when she is very anxious. Jobs for youth with intellectual disability are 'elusive' Deputy Minister of Employment and Labour Jomo Sibiya recently told Parliament that enforcing disability-related provisions of the Employment Equity Act is key. 13 state-run factories also employ over 1000 people with disabilities, aiming to reach 3000 by 2030. However, Michel'le Donnelly, communications and awareness lead at SAFMH, which represents mental health organisations like Cape Mental Health, says: 'Employment in the open-labour market remains elusive for youth with ID.' SAFMH recognises that the general youth unemployment rate of 46.1% makes it harder for youth with ID to find work outside protective workshops. However, it wants government to do more to encourage supported employment in the private sector. Following dreams starts with support systems The government disability grant tangibly supports over 1 million people. But Zintle stresses that the grant is not the answer: 'We can't just apply for SASSA. No, we have dreams.' Zintle dreams of compiling her memoir and employing others with ID in her future fashion business. She encourages others with disabilities to seek support: 'It's hard for us to tell people that we want something, especially when you don't get the support, but people must try to speak out. Say, 'I want to do this. Can you support me to do this thing?'' What should be done to include youth with intellectual disabilities? Let us know by leaving a comment below or send a WhatsApp to 060 011 0211. Subscribe to The South African website's newsletters and follow us on WhatsApp, Facebook, X, and Bluesky for the latest news.
IOL News
2 days ago
- IOL News
Cataracts explained: What they are and why you shouldn't ignore them
As we mark Cataract Awareness Month, it's a good time to bring our eye health back into focus because the truth is, cataracts are the world's leading cause of blindness. Image: Şeyhmus Kino/pexels You'd be forgiven for thinking cataracts are an 'old person's problem'. After all, we often associate them with grey hair and reading glasses. But more South Africans are being diagnosed with cataracts much earlier in life and it's affecting how they live, work and drive, especially at night. So, what's going on? And do you always need surgery to fix it? As we mark Cataract Awareness Month, it's a good time to bring our eye health back into focus because the truth is, cataracts are the world's leading cause of blindness, according to the World Health Organization, yet they're also one of the most treatable. What are cataracts, really? Simply put, cataracts happen when the lens of your eye becomes cloudy, almost like someone smeared Vaseline on your glasses. Wesley Language, an optometrist from Execuspecs, explains, 'It's like looking through a foggy window. Over time, it distorts your vision, dulls colours and makes tasks like reading or recognising faces difficult. While age is a major risk factor, cataracts don't always wait for your 60s. In fact, younger South Africans, some in their 30s and 40s, are experiencing early-onset cataracts due to factors like: Diabetes Smoking Excessive sun exposure Eye injuries Family history 'There's a misconception that eye problems only start later in life,' says Language. "But by the time you're struggling to see at night or feeling like your glasses never work quite right, the cataract may already be advanced.' While age is a major risk factor, cataracts don't always wait for your 60s. Image: Karolina Grabowska/pexels How cataracts disrupt daily life The early symptoms of cataracts can be subtle slightly blurry vision, sensitivity to light, or colours looking a bit faded. But as they progress, they can seriously impact your quality of life. You might: Struggle to drive at night due to glare from headlights Avoid reading because the text feels too fuzzy Feel disconnected in social settings because faces aren't clear Experience frustration at work, especially in front of screens. This kind of slow, creeping vision loss can be isolating, especially for younger people who aren't prepared for it. Do you always need surgery? The good news is that not every cataract needs surgery right away. If caught early, your optometrist may recommend regular monitoring, stronger prescription lenses and lifestyle changes to slow progression. But when cataracts begin to interfere with daily functioning, such as when you're constantly squinting at your computer or feeling unsafe driving at night, surgery is often the best option. And thankfully, it's one of the most common and successful surgeries in the world. The cloudy lens is simply replaced with a clear artificial one, often restoring vision almost immediately.'It's a life-changing procedure,' says Language. 'Patients often don't realise how much they've adapted to poor vision until they see clearly again.' Can you prevent cataracts? not every cataract needs surgery right away. If caught early, your optometrist may recommend regular monitoring, stronger prescription lenses and lifestyle changes to slow progression. Image: Antoni Shkraba Studio /pexels
