The third edition of the World Health Organization WHO report on trends in prevalence of tobacco use says tobacco kills and sickens millions of people every year. Around 8 million people died from a tobacco-related disease in 2017. According to the report, the number of annual deaths can be expected to keep growing even after rates of tobacco use start to decline, because tobacco-related diseases take time to become apparent.
A global commitment to reversing the tobacco epidemic was made in 2003 when member states of the World Health Organization adopted the WHO Framework Convention on Tobacco Control, which lays out specific, evidence-based actions that all parties to the convention should take to effectively reduce demand for tobacco. World Health Organisation says in 2000, around a third, or 33.3% of the global population both sexes combined and aged 15 years and older, were current users of some form of tobacco.
By 2015, this rate had declined to about a quarter, or 24.9 per cent of the global population. Assuming that current efforts in tobacco control are maintained in all countries, the rate is projected to decline further to around a fifth (20.9%) of the global population by 2025. It was further shared that in the same year 2000, around half of men aged 15 years and older were current users of some form of tobacco. By 2015, the proportion of men using tobacco had declined to 40.3%.
By 2025, the rate is projected to decline to 35.1 per cent. Around one in six women or 16.7 per cent aged 15 years and older were current users of some form of tobacco. In 2015, the proportion of women using tobacco had declined to under one in ten. By 2025, the report says the rate will decline to 6.7%. In 2000, according to WHO report, the proportion of males using any form of tobacco was three times the proportion of users among women. By 2015 the rate for males was more than four times the rate of females.
By 2025, the rate for males is expected to be five times the rate of females. The 2025 target set under the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020 specified that countries should strive to achieve a 30 per cent reduction in tobacco use prevalence using 2010 level as baseline. This translates to a maximum total tobacco use prevalence rate of 19.1 per cent for the total population aged 15 years and older, 30.2 per cent for males and 8.0 per cent for females.
The trend analyses undertaken for this report indicate that the reduction target will not be met for males but will likely be met for females. The projected 2025 prevalence rate of 35.1 per cent for males would be short of the target by an absolute 4.9 per cent. The projected 2025 prevalence rate of 8.0 per cent for females would exceed the target by 1.3 per cent.
Overall, the report indicated that the global target for the total population will fall short of meeting the overall global target of 19.1 per cent by 1.8 per cent. Instead of achieving the 30% relative reduction globally called for in the NCD target, the relative reduction likely to be achieved based on current efforts is 23.4 per cent (18.8 per cent and 41.2 per cent for males and females respectively)
Further, the report noted that there has been a steady decline in any tobacco use for both males and females in each age group over the observed period 2000-2015. The age-specific rates are projected to continue declining to 2025 for both males and females. The age-specific rates peak at age group 45-54 for men and, for women, at age group 55-64 in some years and 65-74 in others. The report said the absolute prevalence levels have been consistently higher for males than those for females in each age group.
Among young people aged 15-24 globally; the average rate of tobacco use has declined from 22.6 per cent in the year 2000 to 17.0 per cent in 2015. The rate in 2025 is projected to be 14.2 per cent. Among men in the age group 15-24, the report stressed that tobacco use has declined from 35.3% in the year 2000 to 27.6 per cent in 2015. The rate in 2025 is projected to be 23.6%. Among women in this age group, the 2000 rate of 9.3% reduced to 5.6% by 2015, and is projected to continue downwards to 4.2% by 2025.
The age-standardized tobacco use prevalence rates are declining in all WHO regions, the report claims. In the year 2000, it is estimated that the South-East Asia region had total tobacco use rates at around 47%. This was the highest average rate of any WHO region. The lowest average rate was estimated to be 18.5% in the African region. These two regions have continued to be the regions with highest and lowest average rates respectively, but the gap between them have narrowed and are expected to keep narrowing to 2025. The South-East Asia region is tracking towards an average prevalence rate in 2025 of 25.1 per cent and the African region is tracking towards 11.2 per cent.
Focusing on the period 2010-2025- the period of interest for monitoring reduction targets under the WHO Global Action Plan for Prevention and Control of Non-Communicable Diseases 2013-2020- the only WHO region expected to achieve a 30 per cent relative reduction in prevalence of current tobacco use by 2025 is the Americas region.
The average rate of current tobacco use in Americas region is expected to fall from around 23% in 2010 to 15% in 2025, assuming tobacco control efforts in Americas region countries are maintained at current levels. Western Pacific is the region expected to experience the least decline in the average prevalence rate- a relative reduction of around 12% between 2010 and 2025. The other region with a relatively slow rate of decline is the European region, currently tracking towards an 18% relative reduction between 2010 and 2025.
According to this report, in 2000, the highest average prevalence rates among males were in the South-East Asian region (62.5%), followed by the Western Pacific region (55.6%). The trend in these two regions crossed over in 2014 and the Western Pacific region is now projected to have the highest rates among males in 2025, averaging 46.4%. The South-East Asian region average is projected to reach 42.9%.
The report said the Eastern Mediterranean and European regions are in the middle ground, with very similar prevalence levels and trends among men in all years, from 46-47% in 2000 to 30-31% in 2025. The African region is the region with the lowest average rates for males, and is projected to remain lower than other regions until 2025, when the rates for the Americas region to around the same level (20.4%).
Among males, only countries in the Americas region will collectively achieve a 30% relative reduction in the average prevalence by 2025, the report said. All other regions except the Western Pacific region are on track to reduce male prevalence rates between 19% and 22%. Western Pacific region countries are likely to achieve close to a 10% reduction between 2010 and 2025.
An international report complied in South Africa dubbed ‘Legal Gender Recognition in Botswana’ says that the transgender and gender non-conforming people in Botswana live a miserable life. The community experiences higher levels of discrimination, violence and ill health.
In this report, it has been indicated that this is because their gender identity, which does not conform to narrowly define societal norms, renders them more vulnerable. Gender identity is a social determinant of health, which means that it is a factor that influences people’s health via their social context, their communities and their experiences of social exclusion. The Ministry of Health and Wellness has recognized this, and transgender people are considered a vulnerable population under the Botswana Second National Strategic Framework for HIV and AIDS 2010-2017.
In a recent study that shed light on the lived experiences of transgender and gender non-conforming people in Botswana, transgender persons often experience discrimination because of their gender identity and expression. The study was conducted by the University of Cape Town, LEGABIBO, BONELA, as well as Rainbow Identity Association and approved by the Health Ministry as well as the University of Botswana.
Of the 77 transgender and gender non-conforming people who participated in the study, less than half were employed. Two thirds, which is approximately 67% said that they did not have sufficient funds to cover their everyday needs. Two in five had hidden health concerns from their healthcare provider because they were afraid to disclose their gender identity.
More than half said that because of their gender identity, they had been treated disrespectfully at a healthcare facility (55%), almost half (46%) said they had been insulted at a healthcare facility, and one quarter (25%) had been denied healthcare because of their gender identity.
At the same time, the ‘Are we doing right’ study suggests that transgender and non-conforming people might be at higher risks of experiencing violence and mental ill-health, compared to the general population. More than half had experienced verbal embarrassment because of their gender identity, 48% had experienced physical violence and more than one third (38%) had experienced sexual violence.
The study showed that mental health concerns were high among transgender and gender non-conforming people in Botswana. Half of the transgender and gender non-conforming study participants (53%) showed signs of depression. Between one in four and one in six showed signs of moderate or severe anxiety (22% among transgender women, 24% among transgender men and 17% among gender non-conforming people).
Further, the study revealed that many had attempted suicide: one in three transgender women (32%), more than one in three transgender men (35%) and three in five gender non-conforming people (61%).
International research, as well as research from Botswana, suggests that not being able to change one’s gender marker has a negative impact on access to healthcare and mental health and wellbeing. The study further showed that one in four transgender people in Botswana (25%) had been denied access to healthcare. This is, at least in part, linked to not being able to change one’s gender marker in the identity documents, and thus not having an identity document that matches one’s gender identity and gender expression.
In its Assessment of Legal and Regulatory Framework for HIV, AIDS and Tuberculosis, the Health Ministry noted that “transgender persons in Botswana are unable to access identity documents that reflect their gender identity, which is a barrier to health services, including in the context of HIV. In one documented case, a transwoman’s identity card did not reflect her gender identity- her identity card photo indicated she was ‘male’. When she presented her identity card at a health facility, a health worker called the police who took her into custody.”
The necessity of a correct national identity document goes beyond healthcare. The High Court of Botswana explains that “the national identity document plays a pivotal role in every Motswana’s daily life, as it links him or her with any service they require from various institutions. Most activities in the country require every Motswana to produce their identity document, for identification purposes of receiving services.”
According to the Legal Gender Recognition in Botswana report, this effectively means that transgender, whose gender identity and expression is likely to be different from the sex assigned to them at birth and from what is recorded on their identity document, cannot access services without risk of denial or discrimination, or accusations of fraud.
In this context, gays and lesbians advocacy group LEGABIBO has called on government through the Department of Civil and National Registration to urgently implement the High Court rulings on gender marker changes. As stated by the High Court in the ND vs Attorney General of Botswana judgement, identity cards (Omang) play an important role in the life of every Motswana. Refusal and or delay to issue a Motswana with an Omang is denying them to live a complete and full-filing life with dignity and violates their privacy and freedom of expression.
The judgement clarified that persons can change their gender marker as per the National Registrations Act, so changing the gender marker is legally possible. There is no need for a court order. It further said the person’s gender is self-identified, there is no need to consult medical doctors.
LEGABIBO also called on government to develop regulations that specify administrative procedure to change one’s gender marker, and observing self-determination process. Further, the group looks out for government to ensure members of the transgender community are engaged in the development of regulations.
“We call on this Department of Civil and National Registration to ensure that the gender marker change under the National Registration Act is aligned to the Births and Deaths Registry Act to avoid court order.
Meanwhile, a gay man in Lobatse, Moabi Mokenke was recently viciously killed after being sexually violated in the streets of Peleng, shockingly by his neighbourhood folks. The youthful lad, likely to be 29-years old, met his fate on his way home, from the wearisome Di a Bowa taverns situated in the much populated township of Peleng Central.
CEO of Khato Civils Mongezi Mnyani has come out of the silence and is going all way guns blazing against the company’s adversaries who he said are hell-bent on tarnishing his company’s image and “hard-earned good name”
Speaking to WeekendPost from South Africa, Mnyani said it is now time for him to speak out or act against his detractors. Khato Civils has done several projects across Africa. Khato Civils, a construction company and its affiliate engineering company, South Zambezi have executed a number of world class projects in South Africa, Malawi and now recently here in Botswana.
About ten (10) Umbrella for Democratic Change (UDC) parliamentary candidates who lost the 2019 general election and petitioned results this week met with UDC Vice President, Dumelang Saleshando to discuss the way forward concerning the quandary that is the legal fees put before them by Botswana Democratic Party (BDP) lawyers.
For a while now, UDC petitioners who are facing the wrath of quizzical sheriffs have demanded audience with UDC National Executive Committee (NEC) but in vain. However after the long wait for a tete-a-tete with the UDC, the petitioners met with Saleshando accompanied by other NEC members including Dr. Kesitegile Gobotswang, Reverend Mpho Dibeela and Dennis Alexander.