The economic and health impacts of tobacco and alcohol use in South Africa

In a striking revelation, a new study conducted by Zunda Chisha, a PhD candidate at the University of Cape Town (UCT), has shed light on the profound economic and health consequences of tobacco and alcohol use in South Africa at both household and child health levels.

Chisha's thesis, titled “Economic and Health Implications of Tobacco and Alcohol Use in South Africa: A Household Expenditure Analysis,” is set to be unveiled during his graduation ceremony on Thursday, 3 April.

Supervised by the eminent Professor Corné van Walbeek, a leading expert in economics and director of the Research Unit in the Economics of Excisable Products (REEP), and Grieve Chelwa, an associate professor in political economy at the Africa Institute in the United Arab Emirates, Chisha’s research presents a comprehensive analysis that highlights the economic burden placed on households, particularly those with lower incomes.

“Tobacco spending diverts resources from essential needs, particularly education, housing, transport, and household goods – posing especially severe challenges for lower-income households,” Chisha explained. Notably, the study revealed a concerning trend: as household expenditures on tobacco increase, spending on alcohol tends to rise in tandem, illustrating the interconnectedness of these substances.

Through meticulous analysis of household budget changes from 1995 to 2010-2011, using data sourced from four household Income and Expenditure Surveys, Chisha scrutinised the negative impact of parental spending on both tobacco and alcohol on child health outcomes, including height-for-age and weight-for-age metrics. Further exploration was conducted using the National Income Dynamics Study data from 2008 to 2017 to assess how historical spending on these substances affects current child health.

In an innovative approach to understanding the nuances of these spending habits, Chisha compared budgetary patterns between households that purchase tobacco and those that abstain, employing advanced statistical techniques to identify which essential areas – such as education, transport, and housing – were most vulnerable to financial strain from tobacco purchases.

This comprehensive study also tracked changes in spending behaviors over time, factoring in the implications of increased tobacco taxes, and explored the repercussions of parental substance use on children's health through a longitudinal dataset that observed families across several years.

Chisha's findings significantly enrich the current understanding of how expenditures on tobacco and alcohol affect household welfare and child development. The thesis introduces several methodological advancements, including robust data quality handling, a novel difference-in-differences approach, and mediation analysis to uncover the transmission mechanisms underpinning these impacts. While acknowledging that tobacco tax increases can reduce smoking prevalence, he cautioned about unintended consequences for households that continue to smoke.

Moreover, the study underscored a vital point: households consuming tobacco products are more likely to indulge in alcohol consumption and vice versa. “The findings underscore the importance of well-designed tobacco tax policies that are complemented by strong cessation support and alcohol control measures,” said Chisha, urging policymakers to adopt a holistic approach to combat the broader developmental impact of substance use, particularly its repercussions on education and child health.

Chisha advocates for future research to delve into the intergenerational effects of parental tobacco and alcohol consumption on children's long-term outcomes, such as educational achievement and income levels. “We must also examine gender-specific consumption patterns and decision-making processes within households, as well as the interplay between mental health, social networks, and substance use behaviour,” he added.

Professor Van Walbeek remarked on the importance of Chisha’s work, stating, “A lot is known about the harmful impact of tobacco on people’s health. What Zunda Chisha’s thesis shows is that tobacco and alcohol use have detrimental economic consequences, not only on the users themselves but also on the people in the household.”

By quantifying these effects, Chisha provides valuable insight into the various pathways affecting smoking households over the past few decades in South Africa.