Tobacco Harm in Zambia

Tobacco use results in over 7,000 deaths and costs Zambia an estimated ZMW 2.8 billion (US$ 165 million) every year.


Tobacco consumption and production cause avoidable illness and premature death, which results in economic losses, widens socioeconomic inequalities, and contributes to environmental degradation.

This page discusses the negative health, economic and environmental impacts of tobacco use and tobacco production in Zambia.

Tobacco is the only legal consumer product that kills up to half of its users when used exactly as intended by the manufacturer.”

Pan American Health Organisation

Over 7,000 people die every year as a result of using tobacco in Zambia and over 60% of these deaths occur among those below 70 years of age.

This high incidence of premature mortality and disability imposes a significant cost on the economy of Zambia. 

Four of the top ten leading causes of death in Zambia (lower respiratory infections, ischemic heart diseases, tuberculosis, and stroke) are caused by, exacerbated by, or associated with tobacco use.  The top 3 leading causes of tobacco-related deaths in Zambia are lower respiratory infections, ischemic heart disease and tuberculosis.

The graph below presents the total number of tobacco-related deaths in Zambia disaggregated by cause (2016).

Tobacco-related deaths by leading cause in 2016

02004006008001,0001,2001,4001,6001,8002,000Number of Tobacco related deathsTracheal bronchus and lung cancerHypertensive heart diseaseDiabetes mellitusHemorrhagic strokeIschemic strokeOther cardiovascular and circulatory diseasesChronic obstructive pulmonary diseaseOtherTuberculosisIschemic heart diseaseLower respiratory infections

Source: Ministry of Health (2019)

Tobacco consumption imposes significant costs on Zambia’s economy. In 2016, health expenditure on tobacco-attributable illness was  estimated at ZMW 154.3 million (US$ 9 million).

Government health expenditure as a result of tobacco-attributable illness is high at ZMW 74.2 million (US$ 4.4 million). Out- of- pocket healthcare expenditure at ZMW 42.5 million (US$ 2.5 million), and private insurance at ZMW 37.6 million (US$ 2.2 million), also represent significant health-related costs.

The indirect costs include those associated with loss of productivity, for example, from  missing work (absenteeism), reduced productivity while at work (presenteeism), and taking excessive breaks because of smoking. Absenteeism imposes a cost of ZMW 204 million (US$ 12 million), presenteeism a cost of ZMW 613 million (US$ 36 million), and excessive breaks a cost of ZMW 434.2 million (US$ 25.5 million) annually.

Tobacco-related premature deaths impose an indirect cost of approximately ZMW 1.4 billion (US$ 82 million) on the Zambian economy annually, which brings the total economic cost of tobacco use to ZMW 2.8 billion (US$ 165 million).

Economic cost of tobacco use as a percentage of annual GDP in Zambia

Tobacco use costs the Zambian economy about ZMW 2.8 billion (US$ 165 million) annually when all direct (ZMW 154 million) and indirect costs (ZMW 2.7 billion) are considered. This amounts to about 1.2% of Zambia’s annual GDP.

The chart below presents the percentage and value breakdown of the total cost of tobacco use of ZMW2.8 billion (US$ 165 million).

Economic cost of tobacco use by cost component

50%7%22%15%6%ZMW2.8 billion (US$ 165 million)

Source: Ministry of Health (2019)

Comparison between tobacco-related costs and the amount of taxes collected from tobacco companies

Total tax revenue from tobacco in Zambia is estimated at ZMW 246.9 million (US$ 14.1 million) using 2016 data and falls

significantly short of total tobacco-related costs at ZMW 2.8 billion (US$ 165 million).

The graph below presents a comparison between the various tax revenues for tobacco and tobacco-related costs disaggregated by the source. Revenue from tobacco taxes falls significantly short of tobacco-related costs.

Tobacco tax revenue versus tobacco-related costs 2016

RevenueCost02004006008001,0001,2001,4001,6001,8002,0002,2002,4002,6002,8003,000Revenue/Cost in millions of ZMW162.21,406.0204.0613.0434.0

Source: Ministry of Health (2019)

Tobacco Use and Household Expenditure in Zambia

Smoking households consistently allocate less expenditure towards essential goods and services such as food, school, housing, and daily transport. This implies that smoking households have a lower standard of living than non-smoking households. This crowding-out effect of tobacco use is more severe for poorer households.

The graph below compares expenditure by smoking households and non-smoking households on four essential goods and services – food, school, housing, daily transport in Zambia using 2014 data.

Comparison of expenditure on essential goods and services between smoking and non-smoking households in Zambia (2014)

FoodSchoolHousingDaily TransportType of expenditures 0%5%10%15%20%25%30%35%40%45%50%Share of household income

Source: Chelwa and van Walbeek (2014)

Tobacco farming is associated with significant health risks such as green tobacco sickness and respiratory illness.

Studies show that the prevalence of green tobacco sickness varies from 8.2% to 47% amongst tobacco farmers.

While it is perceived to be lucrative, contractual arrangements between farmers and the tobacco industry expose farmers to significant economic risk, and often leads to farmers being caught indebt traps. Compared to other cash crops, small-scale tobacco farming is more labour intensive. While data on labour requirements for comparable crops in Zambia are not available, data from Zimbabwe reveal that flue-cured tobacco requires 480 hours of labour per hectare and burley tobacco requires 390 hours per hectare. Other crops require substantially less labour input. For example cotton requires 170 hours per hectare, maize 125 hours per hectare, groundnuts 120 hours per hectare and soybeans 70 hours per hectare.

Green Tobacco Sickness

Green tobacco sickness, which is a risk unique to tobacco farming, occurs when nicotine is absorbed through the skin as farm workers are engaged in handling the uncured tobacco leaves. Farm workers can protect themselves by wearing protective clothing, but they can still be at risk if their clothing becomes saturated with rain, dew or perspiration.

Some symptoms of green tobacco sickness are similar to those of heat exhaustion and pesticide poisoning. If healthcare workers are not familiar with this illness, it may be misdiagnosed.

Profitability of tobacco farming for small-scale farmers

In Zambia, small-scale farmers are either engaged in tobacco farming as contract farmers or as independent farmers. The vast majority of farmers are contract farmers. Despite the perception that tobacco production is lucrative, studies show that it is not. On average, contract farmers incur a loss of US$ 286 per acre, compared to an average profit of US$ 227 per acre made by independent farmers. Losses are exacerbated when the value of family labour is taken into account, with contract farmers incurring a loss of US$ 1,915 on average, compared to a loss of US$ 579 incurred by independent farmers.

 A recent study amongst smallholder farmers in Manicaland, Zimbabwe, corroborates the finding that smallholder tobacco farmers have not benefited sustainably from the tobacco farming. The study attributes the continued engagement of smallholder farmers in tobacco farming, despite sustaining losses, to the perceived lack of viable alternative crops that offer a well-organised supply chain and ancillary support in the form of physical inputs, loans, transport to market, and a guaranteed market that is as robust as that offered by the tobacco industry.  There is a significant role for government, the private sector, and development partners to play in strengthening value chains for other, more sustainable, cash crops so as to facilitate tobacco farmers’ transition to alternative livelihoods.

The graph below compares the profits of contract farmers and independent farmers when the value of family labour is taken into account and when the value of family labour is not taken into account.

Profitability of tobacco farming

Contractor FarmerIndependent Farmer-$2,000-$1,500-$1,000-$500$0$500$1,000$1,500$2,000Profit per Acre USD

Source: Goma et al., (2017)

Tobacco farming and food security

Tobacco farming undermines food security because of the significant price risk associated with the activity, coupled with its high labour intensiveness. In the case of Zambia, where the price risk for tobacco is significant, tobacco farmers often do not realise sufficient value from their tobacco harvest to meet their food needs. At the same time, farmers often have an insufficient stock of maize and other subsistence crops because the level of effort that tobacco farming requires limits their ability to  tend to other crops adequately. The prevalence of price risk, combined with the labour intensiveness of tobacco farming, therefore presents significant potential for food insecurity for tobacco farmers and corroborates the experiences noted by many farmers.

Tobacco farming and child labour

Tobacco farming is labour intensive and usually necessitates household participation and, hence, the use of child labour.

Child labour has both immediate and long-term consequences for the affected children and for society as well. Children working in the tobacco field  miss out on school and compromise their education. Children are also more likely to contract a tobacco-related illness as a result of sustained exposure to tobacco.

Scale of child labour

A 2014 study revealed that unpaid family labour accounts for 34% of all labour while hired labour accounts for 66%. Child labour is a significant component of family labour and is also a component of hired labour.

The graph below presents a break-down of the proportion of tobacco farmers that used unpaid household labour versus paid hired labour in a sample of farmers from Kaoma district of Western Province.

Proportion of farmers relying on unpaid family labour versus paid hired labour in a sample taken from Kaoma district in 2014


Source: International Labour Organization (2014)

Tobacco products harm the environment at every stage of their production and consumption, from farming to disposal of the final product. Globally, the tobacco industry is responsible for 84 million tonnes of greenhouse gas emissions into the atmosphere and contributes about 0.2% of the global total.

Zambia is ranked as the second leading producer of tobacco leaf in Africa, producing 16.4% of Africa’s output and 1.87% of the global total.

Zambia is among the top 5 tobacco exporters of tobacco leaf  in Africa. The agricultural land devoted to growing tobacco increased twenty-fold between 1996 and 2016. Following the establishment of cigarette-manufacturing facilities in the Lusaka Multi-Facility Economic Zone, the capacity to manufacture cigarettes has increased significantly and the facilities can produce up to 20 million cigarettes daily.

Smoking and cigarette disposal are also significant contributors to environmental damage. Smoke from cigarettes and other smoked tobacco products releases toxic chemicals into the air. Greenhouse gases such as carbon dioxide, methane, formaldehyde, and nitrous oxides are also found in tobacco smoke; these chemicals have been found on surfaces although people have not smoked there for months.

Up to two-thirds of cigarettes are disposed of on the ground, and often end up in water systems. Not only are these polluting the environment with plastic, but cigarette filters contain cancer-causing chemicals and other dangerous toxins. The long-term effects of this are still unknown.

Source: Bialous et al., (2017). Tobacco and its environmental impact: An overview

The high prevalence of and early initiation into tobacco use are fuelled by specific gaps in the regulatory framework.

Cigarettes are cheap/affordable in Zambia.

The real (i.e. inflation-adjusted) price of cigarettes halved between 2002 and 2016.

Taxes are currently 37.3% of the retail price of an average pack of cigarettes, which is well below the recommended amount of 75% of retail price. Selling of single-stick cigarettes is also legal, and approximately 49% of sales of cigarettes are single-stick.

Zambia legislated a total ban of smoking in public places.

Violators of the smoking ban face a fine  of k400 (approximately 25 dollars) or two years imprisonment. Despite these potential penalties, the enforcement of the smoking ban in Zambia remains weak. There is also weak enforcement on the ban on buying and selling of cigarettes by minors.

Advertising of tobacco products on TV, radio, newspapers, billboards, posters and other direct and indirect forms of media is permitted.

Zambia prescribes text-only warnings on cigarette packages. Compliance with WHO FCTC standards requires going a step further and mandating graphic warning labels.

There are low levels of awareness on the harms of tobacco consumption in Zambia. Zambian smokers were least likely among 12 ITC countries to be aware that smoking causes lung cancer.