Tobacco Control in South Africa

This case reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health, Dr. Nkosazana Zuma. After providing contextual information on South Africa, including historical, demographic, social, and health information, the case delves into the history of tobacco and of global tobacco control efforts. The case then details the history of tobacco in South Africa, including data collection, epidemiology, early control efforts, and the policy efforts of the mid-1990s. The case describes the African National Congress (ANC)’s policy victories under Zuma’s leadership. Knowing that tobacco disproportionately affected certain racial and minority groups, Zuma made tobacco control a top priority. With the support of the President, local tobacco experts, and anti-tobacco advocates, Zuma worked hard to break previous connections between the government and the tobacco industry and to reduce smoking. The case ends in 1996 when smoking prevalence had declined to 32 percent from 34 percent in 1995, but South Africa still had one of the highest levels in the developing world. As the ANC was preparing to enact the new Constitution that reinforced health promotion, Zuma had to determine what her next move would be for tobacco control and how she would prioritize it with the other health needs of the country. The sequel to this case is also available, Tobacco Control in South Africa: Next Steps.

Learning Objectives: To understand the political and economic forces that impact tobacco control legislation in a country undergoing an epidemiological shift, the role of research and data, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

The Global Health Delivery (GHD) Project, an interdisciplinary collaboration between Harvard Business School, Harvard Medical School, and Brigham and Women’s Hospital, investigates the management decisions behind disease treatment and prevention globally. The Global Health Delivery (GHD) Case Collection is a set of teaching case studies that are available for all at no cost online through Harvard Business Publishing, GHDonline, and The Case Centre.