As South Africa marks World No Tobacco Day on Sunday 31 May, health experts and civil society advocates are uniting to expose both the immediate biological damage caused by smoking and the aggressive industry tactics designed to addict a new generation of users.

This year, the South African NCD Alliance (SANCDA+) – a collective voice founded by the Cancer Association of South Africa (CANSA), Diabetes SA, and the Heart & Stroke Foundation SA – is aligning with the World Health Organisation (WHO) under the 2026 theme, “Unmasking the Appeal – Countering Nicotine and Tobacco Addiction”.

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Strain on the heart

While public messaging often focuses on the long-term drivers of disease, cardiovascular experts are drawing attention to an overlooked reality: smoking acts as an immediate, repeat-trigger stressor on the heart.

Rather than simply adding up over time, each cigarette sets off a rapid chain of dangerous cardiovascular reactions within minutes.

When nicotine enters the bloodstream, it stimulates the release of adrenaline, triggering a short-term spike in heart rate and blood pressure while narrowing blood vessels. Simultaneously, carbon monoxide binds to haemoglobin, reducing the blood’s ability to carry oxygen.

According to Ingrid Singels, associate director of Scientific Products at Pharma Dynamics, South Africa’s leading supplier of cardiovascular medication, this repeated physiological shock is heavily underestimated.

“Each cigarette triggers a short, intense cardiovascular stress response,” explains Singels.

“For someone smoking regularly, this is happening multiple times a day, sometimes every hour. People often think of heart disease as something that develops slowly over years, but these immediate spikes place repeated strain on blood vessels and the heart itself. It’s a present biological event affecting the heart every time you light up.”

Furthermore, nicotine contributes to insulin resistance, raising the risk of type 2 diabetes and worsening blood vessel damage for those already living with the condition.

National toll

The scale of preventable illness remains severe. Tobacco-use kills up to half of its users, claiming over 25 000 lives annually in South Africa alone. Globally, tobacco claims over 7 million lives each year, including 1,6 million non-smokers exposed to second-hand smoke.

Beyond the devastating human cost, tobacco-use places a massive economic burden on South Africa, costing an estimated R42 billion each year in healthcare expenses, lost productivity and premature deaths.

As health networks work to manage the chronic pipeline of cardiovascular and metabolic diseases, SANCDA+ warns that the tobacco and nicotine industry is actively working to recruit replacement users through innovative packaging, digital media marketing, and flavored alternatives.

By pushing emerging nicotine products like e-cigarettes, vapes, and nicotine pouches, the industry successfully repackages addiction as an innovative lifestyle choice, threatening decades of public health progress.

“As an alliance of civil society organisations and partners, we remain committed to advocating for healthier environments, amplifying community voices, supporting accountability, and advancing policies that protect current and future generations from the harms of tobacco and nicotine addiction,” said Vimla Moodley, member of the Steering Governance Committee for SANCDA+.

“World No Tobacco Day 2026 is a reminder that protecting young people from addiction is a shared responsibility requiring political commitment, public awareness, and united action across society.”

In response to these industry tactics, SANCDA+ is calling for:

• Stronger protection of children and youth from tobacco and nicotine marketing.
• Effective regulation of emerging nicotine and vaping products.
• Enforcement of evidence-based tobacco control policies aligned with the WHO Framework Convention on Tobacco Control (WHO FCTC).
• Increased investment in health promotion, prevention, and cessation services.

From awareness to action

Health professionals emphasise that quitting smoking is one of the most immediate ways to reduce cardiovascular risk, noting that the heart begins to recover and normalize within minutes of the last cigarette.

For South Africans seeking support to manage cravings and build healthier habits, resources are available through the National Council Against Smoking.

• Smokers’ Quitline: 011 720 3145
• WhatsApp Support: 072 766 7812