According to a recent Report (by WHO on 2018 World No Tobacco Day (31st May), there has been reduction in tobacco usage in India
- According to the Report of WHO, India is second to China in terms of number of smokers aged 15 or above accounting for 106 million of the world’s 1.1 billion smokers
- There has been a drop in prevalence of smoking tobacco- from 19.5% in 2000 to 11.5% in 2015
- 9 million adolescents (13-15 years) used tobacco in South-east Asia- sizeable portion in India
- Projection: Prevalence to further drop to 8.5% by 2025
Note: the report only covered tobacco usage in the form of smoking
- According to the Global Adult Tobacco Survey-2 (GATS-2), 2016-17, 28.6% of all adults use of tobacco (smoke and/or smokeless tobacco)
- 19% of men and 2% of women smoke tobacco.
- 6% of men and 12.8% women use smokeless tobacco
- India has the largest number of Smokeless Tobacco users in the world- accounts for 66% of world’s smokeless tobacco users
- Prevalence of tobacco use decreased by 6% from 2009-10 to 2016-17
- According to a Lancet study (2012), in India, tobacco-related cancers represented 42·0% of male and 18·3% of female cancer deaths
- India also has one of the highest rates of oral cancer in the world as the consequence of high prevalence of xi smokeless tobacco use
- Tobacco use also leads to cardiovascular diseases and chronic obstructive pulmonary diseases
- Significant relation is also seen between passive or active exposure to tobacco smoke and tuberculosis infection
- GATS 2 report shows that 39% of adults in India are exposed to second-hand smoking (SHS).
- There is conclusive evidence linking passive smoking to an increased risk of cardiovascular diseases, lung cancer and other cancers, asthma and other respiratory diseases in humans.
- High health Expenditure- Direct medical cost, indirect morbidity cost, productivity loss due to premature mortality
- According to GOI report ‘Economic burden of tobacco-related diseases in India’, tobacco-related disease costed the Indian economy over INR 1, 04,500 crores (1.16% of GDP) for the year 2011, just among adults aged between 35 and 69.
- Tobacco in its cultivation, processing, production and disposal adversely affects the environment
- Tobacco cultivation and the curing process contribute towards deforestation, soil depletion, loss of soil nutrients and pollution due to the heavy use of agrochemicals.
- Curing of tobacco leads to emission of carbon dioxide and causes air pollution
- In 2010, India produced 10,000 million cigarettes. It is estimated to have emitted nearly 6750 tons of carbon dioxide to produce cigarettes
- Toxic waste:
- Cigarette and bidi buts are non-biodegradable.
- Cigarette filters are made of cellulose acetate (a form of plastic) which is resistant to biodegradation and can persist in the environment for a very long time.
- Further, these butts contain toxic substances which contaminate the environment with heavy metals and poisonous chemicals like nitrosamines, polycyclic aromatic hydrocarbons, nicotine
- Violates rights of non-smokers- right to clean air, undermines health of non-smokers
- Affects household welfare-Expenses incurred in tobacco use substitute the basic needs of food and education among disadvantaged population-lower socio-economic group
- Adverse effects on children and adolescents
Tobacco Control in India
- Cigarettes Act, 1975: Largely limited to statutory warnings- ‘Cigarette Smoking is Injurious to Health’ to be displayed on cigarette packs and advertisements. However, it did not include non-cigarettes.
- Prevention and Control of Pollution Act of 1981- Recognized smoking as an air pollutant
- The Motor Vehicles Act 1988- Made smoking illegal in public vehicle
- Cable Television Networks Amendment Act of 2000- Prohibited the transmission of advertisements on tobacco and liquor in India
- Government of India has issued regulations under the Food Safety and Standards Act 2006 which lay down that tobacco or nicotine cannot be used as ingredients in food products
- Cigarettes and Other Tobacco Products Act (COTPA), 2003: Replaced the Cigarettes Act of 1975 The Act also included cigars, bidis, cheroots, pipe tobacco, hookah, chewing tobacco, pan masala, and gutka.
- Prohibition of smoking in public places (including indoor workplaces). This has been implemented from 2nd October 2008 in the whole of India.
- Prohibition of advertisement, direct and indirect, sponsorship and promotion of tobacco products.
- Prohibition of sales to minors- children less than 18 years of age
- Prohibition of sales within a radius of 100 yards of any educational institutions.
- Regulation of health warning:
- English and one more Indian language to be used for health warnings on tobacco packs.
- Pictorial health warnings also to be included.
- Regulation and testing of tar and nicotine contents of tobacco products and declaring on tobacco products packages.
- India is a signatory to the WHO Framework Convention on Tobacco Control (FCTC), 2003.
- Recently, the Cabinet approved accession to the Protocol under FCTC to eliminate illicit trade in tobacco products
- The elimination of illicit trade is expected strengthen comprehensive tobacco control, leading to reduction in tobacco use
- National Tobacco Control Programme (NTCP), 2008:
- Objective: to control tobacco consumption and minimize tobacco consumption related deaths
- Activities include: training and capacity building; information, education, and communication (IEC) activities; tobacco control laws; reporting survey and surveillance and tobacco cessation
- Tobacco Cessation:
- Tobacco cessation clinics have been set up across the country
- mTobaccoCessation program:
- GOI launched bilingual nationwide programme and a national toll-free quit line in 2016
- The program provides targeted support to help people overcome the personal challenge of maintaining efforts to quit tobacco use.
- State-level interventions:
- Prohibition on e-cigarettes: Jammu and Kashmir, Karnataka, Punjab, Maharashtra and Kerala- Complete ban on the sale (including online sale), manufacture, distribution, trade, import and advertisement of Electronic Nicotine Delivery System (ENDS)/ e-cigarettes.
E- Cigarettes: An electronic device that simulates the feeling of tobacco smoking.
- Assam Health (Prohibition of manufacturing, advertisement, trade, storage, distribution, sale and consumption of zarda, gutkha, pan masala, etc, containing tobacco and/or nicotine) Act, 2013: Assam is the first state to legally ban consumption of all forms of smokeless tobacco, Other states to ban include Madhya Pradesh, Kerala
- Tobacco Taxation:
- According to WHO Report on the Global Tobacco Epidemic 2017, cigarette taxes in India are amongst the highest in the world
- Cigarettes are subjected to high and discriminatory rates of taxation, as compared to other tobacco products. As of 2014-15 Government collected 87% of its total tobacco revenue from legal cigarettes
- Post GST, there has been increase in prices of cigarettes. However, there has not been much effect on other tobacco variants.
- India has banned foreign direct investment in cigarette manufacturing
- Awareness Programmes, campaigns, advertisements: Example: The one you see by Rahul Dravid before movies!!!
- Economic contribution of Tobacco industry:
- The tobacco industry has a major contribution to economy: employment generation in agriculture and manufacturing and revenues in the form of exports and taxes.
- Tobacco industry exert undue influence on government
- According to a paper titled ‘Tobacco industry lobbying undermines public health in Asia’ the tobacco industry in India, Pakistan and Laos was reportedly targeting control policies.
- Improper taxation:
- Taxes have traditionally been raised targeting cigarettes. This has rendered other tobacco products like bidi, gutka quite inexpensive and affordable. In a situation where consumption from smokeless tobacco is higher, tobacco taxation in India is faulty.
- Surrogate advertisements of tobacco products:
- It means duplicating of brand image of one product extensively in order to promote the same brand
- According to GATS 2, 19.2% of adults noticed smoking tobacco advertisement and 18.3% of adults noticed smokeless tobacco advertisement.
Should Tobacco be banned in India?
- Given that use of tobacco has irreversible consequences on human health and environment, banning tobacco production and consumption seems to be the most important step to control the menace.
- Smoking bans have been introduced in numerous countries around the world (Iceland, Bhutan) which have resulted in decline in smoking consequently.
- However, it is important to note that banning tobacco is not a viable solution. In India, the tobacco industry has a major contribution in employment and revenue generation
- Further, a complete ban will lead to emergence of smuggling, black-market which will have dire consequences
- For example: In Bhutan, there is a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004.The complete ban on tobacco led to the emergence of black market and increase in tobacco usage.
- Rather than banning, information, communication and awareness should be the approach in controlling the usage of tobacco in India.
- There is a need for comprehensive tobacco control policy – Need to align policies of other departments of public health
- Proper tobacco taxation policy- emphasis on non-smoke tobacco products
- Accessible and affordable cessation services
- Strengthening the implementation of COTPA
- Alternative opportunities for people engaged in tobacco cultivator, processing and manufacturing
- Enhancing public awareness through campaigns, educational programs in schools, strong and prominent graphic health warnings
- Judicial interventions, advocacy by civil society organisations, and active partnerships between health and developmental groups to enforce laws to control tobacco use.