Santosh Jain Passi* Akanksha Jain*
Tobacco usage – a major hurdle undermining developmental gains worldwide, is the foremost preventable cause of premature morbidity/ mortality.
Tobacco products contain nearly 5000-7000 toxic substances, the most dangerous being nicotine, carbon monoxide and tar. Cigarette, bidi, cigar, hookah, sheesha, tobacco chewing, clove cigarettes, snuff and ecigarette are the commonly used forms. WHO reports highlight that each year, direct tobacco usage/secondhand smoke kills nearly six million individuals; and that it is a major risk factor for majority of the NCDs. Further, among communicable diseases, tobacco is responsible for nearly 4-5% of the mortality due to lower respiratory infections and tuberculosis. It is envisaged that by 2030, mortality due to tobacco-related illnesses will be close to 8 million.
Tobacco threatens all individuals, regardless of their age, gender, race and cultural/educational background. Irrespective of the type/form, tobacco adversely affects the individuals’ health; cigarette smoking remains the foremost preventable cause of mortality all over the world. Poisonous substances in cigarette smoke can weaken the body’s immune system and damage the DNA leading to cancer/tumour development. Secondhand smoke – burning cigarette smoke and that exhaled by the smokers, also adversely affects the cardiovascular system leading to coronary heart disease/stroke; and among infants/children, it causes frequent/severe asthmatic attacks, respiratory/ear infections and sudden infant death syndrome.
In India, there are nearly 274.9 million tobacco users; 163.7 million smokeless tobacco (SLT) users, 68.9 million smokers and 42.3 million combined users; SLT usage being particularly dominant in the unorganised sector (Global Adult Tobacco Survey, 2009-10). Compared to NFHS-3 (2005-06), NFHS-4 (2015-16) data indicate a reduction in tobacco use among adults (men: 57% to 44.5%; women: 10.8% to 6.8%).
Every year, 31st May is observed as ‘World No Tobacco Day’ for highlighting the health related risks linked with tobacco usage; and to advocate effective policies for curbing tobacco consumption.
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This year’s theme is “Tobacco – a threat to development” highlighting the close association between tobacco usage, tobacco control and sustainable development. Tobacco control is strongly enshrined in the Sustainable Development Agenda for accomplishing SDG target 3.4 ‘to achieve, by 2030, one-third reduction in premature deaths due to NCDs including CVDs, cancers and COPD’.
Tobacco farming is responsible for 2-4% global deforestation annually; and its manufacture produces >2 MT of solid waste. Pesticides/fertilizers used for tobacco cultivation are often toxic and pollute the water supplies.
Comprehensive tobacco control can address the adversaries of tobacco farming, manufacturing, trade and consumption on environment as well as intercept the vicious cycle of poverty and hunger. Further, it can promote sustainable agriculture/economic growth and address the burning issue of climate change. Increased taxation on tobacco products can help to finance universal health coverage and other developmental programmes.
Apart from the governmental efforts, individuals/communities can also contribute greatly towards a sustainable tobacco-free world. Tobacco being the major preventable risk factor for NCDs, concerted tobacco control efforts can play a significant role in reducing the ever-increasing disease burden and ensuring countries’ development. WHO Framework Convention on Tobacco Control guides to fight the tobacco epidemic while World Bank proposes tax policy reforms for making tobacco products unaffordable, thereby reducing their consumption and improving health status of the masses.
Launched by the MHFW (GoI), National Tobacco Control Programme (2007-08) aims to generate awareness regarding the harmful effects of tobacco coupled with effective implementation of the tobacco control laws. The National Tobacco Control Cell is responsible for overall policy formulation, planning, monitoring and evaluation of various activities envisaged under the programme.
Increased tobacco taxation being a cost-effective strategy, India levies tiered excise taxes on cigarettes and large-scale bidi production (sparing small-scale/cottage industry). Other efforts for curbing tobacco usage include – awareness generation regarding the adverse health effects, hard-hitting anti-tobacco campaigns, escalated actions for de-addiction/rehabilitation of tobacco-users, reducing exposure to second-hand smoke, enforcing ban on tobacco advertising, promotion and sponsorship. In addition, mTobacco Cessation programmes are also under way.
In 2003, India enacted the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act for protecting health of the masses; which (COTPA) was amended in 2014. It prohibits smoking in public places, bans advertising and sale of tobacco products to minors/near educational institutions, prescribes large pictorial health-warnings on tobacco packages and regulates their tar/nicotine contents. In 2007, India launched National Tobacco Control Programme (NTCP) – a pilot for capacity-building of the States to enforce COTPA and generate awareness regarding adverse health effects of tobacco usage/second-hand smoke. With budgetary allocation of INR 700 crore, NTCP is being expanded, in a phased manner, to cover all 36 states/672 districts during 2012-17.
Dr Margaret Chan (Director-General, WHO) has been strongly stressing on an urgent implementation of MPOWER tobacco control measures i.e. monitoring tobacco use/prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning about the dangers of tobacco, enforcing bans on tobacco advertising/promotion/sponsorship and raising tobacco taxes.
In May 2016 – MHFW, WHO-India Country Office and HRIDAY organized a technical consultation for discussing the tobacco control measures in India. Youth can act as catalysts for preventing tobacco use among children/adolescents – by advocating their peers, families and the society at large; hence, there is a dire need to raise their awareness through school-based programmes highlighting the adverse impact of tobacco use. Further, WHO has directed all nations to go for plain packaging of tobacco products.
A ‘Global Knowledge Hub for Smokeless Tobacco’ has been created at National Institute of Cancer Prevention and Research. A complete ban is imposed on the manufacture and sale of Gutkha/Pan Masala containing tobacco or nicotine. Under ‘Be Healthy Be Mobile Initiative’, India has successfully launched a toll-free Tobacco Cessation QuitLine as well as mCessation services. Displaying anti-tobacco health spots, disclaimer and messages is mandatory in films depicting tobacco usage.
In March, 2017, our Government further amended the Cigarettes and other Tobacco Products (Packaging/Labelling) Rules, 2008 to induct image of specified health warning for all tobacco products w.e.f. 1st April, 2017.
Despite the ban on advertising tobacco products, SLT manufacturers employ surrogate means through deceptive brand sharing strategies and endorsement by the celebrities for increasing their sales to masses, particularly the vulnerable youth and the poor. However, the government has been emphatically regulating SLT products through environmental, food safety and other regulations. Food Safety Act bans the manufacture, sale, transportation and storage of packaged SLT products. Further, hard-hitting public awareness messages about SLT and an efficient/systematic surveillance mechanism is an essential component of comprehensive tobacco control programme.
We must fight collectively to free the world of this leading preventable cause of morbidity/mortality. Our present & future generations need to be urgently protected from the devastating health/social/environmental/economic consequences of tobacco consumption/exposure to tobacco smoke.
*Dr Santosh Jain Passi – Public Health Nutrition Consultant; Former Director, Institute of Home Economics, University of Delhi
* Ms Akanksha Jain – Ph D Scholar, Amity University, Noida, Uttar Pradesh; Research Officer – Public Health Nutrition Division, LSTech Ventures Ltd, Gurgaon, Haryana, India
Photo Courtesy: World Health Organization