Thursday, 18 May 2017

20 countries to unite in Delhi to fight against smokeless tobacco

Around 20 countries are coming to Delhi to form guidelines against the smokeless tobacco. The first meet in this regard will take place in Delhi from August 16 to 18 this year, said the reports. 

Due to lack of proper uniform policy against these SLT products consumption such as snus, snuff, gutka, tambaku, khaini, qiwam etc which are very harmful to health the countries are coming together to form guidelines.

The World Health Organisation Framework Convention on Tobacco Control in Noida in collaboration with the Union Health Ministry is already on the path to form a policy against this SLT product consumption.

Now, according to the health ministry officials, it aims to impose heavy taxes and form strict guidelines for the advertisement on the SLT products. 

Dr Ravi Mehrotra, director of WHO FCTC said that it is the first time that a global policy is being looked at for SLTs and it is important to take a stand considering that India is currently one of the biggest exporters of SLT products. 

According to reports, 90.4 per cent of SLT users lives in 11 countries such as India, Bang, Myanmar, Pakistan, United States, China, Indonesia, Nepal, Madagascar, Germany and Uzbekistan. 

Harmful health effects due to consumption of SLTS causes cancer, pre-cancer, cardiovascular effects, adverse pregnancy outcome, respiratory infection, addiction and poor oral health that can lead to death at an early stage in life. 

According to 2015 report, 352 million people in 121 countries were said to be the consumers of SLT products. Among these 352 million people 95 per cent live in developing countries.

Source: OneIndia
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Healthy air is children’s birthright

(Author is an activist of the Human Rights Law Network)

The right to health is an inherent and enforceable fundamental right. It necessarily follows that a clean and pollution-free environment becomes the natural corollary to the statement of right to health.  This acquires a higher degree of sanctity when we  talk  about children who are one of the most vulnerable segments of our society.

There is an obligation on the part of the state to  ensure a healthy environment as part of the fundamental rights in the Constitution under Article 21. This isfurther strengthened by Article 6 of the UN Convention on the Rights of the Child which recognises the right to life and that the state parties shall ensure to the maximum extent possible the survival and development of the child.

The Cigarettes and other Tobacco Products (Prohibition of advertisement and regulation of trade and commerce, production supply and distribution Act 2003
(COTPA) is the principal  comprehensive law governing  tobacco control  in India. India also became a signatory to the WHO framework on the Convention on Tobacco control on February 27 2005. As a consequence of being a party to the framework,  public spaces, workplaces, educational and government facilities and  public transport were declared smoke-free zones. This also included outdoor spaces, open auditoriums, stadiums, railway stations and bus stops.

This has been further augmented by judicial pronouncements which have been a beacon of light in reaffirming  the statutory principles.

It is a well-researched medical fact that use of tobacco and the allied substances causes grave danger to the health of an individual.  Adults  who continue to consume them knowing their adverse effects  do not think of the young vulnerable children who are victims of tobacco use. From an unborn child in the womb to the school-going children, all face this with serious health consequences.

Inhaling the  noxious smoke contributes to the increasing rates of respiratory illnesses, cancer and the like which affect  a holistic quality of life which again is a basic fundamental right of a child.

To discourage the use of tobacco and its allied products,  there have been serious efforts of sensitisation to strike at their consumption  through express pictorial representations and increased taxation measures.   

Unfortunately,  the increasing cost or the extremely visible daunting pictorial representations do not seem to deter the users. The selling of tobacco products near educational premises  is prohibited in law but there are instances where they are sold discreetly or covertly. Glamorous representations of the use of tobacco products as something which is a symbol of a courageous, strong and powerful personality is a major disservice to young impressionable minds.  

Children are gullible individuals who are in the process of establishing their personalities. They  need to follow their role model. This is also the period of risk taking and adventurism.

This requires a delicate handling by regular sensitisation and reiteration of the negative impact of using tobacco products.

If their role models are blatant in their disregard for law, the youngsters will also have the same disregard.

It is essential that a principle of zero tolerance be adopted to ensure a non-negotiable, stricter and effective implementation  of the anti-tobacco legislation for the future of our children.
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Friday, 12 May 2017

കോളജ് വിദ്യാര്‍ഥികളില്‍ പുകവലി വ്യാപകമെന്ന് പഠനം

കോളേജ് വിദ്യാര്‍ത്ഥികള്‍ക്കിടയില്‍ പുകവലി വ്യാപകമാണെന്ന് പഠനം. തൃശൂര്‍ ജില്ലയിലെ കോളജ് വിദ്യാര്‍ഥികളില്‍ 16 ശതമാനത്തിലേറെയും സിഗററ്റിന്റെയോ ബീഡിയുടെയോ രൂപത്തില്‍ പുകവലിക്കുന്നുണ്ടെന്ന് തൃശൂര്‍ ഗവ. മെഡിക്കല്‍ കോളജ് അടുത്തിടെ നടത്തിയ പഠനത്തില്‍ കണ്ടെത്തി.  

രണ്ട് കോളജുകളെ അടിസ്ഥാനമാക്കിയായിരുന്നു സാമ്പിള്‍ പഠനം. ഈ കോളജുകളിലെ  15 മുതല്‍ 24 വയസുവരെയുള്ള  402 വിദ്യാര്‍ഥികളില്‍ നടത്തിയ പഠനത്തില്‍ ഇവരില്‍ 35.4 ശതമാനം പേരും  ദിവസവും പുകവലിക്കുന്നവരാണെന്ന് കണ്ടെത്തി. പുകവലിക്കുന്നവരില്‍തന്നെ 72.3 ശതമാനം പേരിലും  സിഗററ്റാണ് ഏറെ പ്രചാരത്തിലുള്ള പുകയില ഉത്പ്പന്നമെന്നും കണ്ടെത്തി. സിഗററ്റിന്റെ ഉപയോഗം ഏഴു വയസില്‍പോലും ആരംഭിക്കുന്നുവെന്നും 'മധ്യകേരളത്തിലെ യുവാക്കളില്‍ ലഹരിപദാര്‍ത്ഥ ദുരുപയോഗത്തിന്റെ കാരണങ്ങളും വ്യാപ്തിയും' (Prevalence and Determinants of Substance Abuse Among Youth in Central Kerala, India) എന്ന പഠനം കണ്ടെത്തി.  ഇന്റര്‍നാഷണല്‍ ജേണല്‍ ഓഫ് കമ്യൂണിറ്റി മെഡിസിന്‍ ആന്‍ഡ് പബ്ലിക് ഹെല്‍ത്തിലാണ് പഠനം പ്രസിദ്ധീകരിച്ചിരിക്കുന്നത്. 

കോളജ് അധികൃതരില്‍നിന്ന് ഔദ്യോഗിക അനുമതിയും വിദ്യാര്‍ഥികളുടെ സമ്മതവും നേടിയശേഷം മെഡിക്കല്‍ കോളജ് കമ്യൂണിറ്റി മെഡിസിന്‍ വിഭാഗത്തിലെ ഗവേഷകര്‍ വിദ്യാര്‍ഥികള്‍ക്ക് നല്‍കിയ ചോദ്യാവലിയുടെ അടിസ്ഥാനത്തിലായിരുന്നു പഠനം. പ്രായം, മാതാപിതാക്കളുടെ വിദ്യാഭ്യാസസ്ഥിതിയും തൊഴിലും, പുകയില ഉപയോഗത്തിന്റെ തരവും തോതും തുടങ്ങിയ  വിവിധ സാമൂഹിക-ജനസംഖ്യാപരമായ സ്വഭാവസവിശേഷതകള്‍ ചോദ്യാവലിയില്‍ ഉള്‍പ്പെടുത്തിയിരുന്നു. തങ്ങളുടെ സുഹൃത്തുക്കളില്‍ 46 ശതമാനവും, ബന്ധുക്കളില്‍ 29.9 ശതമാനവും രക്ഷിതാക്കളില്‍ 24.4 ശതമാനവും ഏതെങ്കിലും തരത്തിലുള്ള ലഹരിപദാര്‍ത്ഥങ്ങള്‍ ഉപയോഗിക്കുന്നതായി പഠനത്തില്‍ പങ്കെടുത്ത വിദ്യാര്‍ഥികള്‍ പറഞ്ഞു.

ലഹരിപദാര്‍ത്ഥ ദുരുപയോഗത്തിന്റെ ആരോഗ്യപരമായ പ്രത്യാഘാതങ്ങള്‍ 96.1 ശതമാനം വിദ്യാര്‍ഥികള്‍ക്കും അറിയാമായിരുന്നതായി കണ്ടെത്തിയതായി പഠനത്തിന്റെ സഹ ഗ്രന്ഥകര്‍ത്താവ്,   മഞ്ചേരി മെഡിക്കല്‍ കോളജ് കമ്യൂണിറ്റി മെഡിസിന്‍ വിഭാഗം അസി. പ്രൊഫസര്‍ ഡോ. റിനി രവീന്ദ്രന്‍ പറഞ്ഞു. ഈ സാഹചര്യത്തില്‍ ഇത്തരം അനാരോഗ്യകരമായ ശീലങ്ങളില്‍നിന്ന്   സമൂഹമൊന്നാകെ യുവാക്കളെ പിന്തിരിപ്പിക്കേണ്ടതുണ്ട്. കോളജ്, സര്‍വകലാശാല തലത്തിലും ജില്ലാതലത്തിലും ജില്ലാ വികസന കൗണ്‍സില്‍ പോലെയുള്ള നിരീക്ഷണ സംവിധാനങ്ങള്‍ ശക്തിപ്പെടുത്തേണ്ടതുണ്ടെന്നും ഡോ. റിനി പറഞ്ഞു.

സര്‍വേയില്‍ പങ്കെടുത്ത 83.6 ശതമാനം വിദ്യാര്‍ഥികളും പൊതുസ്ഥലത്തെ പുകവലി നിരോധനത്തെ അനുകൂലിച്ചതാണ് പ്രതീക്ഷ നല്‍കുന്ന കണ്ടെത്തല്‍. വിദ്യാഭ്യാസ സ്ഥാപനങ്ങള്‍ ഉള്‍പ്പെടെയുള്ള പൊതുസ്ഥലങ്ങളിലെ പുകവലി കര്‍ശനമായി വിലക്കുന്നതാണ് ഇന്ത്യന്‍ പുകയില നിരോധന നിയമം (കോട്പ 2003)ന്റെ സെക്ഷന്‍ 4.

പുകയിലയിലെ  പുകയ്ക്ക് സുരക്ഷിതമായ അളവ് എന്നൊന്നില്ലെന്നാണ് ലോകാരോഗ്യ സംഘടന പക്ഷേ പറയുന്നത്. നൂറുശതമാനം പുകയില വിമുക്തമായ അന്തരീക്ഷം സൃഷ്ടിക്കുന്നതിനെയാണ് സംഘടന പ്രോത്സാഹിപ്പിക്കുന്നത്. പുകയില പുക കാണാനോ ശ്വസിക്കാനോ തിരിച്ചറിയാനോ അളക്കാനോ സാധിക്കാത്ത അന്തരീക്ഷത്തിനാണ് നൂറുശതമാനം പുകരഹിത അന്തരീക്ഷമെന്ന് പറയുന്നത്. സിഗററ്റ്, ബീഡി കുറ്റികളോ ചാരമോ ഉണ്ടെങ്കില്‍പ്പോലും ഒരു പ്രദേശം നൂറുശതമാനം പുകവിമുക്തം എന്നു പറയാന്‍ സാധിക്കാതെവരും. 

വികസനപ്രക്രിയയില്‍ പുകയില ഉപയോഗം സൃഷ്ടിക്കുന്ന കനത്ത ഭാരം കണക്കിലെടുത്ത് ലോകാരോഗ്യസംഘടന വരുന്ന മേയ് 31 'ലോക പുകയില വിരുദ്ധദിന'മായി ആചരിക്കാന്‍ ആഹ്വാനം ചെയ്തിട്ടുണ്ട്. ഇക്കൊല്ലത്തെ പ്രമേയം 'പുകയില: വികസനത്തിന് ഭീഷണി' എന്നതായിരിക്കും. 

പ്രധാന ഗ്രന്ഥരചയിതാവും തൃശൂര്‍ മെഡിക്കല്‍ കോളജ് കമ്യൂണിറ്റി മെഡിസിന്‍ വിഭാഗം മുന്‍ മേധാവിയുമായ  ഡോ. ലൂസി റാഫേല്‍, അസി.പ്രൊഫസര്‍ ഡോ. സജ്‌ന എം.വി. എന്നിവരും പഠനത്തില്‍ സഹകരിച്ചു.

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Thursday, 11 May 2017

Monday, 8 May 2017

How does smoking lead to anemia?

Thalassemia is a genetic blood disorder. People with Thalassemia disease are not able to make enough hemoglobin, which causes severe anemia. Hemoglobin is found in red blood cells and carries oxygen to all parts of the body. When there is not enough haemoglobin in the red blood cells, oxygen cannot get to all parts of the body. Organs then become starved for oxygen and are unable to function properly.

There are many ways by which smoking cigarettes leads to particular types of anemia, including, but not limited to the following:
  • Smoking causes significant reduction of vitamin C in the body, which is essential in the absorption of iron.
  • Smoking causes gastritis and ulcers, which may result in bleeding, which can cause anemia.
  • Smoking interferes with fertility and menstrual cycles, and may cause abnormally excessive bleeding during periods.
  • Smoking can lead to cancer, which causes chronic blood loss, and anemia.
  • Smoking also destroys the immune system, which may also lead to an autoimmune blood disease called autoimmune haemolytic anemia. The said type of anemia is characterized by the malfunction of the immune system, which mistakenly destroys the red blood cells.
  • Smoking during pregnancy does not only affect the unborn fetus but also lowers folic acid levels in the body. This may likewise cause anemia.
  • Smoking decreases appetite, which may lead to low iron and vitamin C consumption. On the other hand, smoking makes caffeine, alcohol, and other unhealthy food taste good, thus increasing intake and introduction of such substances into the body.

People who have anemia or do not want to develop anemia should stop smoking at the earliest possible time. A combination of professional advice and help, as well as a personal resolve to cut the habit will make it easier to maintain a healthier circulatory system.

Sources: and QuitToday
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Thursday, 4 May 2017

Why not ban chewing tobacco, HC asks authorities

Why should chewing of tobacco not be banned as such a step would end the problem posed by ‘gutka’ and ‘pan masala’, the Delhi High Court asked.

The court asked the Food Safety and Standards Authority of India (FSSAI) whether such a step has been taken by the Centre or any of the state governments.

While ‘gutka’ is a mild stimulant made of areca nut, tobacco and other intoxicants, ‘pan masala’ is a mixture of betel leaf with lime, areca nut and other items.

“Have you considered banning it? If you say that chewing tobacco is per se harmful, has anyone banned it? You know, if you (authorities) ban it the whole problem would be over,” Justice Sanjeev Sachdeva said.

The FSSAI, represented by advocate M Pracha, said there was no need to separately ban chewing of tobacco as the notifications banning ‘gutka’ covers this aspect as well.

However, the ban is not being enforced or implemented, the lawyer said.

The court, on the other hand, observed that the notification only appeared to ban mixing of chewing tobacco with any eatable item or ‘pan masala’ and banned ‘gutka’.

The FSSAI did not agree with the observation and said that as chewing tobacco is an “unsafe food”, its sale would attract penal provisions.

The court was hearing an application moved by a tobacco manufacturing company seeking to amend its main petition challenging the notification banning ‘gutka’.

The company wanted to amend its main plea to also challenge the 2017 notification banning ‘gutka’ as the Delhi government comes out with such orders every year.

The court issued notice to the Delhi government and FSSAI seeking their replies to the plea before the next date of hearing in the main petition on May 11.

Source: State Times
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Friday, 28 April 2017

Taxation on Tobacco in India - Tool for Tobacco Control

Tobacco is the major factor causing non-communicable fatal diseases in India. Tobacco consumption in India is unique and complex with various forms of smoke and smokeless tobacco. Its use is long-standing and is ingrained among Indians from varying cultural backgrounds. Also its social acceptability poses great challenges for the regulation of tobacco products and the enforcement of tobacco legislation. However, there are other barriers as well that prevent the cessation of this practice such as poverty, illiteracy, lack of awareness, aggressive marketing strategies of giant tobacco companies targeting vulnerable groups, a growing economy and a less than optimal implementation of provisions for tobacco cessation by government agencies. This article focuses on the current state of the Indian population addicted to tobacco use and the various methods used to improve cessation, with a focus primarily on taxation as a crucial measure that encourages abstinence.

Tobacco consumption is the single most important avoidable risk factor in the growth of non-communicable diseases in India (Jha and Chaloupka 1999). Tobacco-accounts for 12% to 25% of the deaths among men in India (Gajalakshmi et al 2003; Gupta et al 2005; Jha et al 2008); one half of tobacco-related deaths occur between the ages of 35 and 69 years—the most economically productive period (WHO 2002).

Tobacco Consumption in India
India is the third largest producer of tobacco and the second highest consumer of tobacco products. There is a broad spectrum of tobacco products, aimed at different socio-economic and demographic categories. Unlike other countries, India is unique in the use of multiple non-cigarette preparations such as beedi (an indigenous form of combustible tobacco) and the extensive variety of oral tobacco products (chewing, quid, and dentifrices). Beedis account for 85% of smoked tobacco (John et al 2010), however, there has been growth in the number of cigarette smokers in the past decade (Joseph 2011) due to a rise in disposable incomes and an increased affordability. Studies have also shown that manufactured cigarettes are displacing beedis (Jha et al 2011). Prevalence estimates vary, with most estimates obtained from the National Family Health Survey–3 (NFHS–3) of 2005–06.

Approximately 10% of the world’s tobacco smokers live in India (WHO 2008). Between the ages of 15 and 49 years, 57% of males and 11% of females consume tobacco in a smoked or non-smoked form. Around 120 million Indians smoke, of these 115 million are males and 5–6 million are females. Fourty percent of rural men and 10% of rural women chew tobacco, 31% of urban men and 5.5% of urban women chew tobacco (John et al 2010). Recent trends in tobacco use are not indicated with certainty. However, the absolute number of male smokers is rising, with male smokers between the ages of 15 and 24 accounting for the largest proportion of the increased consumption (Sharma 2014).

About one million deaths are attributable to smoking-related diseases annually in India (John et al 2010) and on an average, male beedi smokers die six years earlier and female beedi smokers die eight years earlier than their non-smoking counterparts. Male cigarette smokers die an average of 10 years earlier than their non-smoking counterparts. More than half of tobacco-related smoking deaths occur in illiterate sub-populations. Roughly 80% of these deaths occur in rural areas. The risk of death due to chewing tobacco is 15% for males and 30% for females. Healthcare costs are a huge burden for a developing economy like India. Healthcare costs for tobacco-related illness, spent by public and private funds, was about 30,000 crore annually (Reddy and Gupta 2004). Households with a smoker have worse child health outcomes, including lower immunisation rates in children (Rani et al 2004).

Tobacco Control Measures
Cessation is the only practical way to substantially reduce the morbidity and mortality issues associated with tobacco consumption, in the relatively near term. This requires comprehensive tobacco control programmes—including both price and non-price interventions. Although India has ratified the WHO Framework Convention on Tobacco Control (WHO FCTC), implementation of its provisions has been suboptimal. According to the WHO, the six policy measures included in the MPOWER policy, if effectively implemented have the ability to reduce tobacco use, however, tobacco taxes are by far the most effective method of decreasing tobacco consumption especially among the young and lower income sections in emerging economies (WHO 2008, 2014a).

Taxation: Taxation plays a critical role in tobacco control. Tobacco taxation and consumption are inversely related (WHO and IARC 2011); higher taxes are particularly effective with poorer or less educated groups (WHO 2010). Most high-income countries have reduced their overall tobacco consumption, over the years, through increased taxation. France reduced its tobacco consumption by 50%, in a span of just 15 years, from 1990 to 2005 mostly due to a sharp rise in tobacco excise taxation (Hill and Laplanche 2003). Even among several low and middle-income countries of South-East Asia—Bangladesh, Sri Lanka and Thailand—taxes have exceeded 70% on top of the retail price (WHO 2014b).

Unfortunately, India has the lowest taxation rates on tobacco in the Asia–Pacific region—well below the recommendations of the World Bank and the WHO. This creates significant challenges for implementing cessation programmes. Tobacco taxation in India is the most complex tax policies in the world and there is no uniformity. Taxes are based on the type of product, length and quantity of tobacco. Low levels of taxation, with an inefficient tax structure contribute to increased tobacco consumption.

Taxation on cigarettes: A tax of 38% on top of the retail price, is far below the World Bank recommended rate of 65% to 80%, and also it varies with length from less than 65 mm to more than 85 mm. Longer cigarettes are taxed at higher rates, so companies manufacture varying lengths to retain their customer base and consumers shift to the cheaper options.

Taxation on beedi: Handmade beedis are taxed at 12 per 1,000 sticks, machine made beedis are taxed at 30 per 1,000 sticks and an average rate of 9% is applied to the retail price. As a result, nearly 98% of beedis are handmade (Sunley 2008) though mechanisation is available. Also, small-scale beedi manufacturing has been reduced to only 50% of the market with a concomitant increase in household beedi rolling, given that no tax is levied if production is less than two million beedis annually.

Taxation on oral tobacco: There is no set tax on chewing tobacco—this is subject to ad valorem taxes that are based on the value of tobacco products. The literature indicates that reducing oral tobacco consumption through taxes, is not as feasible as reducing smoked tobacco consumption, due to the large and informal market of sub-suppliers, in the case of oral tobacco (Jha et al 2011). This leads to its greater use, and is of particular concern in India due to the disproportionate usage by women and youth and the fact that oral tobacco is a major cause of oral cancer, of which India has become an epicentre. It is of paediatric concern also, because children on the street begin consuming tobacco through chewable forms that are available in sachets (Priya and Lando 2014).

Literature on Tobacco Taxation
Higher taxation of tobacco products is the single most effective intervention to reduce consumption (Jha et al 2008). The following are the consequences of an increased taxation on beedi and cigarette manufacturing, with respect to revenue raise and premature mortality. Raising taxes on beedis to 98 per 1,000 sticks would raise tax revenue of over 36.9 billion and would also prevent 15.5 million deaths in terms of current and future beedi smokers (John et al 2010). Raising cigarette taxes to 3,691 per 1,000 sticks would raise tax revenue of over 146 billion and also prevent 3.4 million deaths in current and future cigarette smokers (John et al 2010). Uniformity in taxation also is indicated. The increased tax revenue could support comprehensive tobacco control programmes, including cessation, and other social and public health programmes such as those in Australia (VicHealth) and Thailand (ThaiHealth) (John et al 2010; WHO 2012).

Economic growth: Taxation policy should be in accordance to income growth, with annual systematic inflation-adjusted increases built into the policy; otherwise increased affordability will lead to an increased consumption. In India, beedis were nearly three times more affordable in 2011 than in 1990, while cigarettes were two times more affordable (Blecher and Van Walbeek 2009). Manufactured cigarettes are also displacing beedis (Jha et al 2011) as a measure of affordability.

In the Indian scenario, high consumption of tobacco is due to easy availability, accessibility and affordability, exacerbated by a lack of health education and awareness as well as, poverty. Tobacco control requires strong political will—to control tobacco production, to enforce strict regulations as stated in the Cigarettes and Other Tobacco Products Act 2003, to be compliant with FCTC regulations and guidelines and to include increased and uniform taxation on smoking tobacco, with an equal consideration on taxing smokeless tobacco.

Commentary by Priya Mohan; Harry A Lando and Panneer Sigamani in the Economic and Political Weekly

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