Wednesday, 16 April 2014

Tobacco causes 40 per cent of cancers in India

Around two fifths (40 per cent) of all cancers in India are attributable to tobacco use, and the economic costs of illness and premature death due to tobacco consumption exceed combined government and state expenditure on medical and public health, water supply, and sanitation, a new report on cancer care in India published in The Lancet Oncology revealed.


The report points out that India is facing a cancer crisis, with smoking, belated diagnosis and unequal access to treatment causing large-scale problems. Every year in India,around one million new cancer cases are diagnosed and around 600,000 to 700,000 people die from cancer in India, with this death toll projected to rise to around 1.2 million deaths per year by 2035.


The report compiled by Professor Richard Sullivan and Professor Arnie Purushotham from King's Health Partners Cancer Centre at King's College London with the help of senior Indian colleagues including Professor CS Pramesh and Professor Rajan Badwe at the Tata Memorial Cancer Centre, Mumbai.


Although India has a relatively lower incidence of cancer (around a quarter of that in the USA or Western Europe), the rate of deaths from cancer, adjusted for age, is similar to that seen in high-income countries, the report said.
 
Less than a third of patients with cancer in India currently survive for more than five years after diagnosis.
 
Around 95 per cent of the medical colleges in India do not have comprehensive cancer care services, comprising Surgical, Medical and Radiation Oncology departments, in the same campus.
 
Currently there are around 2,000 medical and radiation oncologists in India one per 5000 newly diagnosed cancer patients and in almost all remote or rural areas even the most basic cancer treatment facilities are non-existent, it said.
 
As a result, urban cancer centres are overcrowded and under-resourced, leading to long waiting times, delayed diagnoses, and treatment that comes too late for many patients.


"Cancer research needs to be central to plans for national cancer control, and cancer needs to be one of the focuses of national research agendas and priorities," said Professor Richard Sullivan, King's College London, series coordinator and lead author of the series paper on cancer research in India.
 

Abstracted from Manoramaonline
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Wednesday, 9 April 2014

Tobacco control long neglected from poll manifestos: Medico-legal experts

As the state and the country are teeming with pre-election activity to usher in the 16th Lok Sabha of Independent India, noted personalities from eminent walks of life wonder why tobacco use - a crying public health issue – has for long been neglected in the intent document of various political parties.

The irony, the social experts say is that while tall promises such as “focus on preventive rather than curative measures”, “health security for all” and “health for all families/habitations” have been made, nothing has come forth to address a heavy but controllable tobacco health burden. 

Justice Smt D Sreedevi, former Chairperson, Kerala Women’s Commission points out, “Tobacco use is not just a public health issue; it is also a matter of social injustice. There is substantial proof that tobacco use leads to multiple health problems such as cancers, cardiovascular diseases and stroke. 

Allowing people to freely use these dangerous products and making them vulnerable to dreadful diseases is a case of social injustice. Macroeconomic policy changes through measures such as higher tobacco taxes coupled with no-holds-barred implementation of Indian tobacco control law, COTPA to protect youth from tobacco initiation is needed in earnest. This intent is not reflected in the poll manifestos of any political party.”

Calling for strict implementation of legal provisions and directions made, Justice Sreedevi added, “The High Court has ruled that smoking in public places should be prohibited. A person smoking in a public place is liable for punishment under Section 278 of the Indian Penal Code. Political parties and those in power should ensure that these directions are met by giving strict instructions to enforce the law and orders of the High Court.” 

Eminent oncologist and Founder Director Regional Cancer Centre here Padma Shri Dr M Krishnan Nair said, “Tobacco causes one million deaths in the country annually. The rate of cancers as a result of tobacco use is 40 per cent in men and 15-20 per cent among women, but various political parties have not taken up this preventable public health issue seriously. A look into the poll manifestos of leading parties in the Lok Sabha elections from 2004 – the year in which India ratified the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) – shows that none of them has shown the political will to remedy this health malady.”

The FCTC, the first international treaty negotiated under the auspices of WHO, was developed in response to the globalisation of the tobacco epidemic. It is also an evidence-based treaty that reaffirms the right of all people to the highest standard of health. India ratified FCTC on 5 February 2004. 

Exhorting various political parties to sincerely consider inclusion of matters that will bring larger public good such as tobacco control Dr Nair pointed out, “Our medical resources are severely stretched. We have now one doctor serving 1,800 people as against the WHO guideline of 1:600. There is a resource gap of approximately 1.4 million doctors and 2.8 million nurses. Hospital bed density in India is significantly short of WHO guidelines of 3.511 per 1000 patients’ population. Collective will is required to limit preventable tobacco-induced diseases and save our medical resources for more genuine needs.” 

Padma Shri Dr G Vijayaraghavan, Vice Chairman and Director, Medical Services, KIMS Hospital here said, “Health has been defined as a state of complete physical, mental and social well-being and not the absence of disease or infirmity. Physical, mental and social well-being cannot be achieved if citizens are under the influence of harmful substances such as tobacco. Tobacco control needs to form a part of the socio-political discourse if it has to be meaningfully curtailed. All states should strictly ban tobacco from public places such as restaurants, bus stations and railway stations in addition to all offices. This should be part of the manifesto of all political parties.”

Noted media person Smt Leela Menon said, “The media has rightly highlighted the harms caused due to tobacco use and has pointed out the need for multiple efforts to bring down its use and resultant diseases. Media coverage on tobacco control matters have especially gone up in the last couple of years. It is interesting to note that in spite of the wide media pressure; none of the political parties have thought it fit to come out in open support of this cause. Political parties do not seem to be interested in people’s health or welfare concerns; they are only interested in generating votes.”
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Tuesday, 18 March 2014

Call for consumption ban of pan masala and gutkha in Kerala

Taking cue from Assam, which has banned consumption of harmful tobacco-based pan masala and gutkha products by law, Kerala’s bureaucrats, health professionals, social advocates and tobacco use victims, have made a collective call for a similar legislation in the state.  

Reflecting popular sentiment, they point out that the desired impact of the ban – of reducing the public health burden – cannot be achieved unless consumption is also prohibited.

Shri K Anil Kumar, Commissioner (incharge), Food Safety, the regulating department for the effective implementation of the ban on pan masala and gutkha in Kerala said, “Ever since our state banned these products in 2012, we have been taking stringent action against violators. However, the illicit smuggling of these products into our state has been a major challenge in implementing the effective ban of pan masala and gutkha containing tobacco and nicotine. As such, any positive step in addition to this ban order or strengthening this ban order would be highly desirable. This would also help in curbing use among children in their vulnerable ages.”

Kerala was the second state in the country after Madhya Pradesh to ban the manufacture, storage, sale or distribution of gutkha and pan masala containing tobacco or nicotine as ingredients under the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations 2011.

Dr. K. Ramadas, Medical Superintendent, Regional Cancer Centre said that while oncologists and medical fraternity at large can treat and provide care to the cancer afflicted, a legislative reform, as has been effected in Assam, would have far-reaching positive implications. 

“Chewing tobacco, whether it is pan masala and gutkha, is a major cause of cancers affecting the head and neck in Kerala. I have seen several youngsters who have lost their taste buds, parts of their tongue and jawbones due to use of these smokeless tobacco products. This sorry state can be corrected to a great extent if Kerala can also legislatively ban the consumption of chewing tobacco products,” Dr Ramadas added.

Shri KS Varghese, Retd. Circle Inspector, Kerala Police and tobacco-induced cancer survivor said, “I took to the habit of using chewing tobacco to keep away sleep during night patrolling, and its use made me a cancer patient. I am now disease-free but the cancer that tobacco presented me with shattered my wife and two children. I would appeal to the Kerala Government to bring out a legislation as in Assam and totally ban consumption of these dangerous tobacco products.”

Assam has banned consumption of pan masala, gutkha, zarda etc containing tobacco and/or nicotine under the 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.

Smt Vimala Menon, well-known social advocate and Secretary, Cheshire Home said, “It is heartening that Assam has given us a worthy example to emulate and follow. As someone who has seen the suffering of cancer victims in palliative care, I feel that everything possible should be done to bring down cancer incidence in our state. Banning consumption of all forms of chewing tobacco products by law and imposing strict penalty on violators would be an effective move.”

The Act prohibits “consumption including possession of zarda, gutkha, pan masala etc containing tobacco and/or nicotine and various types of smokeless and chewing tobacco or any of it derivatives in any form.” 

Further, the Act also makes specific reference on prohibiting advertisements of these products. Violators of the law are liable to be punished with imprisonment up to seven years and a fine between Rs 1 lakh and Rs 5 lakh. 

Consumption or possession of zarda, gutka and pan masala containing tobacco is punishable with a fine of Rs 1,000 for the first offence and Rs 2,000 for each subsequent offence. 

Image courtesy: Midday
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Thursday, 27 February 2014

Kannur police top guardians of public health in Kerala

Kannur district may be known to the world as the major centre of bidi manufacturing in Kerala, but not many would know that its police force is the swiftest and brightest in terms of enforcing the Indian tobacco control law, COTPA, 2003.


Recently updated figures of section-wise COTPA violations in the Kerala police website for the period January - December2013 brings out that the Kannur police have recorded the maximum number of 12,647 challans, across 14 districts of the state.


This assertive police action for the sake of public health has also brought in Rs 2,559,000 to the coffers during the period.

Some of the key provisions of COTPA include, prohibition of smoking in public places  (Section 4); prohibition of all forms of direct/indirect advertisement, promotion and sponsorship of  tobacco products (Section 5); prohibition of sale of tobacco products to minors and within a radius of 100 yards of educational institutions  (Section  6 a & b); and mandatory depiction of specified health warnings on all tobacco products (Section 7).

The most promising action has taken place against public smoking, where the year total of number of persons fines/challaned is  12,606, at an average 1,000 plus challans and an average Rs 213,250 as fines a month.

Congratulating the district police force, Dr Satheesan Balasubramanian, Director, Malabar Cancer Centre (MCC) here said,  “Recent studies conducted in Kerala have shown that implementation of COTPA is a critical factor in bringing down use of tobacco, a grave threat that disables and kills many. Police has an important and integral role to play in implementing and enforcing COTPA and it is heartening that the Kannur police has set a worthy example for all. The role of the district police is curbing smoking in public places, especially cinema theatres, is highly commendable.”

Dr Balasubramanian also requested the police to tighten vigil around educational institutions to prevent youngsters from getting into this addictive habit.

Kerala findings of the Global Adult Tobacco Survey (GATS 2009-10) of the Union Ministry of Health & Family Welfare and the World Health Organisation show that a worrisome 18.6% are initiated to the smoking habit below 15 years of age. Another 27.5% are initiated to this dangerous habit between the ages of 15 and 17.

Kannur District Police Chief Shri PN Unnirajan IPS said, “It is a matter of happiness that the district police force has been able to make a significant contribution towards protecting the public from the harmful effects of tobacco by strictly enforcing COTPA. All our officers are sensitised on the law and we will continue to step up efforts in this regard. We have also been motivating the public to keep away from this dangerous product. Along with Section 4, we will also intensify action against those displaying tobacco advertisements and those found selling tobacco products around educational institutions.”

After Kannur, Ernakulam Rural takes the second position in Kerala, with 11,560 challans during the period January-December 2013, netting Rs 2,106,000 as fines.

Image courtesy: http://www.ceo.kerala.gov.in/maps.html
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Tuesday, 4 February 2014

Global battle against cancer won’t be won with treatment alone



Preventing the spread of tobacco use in low-and middle-income countries is of crucial importance to cancer control, says the World Cancer Report 2014 brought out by the The International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization.

The report, a collaboration of over 250 leading scientists from more than 40 countries, describes multiple aspects of cancer research and control. Based on the latest statistics on trends in cancer incidence and mortality worldwide, this new book reveals how the cancer burden is growing at an alarming pace and emphasizes the need for urgent implementation of efficient prevention strategies to curb the disease. 

In 2012, the worldwide burden of cancer rose to an estimated 14 million new cases per year, a figure expected to rise to 22 million annually within the next two decades. Over the same period, cancer deaths are predicted to rise from an estimated 8.2 million annually to 13 million per year. 

Globally, in 2012 the most common cancers diagnosed were those of the lung (1.8 million cases, 13.0% of the total), breast (1.7 million, 11.9%), and large bowel (1.4 million, 9.7%). The most common causes of cancer death were 
cancers of the lung (1.6 million, 19.4% of the total), liver (0.8 million, 9.1%), and stomach (0.7 million, 8.8%). 

“Despite exciting advances, this Report shows that we cannot treat our way out of the cancer problem,” states Dr Christopher Wild, Director of IARC and co-editor of the book. “More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally.

The report also underlines the need of adequate legislation for cancer control. Lessons from cancer control measures in high-income countries show that prevention works but that health promotion alone is insufficient. Adequate legislation plays an important role in reducing exposure and risk behaviours. 

The first international treaty sponsored by WHO, the Framework Convention on Tobacco Control, the report notes, has been critical in reducing tobacco consumption through taxes, advertising restrictions, and other regulations and measures to control and discourage the use of tobacco

Source: IARC
Image: WHO

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Thursday, 23 January 2014

Tobacco displays, an effective channel for promoting brands among the young

A study conducted in England on the association of tobacco display and brand communications at the point-of-sale (PoS) and adolescent smoking behaviour has found a positive relation between the two. 


Exposure to and awareness of PoS displays and brands in displays were associated with smoking susceptibility in the study that covered more than 5,000 students between the ages of 11 and 15 years. 

The odds of ever-smoking doubled for those visiting shops almost daily relative to less than once a week, and susceptibility increased by around 60%. Noticing tobacco on display every time during store visits increased the odds of susceptibility more than threefold compared with never noticing tobacco. 

For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% and of susceptibility by 4%. The association between frequency of visiting stores and susceptibility was predominantly due to exposure in small shops.

This study shows that tobacco displays are a potentially effective channel for promoting cigarette brands to young people, linking such promotion with ever-smoking and susceptibility to future smoking. The association between exposure to tobacco displays and susceptibility to smoke is predominantly explained by exposure in small shops and therefore the tobacco ban in supermarkets in England fails to safeguard young people from exposure associated with smoking initiation.

In England, point-of-sale (PoS) displays in larger shops were prohibited in April 2012, with an exemption for smaller retailers until 2015.

Source: Tobacco Control journal
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Monday, 20 January 2014

Clarion call for raising tobacco taxes to 65 per cent

As the Kerala Budget date draws close, eminent social advocates, thinkers and doctors have appealed to the Government to raise taxes on all tobacco products to 65 per cent.  In separate letters to the Hon’ble Finance Minister Shri KM Mani, they have pointed out that taxing tobacco products will not only help save many precious lives but can also bring in much-needed revenues to the state exchequer.

Renowned dramatist, poet and theatre personality Padmabhushan Shri Kavalam Narayana Panikker has said, “Taxing tobacco products will prevent draining away of precious resources on induced and preventable morbidity. With one stroke of your pen, you can save so many lives in Kerala that we can by any means.”

Former Vice Chancellor, Kerala University Dr G Balamohanan Thampy has pointed out, “At a time when our state is facing a huge resource crunch, taxing tobacco products can prove to be a major avenue for resource mobilisation.”  Well-known filmmaker Shri Shaji N Karun has said, “Increasing the price of tobacco through higher taxes is the single most effective way to encourage tobacco users to quit and to prevent children from starting to smoke.”

Economist and Professor, Centre for Development Studies here Dr S Irudaya Rajan, in his letter, has cited the case of Rajasthan to explain how tax increase can lead to greater revenues. “The Rajasthan Government has consistently increased taxes on tobacco products over the last years and the tobacco tax in the state is currently peaking at an all-India high of 65 per cent. Currently the state earns revenue of Rs 312.08 crores from taxes on bidis. Cigarettes also show an upward trend in tax revenues; the earnings rose from Rs 62.80 crores in 2009-10 to Rs 139.23 crores in 2011-12.”

Well-known cardiologist and Head, Department of Cardiology, PRS Hospital
Dr Tiny Nair has said, “As a doctor, I see the impact of tobacco every day. The disease, suffering and death which tobacco cause are terrible. As a doctor, I try to cure those suffering but as a human being, I am convinced that we need to prevent the problem in the first place. I urge to increase VAT on all tobacco products to 65 per cent in our state.”

Justice KP Balachandran; Former Director of Encyclopaedic Publications,
Dr George Onakkoor; Retd. DGP Shri KP Somarajan; Retd Principal, Government Arts College, Thrissur Prof CG Rajagopal; Gender Economist Dr S Radha; Consultant Neurologist, PRS Hospital Dr R Anandam;  Consultant Cardiologist, Attukal Devi Institute of Medical Sciences Dr G Girija; Paediatrician Dr T Suresh Kumar; Chairman, IMA Research Cell Dr Sreejith N  Kumar and Retd. Superintendent of Police Shri KN Janarajan have also written to the Government for raising taxes on all tobacco products to 65 per cent.

There are around 55 lakh tobacco users in Kerala and a study conducted by the Johns Hopkins University, USA has shown that as many as 4.54 lakh precious lives can be saved/early deaths averted if VAT on tobacco products is increased to 65 per cent.
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Wednesday, 8 January 2014

Tripling tobacco tax worldwide could cut smokers by a third

Aggressive taxation is the key to achieving a World Health Organization goal of reducing the global prevalence of smoking by one-third, new research led by a Toronto scientist shows.

A study headed by St. Michael’s Hospital’s Centre for Global Health Research, published in the New England Journal of Medicine, found that tripling tobacco taxes around the world could reduce the number of smokers by 433.3 million people and prevent 200 million premature deaths from lung cancer and other smoking-related diseases.

“We hope this will spur governments to (recognize) it’s a no-brainer. There is more revenue, fewer deaths and all sorts of benefits for the population,” said Dr. Prabhat Jha, director of the centre and professor in the Dalla Lana School of Public Health at the University of Toronto.

He launched the study to determine how the worldwide prevalence of smoking could be chopped by a third by 2025, a goal set at the World Health Organization’s 2013 Assembly.

While the proposal to hike tobacco taxes is a global one, it is particularly targeted at 10 regions representing two-thirds of the world’s 1.3 billion smokers. In descending order, they are: China, India, the European Union, Indonesia, the United States, Russia, Japan, Brazil, Bangladesh and Pakistan.

Strong lobbying by the tobacco industry has helped keep taxes lower in those countries, Jha explained.

Residents of China consume a staggering two trillion cigarettes annually, out of a world total of about six trillion.

Jha pointed out that the study is not just theoretical and that some countries have experienced great success in reducing smoking rates by sharply upping taxes.

For example, France tripled cigarette prices by raising taxes at least 5 per cent higher than the inflation rate every year between 1990 and 2005. At the same time, the country managed to halve cigarette consumption and double tobacco revenues.

The number of smokers in Canada has also dropped by half, but the decline has taken three decades and is largely due to tax increases, Jha said.

About 4 million Canadians smoke today, and that number could continue to be reduced — again by a third — if tobacco taxes were tripled, he said.

Jha noted that non-price interventions — including advertising bans, warning labels and smoke-free laws — also help to reduce smoking, but hiking taxes is the “single most effective” tool.

About $300 billion (U.S.) is collected annually in tobacco taxes around the world. Even though higher taxes would lower consumption, tax revenues would continue to rise by another $100 billion, bringing the annual total to $400 billion, the analysis showed.

Source: The Star
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Monday, 30 December 2013

Kerala hotels and restaurants to go smoke free

Hotel industry in Kerala is for making lives of Keralites all the more healthy by making hotels and restaurants tobacco smoke free. Major hotels and restaurants associations of the state have agreed to protect employees and customers from dangers of second-hand smoke by initiating necessary measures soon. 

Key office bearers and senior representatives of hotel associations including Kerala Hotels and Restaurants Association (KHRA); South India Hotels and Restaurants Association (SIHRA); South Kerala Hoteliers Forum (SKHF) and Association of Approved and Classified Hotels of Kerala (AACHK) are also united in their commitment to put up mandated signages and in preventing customers and employees from smoking in their premises. 

The Kerala hotel industry looks at the larger benefits that will accrue to public health as against the possible short-term losses from implementing smoke-free rules, Shri D Chandrasenan Nair, veteran hotel industry leader and General Convenor of South Kerala Hoteliers Forum (SKHF) has said. “By making our hotels and restaurants smoke-free, we are hopeful of attracting greater number of non-smokers including women and children.” 

Shri G Sudhiesh Kumar, State President of the 20,000-member-strong Kerala Hotels and Restaurants Association said the decision to implement smoke-free rules was unanimously approved at the Annual General Meeting of the association that met at Kochi on 19 December.

“We realise that this endeavour is not easy especially in bar hotels but we are going ahead with the decision to protect non-smokers; the provisions of law will be implemented in a phased manner,” said Shri Kumar, who is also the Trivandrum District President of Kerala Bar Hotels Association. He also reiterated his association’s commitment to have COTPA mandated signages set up in all hotels and restaurants.

Shri MR Narayanan, Secretary General of South Kerala Hoteliers Forum has said that through this campaign the hotel industry wishes to communicate the message that efforts to curtail passive smoking should be taken up by all. 

Shri Mathew Thomas, senior representative of Association of Approved and Classified Hotels of Kerala (AACHK)  and Shri S Ajith Kumar, senior representative of South India Hotels and Restaurants Association (SIHRA) have also expressed their commitment to the cause. 
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