Wednesday, 27 August 2014

Economic costs of tobacco use: Kerala surpasses neighbours

Kerala has emerged as a leader of sorts in South India with the huge economic burden it shoulders on account of tobacco use. God’s Own Country has left behind its tobacco cultivating neighbours Karnataka and Tamil Nadu, reveals the findings of a major recent national study conducted to estimate the economic dimensions of tobacco use.

The study supported by the Union Ministry of Health & Family Welfare and the World Health Organisation brings out that the economic resources lost in treating and managing four major tobacco-induced diseases is nearly 75 per cent more than Karnataka. While Kerala burns out Rs 545.4 crores, it is Rs 314.7 crores in Karnataka.

Monetary resources lost due to tobacco use in Tamil Nadu is nearly 17 per cent lesser than Kerala, at Rs 467 crores.

The report following the study called ‘Economic Burden of Tobacco Related Diseases in India’ developed by the Public Health Foundation of India has estimated the economic costs on persons aged 35 – 69 in the year 2011. It has estimated both direct medical costs and indirect morbidity costs in two categories – all tobacco-induced diseases, and four specific diseases – cardiovascular diseases (CVDs); cancer, tuberculosis and respiratory disease.

Direct medical costs include direct healthcare expenditure for inpatient hospitalisation or outpatient visits such as medicines, diagnostic tests, bed charges and surgeon’s fees. Indirect costs accrue from expenses incurred on transportation and lodging charges for caregivers, loss of household income due to inpatient hospitalisation, besides costs from premature death. 

A similar pattern prevails with regard to economic burden of tobacco use from all diseases, with Kerala facing a greater pinch than Karnataka and Tamil Nadu. The economic cost in Kerala on all diseases is Rs 1513.7 crores, as against Rs 983.1 crores in Karnataka and Rs 1171.3 crores in Tamil Nadu.
In line with consumption patterns, tobacco-induced costs are higher among Kerala males as compared to females. Among males, higher costs – both direct and indirect – accrue from smoking tobacco products as against smokeless tobacco products.

On four diseases specifically, tobacco use among Kerala males causes a loss of Rs 518.9 crores, which is nearly 90 per cent more than in Karnataka and 40 per cent more than in Tamil Nadu. Tobacco induced economic costs among Kerala females is Rs 26.4 crores.

Kerala’s saving grace is Andhra Pradesh, a major tobacco producing state in India, which leads with the highest economic burden due to tobacco use among southern states.

The study, among others, recommends prioritisation of tobacco control measures such as strengthening implementation of Indian tobacco control law, COTPA, 2003; uniform taxes on all tobacco products such as cigarettes and bidis; prohibition on sale and manufacture of all forms of smokeless tobacco products/chewing tobacco and high visibility public awareness campaigns to consistently reach different target audiences.

The Value Added Tax on cigarettes in Kerala is 22 per cent and bidis are not taxed at all.
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Wednesday, 20 August 2014

Thiruvananthapuram set to become first smoke-free district

By August 31, all government, public sector and private offices in the district are would become 'Smoke-free' as the district collector has issued directives as part of the drive to make the district the first district in the state to comply with the Indian Tobacco Control law - Cotpa. 

"Initially, directions were issued to ensure a smoke-free environment in all public places, government, public and private offices and establishments in the district by August 15. As some had sought more time to implement it, the deadline to ensure a smoke-free district was extended till 31st," district collector Biju Prabhakar told TOI. 

A decision in this regard was taken at a meeting convened by the district collector with representatives of all major departments such as city and rural police, education, excise, local self government, corporation, food Safety, health, RCC, transport and railways on Tuesday. 

The directive states that all workplaces, government, public offices and private establishments in the district should ensure a smoke-free environment according to Section 4 of Smoking in Public Places Rules 2008 of Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (Cotpa). It has outlined the need to set up warning boards in bilingual template of no less than 60cmx30cm on display at workplaces and public places. 

"Enforcement of the drive to ensure a smoke-free public space in any government, public and private office or establishment will help reduce the menace, even if not 100% eradication. In a workplace or a hotel, smoking should not be permitted in a public space as it will affect others's health. A separate smoker's chamber or room should be there," Biju Prabhakar said. 

With Tobacco-free Kerala, making all workplaces smoke-free is critical to achieving the target of Kerala's first Cotpa compliant district and it will make the state capital a model in the public health arena, he added. 

After the enforcement drive against tobacco products and pan masala, it is almost banned in Kerala with the convergence of various departments including, excise and food safety, he said. 

Courtesy: Times of India
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Thursday, 14 August 2014

Kozhikode district to say no to tobacco

The district administration, with the help of the Police Department and various voluntary organisations, is trying to make Kozhikode a tobacco-free district as per the Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), 2003.

District Collector C.A. Latha said in a press release that the district administration aimed at coordinating various departments and agencies for the purpose. The district would get a ‘public health friendly’ status in three months, she said.

The project was part of the government’s policy to protect the public, especially children, from tobacco and drugs. The Collector had convened a meeting of various departments and agencies on August 7 to discuss the project. The response was favourable, the release said.

The target would be achieved through awareness programmes and strict enforcement of the laws by the police and other agencies, with the help of various institutions and the media, the release said.

The district administration would monitor and evaluate the implementation of the project. The details would be made available on the official website,
Ms. Latha said.

Campaigns would be taken up to make people aware of the harm that tobacco could do. People’s representatives would take part in the project. The plan was to make it a model project for other districts and States to emulate, she said.

As per Section 4 of COTPA, smoking had been banned in public places. Advertising tobacco products in any manner was banned under Section 5. Section 6(a) banned the sale of tobacco products to anyone below 18 years of age.

The section also banned the sale of tobacco products within 100 metres of educational institutions. Section 7 spoke of mandatory health warnings on packets. All these would be enforced strictly, she said.

City Police Commissioner A.V. George and District Police Chief, Kozhikode rural, P.H. Ashraf said the police would cooperate wholeheartedly with the programme.

Police officers in the district had been trained and instructed in this regard. The programme was co-organised by ‘Tobacco Free Kerala.’

Source: The Hindu
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Wednesday, 16 July 2014

Kerala capital to become model COTPA compliant: City police gears up

The Thiruvananthapuram City Police  are fully geared up for time-bound action to make the capital a tobacco free district that fulfils the provisions of the Indian tobacco control law COTPA, 2003. This follows a multi-stakeholder meeting chaired by the District Collector that decided to make Thiruvananthapuram a model COTPA compliant district.

As part of this, Circle Inspectors and Sub Inspectors attended a half-day workshop in which they were explained the various sections of COTPA and the steps for achieving model compliance status.

Deputy Commissioner Smt S Ajeetha Begum talked about the purpose of the training programme and asked all officers to take strict action against COTPA violations. “We are embarking on a prestigious project that will have positive implications on the health and well-being of our people,” she said, even while calling for strengthening reporting of COTPA violations.

Faculty member Retd.DySP Adv K Mohana Kumar made an audio-visual presentation and explained the various sections of COTPA and the punitive measures prescribed for violation of each. Section 4 of COTPA prohibits smoking in all public places; acts of violation will invite a fine up to Rs 200. Public places have also to put up mandatory no smoking signages in the prescribed size and format at the entrance and conspicuous places inside. Educational institutions, hospitals, restaurants, cinema halls and the like are included in the list of public places, he told.

Section 5 prohibits all forms of tobacco advertisements; Section 6 prohibits sale of tobacco products to and by minors – sale of tobacco products around 100 yards (91.4 metres) radially of an educational institution is banned. Section 7 requires statutory health warnings in all tobacco products’ packages.

Joint Commissioner, Food Safety Shri K Anil Kumar explained that products such as gutkha and pan masala containing tobacco or nicotine have been banned in Kerala as per the 2011 regulation of the Food Safety and Standards Act of India, 2006. As per this, tobacco and nicotine shall not be used as an ingredient in any food product and that the product should not contain any substance that is injurious health.  He also sought stronger coordination between Food Safety and other implementing departments such as Police and Health for effective enforcement of the ban in Kerala.

District Health Officer (Rural) Shri PK Raju presented field-level experiences on implementing COTPA. Highlighting a circular issued by the local self government department in 2011, he pointed out that setting up of ‘no smoking’ boards are a precondition for issue of Factory Licences and Dangerous & Offensive Trade Licences under the Kerala Panchayat/Municipality Acts. Secretaries of Local Government Institutions have been directed to display boards prohibiting smoking at public places and premises of offices under their control, Shri Raju added.

In his opening remarks, Shri S Jayaraj, State Coordinator, Tobacco Free Kerala spoke about smoking in public places which violates Articles 21 and 47 of the Indian Constitution. Article 21 is about protection of life and personal liberty and Article 47 calls upon the State to improve public health.

Tobacco use victim Shri Sukumaran narrated the physical and financial hardships he had to face following tobacco induced oral cancer. The workshop was organised by Trivandrum City Police together with Tobacco Free Kerala – a coalition of like-minded organisations formed for tobacco control in Kerala. More than 30 officers participated in the programme. 
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Wednesday, 7 May 2014

National Short Film Contest on Tobacco Control: Entries invited

To heighten awareness about the potent dangers of tobacco among the youth and to enhance their involvement in control efforts, a national short film contest is being organised ahead of World No Tobacco Day (WNTD) that falls on May 31.
Entries are invited from youth between the ages of 18 and 25 for this contest being conducted by WNTD Kerala State Organising Committee formed under the leadership of the Department of Health, GoK, Achutha Menon Centre for Health Science Studies of Sree Chitra Tirunal Institute for Medical Sciences & Technology and Regional Cancer Centre.
The entered short films should be in English or Malayalam and may be made in digital camera, camcorder, handycam or mobile camera. The films should have a minimum duration of 30 seconds and should not exceed one minute. Both individuals and groups can participate.
The short films may be made in one of the themes including ‘raise tobacco taxes’; ‘enforce tobacco control laws’; ‘tobacco and health’ and ‘tobacco and youth’.
The last date for submitting entries is May 19; only the first 100 entries received before the deadline will be considered for evaluation. A jury panel of noted filmmakers and medical experts of repute will evaluate the films. The first three winning entries will get a cash prize of Rs. 10,000, Rs. 5,000 and Rs. 3,000 respectively; there are also two consolation prizes of Rs 1,000 each. All winners will get a certificate and memento.
Submissions of not more than 25 MB in ‘.mov’ or ‘mpeg’ formats are to be sent via email to More details about the contest, its rules and regulations are available here. For further details, contact 0471 – 2524247.
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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:
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