Tuesday, 24 May 2016

States told to withdraw tobacco packs without 85 per cent pictorial warning

The Centre has set May 31 deadline for the States and Union Territories to withdraw from the market tobacco products whose 85 per cent packaging space is not covered with pictorial warning.

A communiqué from the Tobacco Control Division of Union Ministry of Health and Family Welfare, New Delhi, dated May 20, 2015, has requested the Chief Secretaries of all States and Union Territories to take steps for strict enforcement of the new rules on pictorial warnings.

The Pictorial Warning Rules under Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA) 2003 had come into force from April 1, 2016. The communiqué said that packages not compliant with the new rules be allowed for sale “only by printing, pasting or affixing the new warnings thereon covering 85 per cent of the principal display area.”

Referring to continued sale of cigarette packets bearing a pictorial warning only on 40 per cent of the display area, U.S. Vishal Rao, member of Karnataka Government’s High Power Committee on Tobacco Control, told The Hindu that cigarette manufacturers were “misleading the public”.

Though the Union Health Ministry’s notification on the larger size of pictorial warning was issued in September last year to come into force from April 1, the cigarette manufacturers continued to mislead the public by restricting the warning to 40 per cent of the display space on one side. “The rest of the space, 60 per cent on one side and 100 per cent on the other, continues to be an advertisement,” he said.

Dr. Rao also said the stores had been directed to display the product in such a manner that the side of the cigarette packet without warning faces the public.

Meanwhile, most cigarettes packs available in Mysuru not only bore a pictorial warning that was restricted to just 40 per cent of the display area on one side, but also a packaging date that was prior to April 1, 2016, when the law on larger pictorial warning came into force.

Though wholesale cigarette dealers, speaking on condition of anonymity, said they did not possess any pack packaged prior to April 1, they did not rule out the possibility of retail shops and stores continuing to sell old stock.

Source: The Hindu
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Monday, 9 May 2016

The bumpy road to 85%: How tobacco packs came to have bigger warnings

A Supreme Court directive last week that tobacco packs would have to adhere to the 85% pictorial warning norm may have finally brought the curtains down on a long and bitter battle that had been raging in the country for about 19 months. Here’s all you need to know about the battle that has been as much about public health as it has been about politics and business. 

When was the decision taken to increase the size of pictorial warnings on tobacco packs to 85% of the principal display area instead of the original 40%?
The Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules 2014 were notified in October 2014 under which the size of the pictorial warning was to be increased, the intention being to reach out to people who may be illiterate, or may not notice small warnings. The larger warnings were to come into effect from April 1, 2015. Many believed the move was powered by then Health Minister Dr Harshvardhan’s firm commitment to the anti-tobacco cause — his sudden removal from the Health Ministry less than a month after the notification was issued, likewise led to frenzied speculation about the hand of the “tobacco lobby”.

How did the Committee on Subordinate Legislation come into the picture?
The Committee, among whose members is Allahabad MP Shyama Charan Gupta, the owner of a self-declared bidi empire that has an annual turnover of Rs 200-250 crore, suo motu decided to examine the notification soon after the first reshuffle of the Cabinet. It tabled an interim report in Parliament in March 2015, asking the Health Ministry to postpone the implementation of the warnings until it had managed to examine various aspects in greater detail. The report made a strong pitch for exempting bidis, saying: “Bidis are natural product and are very small as compared to cigarettes. As such, bidis should not be compared with cigarettes as far as rules are concerned… There is no alternative crops for bidi/tobacco farmers… The new rule that 85% of the bidi wrapper should contain horrific warnings etc. will cause the bidi industry to collapse.” Outside of Parliament, Committee chairman Dilip Gandhi got into another major controversy after he claimed that there was no Indian study to prove that tobacco actually causes cancer.

What was the response of the government? 
Immediately after the report of the Committee on Subordinate Legislation came in, the Health Ministry decided to put on hold the five-month-old notification, five days before it was to have come into effect. This, despite the fact that the report of the Committee was not binding on the government. There have been numerous instances of governments having gone ahead with decisions despite objections from Parliamentary panels — a recent example being the Juvenile Justice (Care and Protection) Act, 2015 that mandated that children aged between 16 and 18 years, who are accused of heinous crimes, may be tried under adult laws if certain conditions are fulfilled. Health Minister J P Nadda defended the decision saying he believed in stakeholder consultation. 

Did the government share the Committee’s concerns about the loss of livelihood for tobacco farmers etc.?
In its written reply to the Committee, the Agriculture Ministry said that alternative crops had been mapped out in regions engaged in tobacco production, so there would be no great implications for farmers’ livelihood. The crops thus identified were onion, chilli, maize and sunflower in Tamil Nadu; sugarcane, soyabean, groundnut and sorghum in Karnataka; potato, maize, wheat and mustard in West Bengal; and maize, sunflower, black gram and chickpea in Andhra Pradesh. 

So what forced the Health Ministry to move on the pictorial warnings? 
In August last year, the Rajasthan High Court, responding to a PIL, ordered the Centre and the state government to immediately implement the 2014 rules under the anti-tobacco law. “After hearing the learned counsel appearing for the petitioner and considering the research as well as orders passed by various High Courts and the Supreme Court, we find it imperative, and in larger public interest, to stay the operation of the corrigendum. The rules of 2014 will come into force immediately, and will be enforced by the Centre and the Government of Rajasthan,” stated the order, passed by a two-judge bench of the High Court on July 3, 2015. The Centre was forced to make a commitment that the rules would come into effect from April 1, 2016, exactly one year after its original date of implementation. 

And did the Committee on Subordinate Legislation too come round to the idea that 85% warnings on tobacco packets is a public health requirement? 
It did not. In its final report submitted in the Budget Session of Parliament this year, it said: “The Committee are of considered view that in order to have a balanced approach, the warning on the cigarette packets should be 50% on both sides of the principal display area instead of 85% of the principal display area as it will be too harsh and… will result in flooding of illicit cigarettes in the country.” On bidis, it held: “The Committee strongly feel that the Government need to re-consider their decision to cover bidi industry under the amended rules and recommend that a practical approach in the matter may be adopted by increasing the size of warning up to 50% on one side of the bidi pack, chewing tobacco and other tobacco, products namely zarda, khaini, misri etc. which will be feasible to follow and which would also ensure that a large number of people in the trade will be saved from being rendered unemployed.” 

Who went to the Supreme Court? 
The Karnataka Bidi Association had approached the apex court against the notification on the bigger pictorial warnings. “Tobacco manufacturers have a duty towards the society. Bigger pictorial warnings on tobacco products are necessary to educate people. They should know about its effect on health,” observed a Bench of Justice P C Ghose and Justice Amitava Roy.

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Saturday, 7 May 2016

Indian Trains Carry Tobacco Harms Messages

In India, millions of people commute to and from work via train. The Indian rail network is the fourth largest in the world, and is used most heavily by low-and middle-income Indians. 

As such, the Union Ministry of Health and Family Welfare’s (MoHFW) new outdoor campaign is set to reach a significant portion of the Indian population. MoHFW launched “Tears You Apart,” an anti-tobacco campaign that will appear on the exterior of trains on some of India’s busiest major railway routes across eight states from 27 April until September 2016. Vital Strategies has provided technical assistance to the Ministry.

The campaign is one of the most geographically extensive health promotion campaigns to utilize the world’s most heavily used railway network, which is used by over 10 million people a day. The campaign will also feature a PSA a Public Service Announcement (PSA) filmed in B. Barooah Cancer Institute in Guwahati, Assam and at the Tata Memorial Hospital in Mumbai, Maharashtra, which shows real victims suffering from horrific cancers and disfigurements as a result of their chewing addiction. It also includes the victims’ relatives, who describe how tobacco-related disease has destroyed careers and family life, and added to their financial burdens. The railway ads could reach people who had not previously seen the campaign on TV.

Although smoking rates have declined in many parts of the world, it has not gone down equally for all segments of society. Low- and middle-income individuals maintain the highest smoking rates in many countries, including India, and tobacco industry tactics continue to be directed towards this segment of the population—especially youth. This campaign is an enormous opportunity to reach those people who suffer the greatest harm from the global tobacco epidemic.

That means a chance to reduce the burden of death and disease that tobacco continues to place on the Indian people and their government. According to the Tobacco Atlas, 120 million adults and over 2.5 million children continue to use tobacco in India. Of those, nearly one million people are killed by a tobacco-related disease every year in the country.

According to Mr. C.K. Mishra, Additional Secretary, Ministry of Health and Family Welfare, Government of India, “The Government is committed to ensuring healthcare and social safety for all Indians. Warning people about the dangers of tobacco is a key part of our strategy, using mass media campaigns, Film Rule, and all other methods of Behaviour Change Communication. Tears You Apart shows that tobacco-related suffering isn’t limited to disease and disability among patients; their loved ones also share immense health, emotional and financial pains and hardships. It was important for us to highlight this reality in this campaign.”

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Thursday, 5 May 2016

Supreme Court reminds tobacco makers of their 'duty to society'

The Supreme Court on Wednesday reminded tobacco makers of their "duty to society" and to carry pictorial warnings spread over 85% of both sides of their packaging as mandated under the government's amended 2014 rules, staying a Karnataka High Court order that had prevented implementation of these rules.

"You owe a duty to society," a bench of justices Pinaki Chandra Ghosh and Amitava Roy said while staying the Dharwad bench order.

The earlier 2008 rules required pictorial warnings on just 40% of the packaging on one side.

The new rules mandate pictorial warnings that the industry has said are "gruesome", "gory" and "extremely repulsive", intended to "shock and terrorise the user" rather than being factual and intended to warn the consumer.

The industry has said that the images as well as the textual warnings prescribed are false and misleading. It has said there is no evidence to prove that the images on the pictorial health warnings are of tobacco­related diseases or tobacco consumers.

However, non­governmental organisation Health for Millions, which has been demanding its implementation, urged the court to impose a stay on the high court order.

The Cigarettes and other Tobacco Products (packing and Labelling) Amendment Rules,2014, made under the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and regulation of Trade and Commerce, Production, Supply and Distribution), Act of 2003, were notified to take effect from April 1, 2016.

These were immediately challenged in different high courts. A plea was later made to transfer all these petitions pending in different high courts to the top court which could then deal with the legality of these rules. Instead the top court transt transferred all these pending cases to the Karnataka High Court for a decision.

The top court requested the Karnataka High Court chief justice to ensure that the case was disposed of within eight weeks and despite resistance from the tobacco companies asked them to implement the rules in the meantime. To facilitate this, the top court bench stayed a Dharwad bench order which had prevented these rules from coming into effect for now.

The Dharwad stay "shall not be given effect to till further orders of the Karnataka High Court", it said. Earlier, appearing for the Tobacco Institute of India, senior advocate Arvind P Datar, argued that these rules were "unreasonable", "arbitrary", "unforceable" and violative of the 2003 Act. Datar argued that no consultations were made with the industry before enacting rules which made it mandatory to carry such "gruesome" warnings.

The earlier rule, covering 40% of the packaging only on one side, cannot be overruled without any consultation as it has a huge socioeconomic impact on many sections, Datar argued. "The rules were ultra vires of the Act... as it does not empower the central government to prescribe the size of the warnings.

The Act merely requires the warnings to be legible, prominent and conspicuous as to the size and colour which were met by the unamended 2008 rules. This increase is completely arbitrary, unreasonable and is not based on any parameter," Datar said.

The industry association claimed that the new warnings would prevent tobacco makers from appropriately displaying their trademarks and would cause the market to be flooded with counterfeit products. It said that the tobacco crop directly and indirectly supports 38 million people engaged in production, processing, marketing and exports, including six million farmers.

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Tuesday, 3 May 2016

Exposure to tobacco in home increases risk of childhood illness: New study

The study found children who lived with a smoker or who had exposure to tobacco smoke inside the home were significantly more likely to have had any medical care visit, including sick care.

The dangers of smoking near a child have been well-documented and now, a new study has revealed that exposure to tobacco smoke inside the home can increase their childhood illnesses.

Researchers analysed 2011-2012 data from the National Survey on Children's Health, which is conducted by the US Centres for Disease and Control Prevention's National Centre for Health Statistics. They looked at patterns of health care utilisation among children ranging in age from newborn to 17 who were living with smokers compared with those who not exposed to tobacco smoke at home.

Results showed a total of 24% of the 95,677 children in the study, corresponding to a weighted total of 17.6 million children across the United States (US), lived with smokers. About 5% of the children lived with someone who smokes inside the home, equivalent to a weighted sum of 3.6 million US children.

Researchers said that children who lived with a smoker or who had exposure to tobacco smoke inside the home were significantly more likely to have had any medical care visit, including sick care. At the same time, researchers said, they were considerably less likely to have had any dental care visits.

Lead author Ashley Merianos of the University of Cincinnati said that settings with a high volume of children exposed to tobacco smoke at home, including paediatric emergency departments, could serve as effective outlets for health messages to inform caregivers about the dangers of smoking around children and help decrease these potentially preventable tobacco smoke exposure-related visits and associated costs.

The research is being presented at the Paediatric Academic Societies 2016 Meeting.

Source: DNA
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Monday, 25 April 2016

Label 'tobacco' as food item to ban it, suggests Delhi government to Centre

Delhi government's health department has urged the Centre to amend the definition of 'Food' and label 'tobacco' as a food item in the Food Safety and Standards Act 2006 to tackle the menace of chewable tobacco in India.

"It is mentionable that no government will allow to put anything inside the mouth which is a poison or a toxic substance. If we modify the definition of 'food' by saying that 'a substance which is put into the mouth for the purpose of consumption fully or partially, by methods like chewing, sucking or any other method may be labelled as a 'Food Item," said S K Arora, Additional Director, Health, Government of Delhi, in a letter to the Union Health Ministry.

Referring to the 2011 regulation of Food Safety Act which prohibits consumption of any substance as food which contains tobacco or nicotine as an additive substance, Arora said, "Thus, all kinds of chewable tobacco whether raw, scented, flavoured or any other will automatically get banned permanently through a Central Act for which no state will have to issue repeated notifications and which usually lands up in the court because of the tobacco industry's interference."

Arora said consumption of chewable tobacco is increasing in Delhi because of surrogate advertisements of pan masala, especially by Bollywood celebrities.

Immediately after coming to power in February 2015, the AAP government had issued a notification banning chewable tobacco but some manufacturing companies filed a writ petition in the Delhi High Court on account of which it could not implemented.

"The previous notification lapsed its 1 year term but the court could not give a concrete decision on this matter.

"However, Delhi Government on its commitment to public health revised the notification on April 13, 2016 after the lapse of the previous notification. But this time also this notification has been challenged in the High Court and is due for hearing on May 3," Arora said.
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Wednesday, 13 April 2016

Golden Tobacco first to implement 85% pictorial health warnings

Health activists have welcomed the move by Golden Tobacco Company, among the oldest companies in the business of manufacturing tobacco items in India, to implement 85 per cent pictorial health warnings on both sides of their products.

Brands Panama and Golden Gold Flake are associated with the company.

The Union Health Ministry has written to all key government departments – Revenue, Commerce, External Affairs, Labour, Civil Aviation, and Tourism— to ensure that health warnings covering 85 per cent of the principal display on both sides of packages apply to all tobacco brands in India. The Ministry has also written to all Chief Secretaries of States/UTs to adhere to the policy.

“Golden Tobacco Company has shown that there are no issues in implementing the new health warnings. The arguments given by other tobacco companies are baseless,’’ said Binoy Mathew, senior programme officer at Voluntary Health Association of India.

He added that it if one company could comply with the rules, even others could.

“There is no evidence to suggest that introduction of large warnings ever had any adverse effect on the livelihood of people, while there is ample evidence to prove that millions of people in India face economic and health hardships because of their present engagement in tobacco farming, manufacturing of tobacco products, and related work,’’ read a statement released by the Voluntary Health Association of India.

Since tobacco is an addictive product, there cannot be any immediate impact, it added. Therefore, the introduction of larger pictorial health warnings is not likely to have an impact on the livelihood of farmers and other stakeholders.

Tobacco use is a leading cause of tuberculosis-related mortality in India. Pictorial warnings on packages create awareness about health consequences of tobacco usage, especially among youth, children, illiterate, semi-illiterate and the uninitiated, who are either the primary users of tobacco or who may be vulnerable to using tobacco products.
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Tuesday, 12 April 2016

Smoking makes your vision poorer shows research

With a surge in eye-related diseases in India, Ophthalmologist has said smoking is emerging as one of the major reasons behind vision-loss among patients. However, only 10-20 percent people are aware of it.

According to the doctors, several studies have shown that smoking increases the risk of age-related macular degeneration, cataract, glaucoma, diabetic retinopathy and dry eye syndrome.

"One way to reduce the risk of developing Age related Macular Degeneration (AMD) is by not smoking. Smokers are three to four times more likely to develop AMD than non-smokers. Non-smokers living with smokers almost double their risk of developing AMD," said Mahipal S. Sachdev, chairperson and managing director of city-based Centre for Sight.

Macular degeneration causes loss in the centre of the field of vision. In dry macular degeneration, the centre of the retina deteriorates. With wet macular degeneration, leaky blood vessels grow under the retina.

Elaborating further, he said: "AMD begins as a loss of central vision which makes it difficult to read and see fine details. Over time, vision loss increases significantly.

Sachdev said vision loss due to smoking does not have any symptoms like many other eye diseases, but a dilated exam can detect eye diseases in their early stages before vision loss occurs.

Some other types of eye-related problems caused by excessive smoking include cataract and glaucoma.

"People who smoke in excess like 10 cigarettes a day have up to three times the risk of cataract as non-smokers. Similarly, there is a strong nexus between glaucoma and smoking," said Sachdev.

Talking about prevention, Ritika Sachdev, a Delhi-based opthalmologist, said there is a need for special awareness among people about the strong link between smoking and vision loss.

"First of all, it is important for people to either quit smoking or bring down its consumption. Not just lungs and throat but the eye nerves too get damaged in the entire process," said Ritika.

The doctor added that it’s time to seek professional help if any smoker finds that straight lines appear wavy, faded or blurred vision, or trouble seeing things in the distance, or faces or words on a page or constant water dripping from eyes.

"One of the major areas that need to be emphasised for all smokers includes eating healthy. Protecting eyes starts with a healthy balanced diet. Nutrients such as omega-3 fatty acids, zinc and vitamins C and E might help ward off age-related vision problems such as macular degeneration and cataract due to smoking," she said.

Source: Indiainfoline
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Monday, 11 April 2016

Healthy, wealthy and wise: Why it’s important to invest in health

India’s policies on tobacco control perhaps best reflect the complexities that define the nation, discovered Dr Henk Bekedam when he switched on the television after arriving in Delhi as World Health Organisation Representative to India four months ago.

“I’m still amused when I see health warnings with scenes of someone smoking -- I don’t think I’ve haven’t seen it in any other country – and it shows high awareness, but despite that, India lags in two major issues of tobacco control, tobacco taxation and pictorial warnings,” says Dr Bekedam.

As an economist and medical doctor, he is more than familiar with complexity. The Dutch national has worked as a physician, obstetrician, gynaecologist, paediatrician and civil servant in Africa for seven years before doing a masters in economics at the London School of Economics. He joined the WHO in 1996, and his postings took him to China during the SARS outbreak in 2003 and to Cambodia to help government rebuild health systems destroyed by the Khmer Rouge.

Increase tobacco taxes
India’s new law that has made it mandatory for pictorial health warnings to cover 85% of the tobacco packages gets his approval, but its reluctance to substantially raise tobacco taxes offends both his economist and public health specialist sensibilities. “I’m very critical on tobacco taxation (policies in India). It’s one of the most efficient tools to stop people from smoking and a strong deterrent for deters people with some financial difficulty, mainly the young and the poor,” he says.

“It’s a win-win situation – your revenue goes up and people stop using something that may kill them, but in India, this knowledge is not being used properly,” says Dr Bekedam. “The increase in tobacco taxation has been very gradual, it’s actually less than inflation. And then there are exemptions – the tax on bidis is very, very little. So people who can’t afford cigarettes move to the cheaper product. Not raising taxes is almost like targeting the poor by making their access to something that can kill so easy. And I think it is very, very unfortunate,” he says.

“If you try to control tobacco use, there’s always this fight. The industry says you’re denying people something they like, people will lose jobs, revenue will fall etc, but it is for the government to decide whether it wants people to have easy access to something that can kill or not,” he says.

Health security drives consumption
“India has been neglecting health for quite some time and I don’t think there are very strong systems in place,” says Dr Bekedam. Investment in public health infrastructure must start now to have it in place by 2030.

Increasing public health spend using innovative solutions is a start. “The public health expenditure is a very low 1.1%, which puts India in the bottom quarter in the world in providing support to health. This has major consequences. Life expectancy is just one issue. A Harvard study found one extra year of life expectancy is equal to 4% GDP growth,” he says.

“If you do not invest in health, you put yourself at economic risk. Look at how Ebola devastated west Africa,” says Dr Bekeman. “What I like about the Modi government is its focus on economic growth, but what is not well understood is that if 60 million people are pushed into poverty because of healthcare bills, you can’t grow economically,” he says.

More certainty in health and education boosts economic growth. “In 2006, China became a big proponent of investing in the health and education sectors because they wanted to move from economic growth based on exports and infrastructure (roads and buildings) to domestic consumption,” says Dr Bekedam. “They wanted more people buying bicycles, cars and televisions and instead of saving money for health emergencies and education. Although I haven’t seen studies on saving rates in India, but I’m pretty sure Indians save a lot, and if health and education is taken care of, they will spend more,” says Dr Bekedam.

He is unhappy that there was no real increase in health spending in the Budget. “There are many areas in public health that need Central support, such as health insurance. In China, they moved (health insurance) coverage from 20-25% of the population in 2002 to 90% in 2007!” he says.

Social health insurance has three dimensions, population coverage (number of people you want covered), the package being offer, and how much financial protection you want to give. “In China, partly for political reasons, they started increasing coverage quickly and kept the financial cover fairly low-30-40%. With the economic growth projected for India, you can play with these three factors –say, increase population coverage and then move to increasing the package and cover,” he says.

With the private sector providing 70-80% of services, there’s need to regulate and engage it to increase outreach. “India has to improve immunization and eliminate kala azar, leprosy and leishmaniasis, these are low-hanging fruits that need a final push,” says Dr Bekedam.

And the way to do it by building a stronger public health system. “You have it in some states, like Tamil Nadu, already. You need it in other states too,” he says. “Health needs to get the right attention and the government need to understand is how important is a healthy population for economic growth,” says Dr Bekedam.

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