Bidi use increases Kerala’s most common cancer risks: Study

India’s first cohort studies have conclusively proven that bidi smoking presents a many fold increase in the incidence of Kerala’s most prevalent cancers among men.

Separate studies on the impact of bidi smoking on lung and oral cancers, and cancers of larynx and hypo pharynx in men between the age group of 30-84 in Karunagappally of Kollam district show that bidi – unfiltered tobacco flakes rolled in tendu leaf and tied with thread - is indeed among the most harmful smoking products.

The cohort study on bidi and lung cancer, covering a total of 65,829 men, found that bidi smokers had a 3.9-fold increase in lung cancer incidence when compared to those who never smoked bidis. The risk of cancers affecting the cheek (buccal) and lips (labial) showed a nearly four-fold increase in the cohort study covering 66,277 men.

Yet another painful group of cancers are those affecting the lower part of the throat including voice box, known as laryngeal and hypo pharyngeal cancers. Another cohort study conducted on 69,943 men, again in the 30-84 age group in Karunagappally, shows a significant relationship relation between bidi smoking and cancers affecting the larynx and hypo pharynx.

Dr P Jayalekshmi of Regional Cancer Centre and the principal author of the studies on bidi-induced lung, oral, laryngeal and hypo pharyngeal cancers said, “The mainstream smoke of bidi contains a much higher concentration of carcinogenic hydrocarbons. Bidi smokers also are found to be taking five puffs per minute compared to two puffs by cigarettes in the same time. All these contribute to increasing the carcinogenic nature of bidi smoke.”

The Karunagappally studies have also reiterated the common knowledge that bidi smoking is more widespread among those with lowers levels of education and lower family income. The Global Adult Tobacco Survey (GATS 2009-10) has it that 31.1 per cent of male bidi smokers in the country have no formal schooling while 19.7 per cent are self-employed. Bidi smokers in Kerala spend nearly Rs.140 monthly on this habit. 

Image courtesy Wikipedia

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Kerala Budget's tobacco taxes dismays activists

The Kerala Budget 2013-14 has raised cigarettes by a token, from 15 per cent to 20 per cent, while it has left bidis taxes untouched. Bidis, which among the most harmful smoking products, continue to be zero VAT slab.

Tobacco control activists share their thoughts:

Justice K Narayana Kurup, Former Judge of Kerala High Court and the legal luminary behind the legendary smoking ban in Kerala in 1999 said, “It pains me to see that the Government has given low priority to an-all important public health issue when it comes to taxing tobacco products. Exempting bidi from taxes to safeguard the interest of the poor does not hold merit, as poor bidi smokers could lead a healthy and longer productive life if they can reduce consumption, brought out through tax-induced price hikes.”

“Our neighbouring Tamil Nadu is taxing bidis at 14.5 per cent, why can’t Kerala do the same?” Justice Kurup, also founder, Anti Tobacco Foundation, Kochi asks. “The tax increase on cigarette is also disappointing in a state which prides itself for its public health initiatives,” he added.

Adv A Sampath MP said, “Tobacco use is high in Kerala and controlling it is vital for prevention of non-communicable diseases. The use of tobacco reflects in the growing health risks among our people. I hope that the Government of Kerala will wake up to this worrisome factor and initiate measures to curb its use by levying higher taxes on all tobacco products.”

Dr Tiny Nair, Head, Department of Cardiology, PRS Hospital said, “Taxing tobacco products is a proven way to reduce consumption, as WHO studies have shown. There are 1.6 million bidi smokers in Kerala, who mostly belong to poorest socio-economic backgrounds. Taxing bidis, which are among the world’s most harmful smoking products, will contribute to bringing down use among bidi smokers. Irreplaceable lives can be safeguarded from untimely morbidity and mortality.” 

Dr Nair adds that any reduced consumption brought out through increased tobacco taxes will also save non-smokers from the negative effects of passive smoking. “Passive smoking is not some third person singular number anymore; it affects each one of us. The particles in the unfiltered smoke that drifts from burning cigarette are finer and more concentrated, thus increasing their capacity to penetrate deeper and stay longer in the lungs of a passive smoker than the actual smoker. Revenues raised from higher taxes on tobacco products can finance large-scale tobacco cessation measures.” 

Magician Gopinath Muthukkad who spreads anti-tobacco messages through magic said, “A man smoking in his house is in fact passing on unseen hardships to his family members including children. WHO figures show that worldwide 165,000 children have lost their lives to passive smoking. 

Even though Indian tobacco control legislation COTPA has banned smoking in public places, it is poorly implemented. What we need to do is to make cigarettes and bidis unaffordable to the poor who bear the higher brunt of diseases that cripple their life and make them unproductive to eke out a living. This can be possible only by raising taxes on these products.”

“The courage shown by the Government to ban gutkha and pan masala in the state was praiseworthy. A similar people-oriented commitment is found missing in this Budget when it comes to taxing bidis and cigarettes,” Shri Muthukkad added.

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Rajasthan sets an example for Kerala

The WHO best practices are that taxes should constitute 65% - 70% of the retail price of tobacco products and Rajasthan, setting an example for Kerala and the rest of the country, has raised taxes on all tobacco products to 65% in the 2013-14 Budget presented by Hon'ble Chief Minister Shri Ashok Gehlot who also holds the Finance Portfolio on 6 March. 

In the process, the state will be able to save an additional 340,000 as tobacco users quit and new users do not enter the market due to the increased price of tobacco, according to a modelling by Johns Hopkins University Bloomberg School of Public Health.

Rajasthan clearly testifies the theoretical framework that increasing price of tobacco through tax increases will decrease its consumption, save lives and raise tax revenue. Since 2010, Rajasthan has consistently raised taxes across all products from 20% to 40% in 2011-12 and to 50% in 2012-13.

A study analysing the immediate impact of the 2011-12 tax increase found that increased taxes led to 8% and 6.2% reduction in users’ consumption of cigarettes and beedis respectively. During the same year, Rajasthan tax earnings from cigarettes were Rs 139.23 crores and Rs 312.08 crores from beedis.

The Johns Hopkins modelling has it that VAT tax increases in Rajasthan in fiscal year 2010-11 alone has saved over an estimated 567,000 lives and the increase to a VAT of 50% in fiscal year 2011-12 another additional 243,000. 

In Kerala, cigarettes are taxed at 15%, while beedis are not taxed at all. Tobacco use causes over 40% of cancers in Kerala.

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Expensive cigarettes equals more revenue and less health risks

Announcing an increase of excise duty on cigarettes, Finance Minister
Shri P Chidambaram during his Budget speech on Thursday said, “What does a Finance Minister turn to when he requires resources? The answer is cigarettes.”

The FM could well have rephrased his comment to what should government do to force people to quit smoking? The answer is, impose higher tax on cigarettes.

Rajasthan has shown the way. Consumption of cigarettes, bidis and zarda (chewing tobacco) has declined drastically in the state since the last three years after the state government increased tax rate on tobacco products from 20 per cent to 50 per cent.

While in terms of value, cigarette sale was Rs 413.55 crore in 2010-11, it came down to Rs 349.67 crore in the following year while in the first six months of current financial year the total sale of cigarettes was just Rs 160.28 crore.

Similarly, bidi industry registered a decline in sale by more than 50% in last two years from Rs 73.45 crore to Rs 25.10 crore and chewing tobacco sale dropped from Rs 31.54 crore to Rs 14.56 crore.

Buoyed by this trend the state government is contemplating a 50 per cent hike in the tax rate on tobacco products in the upcoming Budget. The state government while presenting a paper on strategy to reduce tobacco consumption in the National Consultation on Economics of Tobacco in December last year proposed to increase tax rate on tobacco products from existing 50 per cent to 75 per cent in line with WHO norms.

Experts say that raising taxes on cigarettes and bidis would have twin impact on health and revenue. Dr Virender Singh, Medical Superintendent of SMS Hospital said, “Cost escalation in tobacco products would not only reduce their consumption but also increase revenue for the government.” If the trend continues actual health benefits would be witnessed in a decade, he added.

As per WHO, in developing countries every 10% increase in price of tobacco will result in 8% reduction in tobacco use or consumption.

A recent study titled ‘Economics of Tobacco and Tobacco Taxation in India’ also highlights the crucial role that the government can play in reducing tobacco-related deaths by raising taxes on tobacco products.

Quoting a study by John’s Hopkins University (USA), Dharamveer Katawa, secretary Indian Asthma Care Society said, “The state government saved four lakh young lives when it raised tax rate on tobacco products from 20 per cent to 40 per cent.” At the same time, the state government’s earnings from tax on tobacco products have increased almost three folds. From Rs 288.16 crore in 2009-10, it went up to Rs 627.82 crore in the last financial year.

Courtesy: Daily Bhaskar

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