Tobacco litter a challenge to a clean India: Environmental experts

Even as the Clean India campaign is making waves with both standalone and coordinated efforts in Kerala as across the country, acclaimed environmental experts  have called for no-holds-barred implementation of the ban on public smoking as a means to keep our cities, towns and villages clean and litter-free.

They contend that callously discarded cigarette stubs found abundantly in public places in violation of the smoking ban poses a challenge to dream of a clean India besides bringing the need for stricter implementation of laws to the fore.

Prof MK Prasad, noted environmental expert and educationist said, “While there are public discourses on the health impacts of tobacco use, its effect on the environment have come up for scant discussion in Kerala and India. Developed countries have woken up to this fact and have undertaken steps to identify the enormity of the problem. According to one estimate, the overall littering rate for cigarette butts in America is 65 per cent.”

“The non-biodegradable nature of cigarette butts, a hazardous solid waste, makes it a challenging area to address. The butts also contain dangerous chemicals such as cadmium, arsenic and lead. Stricter implementation of laws on public smoking will not only improve public health but also restrict the environmental damage caused from cigarette use,” Prof Prasad added.

A paper published in the International Journal of Environmental Research and Public Health cites that an estimated 1.69 billion pounds of butts are littered worldwide a year.

Adv. Harish Vasudevan, environmental law expert said, “Studies point out that tobacco refuse is a major source of litter on the planet. Filtered cigarettes offered as an alternative to reduce the amounts of nicotine and tar consumed are a mainstay with smokers now. Cigarette filters are made of cellulose acetate, a plastic slow to degrade.”

“Presence of cigarette stubs in public places provides cues for smoking. This major environmental and public health issue can be effectively controlled by implementing laws that prohibit smoking in public places. If sufficient multi-stakeholder efforts are not taken on time, it can pose a challenge to having a clean India,” Adv. Vasudevan added.

Indian tobacco control law COTPA, 2003 vide Section 4 prohibits smoking in all public places including public offices, educational institutions, public conveyances, restaurants, hotels, health institutions and all workplaces.

Highlighting how in-flight smoking has been effectively prohibited, Dr CN Mohanan, Retd., Scientist and Head, Environmental Sciences Division, Centre for Earth Science Studies here said that education, awareness generation and enforcement all have equal roles to play while addressing the cigarette litter issue.

“Policy backing, repetitive communication, and punishment for violators have made it possible to curb smoking during air travel. Similar measures will have to be taken to tackle cigarette littering in public places by enforcing laws against public smoking. Having a clean India is a collective dream; cigarette butt littering is something we cannot afford to ignore,” Dr Mohanan noted.

The Centre-State Rs 62,000 crore Clean India campaign launched by the Indian Prime Minister Shri Narendra Modi aims to accomplish the vision of a ‘Clean India’ by October 2, 2019. Among others, the campaign envisages cent per cent collection and scientific processing, disposal, reuse and recycling of solid waste.

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Koolimadu: India's first tobacco free area

Even as dedicated efforts are on to make three districts of Kerala, viz., Trivandrum, Ernakulam and Kozhikode models in tobacco control by following the provisions laid out in Indian tobacco  control law, COTPA, 2003, here's an engaging story of Koolimadu in Kozhikode.

Reproducing the story carried by the India Today on 15 December 1996 that recounts how locals of Koolimadu turned their village into India's first tobacco free area.

While acknowledging that the current status of Koolimadu with regard to tobacco control has not been checked, the story is being carried here for the sheer energy it provides to Kerala's tobacco control efforts.

Weeding out tobacco

Inspired locals turn their village into India's first tobacco-free area

For most smokers, the statutory warning on cigarette packs means only puff and nonsense. But the 2,200 villagers of Koolimadu, 25 km from Kozhikode town, have taken it very seriously.

With the Kozhikode district administration declaring it tobacco-free, smoking has not just been banned in this tiny hamlet, you run the risk of being excommunicated for a day if you flout the ban.

At village gatherings now, tendrils of smoke curl up only from tea glasses. Wizened women no longer chew away at pukayila (tobacco leaves). And the village shops no longer stock the cigarettes or beedis that used to make them richer by about Rs.2,000 every day.

It was a death that sparked the campaign. In 1994, chain smoker Ahmed Kutty, 58, a regular at the popular village reading room, Akshara, died of cancer. And the founders of the reading room, E.A. Moideen and Kader, all smokers in arms, who learnt how cancer is linked to heavy smoking, decided to launch an anti-smoking movement in the village.

Says Kader, a smoker for 30 years: "Kutty's death came as a shock. His sudden demise, caused by smoking, was enough of a deterrent."

It wasn't easy. Die-hard smokers were initially not interested in a fresh lease of life just because it came smoke-free. And a lot of women - like Kader's compulsively pukayila-chewing mother, Ameena - felt they would much rather die than kick their addiction.

But the village elders, whose diktat runs in the 250-odd houses here, ensured that the campaign was a success. Explains Moideen: "We printed no-tobacco pledge cards and went to every house in the village and asked everyone to sign or put their thumb impression on them." Persuasion finally worked. As did Kutty's death.

The promise of a long, healthy life rather than a rasping early death was not enough to wean away smokers from their addiction for good. The supply had to be cut off at source. The campaigners approached the two village stores which sold about 300 packs of cigarettes and beedis every day and asked them not to replenish their stocks.

Says a shop owner, M. Khalil: "They bought whatever was there in the shop for Rs.300 and made a public bonfire. We thought we lost some good business but later realised that a healthy, smoke-free life is much more rewarding in the long run."

Next, the campaigners got in touch with the Kozhikode branch of the Nehru Yuva Kendra (NYK) - established by the Centre in November 1972, to mobilise rural youth for development work in villages - for guidelines on how to systematically eradicate tobacco from the villages.

Placards, festoons and banners ("Stop smoking, save family" and "Koolimadu is tobacco-free zone"), were put up. Banners at the village bus stop entreated travellers not to smoke while they were in the village.

Koolimadu residents who can't help lighting up risk being excommunicated for a day. But this punishment has not had to be enforced yet. 

The inveterate smoker, of course, has only to walk about a kilometre to either Nairkuzhi village in the north, Mavoor village in the south or the banks of the river Chaliyar in the south and east to enjoy a smoke.

This also means that the anti-tobacco campaign has not caught on in any of the other villages. Neither does the district administration have any plans to mobilise such campaigns elsewhere in the area.

But inside Koolimadu, smoking remains strictly a no-no. Says local civil engineer K. Abdullah, 29: "We have groups of youth to monitor the ban." Fortunately, according to Kozhikode NYK coordinator M. Anil Kumar, the punishment of being excommunicated for a day for defying the ban has not had to be enforced as yet.

Ultimately, the effort to banish tobacco may turn out to be the healthiest investment Koolimadu residents have made till now.

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State-level laws banning gutka are impacting product availability and use: WHO

A study by the World Health Organisation to examine the impact of gutka ban in select states of India has found that state-level laws banning gutka are having a positive impact – reduced product availability and a decrease in consumption of gutka. 

The study, 'Examining the impacts of the gutka bans in selected states in India' revealed that the support for gutka bans is very high (92%) and there was an almost universal agreement (99%) that gutka bans are good for the health of India’s youth.

The study was conducted by the World Health Organization Country Office for India in collaboration with Johns Hopkins Bloomberg School of Public Health in seven states (Assam, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra and Orissa) and the National Capital Region region.

“These findings have a strong message that regulatory mechanisms are effective and can have a positive impact on the consumption pattern,” said Dr Nata Menabde, WHO Representative to India. 

Surveys were conducted with 1,001 current and former gutka users and 458 tobacco product retailers to gain insight into the e ffect of the bans on consumer use and product availability in seven states and the National Capital Territory. 

Observations of 450 retail environments and 54 in-depth interviews with government officials, enforcement officials and citizens working with civil society groups were also conducted to the same end.

The study has recommended the following measures for better public health impact and saving lives:

• Government to expand the Gutka ban to all smokeless tobacco products. The ban should also cover products that can be bought separately and mixed to be consumed as Gutka or a product similar to Gutka (by whatever named called).
  
• Enforcement mechanisms need to be strengthened to ensure complete compliance of the ban
  
• Provision for tobacco cessation services to be scaled up to cater to the unmet need for cessation after the ban
  
• Products like pan masala are used as a base for making products akin to Gutka and also are produced and marketed by the same manufacturers under the similar brand names. These pan masala products are blatantly advertised and act as a surrogate advertising medium for smokeless tobacco.
  
• Therefore, the Government needs to take urgent action to stop advertisements of pan masala to protect the vulnerable sections of society including the youth.

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Kerala, the first Indian state to become tobacco advertisement free

Kerala has become India’s first state to be free of tobacco advertisements after the southern state completely did away with giving publicity to the nicotine-laden material at its points-of-sale.

Tobacco advertisements from 95.3 per cent of points-of-sale across 14 districts were successfully removed in an 18-month-long campaign spearheaded by the Public Health wing of the Kerala Health Services Department. The state police joined forces in this mega effort.

Tobacco control champion and Kerala Home Minister Shri Ramesh Chennithala declared Kerala as tobacco advertisement-free at function held in the presence of State Health Minister Shri VS Sivakumar in the Kerala capital of Thiruvananthapuram on November 14.

Dr AS Pradeep Kumar, Additional Director of Health Services (Public Health) who coordinated this massive effort, said a three-phase activity plan was developed with District Medical Officers at the core. “Sensitisation programmes were conducted with emphasis on Section 5 of COTPA for district officers at the state capital,” he added. “District officers in turn trained and authorised personnel attached to the Primary Health Centre.”

Section 5 of Indian tobacco control law called COTPA, 2003 bans all forms of advertisement, direct or indirect, of tobacco products.

The districts were given the freedom to customise according to their local needs. “This, in turn, raised the level of commitments and ownership taking,” pointed out the medical doctor who has a PhD in tobacco control. “At the state level, we supported the districts by framing guidelines, monitoring and advising course corrections,” said Dr Kumar who is among the few in India to have completed the Global Tobacco Control Leadership Program of the Johns Hopkins Bloomberg School of Public Health, USA.  

The process that started during World No Tobacco Day 2013 saw both integrated and intensive drives that effectively pooled the services of health personnel from district to primary health centre level. In drives integrated with regular activities during the first phase from June to December 2013, over 23,500 notices were issued to shops that violated the provisions of Section 5. 

Intensive weeklong drives in January and May 2014 marked the second leg of the campaign. As many as 32,566 shops and 62,365 eateries were inspected during the period 10 to 17 January 2014. While the January round revealed violations in 48.8 per cent of sites, field assessments conducted by personnel of Primary Health Centres in May showed that 90 per cent of points-of-sale were free of tobacco boards. 

In October 2014, teams led by District Medical Officers at the district level and Programme Officers at the Panchayat and Primary Health Centre level certified that tobacco advertisement boards were surfaced out. 

As many as 22,344 points-of-sale in 84 wards across Kerala were observed during 28 October to 7 November. Dr Pradeep Kumar says, “A civil society group with nearly four-decade-long experience in research and field implementation in Kerala conducted the evaluation study.”

The evaluation reported an overall compliance of 95.3 per cent – 98.5 per cent of points-of-sale are free of any advertisement hoardings and 96.7 per cent of points-of-sale are free from stickers and print advertisements. International standards prescribe that 90 per cent of sites have to be free of advertisements to become eligible for the tag of tobacco advertisement free. 

Noted head and neck cancer surgeon Dr Pankaj Chaturvedi of Mumbai’s Tata Memorial Centre and an internationally acclaimed tobacco control proponent said, “Tobacco is the only consumer product in the world that has not a single beneficial use apart from causing death and disability. Industry spends billions in advertising this killer product to lure youngsters. Ban on advertising will save innocent youths from initiating this habit. I congratulate the Kerala Government.”

The Global Adult Tobacco Survey (2009-10) said 44.2 per cent of adults above 15 years in Kerala had noticed advertisements or promotions on cigarettes and 70.9 percent and 72.3 per cent had noticed advertisements on bidis and smokeless tobacco respectively. 

Bangalore-based senior head and neck cancer surgeon and tobacco control advocate Dr Vishal Rao said, “This is a significant step that Kerala has achieved in its efforts to improve public health of Keralites, especially the youth of Kerala. Youth between the age of 10 and 18 fall prey to the advertisement of tobacco and lured into addiction. Today we are seeing cancers in age group of 20s and 30s, which we earlier saw in the 70s. A healthy society should have less illness, less hospitals and less doctors and this can only be achieved through preventive health.” 

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Oral cancer not the only risk for those who chew tobacco

Contrary to the prevailing notion that chewing tobacco only increases the risk of oral cancer, a study that looked at different researches conducted in India has shown that smokeless tobacco can also cause oesophageal, throat and even stomach cancer.

The findings are critical. While one-third of the country’s population takes tobacco, 21% of them consume smokeless tobacco, such as gutkha and khaini, according to the Global Adult Tobacco Survey released in 2010.

“While reviewing various studies, we found the incidence of oesophagal [foodpipe] cancer was higher in the north-east, while in the south we found pancreatic cancer was prevalent in those who consumed smokeless tobacco,” said Dr Pankaj Chaturvedi, head and neck cancer surgeon at Tata Memorial Centre and co-author of the review study.

He added that researches in Madhya Pradesh have showed that throat cancer is common among smokeless tobacco users.

The study, titled A Review of Indian Literature for the Association of Smokeless Tobacco with Malignant and Pre-malignant Diseases of Head and Neck Region, was published last week in the Indian Journal of Cancer.

Researchers said the review exposed the risk of developing throat, stomach, oesophageal, pancreatic, cervical cancer as a result of chewing tobacco.

“It depends how and where you are consuming tobacco. There is a difference in the incidence of tobacco-related cancer between India and the western world. Those who place the tobacco mixture under the lip are more prone to cancer in that region. Those who also consume areca nuts are increasing their risk of two cancers, as areca nut itself is carcinogenic,” said Dr Chaturvedi.

Researchers said apart from the way tobacco is consumed, the ethnicity of the consumer is also a factor in determining the type of cancer he or she is prone to develop.

Unlike in western countries, smokeless tobacco use is far more common than smoking in India. “Unfortunately, there is nobody regulating the use of smokeless tobacco. It is easy to grow tobacco crop anywhere. It is sold loose and also not taxed. A person who stops consuming smokeless tobacco is at the risk of developing cancer for at least a decade after giving up the habit. This itself shows the impact of the habit,” said Dr Chaturvedi.

Source: Hindustan Times

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Ban on loose cigarettes: An open letter from a cancer survivor to PM Narendra Modi

After the announcement of amendments of COTPA (such as ban on  sale of loose cigarettes), a cancer survivor has sent an open letter addressed to PM that he as addressed to PM Narendra Modi. He expresses his views about the ban on loose cigarettes and urges Modiji to reconsider its implementing the amendments it with full vigour.

Respected Modi Ji,

It was with great sense of pride and satisfaction that I learnt from the Newspapers reports that Government of India has decided to ban sale of loose cigarettes as it constitutes over seventy percent of its sale. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn, it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn , it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

Sir, I am a tobacco victim and cancer survivor. After having smoked cigarettes made attractive by constant  advertising with inciting slogans like, ‘Made for Each Other’ by ITC , I was detected with Throat Cancer in 2008. It resulted in removal of my voice box and now I speak with the help of a prosthesis (machine). Eating and Speaking has become a challenge. As ill lack would have it, I suffered yet another Cancer of the Tongue in 2013 resulting in partial removal of my tongue. It can be thus well imagined that my life has become virtual hell. Please see the attached picture that was taken recently during my discharge from hospital. 

I never wanted any other person to have the same fate which was the reason for my joy on learning that sale of loose cigarettes is going to be banned and loop holes in COTPA are going to be plugged by amendment.

Mr. Prime Minister, the case before Consumer Court filed by me for compensation from ITC could not succeed  as one of the grounds taken in defense was that I could not produce bills for cigarettes purchased by me. 

Can you imagine any person being issued with bills for sale of loose cigarettes by the vendors. Therefore, if at all loose cigarettes are to be sold then issuance of sale bills must be made mandatory for loose as well as packets of cigarettes. The activities of cigarettes manufacturing companies must be curbed as they are nothing but merchants of death. One cannot protect these companies and tobacco growers, vendors etc on the plea that the Revenue of the Government as also employment opportunities of persons shall be affected.

For generation of jobs and revenue at the cost of millions of lives lost due to cigarette smoking and  expenditure on health care cannot be justified on this score. You had tweeted on 31st May (World no tobacco day) for a healthier and Tobacco Free India. You had pledged to reduce tobacco consumption in India. Unfortunately your senior Cabinet Ministers do not support your ideologies and continue to patronage tobacco lobby.

It is, therefore, prayed that the Honourable Prime Minister may kindly reconsider its rethinking on proposed  curbs on sale and consumption of tobacco and implement it with full vigour. Sir, you have evoked high hopes in people of India. It is our cherished desire that the Government shall take decisive steps to make India tobacco free. It would not only save lives but also save enough money spent in health care and loss of economic activity to compensate for the loss of Government Revenue. Surely the Government does not want to earn Revenue by allowing its citizens to be killed by Companies like ITC whose share prices have surged by 6% after the announcement to defer ban on loose cigarettes.

The main beneficiaries of tobacco business aren’t farmers/vendors but few powerful families who run this trade only to make vulgar profits. How can you ignore that these business families are killing one million Indians every year and making the nation lose nearly one lac crore every year on health care expenditure? At the end, it is urged that all the proposed amendments in COPTA and its implementation may kindly be done immediately.

Yours Sincerely,
Deepak Kumar
Commissioner of Customs,Central Excise & Service Tax (Retd)

Courtesy: Healthsite

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