Impose stricter controls and regulation of bidis: Lancet study

At a time when the Union Health Ministry has called for taxing bidis at 28 per cent along with the highest cess under the new GST regime, a recent Lancet study recommends stricter controls and regulation to combat the health burden caused by this small, but lethal, tobacco product.

Higher levels of severe respiratory impairment, significant cardio-respiratory conditions and follow-up mortality were found among bidi smokers as against cigarette smokers and non-smokers, reports the study in the respected Lancet Global Health journal.

The largest-ever prospective international community-based cohort study of its kind covered as many as 14,919 men across five centres in India, including Thiruvananthapuram besides a centre each in Bangladesh and Pakistan. The other Indian centres covered in this sub-study of Prospective Urban Rural Epidemiology (PURE) were Chennai, Bengaluru, Chandigarh and Jaipur.

Households with at least one member aged 35-70 years were approached for the study, which was coordinated by the Population Health Research Institute in Canada. Baseline data was collected from January 1, 2003, to December 30, 2009, and follow-up data collection took place from January 1, 2008, to December 30, 2013.

Trained personnel administered standardised interview-based questionnaires that surveyed and accounted for demographic, household, behavioural and medical information, including risk factors, symptoms and the occurrence of any multiple disorders. 

Dr Sanjeev Nair, from the Department of Pulmonary Medicine, Thiruvananthapuram Medical College, is one of the co-authors of the study. “The health and economic burden caused from bidi smoking is tremendous, leading to the recommendation of stricter controls and regulation on this product. High levels of taxation to dissuade consumption would be a welcome policy initiative,” he said.

“Collective efforts should be made to provide alternative livelihoods to workers involved in bidi manufacturing in cottage industries that escape other prevailing tobacco regulations and taxes. Such a measure would be in the interest of the health of bidi workers as well. As the Kerala Government is striving hard to achieve the Sustainable Development Goals, tobacco control also has a key role in reducing mortality from cardiovascular diseases, COPD, and cancers, for which all stakeholders must come together,” Dr Nair added.

Another co-author, Dr K. Vijayakumar, Secretary, Health Action by People said, “The study has shown conclusively that there is no safe threshold from the harmful effects of tobacco smoking and even low-intensity, clinically-trivial smoking is associated with respiratory impairment. Our way forward should be to create 100 per cent tobacco smoke-free environments that would benefit the poor and the young significantly.”

Reaffirming existing information on the enormous impact of bidi smoking on the poor, the study has found that heavy bidi smokers were more likely to come from rural communities and from lower socio-economic sections.

Further, in what should be a worrying trend with a fast-aging population, the study pointed to a marked rise in decreased lung function among older bidi smokers.