India recently reported a sharp decrease in tobacco consumption, a major public health victory. According to the Global Adult Tobacco Survey (GATS) India 2016-17, 81 lakh fewer Indians now use tobacco compared to 2009-10. This represents a 17 percent relative reduction in tobacco consumption across all age groups and a 60 percent relative dip in tobacco use among minors (aged 15-17). The age of initiation for both smokeless and smoking tobacco in the country has also increased by a year. The decrease is important because tobacco is the leading contributor to heart disease, cancers, chronic respiratory diseases and diabetes, which are responsible for 43 percent of all deaths in India. India’s tobacco control policies, which have focused on prevention and decreasing initiation, appear to be working.
Major tobacco control measures
Over the past several years, India has taken a series of measures to control the tobacco-related epidemic. In 2011, gutka, a form of chewable tobacco that is one the biggest cause of oral cancers, was banned by the Government of India and subsequently by various states. The ban was ambitious and faced a severe backlash from the influential gutka industry in the country.
The results are impressive. Smokeless tobacco use has dropped from 25.9 percent in 2010 to 21.4 percent in 2017. The impact on oral cancer, a leading cause of cancer in India is expected to be profound but it is too early to tell.
India’s second big win came in the face of combined resistance from the smoking and smokeless tobacco industry: increasing the size of pictorial health warnings on tobacco products. In the face of industry pressure for less graphic warnings, India signed on for warnings that cover 85 per cent of packaging on all tobacco products in 2015. These efforts appear to be working. According the latest evidence, more than 60 percent of cigarette smokers, 53 percent of bidi smokers, and 46 percent of smokeless tobacco users attribute their desire to quit tobacco to pictorial warnings.
The third important measure was the increased taxation (in the form of value added tax or VAT) on tobacco products across states over the last six years. Almost two-thirds of tobacco users in India smoke bidis, which was taxed at a rate between 12 per cent to 65 percent depending on the state. The central government has proposed to tax all tobacco products at the highest bracket of 28 percent under the new Goods and Services Tax (GST).
Road ahead
Tobacco-related diseases cost the country more than one lakh crores a year (2011 estimates) and more needs to be done to improve on India’s performance over the last decade. The implementation of the Cigarettes and Other Tobacco Products Act (COTPA), which restricts the sale of tobacco to minors, point-of-sale advertising, surrogate advertising should be strengthened.
India should also curb the other variants of smokeless tobacco such as khaini and paan masala, which have been banned in some states. Implementation of the ban on smoking in public places must also be enforced, as evidence shows minimal change in second hand smoke exposure at workplaces.
Cessation services should be made more widely available. Despite the National Tobacco Control Program being enumerated in the last two five-year plans, little progress has been made. Latest evidence shows that thanks to various awareness measures taken by the government, about half of all smokers and smokeless tobacco users now have the desire to quit tobacco use (an increase of approx. 9 percent and 4 percent, respectively, since 2010). This demand needs to be met with counselling and pharmacotherapy services. Without effective and operational cessation services made available down to the sub-district level, the gains cannot be sustained. Funding, capacity building and integrated health services are the need of the hour.
The question of alternative livelihoods for tobacco farmers and bidi rollers in the country also needs to be addressed. The Indian Tobacco Board had for many years, rolled out subsidies and incentives that encourage tobacco cultivation in the country, conflicting with India’s obligations under the WHO Framework Convention for Tobacco Control (FCTC). Despite growing evidence of the demand for viable alternatives, efforts in the direction have been countered by the tobacco industry, with a pretext of saving livelihoods. Efforts are now being made to phase out the current subsidies and support farmers for growing alternative crops.
The COTPA should also be made more progressive, for example, to increase the legal smoking age to 21 years from 18 years, as has been done for alcohol consumption in many states.
Tobacco control involves multi-sectoral commitment and action and is therefore a challenge for developing countries to implement. There are few investments that India could make that match the returns on tobacco control. Millions of lives are at stake.
Source: ETHealthworld
