8-9 Lakh Deaths Can be Attributed to Tobacco Use: Health Minister JP Nadda

Nearly 8-9 lakh people die every year due to diseases related to tobacco use, the government today said while assuring the Rajya Sabha that a number of multipronged initiatives to reduce its consumption in the country have been undertaken.

"As per the report of Tobacco Control in India (2004), each year 8-9 lakh deaths in India can be attributed to tobacco use," Health Minister JP Nadda said in a reply.

He said that as per the findings of the study "Economic Burden of Tobacco related Diseases in India" (2014), commissioned by the Health Ministry, the total economic costs attributable to tobacco use from all diseases in India in 2011 for persons aged 35-69 accounted for Rs. 1,04,500 crore.

Replying to another question, he said that the government had notified a few new rules on October 15, 2014 as per which, health warnings shall cover at least 85 per cent of the principal display area on both sides of the tobacco products.

The committee on Subordinate Legislations, 16th Lok Sabha is currently examining the rules. The committee submitted its interim report in Lok Sabha on March 18, 2015 recommending to keep in abeyance the implementation of the rules till the committee finalises the examination of the subject and arrive at appropriate conclusions and present an objective report in the House.

"Considering that the report of the committee is interim in nature, the Ministry decided to keep the notification in abeyance. Accordingly a corrigendum was issued on March 26, 2015 suspending the date of implementation and stating that the rules shall come into force on such date as the central government may by notification in official gazette appoint," the Minister said.

Other initiatives include ratification of WHO framework convention on tobacco control, launch of national tobacco control programme, launch of pilot project titled 'Alternative crops for 'bidi' and chewing tobacco in different agro-ecological sub-regions' and notification of rules to regulate depiction of tobacco products of their use in films and television programmes.

"The government is not under any pressure from the tobacco lobby," Mr Nadda said.

Replying to another question, Mr Nadda said the government has constituted an inter-ministerial committee of secretaries under the chairmanship of Cabinet Secretary to review and develop a comprehensive policy on tobacco and related issues.

He said the government got an external evaluation done of the National Tobacco Control Programme through Public Health Foundation of India (PHFI).

"Recommendations of this evaluation have been suitably incorporated in the 12th Five Year Plan for national tobacco control programme to make the outcomes more effective," Mr Nadda said.

When asked whether the government has stakes in cigarette manufacturing companies in the country, he said information is being collected and will be laid on the table of the House.

Courtesy: NDTV

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History of pictorial warnings on tobacco products in India

The issue of pictorial warnings on tobacco packets is not one which is troubling a government at the centre for the first time.

The latest controversy is following BJP MP Dilip Gandhi's comments that there were no Indian studies to substantiate the claim that usage of tobacco could cause cancer. Gandhi, heads a Parliamentary panel subordinate legislation examining the provisions of Cigarettes and Other Tobacco Products Act, which has asked the government to keep plans of increasing pictorial warnings on tobacco products to 85% in abeyance.

It was in 2006 that India’s health warnings policy was first drafted. But there was no consensus on how severe the warnings should be, and after two sets of revisions in 2006 and 2007, the first set of health warnings were approved by a Group of Ministers led by Pranab Mukherjee in 2008.

The warnings shown below, was approved initially, then toned down dramatically in 2008.

In spite of toning down the warnings, they were not implemented for months. After postponing the implementation of warnings seven times, it was finally done on May 31, 2009.

And after years of discussion and debate, one would have expected that the warnings would be worth it, but one of the three pictorial warnings was the picture of a scorpion, though it was meant to be a crab.

(Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors. In Greek, these words refer to a crab, most likely applied to the disease because the finger-like spreading projections from a cancer called to mind the shape of a crab. The Roman physician, Celsus (28-50 BC), later translated the Greek term into cancer, the Latin word for crab.) Source- Cancer.org. 

Two other pictorial warnings from that period on cigarette packets show corroded lungs in one and an x-ray image of damaged lungs in a picture which lacked in clarity.

The Congress in 2009 had defended its stand of toning down the warnings. A CNN IBN article quotes Congress leader Oscar Fernandes, "If we’re talking about making the pictures harsher, we may as well shut down the industry. There are several districts in West Bengal where poor bidi workers earn their livelihood from this.”

It had also been reported then that as Pranab Mukhejee won from the Jangipur constituency, that has a sizable population of bidi workers, this was one of the reasons why the government was not keen on harsh warnings.

The tobacco packets between 2011 and 2013 though contained graphic images of people ridden by oral cancer which were visible distinctly.

The warning on cigarette packets during the same phase were controversial for another reason altogether. They carried a doctored picture of the then English football captain John Terry with corroded lungs. After Terry found out and threatened to sue the government at the start of 2012, another picture, with just his head taken off, was used for another year.

Between 2013 and 2015 again, the warning on cigarette packets concentrated on the lungs again, not looking to focus on oral cancers or those of the throat. Packets of tobacco did not change during this period either though.

The images that were proposed to be put on tobacco packets from April 1, 2015 were these

Courtesy: Newsminute

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Call for bigger health warnings on tobacco product packs

Concerned over the growing tobacco menace in India, health organisations from across the world have asked the Indian Government to oversee new warning labels on tobacco packets.

Tobacco products like cigarettes and gutkas will have more prominent health risk warnings from April 1 this year. 

“Similar health warnings were first proposed in 2006 and they were vigorously opposed in and out of courts by the tobacco industry.

"The Government of India persevered until announcing the new measures last year. The tobacco industry will certainly object to the warnings, just as it does in other countries. 

"We recommend that the tobacco industry simply be ignored and that priority be given to the health of the Indian population,” wrote Laurent Huber, director of Framework Convention Alliance (FCA), Switzerland. 

“If countries such as Nepal, Thailand, Australia and Uruguay can implement similar size warnings (80-90 per cent), there is no reason why India cannot. 

"The FCA also notes that in India, the new warnings will apply to tobacco products generally and not just cigarettes. This is essential, given the diversity of tobacco products in Indian market,” he added. 

Various international public health organisations working on tobacco control and cancer have individually written letters to Prime Minister Narendra Modi and Union Health Minister J.P. Nadda on the new tobacco package issue. 

“The large and improved warnings on tobacco packs serve as a no-cost and proven mass education tool that can protect the health of our people... The best evidence of their efficacy lies in the tobacco industry’s opposition to the warnings. 

"The Government needs to prioritise the nation’s health over narrow commercial interests,” said Shoba John, Health Bridge programme director. 

Former Union Health Minister Dr Harsh Vardhan had on October 15, 2014, issued a notification requiring tobacco manufacturing firms to devote at least 85 per cent of the surface areas of all tobacco products on both sides to graphically and literally represent the statutory warning. 

“Awareness has increased gradually regarding the harmful effects of tobacco. This decision will further help,” said Dr Jagdish Kaur, Chief Medical Officer at the Union health ministry, adding: “Industries have been given enough time to prepare new stocks.” 

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Governor sets agenda to monitor tobacco control measures in educational centres

His Excellency Governor of Kerala with Dr Paul Sebastian

Shri Justice (Retd) P. Sathasivam, Hon’ble Governor of Kerala, said that Tobacco control in campuses of higher learning will be made an item in the agenda at Vice Chancellors’ Meet held every quarter.

He said this during an interaction at Kerala Raj Bhavan with the activists of ‘Tobacco Free Kerala’ led by Dr Paul Sebastian, Director, Regional Cancer Centre and Vice Chairman of the Organisation.

Expressing concern at the growing affinity for tobacco products among youngsters and the increasing number of tobacco-induced cancers in Kerala, the Governor said that he will also direct the inclusion of tobacco control measures in campuses in Vice Chancellor’s monthly reports.

“Every month, Vice Chancellors send reports to me on any instances of sexual harassment, ragging and the like in campuses, action taken and steps planned for the future. Tobacco control measures in campuses too will be included in the monthly reports,” the Governor said. 

Dr Sebastian briefed the Governor about the extent of tobacco use and the harms it causes in Kerala. “An alarming 21.4 per cent of Kerala’s adults above 15 years use tobacco products in any form. Around 50,000 new cancer cases are detected every year, of which more than 40 per cent of cancers in males are tobacco-induced. The economic burden of tobacco use in Kerala is over Rs 1500 crore a year.”

Tobacco-induced cancer victims also shared their experiences with the Governor. Fisherman Saju K, a 34-year-old tobacco-induced oral cancer victim from Kollam recounted how he started smoking in his early 20s as a means to fight chill while fishing.

“Gradually, I was drawn to smoking and I would smoke cigarettes in addition to using smokeless tobacco products. Tobacco use made me an oral cancer patient that changed the course of my life forever,” Saju said.

The group requested the Hon’ble Governor’s intervention for strengthening tobacco control in educational institutions, particularly in centres of higher learning, and in mentoring and directing to sustainable completion the plan to make three districts of Kerala models in tobacco control by adhering to the provisions of the Indian tobacco control law COTPA, 2003.

With a view to creating replicable benchmarks in tobacco control for the rest of the state and the country to emulate, District Collectors of Trivandrum, Ernakulam and Kozhikode are driving efforts to make these model tobacco free COTPA compliant districts. Police, Health and Education Departments are supporting the District Collectors in this endeavour to improve Kerala’s public health through effective tobacco control. 

Shri S Jayaraj, State Coordinator, Tobacco Free Kerala was also present during the interaction. 

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Call for consumption ban of pan masala and gutkha in Kerala

Taking cue from Assam, which has banned consumption of harmful tobacco-based pan masala and gutkha products by law, Kerala’s bureaucrats, health professionals, social advocates and tobacco use victims, have made a collective call for a similar legislation in the state.  

Reflecting popular sentiment, they point out that the desired impact of the ban – of reducing the public health burden – cannot be achieved unless consumption is also prohibited.

Shri K Anil Kumar, Commissioner (incharge), Food Safety, the regulating department for the effective implementation of the ban on pan masala and gutkha in Kerala said, “Ever since our state banned these products in 2012, we have been taking stringent action against violators. However, the illicit smuggling of these products into our state has been a major challenge in implementing the effective ban of pan masala and gutkha containing tobacco and nicotine. As such, any positive step in addition to this ban order or strengthening this ban order would be highly desirable. This would also help in curbing use among children in their vulnerable ages.”

Kerala was the second state in the country after Madhya Pradesh to ban the manufacture, storage, sale or distribution of gutkha and pan masala containing tobacco or nicotine as ingredients under the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations 2011.

Dr. K. Ramadas, Medical Superintendent, Regional Cancer Centre said that while oncologists and medical fraternity at large can treat and provide care to the cancer afflicted, a legislative reform, as has been effected in Assam, would have far-reaching positive implications. 

“Chewing tobacco, whether it is pan masala and gutkha, is a major cause of cancers affecting the head and neck in Kerala. I have seen several youngsters who have lost their taste buds, parts of their tongue and jawbones due to use of these smokeless tobacco products. This sorry state can be corrected to a great extent if Kerala can also legislatively ban the consumption of chewing tobacco products,” Dr Ramadas added.

Shri KS Varghese, Retd. Circle Inspector, Kerala Police and tobacco-induced cancer survivor said, “I took to the habit of using chewing tobacco to keep away sleep during night patrolling, and its use made me a cancer patient. I am now disease-free but the cancer that tobacco presented me with shattered my wife and two children. I would appeal to the Kerala Government to bring out a legislation as in Assam and totally ban consumption of these dangerous tobacco products.”

Assam has banned consumption of pan masala, gutkha, zarda etc containing tobacco and/or nicotine under the Assam Health (Prohibition of manufacturing, advertisement, trade, storage, distribution, sale and consumption of zarda, gutkha, pan masala, etc, containing tobacco and/or nicotine) Act, 2013.

Smt Vimala Menon, well-known social advocate and Secretary, Cheshire Home said, “It is heartening that Assam has given us a worthy example to emulate and follow. As someone who has seen the suffering of cancer victims in palliative care, I feel that everything possible should be done to bring down cancer incidence in our state. Banning consumption of all forms of chewing tobacco products by law and imposing strict penalty on violators would be an effective move.”

The Act prohibits “consumption including possession of zarda, gutkha, pan masala etc containing tobacco and/or nicotine and various types of smokeless and chewing tobacco or any of it derivatives in any form.” 

Further, the Act also makes specific reference on prohibiting advertisements of these products. Violators of the law are liable to be punished with imprisonment up to seven years and a fine between Rs 1 lakh and Rs 5 lakh. 

Consumption or possession of zarda, gutka and pan masala containing tobacco is punishable with a fine of Rs 1,000 for the first offence and Rs 2,000 for each subsequent offence. 

Image courtesy: Midday

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Clarion call for raising tobacco taxes to 65 per cent

As the Kerala Budget date draws close, eminent social advocates, thinkers and doctors have appealed to the Government to raise taxes on all tobacco products to 65 per cent.  In separate letters to the Hon’ble Finance Minister Shri KM Mani, they have pointed out that taxing tobacco products will not only help save many precious lives but can also bring in much-needed revenues to the state exchequer.

Renowned dramatist, poet and theatre personality Padmabhushan Shri Kavalam Narayana Panikker has said, “Taxing tobacco products will prevent draining away of precious resources on induced and preventable morbidity. With one stroke of your pen, you can save so many lives in Kerala that we can by any means.”

Former Vice Chancellor, Kerala University Dr G Balamohanan Thampy has pointed out, “At a time when our state is facing a huge resource crunch, taxing tobacco products can prove to be a major avenue for resource mobilisation.”  Well-known filmmaker Shri Shaji N Karun has said, “Increasing the price of tobacco through higher taxes is the single most effective way to encourage tobacco users to quit and to prevent children from starting to smoke.”

Economist and Professor, Centre for Development Studies here Dr S Irudaya Rajan, in his letter, has cited the case of Rajasthan to explain how tax increase can lead to greater revenues. “The Rajasthan Government has consistently increased taxes on tobacco products over the last years and the tobacco tax in the state is currently peaking at an all-India high of 65 per cent. Currently the state earns revenue of Rs 312.08 crores from taxes on bidis. Cigarettes also show an upward trend in tax revenues; the earnings rose from Rs 62.80 crores in 2009-10 to Rs 139.23 crores in 2011-12.”

Well-known cardiologist and Head, Department of Cardiology, PRS Hospital
Dr Tiny Nair has said, “As a doctor, I see the impact of tobacco every day. The disease, suffering and death which tobacco cause are terrible. As a doctor, I try to cure those suffering but as a human being, I am convinced that we need to prevent the problem in the first place. I urge to increase VAT on all tobacco products to 65 per cent in our state.”

Justice KP Balachandran; Former Director of Encyclopaedic Publications,
Dr George Onakkoor; Retd. DGP Shri KP Somarajan; Retd Principal, Government Arts College, Thrissur Prof CG Rajagopal; Gender Economist Dr S Radha; Consultant Neurologist, PRS Hospital Dr R Anandam;  Consultant Cardiologist, Attukal Devi Institute of Medical Sciences Dr G Girija; Paediatrician Dr T Suresh Kumar; Chairman, IMA Research Cell Dr Sreejith N  Kumar and Retd. Superintendent of Police Shri KN Janarajan have also written to the Government for raising taxes on all tobacco products to 65 per cent.

There are around 55 lakh tobacco users in Kerala and a study conducted by the Johns Hopkins University, USA has shown that as many as 4.54 lakh precious lives can be saved/early deaths averted if VAT on tobacco products is increased to 65 per cent.

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Tripling tobacco tax worldwide could cut smokers by a third

Aggressive taxation is the key to achieving a World Health Organization goal of reducing the global prevalence of smoking by one-third, new research led by a Toronto scientist shows.

A study headed by St. Michael’s Hospital’s Centre for Global Health Research, published in the New England Journal of Medicine, found that tripling tobacco taxes around the world could reduce the number of smokers by 433.3 million people and prevent 200 million premature deaths from lung cancer and other smoking-related diseases.

“We hope this will spur governments to (recognize) it’s a no-brainer. There is more revenue, fewer deaths and all sorts of benefits for the population,” said Dr. Prabhat Jha, director of the centre and professor in the Dalla Lana School of Public Health at the University of Toronto.

He launched the study to determine how the worldwide prevalence of smoking could be chopped by a third by 2025, a goal set at the World Health Organization’s 2013 Assembly.

While the proposal to hike tobacco taxes is a global one, it is particularly targeted at 10 regions representing two-thirds of the world’s 1.3 billion smokers. In descending order, they are: China, India, the European Union, Indonesia, the United States, Russia, Japan, Brazil, Bangladesh and Pakistan.

Strong lobbying by the tobacco industry has helped keep taxes lower in those countries, Jha explained.

Residents of China consume a staggering two trillion cigarettes annually, out of a world total of about six trillion.

Jha pointed out that the study is not just theoretical and that some countries have experienced great success in reducing smoking rates by sharply upping taxes.

For example, France tripled cigarette prices by raising taxes at least 5 per cent higher than the inflation rate every year between 1990 and 2005. At the same time, the country managed to halve cigarette consumption and double tobacco revenues.

The number of smokers in Canada has also dropped by half, but the decline has taken three decades and is largely due to tax increases, Jha said.

About 4 million Canadians smoke today, and that number could continue to be reduced — again by a third — if tobacco taxes were tripled, he said.

Jha noted that non-price interventions — including advertising bans, warning labels and smoke-free laws — also help to reduce smoking, but hiking taxes is the “single most effective” tool.

About $300 billion (U.S.) is collected annually in tobacco taxes around the world. Even though higher taxes would lower consumption, tax revenues would continue to rise by another $100 billion, bringing the annual total to $400 billion, the analysis showed.

Source: The Star

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Apex Bank's recommendation to check contraband tobacco products

The Reserve Bank of India (RBI) has recommended to the government that a special clause in the Foreign Direct Investment (FDI) policy needs to be introduced to check foreign funds clandestinely flowing into the tobacco sector under the guise of brand building and marketing activities.

RBI in a letter sent to the finance ministry has highlighted the fact that there is a need to check "circumvention of FDI norms by international tobacco companies and their conduits", sources said.

The central bank has recommended that the government should incorporate a specific clause to plug this loophole. RBI has cited the example of the lottery business, in which the government has banned FDI and also introduced a specific clause pertaining to marketing as well.

The FDI notification related to the ban on lotteries states, "Besides foreign investment in any form, foreign technology collaboration in any form, including licensing for franchise, trademark, brand name, management contract, is also completely prohibited for lottery business and gambling and betting activities."

The note further states, "A notification akin to that in the lottery business should be issued in order to prevent such FDI in the guise of current account flow into the tobacco/cigarette industry."

According to the new clause, "Foreign fund investment received by an Indian company in any form, including that in the guise of current account transactions for the purpose of creating band awareness, brand building, promotion and management contract, is also completely prohibited for cigars, cheroots, cigarillos and cigarettes of tobacco or of tobacco substitutes etc."

The issue is considered controversial as even the Federation of Indian Chambers of Commerce and Industry (FICCI) has alleged that although the government has prohibited FDI in the tobacco sector since May 2010, multinationals have set up entities in India for wholesale trading. This serves as a platform for creating demand for their brands, which is then met through large-scale contraband/smuggling, according to FICCI.

"This adversely impacts domestic farmer income, employment and revenue interests. Hence, the existing ban on manufacturing must be strengthened by extending the ban to cover FDI in manufacture as well as wholesale trade in these products," according to FICCI.

Source: India Today

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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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Centre asks states to be strict on tobacco ads

The Central Government has sent an advisory to states reminding them to follow rules in restricting advertisement of cigarette and other tobacco products inside shops selling them.

The advisory has asked state governments to implement rules, which stipulates a particular size for tobacco advertising boards inside shop without any illumination, one-third of which will carry a warning message in local language.

Even though the rules were framed in 2005, the advisory was repeated following a Supreme Court directive earlier this month to vacate a stay given by Bombay High Court in 2006 on these rules.  

Among other things, it gave specifications for advertisement at the entrance of or inside of a shop or warehouse (point of sale) selling tobacco products. 

In a letter to Chief Secretaries in the state, Shri Keshav Desiraju, a special secretary in the Union Health Ministry said size of these display boards should not exceed 60 cm x 45 cm, one third of which will contain an warning message prominently either saying 'tobacco causes cancer' or 'tobacco kills.'

Source: Deccan Herald

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India moots 'sin tax' on tobacco

India has mooted the introduction of a designated "sin tax" to finance a part of the health budget during the 12th five year plan (2012-2017).

The 12th plan document, to be submitted to the National Development Council (NDC) presided over by Prime Minister Manmohan Singh, says "a sin tax can lead to reduced consumption of harmful items such as tobacco and alcohol and could be considered".

The move is part of the health ministry's larger plan to combat non-communicable diseases like cardiovascular diseases, diabetes, cancers and chronic respiratory diseases which are emerging as major killers.

The document for NDC says a package of policy interventions would be taken up which includes raising taxes on tobacco, enforcing ban on tobacco advertising in electronic media, counselling for quitting tobacco, early detection and effective control of high blood pressure  and diabetes, screening for common and treatable cancers and salt reduction in processed foods.

Around 275 million Indians consume tobacco which has 3,095 chemical components of which 28 are proven carcinogens that can cause cancer. Around 2,500 people die every day due to tobacco related diseases in India.

Source: Times of India

Image courtesy: Jai Maharasthra News

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Kerala CM puts foot down on tobacco industry

Kerala Chief Minister Oommen Chandy Thursday informed the state assembly that, barring the tobacco industry, his government has taken steps to support the coir, handloom, cashew and other traditional sectors of industry.

"Barring the beedi (tobacco) sector, my government has done a lot for all other traditional industries. Since we have taken an anti-smoking stand, the employment in that sector is dwindling," said Chandy in response to an adjournment motion moved by the Left opposition.

Ever since Chandy assumed office, he has maintained a strong stance against tobacco and went on to the extent of banning gutka (a tobacco-laced chewing mix) in the state a few months back.

Earlier this month, Chandy wrote to the prime minister for a nationwide ban on tobacco.

The sale of tobacco has dropped from Rs 1.30 crore annually to a few thousands only in the state over the last one decade. 

Source: SMETimes

Image courtesy: Zee News

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India falls short of FCTC guidelines on tobacco products’ packaging

A new report has revealed that pictorial warnings in tobacco products in India do not meet the internationally stipulated size parameters, at a time when health warnings on tobacco products have come to be recognised as a cost-effective means of communication.

Called ‘Cigarette Package Health Warnings: International Status Report’, it points out that pictorial warnings in packets of tobacco products in India fall short of the stipulated 50% of the display area, even after two rounds of revisions of warnings in 2009 and 2011. 

The report released in the Conference of Parties to the WHO Framework Convention of Tobacco Control (FCTC) that concluded in Seoul, South Korea on November 17, shows that health warnings in cigarette packets in India only cover 40% of the front face of the packet. 

Brought out by leading Canadian non-government organisation, Canadian Cancer Society in October 2012, it also brings out that India has fallen 23 places in the ranking of countries on depiction of health from 100 in 2010 to 123 in 2012.

Article 11 of World Health Organisation’s FCTC, which India ratified in 2004, requires that health warnings “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” – the principal display areas being front and back of the package. It further stipulates that such warnings should be applied to all categories of tobacco products.

India’s current pictorial warnings, notified by the Union Government in 2011 under Section 7 of the country’s tobacco control legislation – COTPA 2003, have designated picture and text warnings for smoking and smokeless tobacco products. In September, India brought out a revised set of warnings that will take effect from 1 April 2013.  

On the relevance of pictorial warnings, the report that provides a ranking of 198 countries notes, “A picture really does say a thousand words. Pictures are especially important for individuals who are illiterate or who have low literacy. Pictures are also important to immigrants, temporary workers as well as individuals from minority language groups who may not yet be able to read the national language(s).”

The International Status Report also has that Australia leads the pack with pictorial warnings occupying an impressive 82.5% of the principal display area. India’s neighbour in the Asian region, Sri Lanka has notched up the second rank, with pictorial warnings covering 80% of the front and back covers of the packet. Thailand sells tobacco products with warnings spread over 55% on its front and the back faces. 

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Poor more susceptible to smoking in India

The poor in India are more susceptible to smoking, as a recent study reveals. Called ‘Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey’, the study was conducted to assess the socio-economic inequality in smoking in low and middle income countries.

The study based on data from the World Health Survey (WHS) of the World Health Organisation (WHO) found that 46.7 per cent of the poorest men smoke in India as against 21.8 per cent of the richest men.

Though the findings are in line with common knowledge regarding smoking prevalence, what is distressing that well over a quarter of India’s population are under the addictive spell of tobacco. According to figures of the Planning Commission, GoI, there are as many as 3546.8 lakhs people below the poverty line in India, which is nearly 29 per cent of the total population.

A total of 213,807 men and women of 48 low and middle income countries were covered in this study that was initiated in the context of the fact that the risk of dying from smoking is significantly higher in the lowest socio-economic groups as compared to higher socio-economic groups. 

Commenting on the study, Dr R Jayakrishnan, Assistant Professor, Community Oncology Division, Regional Cancer Centre said, “The findings reinforce the trend seen during clinical practice. Majority of tobacco-induced cancer patients who visit the Centre are from the lower income strata of the society. The need of the hour is to develop prevention strategies that specifically focus on the more vulnerable sections.”

Outlining some possible prevention strategies, Dr M A Oommen, renowned economist said, “While linking high incidence of smoking with poverty is a simplistic correlation, the issue has to be tackled in a multi-pronged manner such as incentivising the poor to get out of the habit, moral suasion, higher incidence of excise duty on tobacco products, expanding capability building of the poor and structural reforms through better employment opportunities.”

Image courtesy http://www.nytimes.com

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Nine Indian states ban gutkha!

Nine Indian states - Kerala, Madhya Pradesh, Bihar, Haryana, Chattisgarh, Himachal Pradesh, Jharkhand, Maharasthra and Rajasthan have banned gutkha containing tobacco or nicotine under the Food Safety and Standards (Prohibition and Restriction on sales) Regulation, 2011 of the Food Safety and Standards Act, 2006.


The union territory of Chandigarh is also well on its way to ban this deadly product, notification to this effect is updated. 

Regulation 2.3.4 of the Food Safety and Standards Regulation 2011 states, "Product not to contain any substance which may be injurious to health: Tobacco and nicotine shall not be used as ingredients in any food products."


Going by the population figures of various states in Census 2011 and the findings of tobacco usage in Global Adult Tobacco Survey (GATS) 2009-10, the ban has impacted a population of 48.2 crore and 3.1 crore gutkha users in India.

In Kerala alone, it has impacted 4.9 lakh users. 

The Hindu, Editorial - 26 July 2012

Image Courtesy: http://www.facenfacts.com/

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Blanket ban on ghutka/pan masala in Kerala

In a powerful statement that re-affirms Kerala’s commitment to public health, the Government has decided to ban ghutka/pan masala in the whole of the state with immediate effect.

Kerala has thus become the second State in the country after Madhya Pradesh to ban ghutka products.

Hon’ble Chief Minister Shri.Oommen Chandy announced this at a press conference on 25 May 2012 and said the increasing incidence of ghutka/pan masala-induced diseases, including oral cancers, prompted the Government to go in for a total ban of such products in Kerala. 

“I have come across oral cancer patients and understand the pain and trauma that they and their family members undergo. Though our state has advanced centres and experts for cancer care, use of ghutka/pan masala is inviting unwarranted suffering,” he said.

“The Government would spare no efforts to enforce the ban on ghutka/pan masala and will take strong measures to maintain and improve the health of our people,” the Chief Minister said, hoping that this Kerala model in the public health would be another precedent. 

The Chief Minister had written to the Prime Minister in July seeking a total ban on ghutka/pan masala across the country. However, the Union Ministry of Health & Family Welfare in last week of April this year, replied that States had the jurisdiction to ban ghutka/pan masala under the Food Safety and Standards Regulation Act, 2011. The Health Department initiated steps immediately in this regard following this.

The notification banning ghutka/pan masala in Kerala issued by Commissioner of Food Safety, Kerala on 22 May prohibits the manufacture, storage, distribution and sales of these products that contain tobacco and nicotine, in whatsoever name it is available in the market today.

The Chief Minister pointed out that a coordinated effort is needed to strictly enforce the ban. “The ban will be successful only if it is implemented in both letter and spirit. We will work with all stakeholders - police, teachers, health personnel and voluntary associations to achieve this,” he said.

Hon’ble Health Minister Shri.V.S.Sivakumar, who was present in the press briefing, said that the Government was aware and concerned about the wide use of tobacco and nicotine in ghutka/pan masala nowadays.

“The use of ghutka/pan masala begins as a mouth freshener or stress reliever. But quickly, people get addicted to these products due to the tobacco and nicotine in them and very soon develop painful oral diseases,” he said.

“Such products are not just favoured by people from poor socio-economic background; today school and college going students are the biggest victims. The Health Ministry will work with the Education Department to ensure that the ban is strictly implemented and monitored with the help of three-tier committees formed for monitoring sale of tobacco products around schools,” the Minister added. 

The ban on gutka/pan masala follows a string of proactive initiatives taken by the Kerala Government for tobacco control. Recently, the Government reinforced its stand on ban on sale of tobacco products such as pan masala around 400 metres of educational institutions, in spite of stiff opposition from traders and dealers.

Image courtesy: The Hindu

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India to combat illicit tobacco trade

India, along with 134 countries of the world has agreed on a global deal to combat tobacco smuggling.


Under the Protocol agreed upon by the Intergovernmental Negotiating Body (INS) after lengthy discussions, countries will establish a global tracking and tracing system for tobacco products. It sets the rules for combating illicit trade through supply chain controls.


A report brought out by Bloomberg Philanthropies and the Bill & Melinda Gates Foundation in 2009 showed that the volume of illicit cigarette trade in India was 14% of the total cigarette consumption. 


India also found place in the list of 10 countries with the greatest cigarette illicit trade with 18 billion cigarettes in 2007.


The report 'How Eliminating the Global Illicit Cigarette Trade Would Increase
Tax Revenue and Save Lives' notes that if the global illicit trade were eliminated, governments would gain at least $31 billion, and from 2030 onwards would save over 160,000 lives a year. 


Image source - Euromonitor

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Smoking in 'Public Places' - Public Place Defined

Smoking is strictly prohibited in public places in India with effect from 2 October 2008. Public places includes auditorium, hospital buildings, health institutions, amusement centres, restaurants, work places, cinema halls 

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Kerala Budget raises tax on tobacco products

Kudos to the Kerala Government and the Hon'ble Finance Minister Shri.K.M.Mani for raising tax on tobacco products! VAT on cigarettes increased from 12.5 to 15 per cent and tax on pan masala raised from 20 to 22.5 per cent.

The Hindu Business Line, 20 March 2012

The Hindu, 20 March 2012

Janmabhumi, 20 March 2012

Malayala Manorama, 20 March 2012

Mathrubhumi, 20 March 2012

The New Indian Express, 20 March 2012

Times of India, 20 March 2012

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Bloomberg Head speaks on tobacco control in India

The figures don't read too well for India with the Global Adult Tobacco Survey (GATS) 2010 stating that of the estimated 275 million tobacco users in India, about 120 million of them are smokers (accounting for 10 per cent of the world's smoking population) and 163 million use smokeless tobacco. It is estimated that 2,500 Indians die every day and one million Indians die every year from tobacco-related diseases. If current trends continue tobacco will account for 13 per cent of all deaths in India by 2020.

And warning that unless these figures are controlled it would register a sharp ascend in the coming years, Dr. Kelly Henning head of global health programs at Bloomberg Philanthropies who was in India recently said: "In India too many lives are lost to tobacco abuse. We, however, know that hard hitting, evidence based mass media campaigns work to warn people about the ill effects of tobacco. That is why Bloomberg Philanthropies is partnering with the Indian Government to help strengthen the tobacco control policies. 

Through our global initiatives we continues to advocate for the use of these types of campaigns along with other evidences based strategies such as ensuring a 100 per cent smoke free workplace and higher price on all tobacco products. Stopping this epidemic requires nothing less.''

“Stringent monitoring, higher taxes, advertising ban on tobacco products are the way forward to ensuring that India has an edge over the war that it should wage against tobacco abuse in the country. The Government needs to get members from all sections of society to contribute towards preventing the spread of tobacco abuse especially among the youth of the country. There is an urgent need to tell the youth that tobacco kills and that can be reinforced in several ways. The tobacco abuse among the under 15 age group is alarming. Besides this, the abuse of chewable tobacco is a massive problem in the country and needs to be taken up on a war footing,'' she added.

Dr. Kelly underlined the four major objectives of the $375 million six year Bloomberg Initiative to Reduce Tobacco – a global project aimed at curbing the tobacco epidemic in low and middle income countries.

This includes working towards developing a rigorous system to monitor the status of global tobacco use, to support advocates' efforts to educate communities about the harms of tobacco and to enhance tobacco control activities that work towards a tobacco free world.

“We are also working towards supporting public sector efforts to pass and enforce key laws and implement effective policies, including taxing cigarettes, preventing smuggling, altering the image of tobacco and protecting workers from exposure to second hand smoking. Work is also on to refine and optimize tobacco control programs to help smokers stop using tobacco and to prevent children from starting,” she said.

Excerpted from “Too many lives lost…”, The Hindu dated 16 March 2012
http://www.thehindu.com/health/policy-and-issues/article3001928.ece

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