Govt proposes regular scrutiny to enforce curbs on tobacco sale

In a blatant violation of the Cigarettes and Other Tobacco Products Act (COTPA), 2003, vendors are openly selling tobacco products to minors within a radius of 100 yards of educational institutions in the national capital. After a program evaluation under the National Tobacco Control Program (NTCP), the ministry of health and family welfare has now proposed regular scrutiny for compliance of the act across the country.

A study of randomly selected 100 educational institutions was conducted December 2015 in Delhi by the epidemiology division, National Centre for Disease Control (NCDC), National Tobacco Control Program, Directorate General Health Services (DGHS), ministry of health and family welfare along and World Health Organization (WHO).

Activities related to Section 6 of COTPA around educational institutions, such as the sale of tobacco products within a radius of 100 yards, sale of tobacco products to and by minors, and existence of display boards prohibiting sale of tobacco products were observed using Global Positioning System (GPS) enabled tablet computers preloaded with maps and Open Data Kit software.

“We accessed compliance of Section 6 of COTPA around educational institutions in Delhi. Among the 100 educational institutions surveyed (53 government, 47 private), tobacco products were sold at 43 outlets within a radius of 100 yards of 27 educational institutions. No outlet had a display board prohibiting sale of tobacco products to minors,” said Rajesh Yadav from NCDC.

“One outlet sold tobacco products to minors during the period of observation, but sale of tobacco products by minors was not observed. Only 38% of educational institutions displayed board prohibiting tobacco sales; private educational institutions were significantly less likely to display signs prohibiting tobacco sales than government educational institutions,” he said.

The study has also been published in the latest issue of International Journal of Preventive Medicine. Although COTPA (2003) and the NTCP have been in existence for many years, health ministry officials said studies from around the country have shown poor compliance of laws for tobacco control in previous years.

Studies in Rajasthan, Maharashtra, Kerala, Karnataka and Bihar reported sale of tobacco products within a radius of 100 yards to be in 46%, 57%, 50%, 65%, and 62% of educational institutions, respectively, in 2012-2013. Non-existence of the statutory display boards prohibiting sale of tobacco products outside schools in the states of Rajasthan, Maharashtra, Kerala, Karnataka, and Bihar was reported in 78%, 98%, 82%, 71%, and 93% of educational institutions, respectively, in 2012-2013.

“Similar periodic surveys are required to enable regulatory agencies to enforce COTPA in letter and spirit to control tobacco use,” Yadav said.

Tobacco use is the leading preventable cause of disease and premature deaths globally and in India. Tobacco related diseases account for an estimated 6 million deaths globally and 0.8-0.9 million deaths in India each year. The Global Adult Tobacco Survey, India (2009), shows that nearly 35% of adults use tobacco, and the average age at initiation of daily tobacco use is 17.9 years.

Source: Livemint

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Hardcore smokers are softening over time

Cigarette smokers with high levels of psychological distress are often heavy smokers, and thus identified as a “hardcore” group who are less willing or able to quit than other smokers. However, a study by UC San Francisco researchers shows that over the course of 19 years, from 1997 to 2015, this hardcore group smoked progressively fewer cigarettes per day and tried to quit in increasingly greater numbers, along with every other group of smokers in the United States.

“Even though they smoke more than the general population, smokers with high psychological distress have been smoking less and trying to quit more, as the overall level of smoking has decreased,” said Margarete C. Kulik, a postdoctoral fellow with the UCSF Center for Tobacco Control Research and Education (CTCRE) and the lead author of the study. “This shows that with effective tobacco control policies, even hardcore smokers will soften over time.”

The study, published on Oct. 10, 2017, in the American Journal of Preventive Medicine, draws on data from the U.S. National Health Interview Survey (NHIS) administered annually by the U.S. Census Bureau. Current smokers were asked how many cigarettes they smoked per day and whether they had tried to quit smoking for one day or longer in the past 12 months. Based on answers to the Kessler Psychological Distress Scale, which is included in the NHIS, smokers were assigned to one of three categories: no distress, moderate distress and serious psychological distress. Responses from a total of 118,604 smokers were analyzed.

The researchers found that from 1997 to 2015, cigarette consumption declined significantly among all three groups. Among the no distress group, cigarettes smoked per day decreased from 16.3 to 11.2, while cigarette consumption in the high distress group decreased from 19.6 to 14.5. The proportion of smokers who reported trying to quit increased in all groups and was highest among those with serious distress.

“The finding that there were more quit attempts among smokers with the highest levels of distress might reflect the fact that although these smokers are motivated and willing to quit, they may need more help quitting successfully,” said senior author Stanton Glantz, UCSF professor of medicine and director of CTCRE. “This indicates that we should be encouraging our mental health providers to treat tobacco dependence along with other problems. Contrary to popular belief, treating nicotine addiction does not complicate the treatment of other substance abuse or mental health issues and in fact has been shown to improve outcomes among people in substance abuse treatment and recovery. Even smokers with the greatest psychological distress can be reached and helped to quit.”

Glantz added that the new findings, combined with earlier research that also showed softening among the general population, “seriously challenge the tobacco industry’s position that ‘harm reduction’ products such as e-cigarettes and heat-not-burn products are the only way out of the tobacco epidemic. These products are premised on the unproven assumption that there is an intractable hard core of smokers who cannot be reached using established tobacco control policies.”

The study was supported by funds from the UC Tobacco Related Disease Research Program and the National Institute on Drug Abuse.

The UCSF Center for Tobacco Control Research and Education specializes in tobacco control research focused on policy change, smoking cessation, nicotine addiction, health disparities in smoking, novel tobacco devices and tobacco marketing. It also houses the Truth Tobacco Documents Library, a rich resource of previously confidential tobacco industry documents.

Source: University of California

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Netflix, Amazon Prime, Hotstar may soon have to display anti-tobacco warnings

Digital streaming services like Netflix, Hotstar and Amazon Prime may soon have to display messages and warnings during scenes showing use of tobacco products.

The health ministry has written to the telecom regulator to issue an advisory to online movie and TV programme streaming companies to comply with anti-tobacco rules and display messages and warnings during scenes showing tobacco products or their use. The letter came after the ministry observed violation of anti-tobacco rules by these companies.

“While the rules are well implemented in films screened in movie theatres, the films and TV programmes streamed using internet like Netflix, Amazon Prime, Hotstar, Voot and Hungama among others are ‘not fully compliant’ to these rules,” the letter from the ministry of health and family welfare to the Telecom Regulatory Authority of India (Trai) stated. 

As per the rules, all films and TV programmes, while displaying tobacco products or their use, are required to run anti-tobacco health spots of minimum 30 seconds at the beginning and middle of the programme, the letter further said.

Also, the rules mandate display of anti-tobacco health warning as a prominent static message at the bottom of the screen during the period of display of the tobacco products or their use in the television programmes.

The letter also mentioned that they are also required to submit a strong editorial justification explaining the necessity of display of tobacco products or their usage in the film to the Central Board of Film Certification.

An audio visual disclaimer on the ill-effects of tobacco use in the beginning and middle of the film or television programmes is also necessary. They should be of minimum 20 seconds duration each, the letter stated.

The Union health ministry notified the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce,Production, Supply and distribution) (second amendment rules) 2011 and 2012 to regulate the depiction of tobacco products or their use in films and TV programmes.

Earlier this year in February, noticing that television programmes were breaking rules under the Cigarettes and Other Tobacco Products Act (COTPA), the Union ministry along with the ministry of information and broadcasting had said that they are planning to put in place a mechanism to monitor telecast that display tobacco products or their use.

Source: LiveMint

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Youth more likely to discourage than promote smoking among peers

Young people more often discourage smoking among their peers than encourage it, new University of Otago research suggests.

Around half of 14-and 15-year old New Zealanders have carried out at least one behaviour during the past year to discourage smoking, most often by telling their peers that smoking is bad for their health; to stop smoking; that they do not like smoking; and that smoking is a waste of money.

By contrast, fewer than one in ten 14-and 15-year olds did something to encourage smoking among their peers, most typically by giving them a cigarette or offering to share a cigarette. The findings come from a new Otago study published in the Australian and New Zealand Journal of Public Health.

The Study used survey findings from the 2014 Youth Insights survey of 2919 Year 10 students from 142 high schools throughout New Zealand.

The study's lead researcher, Dr Louise Marsh, says the Tobacco industry often uses the argument that smoking among young people is due to peer pressure.

"Our findings suggest that there is considerable promotion of non-smoking in the opposite direction.

"This was the case even among young people who reported smoking. It was also encouraging that Māori and Pacific young people were more likely to discourage smoking than young people from other ethnicities," Dr Marsh says.

Those students who discouraged smoking were also more likely to report exposure to anti-smoking messages from a range of sources including classes at school, smokefree events and smokefree adverts. This is positive in that it indicates the spreading of smokefree messages throughout the community might influence young peoples' desire to be "agents of change", and to spread their own smokefree messages.

US research based on the Truth campaign has shown the effectiveness of "peer-to-peer" influence in reducing tobacco smoking among young people. In New Zealand, the Health Promotion Agency's Stop Before You Start campaign has helped shape social norms around non-smoking."

Our findings demonstrate that a lot of informal youth-to-youth health education is already happening in NZ. This could be extended to engage young people as active ambassadors of Smokefree 2025," she says.

Source: MedicalExpress

More information: Louise Marsh et al. New Zealand adolescents' discouragement of smoking among their peers, Australian and New Zealand Journal of Public Health (2017). DOI: 10.1111/1753-6405.12698 

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​High tobacco use behind worrisome​ ​incidence of lung cancers in North Kerala districts

Tobacco use once again is proven as the villain, and a cause behind the high incidence of lung cancers in north Kerala districts of Kozhikode, Kannur and Kasargod, notes a recent study brought out by the Malabar Cancer Centre (MCC), a tertiary cancer centre in Kannur.

As much as 36 per cent of overall patients across these districts had the habit of smoking.  Patients from Kasargod were the most prone to smoking at 40 per cent; followed by Kannur at 34 per cent and Kozhikode at 33 per cent. The extent of smoking among Kerala adults, as per latest benchmark figures of Global Adult Tobacco Survey of Union Health Ministry, is 13.4 per cent.

Lung and breast cancer rank high among the various cancers across the three study districts. The distribution of lung and breast cancers in Kannur is 15 per cent. Lung cancers contribute to 11 percent and breast cancers are at 13 per cent in Kozhikode. In Kasargod, lung and breast cancers are 13 and 15 per cents respectively. 

The retrospective study ‘Geographical Distribution of Cancer in Northern Kerala, India: A Retrospective Analysis’ was conducted based on data of the hospital based cancer registry (HBCR) for the year 2011 in MCC and published in the Indian Journal of Applied Research. A total of 2,366 cancer patients – 1,259 males and 1,107 females – had registered at the MCC in 2011 from the districts of Kozhikode (457), Kannur (1670) and Kasargod (239). A semi-structured questionnaire was used to collect the information from patient’s medical records to understand the demographic factors, personal habits, and tumour staging.

The study also refers to harms of second-hand smoke or passive smoke as it found that 10 per cent of female registered patients were passive smokers. Citing scientific literature, it adds that second-hand smoke is linked to lung cancer and also lymphoma, leukaemia, brain tumours in children, cancers of breast, stomach and the brain, among others.

Dr Satheesan B, Director, Malabar Cancer Centre and the study’s principal investigator and co-author said, “The study findings yet again brings out the role of tobacco in cancers and underlines that tobacco control is the best way to prevent cancers. Things can no longer be left to chance as the combined burden that tobacco use causes on morbidity and mortality at micro and macro levels is enormous. Regular monitoring and consolidation of tobacco control measures taken at the district level should happen through monthly reviews of enforcement and awareness activities.” 

The high availability and consumption of tobacco both in smoking and chewing forms in north Kerala may also be attributed as a reason for high rate of tobacco related cancers in the area. “Provision of health-friendly alternative livelihoods to beedi workers which has been adopted by leading groups in the field is expected to change the scenario. But increasing the beedi prices to dissuade users would be welcome,” Dr Satheesan added.

Pan chewing among patients from Kannur, Kasargod and Kozhikode stands at 14, 19 and 16 per cents respectively.  The International Agency for Cancer Research (IARC) of the World Health Organisation, after scientific evaluations, has pronounced that chewing betel quid with and without tobacco is carcinogenic to humans.

Dr Saina Sunilkumar, Lecturer, Department of Cancer Registry and Epidemiology; Shri Ratheesan.K and Shri Subhradev Sen, Lecturers in Biostatistics collaborated for the study.

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Tobacco sales rampant near educational institutions, says RCC study

More than a half of the high school and higher secondary school students surveyed found illegal tobacco sales near their educational institutions, according to a study carried out in the district’s rural areas by the Regional Cancer Centre (RCC), Trivandrum.

An alarming 60 per cent of students in the higher secondary group (HSS) and 52 per cent in the high school (HS) group reported tobacco sales in the study, which covered 1,114 students across 10 random Government schools.   

The study, “Tobacco and Alcohol Use and the Impact of School Based Anti-tobacco Education for Knowledge Enhancement among Adolescent Students of Rural Kerala, India”, conducted in 2014-15 has been published in a recent edition of the peer-reviewed ‘Journal of Addiction’.  It points to the inadequate enforcement of the ban on sale of tobacco products around 100 yards of educational institutions, as mandated the Indian tobacco control law, COTPA, 2003. 

RCC Director Dr Paul Sebastian, the study’s principal investigator and co-author, said, “Limited information on tobacco use among adolescents in rural Kerala triggered this study. The high prevalence of tobacco sales near educational institutions is worrisome as tobacco use initiated during adolescence often emerges as a major risk factor for non-communicable diseases in adulthood.”

“It is important to identify the source of tobacco product sales near institutions.  Regular checks and multi-pronged strategies to prohibit availability of these products are critical,” added Dr Sebastian, who is also the Chairman of Tobacco Free Kerala. 

The study reports that 4.3 per cent of the students covered were ‘current tobacco users’, viz, a person who used tobacco three days or more a week.  A higher 7.4 per cent were ‘ever users’ or persons who have used tobacco at least once during the academic year under analysis. 

Cigarette smoking was the predominant habit followed by gutkha use and then by beedi smoking among ‘ever users’.  Also, 63 per cent of the members of an ever user’s household had consumed tobacco in one form or another.

Dr R. Jayakrishnan of RCC and the principal author of the study said, “A questionnaire was used to elicit information from the students through self-reporting.  Participation in the study was purely voluntary and complete anonymity for the information provided was assured.”

“Other than tobacco sales, students were also asked about habits of family members, knowledge of tobacco hazards and the tobacco control law in India. A wider sample study would be desirable under the circumstances,” he added while expressing concern about the high prevalence of tobacco use among family members of surveyed students. 

Two-thirds of respondents were unaware of the presence of tar and nicotine in tobacco, the study points out.

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India to host maiden global tobacco control conference

India is set to host the crucial global tobacco control conference today for the first time, where it will push for incorporating smokeless tobacco as an agenda amid a presence of delegates from about 180 countries. 

The Seventh Session of the Conference of Parties (COP7) to World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) to be held from November 7 to 12 at Greater Noida. Sri Lankan President Maithripala Sirisena will be the special invited speaker at the conference, which will be inaugurated by Union Health Minister J P Nadda.

Noting that there is a large number of people in India who are increasingly opting for smokeless form of tobacco, Health Ministry officials said the country's effort will be to put it on the agenda of FCTC. 

India has already implemented 85 per cent pictorial warning on tobacco products, but the issue of plain packaging, that refers to packaging that requires the removal of all branding "will still be on the mind" during the deliberations at the conference, they added. 

About 1,500 delegates are expected to participate in the conference from around 180 countries along with other observers in official relations with the WHO FCTC Secretariat in Geneva. 

India has provided a leadership role in the negotiations of FCTC and has also served as the regional coordinator for the South-East Asia Region. 

India is obligated to comply with the treaty provisions and its guidelines to reduce tobacco consumption globally. 

It is the first occasion that a COP meeting is being held in India and signals a strong commitment of the government to increase international co-operation and awareness of the WHO FCTC globally and especially in the WHO South-East Asia Region, the Health Ministry said. 

The WHO FCTC is the first global evidence-based public health treaty that recognises the right of all people to the highest standard of health. The treaty was developed by countries in response to the globalisation of the tobacco epidemic. There are at present 180 parties to the Convention.

Among the issues on the COP7 agenda include, tobacco industry liability for the devastation caused by its products (Article 19); the FCTC’s illicit trade protocol; the treatment of tobacco in trade agreements and tobacco and sustainable development.

Source: Moneycontrol

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Chewable Tobacco Major Health Threat, Needs Regulation: Doctors

Chewable tobacco is emerging as a major threat in India when it comes to causing cancer that affects 11 lakh people a year, top doctors today said while urging the government to increase taxation on it to reduce its consumption.

Over 700 delegates from around 15 foreign countries have gathered in Delhi for a four-day global conference on head-neck cancer, organised by International Federation of Head and Neck Oncologic Societies (IFHNOS) and Foundation for Head-Neck Oncology (FHNO).

They also urged the government to remove tobacco and cigarette vendors from near school and college premises. There are 11 lakh incidences of cancer every year in India, as per the estimates of Indian Council of Medical Research (ICMR). And 2.5-3 lakh cases are of head and neck cancer. Over 80 per cent of head and neck cancer are caused by tobacco alone.

"Head and neck cancers are emerging as the major killers now, and if the sale and consumption of chewable tobacco like beedi-khaini, tambaku, gutka and zarda are not regulated, it will increase the country's health burden dramatically," said Dr Alok Thakar, professor of head-neck surgery and otorhinolaryngology at the AIIMS.

Dr Thakar, Organising Chairman of the conference, and a host of other oncologists from India's top cancer-cure institutions like Tata Memorial Centre, addressed a press conference here on the opening day of the conference today.

"27 per cent male population is affected by head-neck cancer while its incidence is 10-12 per cent in women. In foreign countries, lung cancer is more prevalent, as people smoke more tobacco than chew it, unlike in India, where every nook and cranny sell chewable tobacco in the open," he said.

"The incidences have increase in the last decade or so. 10-15 years ago, the incidence was about 8 lakh. People today consume gutka and zarda like saunf and that is very dangerous, more so the youth are consuming chewable tobacco from very early age," he added.

Dr Anil D'Cruz, Director of Mumbai-based Tata Memorial Centre, said, "I have operated on a cancer patient as young as an 8-year-old boy. He was chewing tobacco from time when he was four."

"Tobacco consumption has begun in schools and so it is important that law is properly enforced and tobacco and cigarette vendors found violating the stipulated minimum distance rule should be removed," he said.

Dr D'Cruz said, "After increasing tax burden on cigarettes, its consumption has gone down. Tax serves as a major deterrent, and therefore, we hope the government will increase the tax on it."

Countries like France and South Africa have decreased tobacco consumption in one decade for which the US took four decades, just by increasing the taxation, the doctors said.

Source: NDTV

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Ban on sale of loose cigarettes comes into effect in Himachal

With an aim to dissuade youngsters from tobacco use and smoking, the ban on sale of loose cigarettes and beedis in Himachal Pradesh came into force from on Saturday.

'HP prohibition of sale of loose cigarettes/beedis and regulation of retail business of cigarettes and other tobacco products Bill 2016' was passed during the Monsoon session of the Assembly and has been notified after getting assent from Governor.

The Act provides for complete ban on sale of loose cigarettes and beedis and compulsory registration of dealers of tobacco products.

A provision for fine up to Rs 50,000 and jail up to three months for contravention of law in the first instance and fine up to Rs 1-lakh and jail up to one year for committing the offence the second time has been made in the act, aimed at reducing consumption of tobacco products.

No dealer would allowed retail business without registration from Registering authority and violation of the provision would attract fine up to Rs 10,000 for the first time and Rs 15,000 for subsequent offences.

Further, any police officer, not below the rank of Assistant Sub Inspector or any authorized officer of the state government, if he has reason to suspect that any provision of this Act has been, or is being, contravened, can enter and search any business premises or any other place where retail business of cigarettes or beedis or any other tobacco products is being carried or such products are stored. 

Source: Millennium Post

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Michael R. Bloomberg Becomes WHO Global Ambassador for Noncommunicable Diseases

The World Health Organisation has today named Mr Michael R. Bloomberg, philanthropist and former three-term Mayor of the City of New York, as Global Ambassador for Noncommunicable Diseases (NCDs).

NCDs (including heart disease, stroke, cancer, diabetes and chronic respiratory diseases) and injuries are responsible for 43 million deaths each year - almost 80% of all deaths worldwide. Each year, 16 million people die from NCDs before the age of 70. Road traffic crashes account for a further 1.25 million deaths each year and are the leading cause of death among young people, aged 15–29 years. The premature death and disability from NCDs and injury can largely be prevented, through implementing proven, cost effective measures.

For the past decade, Bloomberg has been working with WHO on tobacco control and injury prevention. “Michael Bloomberg is a valued partner and has a long track record of supporting WHO in the areas of tobacco control, improving data for health, road safety and drowning prevention,” said Dr Margaret Chan, WHO Director-General. “I am therefore absolutely delighted to be able to appoint him as Global Ambassador for Noncommunicable Diseases. This will enable us to strengthen our response together to the major public health challenges of NCDs and injuries.”

In his new role, Mr Bloomberg will work with national and local political leaders around the globe to highlight the burden of NCDs and injuries. His track record on public health achievements as mayor will enable him to motivate cities to take on the global agenda for NCD and injury prevention. He will help mobilize national and city level political leaders, donors and the private sector to prevent and treat the NCD epidemic and combat injuries.

Through this work, Mr Bloomberg and WHO will be supporting the attainment of the United Nations’ Sustainable Development Goals (SDGs). World leaders have recognized NCDs and injuries as urgent priorities for action in the SDGs. The SDGs contain a number of specific targets for NCDs and injuries, including halving the number of global deaths and injuries from road traffic accidents by 2020, reducing by one-third premature mortality from noncommunicable diseases by 2030, and strengthening implementation of the World Health Organization Framework Convention on Tobacco Control.

“I am honored to become WHO Global Ambassador for Noncommunicable Diseases and excited about the possibilities that are within our reach. Cities and countries around the world are making great progress reducing preventable, premature deaths, and by replicating the most effective measures on a global scale, we can save many millions of lives,” said Michael Bloomberg. “Together with WHO, we’ll support low- and middle-income countries as they work to achieve their policy goals and direct resources in ways that will best improve public health. We’ll also work to raise awareness among leaders and policy makers at the local level about the real gains that can be achieved when effective programs are in place.”

Mr. Bloomberg’s role and activities will extend the reach of WHO’s work to reduce exposure to the main NCD risk factors: tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol, as well as to promote proven measures to reduce injuries from road traffic crashes, burns, falls and drowning. This includes efforts to strengthen health systems’ response to manage NCDs and injuries, and to improve availability of health data to inform policy and programmes.

Effective strategies to prevent NCDs include increasing the tax and price of tobacco and alcohol, enforcing smoke-free environments, implementing large graphic tobacco health warnings, enforcing bans in tobacco advertisement, promotion and sponsorships, promoting the availability of healthy, affordable diets, and discouraging the consumption of foods and beverages high in sugars, salt and fat. Proven actions to prevent the most common forms of injuries include enforcing speed limits, drink-driving legislation and the wearing of seat-belts and helmets, enforcing laws on smoke alarms and hot water tap temperatures, removing or covering water hazards and fencing pools to prevent drowning, eliminating fall hazards and improving balance among the elderly. These are all strategies where both national and local government officials can play a role.

The position of WHO Global Ambassador is for an initial period of two years and is on a purely honorary basis. It does not carry any right to remuneration or compensation for expenses.

As a philanthropist, Michael R. Bloomberg has given more than $4.3 billion in support of education, the environment, government innovation, the arts, and public health. His philanthropic investments in public health include a $100 million commitment to eradicate polio, a $600 million initiative to reduce global tobacco use, and programs to tackle obesity, road safety, maternal health, and drowning.

Source: WHO
Image: http://www1.nyc.gov/office-of-the-mayor/archive/bio.page

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India to host international summit on tobacco-control

India will host a crucial global summit in November to eliminate the illicit trade of tobacco products in which delegates from 180 countries will take part. 

"India is hosting the 7th session of the Conference of the Parties (COP7) to the WHO Framework Convention on Tobacco Control (WHO-FCTC)," Minister of State for Health Anupriya Patel said in a written reply to a question in the Lok Sabha.

She said the summit scheduled from November 7-12 at the Indian Exposition Mart in Noida will aim "to eliminate illicit trade of tobacco products." 

About 1,000-1,500 delegates from 180 countries along with observers in official relations with the WHO FCTC are expected to participate in the summit, Patel said. 

"India has ratified FCTC in 2004 and is a party to it." 

Patel, however, said that no decision has been taken yet on the composition of the Indian delegation for the event. 

Replying to another question, she said according to the Indian Council of Medical Research - National Cancer Registry data, the estimated number of cancer cases in the country stood at 14.5 lakh in 2016. 

Based on this report, the percentage of tobacco-related cancers is 43.8 among males, 16.0 among females and 30.1 of the population as a whole, she said. 

Patel said generating awareness on harmful effects of tobacco use is the key national and state-level activity under the National Tobacco Control Programme.

Source: Business Standard

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Indian Trains Carry Tobacco Harms Messages

In India, millions of people commute to and from work via train. The Indian rail network is the fourth largest in the world, and is used most heavily by low-and middle-income Indians. 

As such, the Union Ministry of Health and Family Welfare’s (MoHFW) new outdoor campaign is set to reach a significant portion of the Indian population. MoHFW launched “Tears You Apart,” an anti-tobacco campaign that will appear on the exterior of trains on some of India’s busiest major railway routes across eight states from 27 April until September 2016. Vital Strategies has provided technical assistance to the Ministry.

The campaign is one of the most geographically extensive health promotion campaigns to utilize the world’s most heavily used railway network, which is used by over 10 million people a day. The campaign will also feature a PSA a Public Service Announcement (PSA) filmed in B. Barooah Cancer Institute in Guwahati, Assam and at the Tata Memorial Hospital in Mumbai, Maharashtra, which shows real victims suffering from horrific cancers and disfigurements as a result of their chewing addiction. It also includes the victims’ relatives, who describe how tobacco-related disease has destroyed careers and family life, and added to their financial burdens. The railway ads could reach people who had not previously seen the campaign on TV.

Although smoking rates have declined in many parts of the world, it has not gone down equally for all segments of society. Low- and middle-income individuals maintain the highest smoking rates in many countries, including India, and tobacco industry tactics continue to be directed towards this segment of the population—especially youth. This campaign is an enormous opportunity to reach those people who suffer the greatest harm from the global tobacco epidemic.

That means a chance to reduce the burden of death and disease that tobacco continues to place on the Indian people and their government. According to the Tobacco Atlas, 120 million adults and over 2.5 million children continue to use tobacco in India. Of those, nearly one million people are killed by a tobacco-related disease every year in the country.

According to Mr. C.K. Mishra, Additional Secretary, Ministry of Health and Family Welfare, Government of India, “The Government is committed to ensuring healthcare and social safety for all Indians. Warning people about the dangers of tobacco is a key part of our strategy, using mass media campaigns, Film Rule, and all other methods of Behaviour Change Communication. Tears You Apart shows that tobacco-related suffering isn’t limited to disease and disability among patients; their loved ones also share immense health, emotional and financial pains and hardships. It was important for us to highlight this reality in this campaign.”

Source: Vital Strategies

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Smoking makes your vision poorer shows research

With a surge in eye-related diseases in India, Ophthalmologist has said smoking is emerging as one of the major reasons behind vision-loss among patients. However, only 10-20 percent people are aware of it.

According to the doctors, several studies have shown that smoking increases the risk of age-related macular degeneration, cataract, glaucoma, diabetic retinopathy and dry eye syndrome.

"One way to reduce the risk of developing Age related Macular Degeneration (AMD) is by not smoking. Smokers are three to four times more likely to develop AMD than non-smokers. Non-smokers living with smokers almost double their risk of developing AMD," said Mahipal S. Sachdev, chairperson and managing director of city-based Centre for Sight.

Macular degeneration causes loss in the centre of the field of vision. In dry macular degeneration, the centre of the retina deteriorates. With wet macular degeneration, leaky blood vessels grow under the retina.

Elaborating further, he said: "AMD begins as a loss of central vision which makes it difficult to read and see fine details. Over time, vision loss increases significantly.

Sachdev said vision loss due to smoking does not have any symptoms like many other eye diseases, but a dilated exam can detect eye diseases in their early stages before vision loss occurs.

Some other types of eye-related problems caused by excessive smoking include cataract and glaucoma.

"People who smoke in excess like 10 cigarettes a day have up to three times the risk of cataract as non-smokers. Similarly, there is a strong nexus between glaucoma and smoking," said Sachdev.

Talking about prevention, Ritika Sachdev, a Delhi-based opthalmologist, said there is a need for special awareness among people about the strong link between smoking and vision loss.

"First of all, it is important for people to either quit smoking or bring down its consumption. Not just lungs and throat but the eye nerves too get damaged in the entire process," said Ritika.

The doctor added that it’s time to seek professional help if any smoker finds that straight lines appear wavy, faded or blurred vision, or trouble seeing things in the distance, or faces or words on a page or constant water dripping from eyes.

"One of the major areas that need to be emphasised for all smokers includes eating healthy. Protecting eyes starts with a healthy balanced diet. Nutrients such as omega-3 fatty acids, zinc and vitamins C and E might help ward off age-related vision problems such as macular degeneration and cataract due to smoking," she said.

Source: Indiainfoline

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Healthy, wealthy and wise: Why it’s important to invest in health

India’s policies on tobacco control perhaps best reflect the complexities that define the nation, discovered Dr Henk Bekedam when he switched on the television after arriving in Delhi as World Health Organisation Representative to India four months ago.

“I’m still amused when I see health warnings with scenes of someone smoking -- I don’t think I’ve haven’t seen it in any other country – and it shows high awareness, but despite that, India lags in two major issues of tobacco control, tobacco taxation and pictorial warnings,” says Dr Bekedam.

As an economist and medical doctor, he is more than familiar with complexity. The Dutch national has worked as a physician, obstetrician, gynaecologist, paediatrician and civil servant in Africa for seven years before doing a masters in economics at the London School of Economics. He joined the WHO in 1996, and his postings took him to China during the SARS outbreak in 2003 and to Cambodia to help government rebuild health systems destroyed by the Khmer Rouge.

Increase tobacco taxes

India’s new law that has made it mandatory for pictorial health warnings to cover 85% of the tobacco packages gets his approval, but its reluctance to substantially raise tobacco taxes offends both his economist and public health specialist sensibilities. “I’m very critical on tobacco taxation (policies in India). It’s one of the most efficient tools to stop people from smoking and a strong deterrent for deters people with some financial difficulty, mainly the young and the poor,” he says.

“It’s a win-win situation – your revenue goes up and people stop using something that may kill them, but in India, this knowledge is not being used properly,” says Dr Bekedam. “The increase in tobacco taxation has been very gradual, it’s actually less than inflation. And then there are exemptions – the tax on bidis is very, very little. So people who can’t afford cigarettes move to the cheaper product. Not raising taxes is almost like targeting the poor by making their access to something that can kill so easy. And I think it is very, very unfortunate,” he says.

“If you try to control tobacco use, there’s always this fight. The industry says you’re denying people something they like, people will lose jobs, revenue will fall etc, but it is for the government to decide whether it wants people to have easy access to something that can kill or not,” he says.

Health security drives consumption

“India has been neglecting health for quite some time and I don’t think there are very strong systems in place,” says Dr Bekedam. Investment in public health infrastructure must start now to have it in place by 2030.

Increasing public health spend using innovative solutions is a start. “The public health expenditure is a very low 1.1%, which puts India in the bottom quarter in the world in providing support to health. This has major consequences. Life expectancy is just one issue. A Harvard study found one extra year of life expectancy is equal to 4% GDP growth,” he says.

“If you do not invest in health, you put yourself at economic risk. Look at how Ebola devastated west Africa,” says Dr Bekeman. “What I like about the Modi government is its focus on economic growth, but what is not well understood is that if 60 million people are pushed into poverty because of healthcare bills, you can’t grow economically,” he says.

More certainty in health and education boosts economic growth. “In 2006, China became a big proponent of investing in the health and education sectors because they wanted to move from economic growth based on exports and infrastructure (roads and buildings) to domestic consumption,” says Dr Bekedam. “They wanted more people buying bicycles, cars and televisions and instead of saving money for health emergencies and education. Although I haven’t seen studies on saving rates in India, but I’m pretty sure Indians save a lot, and if health and education is taken care of, they will spend more,” says Dr Bekedam.

Insurance

He is unhappy that there was no real increase in health spending in the Budget. “There are many areas in public health that need Central support, such as health insurance. In China, they moved (health insurance) coverage from 20-25% of the population in 2002 to 90% in 2007!” he says.

Social health insurance has three dimensions, population coverage (number of people you want covered), the package being offer, and how much financial protection you want to give. “In China, partly for political reasons, they started increasing coverage quickly and kept the financial cover fairly low-30-40%. With the economic growth projected for India, you can play with these three factors –say, increase population coverage and then move to increasing the package and cover,” he says.

With the private sector providing 70-80% of services, there’s need to regulate and engage it to increase outreach. “India has to improve immunization and eliminate kala azar, leprosy and leishmaniasis, these are low-hanging fruits that need a final push,” says Dr Bekedam.

And the way to do it by building a stronger public health system. “You have it in some states, like Tamil Nadu, already. You need it in other states too,” he says. “Health needs to get the right attention and the government need to understand is how important is a healthy population for economic growth,” says Dr Bekedam.

Source: Hindustan Times

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Male smokers in India cross 100 million, second only to China

More men are smoking in India than ever before, with the number rising by more than a third from 79 million in 1998 to 108 million in 2015, report researchers in the journal BMJ Global Health.

Smoking rates haven’t increased for women, though, with 11 million women smoking in India in 2015, the study found.

Only China has more adult smokers — 300 million — than India, where more than one in four adults also uses smokeless and chewing tobacco.

Tobacco-control measures, such as banning smoking in public places, haven’t helped much. They led to a fall in smoking prevalence from 27% in 1998 to 24% in 2010 among men aged 15-69 years, but the modest gains were offset by rising population and incomes.

“During this period, India added about 1.7 million male smokers each year, with roughly an equal number smoking cigarettes and bidis,” said the study’s co-author Dr Prakash C Gupta, director, Healis-Sekhsaria Institute of Public Health, Mumbai.

The study found that 61 million Indian adult men smoked cigarettes (40 million exclusively) and 69 million smoked bidis (48 million exclusively).

Tobacco use, including smoking, accounts for 10% of all deaths in India. “In 2010, tobacco use caused about one million deaths in India, with about 70% of these deaths killing people in their prime, between ages 30 and 69,” said co-author Dr Prabhat Jha, professor at the Dalla Lana School of Public Health at the University of Toronto.

Smoking causes about 30% of all cancer deaths (including 90% of lung cancer deaths), 17% of heart disease deaths, and at least 80% of deaths from bronchitis and emphysema.

But cessation is uncommon in India. Last year, in the 45-59 age group, there were roughly four current smokers for every person who quit. In comparison, in the US and countries where cessation support is available, there are more quitters than current smokers.

“Raising tax on tobacco is the single most effective intervention to lower smoking rates, increase cessation and deter future smokers,” said Dr Jha.

The Tobacco Institute of India disagrees: “As a result of discriminatory taxation, the share of legal cigarettes in total tobacco consumption declined from 21% in 1981-82 to 11%, but overall tobacco consumption increased 38% during this period.”

For the BMJ Public Health study, researchers used data from three nationally representative surveys — Special Fertility and Mortality Survey (1998), Sample Registration Survey - Baseline data (2004) and Global Adult Tobacco Survey (2010) — covering about 14 million people from 2.5 million households, and made forward projections to 2015.

Source: Hindustan Times

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Quit tobacco for a healthy heart and family budget

More than half of Indians without a medical insurance experience financial catastrophe if any family member suffers a heart attack, suggest one of Asia's biggest studies on the economic burden of acute coronary syndromes.

Carried out on 1,635 patients from 41 hospitals, the study says average out of pocket expenditure for a single case of heart attack is about Rs 1,41,000 ($ 2600).

The financial burden hits almost 60 per cent of the families with no medical insurance. Even for those with medical insurance, one-fifth of the families are crushed under the medical costs associated with the treatment of acute coronary syndromes.

When a patient spent more than 30 per cent of annual household income as out-of-pocket treatment cost, it is defined as catastrophic health expenditure. 

Though insurance helps to tide over the difficulties, the latest data from the central government shows less than one-fifth of Indians – just about 22 crore – have medical insurance. Similar trends due to the absence of insurance were seen from National Family Health Survey results from 15 states.

Acute coronary syndromes are caused by sudden, reduced blood flow to the heart muscle, which are a major cause of mortality and morbidity in the Asia-Pacific region, accounting for around half of the global disease burden.

“In Indian sub-continent, 60 per cent of un-insured and 20 per cent of insured participants, reported catastrophic health expenditure,” said Jitendra P S Sawhney, chairman of the cardiology department at Sir Ganga Ram Hospital, who was the principal investigator from India.

The Indian data is part of an Asian survey which looks at the economic fallout of heart attack in eight nations, including India and China. It found Asians on an average spend Rs 175,769 ($ 3237) as out of pocket expenditure for heart attack treatment, which is one of the highest. 

The World Heart Federation has classified tobacco as a totally avoidable risk factor of cardiovascular diseases. Its use, whether by smoking or chewing, damages blood vessels, temporarily raises blood pressure and lowers exercise tolerance. Moreover, tobacco decreases the amount of oxygen that the blood can carry and increases the tendency for blood to clot. Blood clots can form in arteries causing a range of heart diseases that ultimately result in a stroke or sudden death.

Source: Deccan Herald

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ICPO becomes WHO-FCTC knowledge hub on smokeless tobacco use

The World Health Organisation (WHO) has made Noida based Institute of Cytology and Preventive Oncology (ICPO) a Knowledge Hub in India for "Smokeless Tobacco Use." This is the seventh knowledge hub of WHO-FCTC (Framework Convention on Tobacco Control) around the globe.

The six hubs are in Australia, Finland, Lebanon, Korea, South Africa and Uruguay. The Knowledge Hub in Korea is self-funded. These centres are however, working on different areas of tobacco control like trade and tobacco litigation, surveillance, policy monitoring, illicit trade in tobacco products.

The ICPO, a cancer research institute which works under Indian Council of Medical Research (ICMR), will be a specialised centre on Smokeless Tobacco use. Smokeless tobacco is used orally which results in absorption of nicotine and other chemicals across mucus membranes. This leads to severe health complications and also to mouth cancers.

Ravi Mehrotra, ICPO Director, said that the Knowledge Centre will have expertise on tobacco control. "This will be developed as a vital platform for information sharing. We will develop and implement work plan for intervention. The Knowledge Hub will also report and evaluate the existing plans of the government of use of tobacco products," he said. The WHO will fund the Hub for initial two years. The government of India will then take bear the financial cost.

WHO FCTC is a global public health treaty aiming to tackle some causes of that epidemic related to the use of tobacco products. This advocates price and tax measures as effective means to reduce the demand for tobacco. It also demands for adoption and implementation of effective measures to provide protection from exposure to tobacco products to minors.

The idea to set up a Knowledge Hub in ICPO was due to rising number of smokeless tobacco users in India. A report of National Cancer Institute, United States, entitled Smokeless Tobacco and Public Health, A Global Perspective (2014), prepared by 32 experts from around the world, revealed that at least 80% of smokeless tobacco users globally live in India and Bangladesh. 

"Smokeless tobacco is used by about 300 million people in at least 70 countries, 89% of whom live in the South-East Asia Region, all low and middle-income countries," the report states.

The Noida based WHO FCTC Knowledge Hub will work on the education, communication, training for public awareness on tobacco control issues.

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Tobacco control a development issue

Health and development experts in Kerala have applauded India’s commitment to tobacco control reflected in the first ‘South Asian Speakers’ Summit on Achieving the Sustainable Development Goals (SDG)’ that concluded in Dhaka, Bangladesh last week.

India has endorsed the ‘Dhaka Declaration on SDG Action in South Asia’ that envisions making the region tobacco free by 2030. With this, India has agreed to “develop, strengthen and enforce tobacco-control policies, legislation and regulations” in line with the Framework Convention on Tobacco Control (FCTC). FCTC is the international treaty on tobacco control of the World Health Organisation, which India ratified on 5 February 2004.

Through this Declaration, India has also agreed to work towards decreasing the affordability of all tobacco products by increasing tobacco taxes and “endeavour to set aside revenue generated from tobacco taxes to support tobacco control efforts.”

The Dhaka Declaration emerged after two days of deliberations by the Parliament Speakers of Afghanistan, Bangladesh, Bhutan, India, Maldives, and Sri Lanka on 30 and 31 January 2016.

Hon’ble Speaker of the Lok Sabha Smt Sumitra Mahajan chaired a session on “The Role of Parliaments in Implementing the SDGs”.

Shri CP John, Member, Kerala State Planning Board said, “Addressing public health issues has become a challenge in emerging economies. Tobacco use in different forms is a major threat to public health and development. Unfortunately, tobacco abuse found in marginal communities is wrongly conceived as a tradition. So the state should come forward in controlling tobacco use by strong enforcement and regular monitoring while the responsible citizenry should take the lead in educating the masses through wide public awareness programmes.”

Tobacco control has been included as a target under Goal 3 – Health and Well-being – of SDGs 2015-30.

Dr KR Thankappan, Professor and Head, Achutha Menon Centre for Health Science Studies said, “As the country is grappling with shrinking health budgets, India’s strategy to reduce the burden of non-communicable diseases through controlling tobacco use is a welcome step. Multi-sectoral efforts to reduce tobacco use which kills 1 million Indians a year are the need-of-the-hour.”

The South Asian Speakers’ Summit also announced the establishment of South Asian Speakers’ Forum that will meet at least once a year. India will host the second meeting of South Asian Speakers’ Forum in 2017.

The Bangladesh Summit was convened and organised by the Inter-Parliamentary Union and was hosted by the Bangladesh Parliament with technical support from Campaign for Tobacco-Free Kids. 

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ഒരു പുക കൂടി

ഒരു പുക കൂടി (കല്‍പ്പറ്റ നാരായണൻ )

പോലീസ് വരുന്നുണ്ടോ

എന്നിടം വലം നോക്കി

വലിക്കണോ കളയണോ എന്നായ എന്നോട്

ഒച്ച താഴ്ത്തി ബീഡി പറഞ്ഞു:

എനിക്ക് വയ്യ ഇങ്ങനെ നാണംകെട്ട് കഴിയാന്‍.

നിങ്ങള്‍ക്കറിയുമോ

ഒരിക്കല്‍ ചങ്കൂറ്റത്തിന്റെ പ്രതിരൂപമായിരുന്നു ഞാന്‍.

കൂസലില്ലാതെ ജീവിച്ചവരുടെ ചുണ്ടില്‍

ഞാന്‍ ജ്വലിച്ചു.

നട്ടപ്പാതിരകളും കാട്ടിടകളും

എനിക്ക് ഹൃദിസ്ഥം.

എന്റെ വെളിച്ചത്തില്‍

ഒറ്റത്തടിപ്പാലങ്ങള്‍ തെളിഞ്ഞു.

അന്നൊക്കെ ലക്ഷ്യങ്ങളിലേക്ക്

അഞ്ചും എട്ടും ബീഡിയുടെ ദൂരം.

ചുമരെഴുതാനും

പോസ്റ്ററൊട്ടിക്കാനും

പാട്ടെഴുതാനും ഞാന്‍ കൂടി.

മാറ്റത്തിന് ഞാന്‍ കൂട്ടിരുന്നു.

കയ്യൂരിലും പുല്‍പ്പള്ളിയിലും

കൈപൊള്ളുന്നത് വരെ ഞാനെരിഞ്ഞു.

നാടകവേദികള്‍ക്ക് വേണ്ടി

ഫിലിംസൊസൈറ്റികള്‍ക്ക് വേണ്ടി

ഞാനുറക്കൊഴിച്ചു.

ഞാന്‍ പ്രവര്‍ത്തിക്കാത്ത പ്രസ്ഥാനങ്ങളില്ല.

തണുപ്പില്‍, ഇരുട്ടില്‍

ചെയ്യുന്ന പ്രവൃത്തിയുടെ ഗുരുതരമായ ഏകാന്തതയില്‍

ഞാനായിരുന്നു തുണ.

അന്ന്

എന്നെ ആഞ്ഞു വലിച്ച് ആണ്‍കുട്ടികള്‍

ആണുങ്ങളായി.

എന്നെ കട്ടു വലിച്ച് പെണ്‍കുട്ടികള്‍

പുലരും വരെ മുലകളുയര്‍ത്തിച്ചുമച്ച്

സാഹസികജീവിതം എളുതല്ലെന്ന് മനസ്സിലാക്കി.

എല്ലാ കുമാര്‍ഗങ്ങളിലും

ഞങ്ങള്‍ സഞ്ചരിച്ചു.

അക്കാലത്തെ തീവണ്ടികള്‍ പോലെ

ഉള്ളില്‍ തീയുള്ളവരുടെ പുകയായി

മുന്നില്‍നിന്ന് ഞാന്‍ നയിച്ചു.

പുകഞ്ഞ കൊള്ളിയായിരുന്നു ഞാന്‍

ഭാഗം ചോദിച്ച് മുണ്ട് മാടിക്കുത്തി മുറ്റത്തു നിന്ന

ചെറുപ്പക്കാരന്റെ കൈയില്‍ ഞാനിരുന്ന് പുകഞ്ഞു.

കൂലി കൂടുതല്‍ ചോദിക്കാന്‍

മടിക്കുത്തിലിരുന്ന് ഞാനുശിരു കൂട്ടി.

തീണ്ടലും തൊടീലും ഞാന്‍ പുകച്ചുകളഞ്ഞു.

ഒരു പുകകൂടിയെടുത്ത്

നടന്മാര്‍ വേദിയിലേക്ക്

സദസ്യര്‍ ഹാളിലേക്ക്

തൊഴിലാളികള്‍ തൊഴിലിലേക്ക് കയറി.

തല പുകഞ്ഞെടുത്ത തീരുമാനങ്ങളിലെല്ലാം ഞാനും കൂടി

തീ തരുമോ എന്ന് പില്‍ക്കാലം മുന്‍കാലത്തിനോട് ചോദിച്ചു.

കഴുകന്മാര്‍ കരള്‍ കൊത്തി വലിക്കുമ്പോഴും

ഒരു പുകയ്ക്കു കൂടി ഇരന്നവരുണ്ട്

നിങ്ങളിന്നനുഭവിക്കുന്നതിലൊക്കെ

കത്തിത്തീര്‍ന്ന ഞങ്ങളുണ്ട്.

നേരാണ്

ഞാനൊരു ദുശ്ശീലമാണ്.

എങ്കിലും ആശ്വാസങ്ങളില്ലാത്ത മനുഷ്യന്

ദുശ്ശീലത്തോളം ഉതകുന്ന മിത്രമുണ്ടോ?

നരകത്തിലല്ലാതെ

സ്വര്‍ഗത്തില്‍ മിത്രങ്ങള്‍ വേണമോ?

ശവത്തിനു കാവല്‍ നില്ക്കുന്ന പാവം പോലീസുകാരന്

തൂക്കിക്കൊല്ലാന്‍ വിധിക്കപ്പെട്ട ഏകാകിക്ക്

പങ്കിട്ടെടുക്കാനാരുമില്ലാത്ത പാപഭാരത്തിന്

ഉറപ്പിന്

ഉറപ്പില്ലായ്മയ്ക്ക്

ഞാന്‍ കൂട്ടിരുന്നു,

ആടുന്ന പാലത്തില്‍ ഞാന്‍ കൂടെ നിന്നു.

എനിക്കറിയാം,

ഞാന്‍ നന്നല്ല

ആരോഗ്യത്തിന്

കുടുംബഭദ്രതയ്ക്ക്

ഭാവിഭദ്രതയ്ക്ക്.

സ്വന്തം ചിതയ്ക്ക് തീകൊളുത്തുകയാണ്

ബീഡിക്ക് തീ കൊളുത്തുമ്പോള്‍

പക്ഷേ,

ആയുസ്സോ സുരക്ഷിതത്വമോ

ഓര്‍മ വരാത്ത ചിലരുണ്ടായിരുന്നു ഒരിക്കല്‍

അവരെന്നെ അവര്‍ പോയിടത്തൊക്കെ കൂട്ടി

എരിഞ്ഞുതീരുന്ന എന്നെ നോക്കി

അവരുന്മേഷത്തോടെ എരിഞ്ഞു.

കണ്ടില്ലേ

ഞാന്‍ മാത്രം കൂട്ടുണ്ടായിരുന്ന അരക്ഷിതരെ

വേട്ടയാടിയ നിയമം

ഇന്നെന്നെ വേട്ടയാടുന്നത്?

കണ്ടില്ലേ,

ബീഡിക്കമ്പനികള്‍ വര്‍ണക്കുടകള്‍ നിര്‍മിക്കുന്നത്?

കേള്‍ക്കുന്നില്ലേ,

'ഈ പുകച്ചു കളയുന്നതിന് ഭാഗ്യക്കുറി വാങ്ങിക്കൂടെ?'

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