Smoking killed 100 million in 100 years

Nearly 45 trillion bidis and cigarettes manufactured over the past 100 years in the country are expected to be responsible for nearly 100 million deaths of adult Indians, a recent study has found.

"Our calculations are derived from using the most conservative estimates and yet present mortality estimates which are significant and alarming," researchers Pranay G Lal, Nevin C Wilson and Prakash C Gupta said in a study published in Current Science.

The study concluded that of the estimated 100 million deaths due to tobacco use, smoking bidis alone contribute to 77 million deaths.

The researchers have pressed for an urgent review of tobacco control interventions and re-examination of policies that promote the tobacco industry in India.

They said since it takes three to four decades for a smoker to die after he starts smoking, the current tobacco use was expected cause deaths only in the coming decades.

"For consumption in the last four decades, the mortality may be partially realised and some of the deaths will occur in near future", they said.

"Since the bulk of manufacturing and consumption occurred in the latter part of the last century, the early deaths of these smokers will happen in the first half of this century."

The study has estimated that there were about 190 million and 41 million lifetime bidi and cigarette smokers, respectively, in the country from 1910-2010.

"So in effect, if we were to cease all production and consumption in 2010, deaths would continue to take place. Less than one-fourth of the deaths from 100 year of smoking (from 1910-2010) have already taken place, and the three-fourths of the deaths will take place in the next 40 years", the study said.

The reseachers have reviewed 23 data sources including industry reports, trade and academic journals, paid internet databases, repositories and reports prepared by market research firms from 1920 to arrive at the estimated number of cigarettes manufactured over the last 100 years.

To derive total bidis produced, they used total bidi tobacco produced in India using data from the Ministry of Agriculture and divided it by the average tobacco contained in each bidi. These estimates were compared with 14 other sources.

While Lal and Wilson are associated with the South-east Asia office of the International Union Against Tuberculosis and Lung Disease, Gupta is with the Healis-Sekhsaria Institute for Public Health, Navi Mumbai.

Original story published in the Indian Express

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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.”

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