Kerala, the first Indian state to become tobacco advertisement free

Kerala has become India’s first state to be free of tobacco advertisements after the southern state completely did away with giving publicity to the nicotine-laden material at its points-of-sale.

Tobacco advertisements from 95.3 per cent of points-of-sale across 14 districts were successfully removed in an 18-month-long campaign spearheaded by the Public Health wing of the Kerala Health Services Department. The state police joined forces in this mega effort.

Tobacco control champion and Kerala Home Minister Shri Ramesh Chennithala declared Kerala as tobacco advertisement-free at function held in the presence of State Health Minister Shri VS Sivakumar in the Kerala capital of Thiruvananthapuram on November 14.

Dr AS Pradeep Kumar, Additional Director of Health Services (Public Health) who coordinated this massive effort, said a three-phase activity plan was developed with District Medical Officers at the core. “Sensitisation programmes were conducted with emphasis on Section 5 of COTPA for district officers at the state capital,” he added. “District officers in turn trained and authorised personnel attached to the Primary Health Centre.”

Section 5 of Indian tobacco control law called COTPA, 2003 bans all forms of advertisement, direct or indirect, of tobacco products.

The districts were given the freedom to customise according to their local needs. “This, in turn, raised the level of commitments and ownership taking,” pointed out the medical doctor who has a PhD in tobacco control. “At the state level, we supported the districts by framing guidelines, monitoring and advising course corrections,” said Dr Kumar who is among the few in India to have completed the Global Tobacco Control Leadership Program of the Johns Hopkins Bloomberg School of Public Health, USA.  

The process that started during World No Tobacco Day 2013 saw both integrated and intensive drives that effectively pooled the services of health personnel from district to primary health centre level. In drives integrated with regular activities during the first phase from June to December 2013, over 23,500 notices were issued to shops that violated the provisions of Section 5. 

Intensive weeklong drives in January and May 2014 marked the second leg of the campaign. As many as 32,566 shops and 62,365 eateries were inspected during the period 10 to 17 January 2014. While the January round revealed violations in 48.8 per cent of sites, field assessments conducted by personnel of Primary Health Centres in May showed that 90 per cent of points-of-sale were free of tobacco boards. 

In October 2014, teams led by District Medical Officers at the district level and Programme Officers at the Panchayat and Primary Health Centre level certified that tobacco advertisement boards were surfaced out. 

As many as 22,344 points-of-sale in 84 wards across Kerala were observed during 28 October to 7 November. Dr Pradeep Kumar says, “A civil society group with nearly four-decade-long experience in research and field implementation in Kerala conducted the evaluation study.”

The evaluation reported an overall compliance of 95.3 per cent – 98.5 per cent of points-of-sale are free of any advertisement hoardings and 96.7 per cent of points-of-sale are free from stickers and print advertisements. International standards prescribe that 90 per cent of sites have to be free of advertisements to become eligible for the tag of tobacco advertisement free. 

Noted head and neck cancer surgeon Dr Pankaj Chaturvedi of Mumbai’s Tata Memorial Centre and an internationally acclaimed tobacco control proponent said, “Tobacco is the only consumer product in the world that has not a single beneficial use apart from causing death and disability. Industry spends billions in advertising this killer product to lure youngsters. Ban on advertising will save innocent youths from initiating this habit. I congratulate the Kerala Government.”

The Global Adult Tobacco Survey (2009-10) said 44.2 per cent of adults above 15 years in Kerala had noticed advertisements or promotions on cigarettes and 70.9 percent and 72.3 per cent had noticed advertisements on bidis and smokeless tobacco respectively. 

Bangalore-based senior head and neck cancer surgeon and tobacco control advocate Dr Vishal Rao said, “This is a significant step that Kerala has achieved in its efforts to improve public health of Keralites, especially the youth of Kerala. Youth between the age of 10 and 18 fall prey to the advertisement of tobacco and lured into addiction. Today we are seeing cancers in age group of 20s and 30s, which we earlier saw in the 70s. A healthy society should have less illness, less hospitals and less doctors and this can only be achieved through preventive health.” 

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Oral cancer not the only risk for those who chew tobacco

Contrary to the prevailing notion that chewing tobacco only increases the risk of oral cancer, a study that looked at different researches conducted in India has shown that smokeless tobacco can also cause oesophageal, throat and even stomach cancer.

The findings are critical. While one-third of the country’s population takes tobacco, 21% of them consume smokeless tobacco, such as gutkha and khaini, according to the Global Adult Tobacco Survey released in 2010.

“While reviewing various studies, we found the incidence of oesophagal [foodpipe] cancer was higher in the north-east, while in the south we found pancreatic cancer was prevalent in those who consumed smokeless tobacco,” said Dr Pankaj Chaturvedi, head and neck cancer surgeon at Tata Memorial Centre and co-author of the review study.

He added that researches in Madhya Pradesh have showed that throat cancer is common among smokeless tobacco users.

The study, titled A Review of Indian Literature for the Association of Smokeless Tobacco with Malignant and Pre-malignant Diseases of Head and Neck Region, was published last week in the Indian Journal of Cancer.

Researchers said the review exposed the risk of developing throat, stomach, oesophageal, pancreatic, cervical cancer as a result of chewing tobacco.

“It depends how and where you are consuming tobacco. There is a difference in the incidence of tobacco-related cancer between India and the western world. Those who place the tobacco mixture under the lip are more prone to cancer in that region. Those who also consume areca nuts are increasing their risk of two cancers, as areca nut itself is carcinogenic,” said Dr Chaturvedi.

Researchers said apart from the way tobacco is consumed, the ethnicity of the consumer is also a factor in determining the type of cancer he or she is prone to develop.

Unlike in western countries, smokeless tobacco use is far more common than smoking in India. “Unfortunately, there is nobody regulating the use of smokeless tobacco. It is easy to grow tobacco crop anywhere. It is sold loose and also not taxed. A person who stops consuming smokeless tobacco is at the risk of developing cancer for at least a decade after giving up the habit. This itself shows the impact of the habit,” said Dr Chaturvedi.

Source: Hindustan Times

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Ban on loose cigarettes: An open letter from a cancer survivor to PM Narendra Modi

After the announcement of amendments of COTPA (such as ban on  sale of loose cigarettes), a cancer survivor has sent an open letter addressed to PM that he as addressed to PM Narendra Modi. He expresses his views about the ban on loose cigarettes and urges Modiji to reconsider its implementing the amendments it with full vigour.

Respected Modi Ji,

It was with great sense of pride and satisfaction that I learnt from the Newspapers reports that Government of India has decided to ban sale of loose cigarettes as it constitutes over seventy percent of its sale. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn, it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

However, the joy was short lived as today it has been announced that the amendments of COTPA (such as ban on  sale of loose cigarettes) is going to be deferred. Although I did not believe in the paper published by the Congress party with caption U-Turn , it immediately occurred to me that the decision not to implement ban on sale of loose cigarettes is likely to be dubbed as another U-Turn. 

Sir, I am a tobacco victim and cancer survivor. After having smoked cigarettes made attractive by constant  advertising with inciting slogans like, ‘Made for Each Other’ by ITC , I was detected with Throat Cancer in 2008. It resulted in removal of my voice box and now I speak with the help of a prosthesis (machine). Eating and Speaking has become a challenge. As ill lack would have it, I suffered yet another Cancer of the Tongue in 2013 resulting in partial removal of my tongue. It can be thus well imagined that my life has become virtual hell. Please see the attached picture that was taken recently during my discharge from hospital. 

I never wanted any other person to have the same fate which was the reason for my joy on learning that sale of loose cigarettes is going to be banned and loop holes in COTPA are going to be plugged by amendment.

Mr. Prime Minister, the case before Consumer Court filed by me for compensation from ITC could not succeed  as one of the grounds taken in defense was that I could not produce bills for cigarettes purchased by me. 

Can you imagine any person being issued with bills for sale of loose cigarettes by the vendors. Therefore, if at all loose cigarettes are to be sold then issuance of sale bills must be made mandatory for loose as well as packets of cigarettes. The activities of cigarettes manufacturing companies must be curbed as they are nothing but merchants of death. One cannot protect these companies and tobacco growers, vendors etc on the plea that the Revenue of the Government as also employment opportunities of persons shall be affected.

For generation of jobs and revenue at the cost of millions of lives lost due to cigarette smoking and  expenditure on health care cannot be justified on this score. You had tweeted on 31st May (World no tobacco day) for a healthier and Tobacco Free India. You had pledged to reduce tobacco consumption in India. Unfortunately your senior Cabinet Ministers do not support your ideologies and continue to patronage tobacco lobby.

It is, therefore, prayed that the Honourable Prime Minister may kindly reconsider its rethinking on proposed  curbs on sale and consumption of tobacco and implement it with full vigour. Sir, you have evoked high hopes in people of India. It is our cherished desire that the Government shall take decisive steps to make India tobacco free. It would not only save lives but also save enough money spent in health care and loss of economic activity to compensate for the loss of Government Revenue. Surely the Government does not want to earn Revenue by allowing its citizens to be killed by Companies like ITC whose share prices have surged by 6% after the announcement to defer ban on loose cigarettes.

The main beneficiaries of tobacco business aren’t farmers/vendors but few powerful families who run this trade only to make vulgar profits. How can you ignore that these business families are killing one million Indians every year and making the nation lose nearly one lac crore every year on health care expenditure? At the end, it is urged that all the proposed amendments in COPTA and its implementation may kindly be done immediately.

Yours Sincerely,
Deepak Kumar
Commissioner of Customs,Central Excise & Service Tax (Retd)

Courtesy: Healthsite

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