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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Increase taxes on tobacco products substantially to make them less affordable: Study

Prices of tobacco products in India have not increased substantially over a period, making them easily affordable, and even cheaper than essential food items, says a study.

The study 'Tobacco Taxes in India: An Empirical Analysis', commissioned by the ministry of health and World Health organization (WHO) India, was conducted by the Institute for Studies in Industrial Development and Public Health Foundation of India, that covers the period 2006 to 2013, and includes cigarette, bidi and smokeless tobacco (zarda /kimam/surti, paan masala and chewing tobacco) products, says a WHO statement.

The study corroborates the recent WHO Report on the Global Tobacco Epidemic 2015, which indicates cigarettes have become more affordable over 2008-14.

The study revealed that the current excise and value added tax (VAT) rates are insufficient to increase the prices of tobacco products, therefore making these products easily affordable. In recent times, the share of tax burden has also declined - for cigarettes it declined from 55.3% in 2008 to 36.8 % in 2013, while for bidis from 7.2% in 2011 to 5.3% in 2013.

The study recommends that tax on all type of tobacco products should be increased substantially, and tobacco tax regime should be broadened to include unorganized sector manufacturing under the tax net. It has also recommended that the tax exemptions on production of less than two million bidis should be eliminated and tax slabs on cigarettes based on length should be eliminated in a phased manner.

Highlighting that tobacco taxation as a fiscal policy is a win-win for both public health as well as revenue generation, Dr Henk Bekedam, WHO Representative India, said, "A comprehensive tax policy leads to reduction in tobacco use especially among young people and at the same time provides increased revenues to the government."

It has also been seen that affordability, in relation to income, of tobacco products is increasing at the national level, except for recent years. This is true even for the poorest households in the country.

According to Article 6 of the WHO Framework Convention on Tobacco Control (WHO FCTC) to which India is a signatory, prices of tobacco products must be increased periodically to make them inflation-adjusted, and there should be a uniform increase in tax rates across products.

The tax burden on tobacco products is also not in line with the WHO FCTC recommendations, which says, excise levies should account for at least 70% of retail prices of tobacco products.

"Tobacco taxation policy is the most cost effective strategy for tobacco control and has the ability to affect consumption, prevalence and affordability. Higher prices of tobacco products can promote cessation and prevent initiation among young people. This study reiterates the need for development of comprehensive tax policy for tobacco products to make them progressively less affordable over time by indexing tax increases on tobacco products to inflation. A simplified tax structure that uniformly taxes all tobacco products from the organized and unorganized sectors will have the greatest public health benefit for both consumers and the government," K Srinath Reddy, president Public Health Foundation of India, said.

Another health ministry report estimated that total economic cost attributable to tobacco use from all diseases in the year 2011 amounted to a staggering Rs 1,04,500 crore, equivalent to 1.04% of the country's gross domestic product.

Source: Times of India

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