India slashes tobacco consumption in a major public health win

India recently reported a sharp decrease in tobacco consumption, a major public health victory. According to the Global Adult Tobacco Survey (GATS) India 2016-17, 81 lakh fewer Indians now use tobacco compared to 2009-10. This represents a 17 percent relative reduction in tobacco consumption across all age groups and a 60 percent relative dip in tobacco use among minors (aged 15-17). The age of initiation for both smokeless and smoking tobacco in the country has also increased by a year. The decrease is important because tobacco is the leading contributor to heart disease, cancers, chronic respiratory diseases and diabetes, which are responsible for 43 percent of all deaths in India. India’s tobacco control policies, which have focused on prevention and decreasing initiation, appear to be working.

Major tobacco control measures

Over the past several years, India has taken a series of measures to control the tobacco-related epidemic. In 2011, gutka, a form of chewable tobacco that is one the biggest cause of oral cancers, was banned by the Government of India and subsequently by various states. The ban was ambitious and faced a severe backlash from the influential gutka industry in the country.

The results are impressive. Smokeless tobacco use has dropped from 25.9 percent in 2010 to 21.4 percent in 2017. The impact on oral cancer, a leading cause of cancer in India is expected to be profound but it is too early to tell.

India’s second big win came in the face of combined resistance from the smoking and smokeless tobacco industry: increasing the size of pictorial health warnings on tobacco products. In the face of industry pressure for less graphic warnings, India signed on for warnings that cover 85 per cent of packaging on all tobacco products in 2015. These efforts appear to be working. According the latest evidence, more than 60 percent of cigarette smokers, 53 percent of bidi smokers, and 46 percent of smokeless tobacco users attribute their desire to quit tobacco to pictorial warnings.

The third important measure was the increased taxation (in the form of value added tax or VAT) on tobacco products across states over the last six years. Almost two-thirds of tobacco users in India smoke bidis, which was taxed at a rate between 12 per cent to 65 percent depending on the state. The central government has proposed to tax all tobacco products at the highest bracket of 28 percent under the new Goods and Services Tax (GST).

Road ahead

Tobacco-related diseases cost the country more than one lakh crores a year (2011 estimates) and more needs to be done to improve on India’s performance over the last decade. The implementation of the Cigarettes and Other Tobacco Products Act (COTPA), which restricts the sale of tobacco to minors, point-of-sale advertising, surrogate advertising should be strengthened. 

India should also curb the other variants of smokeless tobacco such as khaini and paan masala, which have been banned in some states. Implementation of the ban on smoking in public places must also be enforced, as evidence shows minimal change in second hand smoke exposure at workplaces.

Cessation services should be made more widely available. Despite the National Tobacco Control Program being enumerated in the last two five-year plans, little progress has been made. Latest evidence shows that thanks to various awareness measures taken by the government, about half of all smokers and smokeless tobacco users now have the desire to quit tobacco use (an increase of approx. 9 percent and 4 percent, respectively, since 2010). This demand needs to be met with counselling and pharmacotherapy services. Without effective and operational cessation services made available down to the sub-district level, the gains cannot be sustained. Funding, capacity building and integrated health services are the need of the hour.

The question of alternative livelihoods for tobacco farmers and bidi rollers in the country also needs to be addressed. The Indian Tobacco Board had for many years, rolled out subsidies and incentives that encourage tobacco cultivation in the country, conflicting with India’s obligations under the WHO Framework Convention for Tobacco Control (FCTC). Despite growing evidence of the demand for viable alternatives, efforts in the direction have been countered by the tobacco industry, with a pretext of saving livelihoods. Efforts are now being made to phase out the current subsidies and support farmers for growing alternative crops.

The COTPA should also be made more progressive, for example, to increase the legal smoking age to 21 years from 18 years, as has been done for alcohol consumption in many states.

Tobacco control involves multi-sectoral commitment and action and is therefore a challenge for developing countries to implement. There are few investments that India could make that match the returns on tobacco control. Millions of lives are at stake.

Source: ETHealthworld

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Govt pulls up airport tobacco stores

Noting a violation of anti-smoking laws at airports, the Ministry of Health and Family Welfare has written to the Ministry of Civil Aviation, Airport Authority of India (AAI) and major airports in the country to ensure adherence to the rules.

The Ministry has written to the Chairman of AAI and CEO of Chhatrapati Shivaji International Airport, Mumbai, Indira Gandhi International Airport, New Delhi and Rajiv Gandhi International Airport, Hyderabad that they should take appropriate steps to discourage smoking as it impacts human health as well as economy of the country.

“It has been observed that under the provisions of the Cigarettes and other Tobacco Products (Prohibition of Advertisement (COTPA, 2003) and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, the enabling rules are being violated at the airports, by shops selling cigarettes and other tobacco products. These shops, in contravention of the provisions of COTPA, display tobacco advertisements and are located just outside the smoking room or in food courts, thus facilitating tobacco use and also enticing non-smokers, especially children to these shops and to the smoking room,” stated Arun Kumar Jha, Economic Adviser, Union Health Ministry in his letter dated 26 May, 2017.

“In certain airports, tobacco products are also sold from shops selling souvenirs, food articles, books, and comics, etc. These shops also do not display the following signage: ‘Sale of tobacco products to a person below the age of eighteen years is a punishable offence’,” the letter said.

Recently, the Union Health Ministry issued a notification banning the use of hookah service in any smoking area or space provided for smoking and also directed that the owner, proprietor, manager, supervisor or in charge of the affairs of the hotel restaurant or airport, must display a board at the entrance of the smoking area or spaces of minimum size of 60x30 cm with a white background and having the message in English and one Indian language as applicable in black colour: “Tobacco smoking is harmful to your health and the health of non-smokers” and “Entry of person below the age of eighteen years is prohibited”

Tobacco related diseases kill about 2,500 Indians daily and over 10 lakh every year. It is estimated that about 5,500 youth and children (as young as 8 years old), start tobacco use daily.

Law violation

Airport shops in contravention legal provisions display tobacco advertisements and are located just outside the smoking room or in food courts

The practice is facilitating tobacco use and also enticing non-smokers ‘especially children’ to these shops and to the smoking room.

Source: DNA

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Tobacco is a deadly threat to global development

Dr Margaret Chan, Director-General of WHO

Commentary 

30 May 2017

When I reflect on my tenure as Director-General of the World Health Organization, there are many areas where the agency played its unique role as the guardian of health for all people.

But I am especially proud of our work to fight tobacco use, something that I have personally championed since 2007.

Tobacco is a deadly product that kills more than 7 million people every year, and costs the global economy more than US$ 1.4 trillion annually in healthcare expenditure and lost productivity.

Tobacco control will play a major part in meeting the Sustainable Development Goal target of reducing premature deaths from noncommunicable diseases by one-third by 2030.

But tobacco control is about more than preventing deadly cancers, heart diseases and respiratory diseases. In addition to posing a serious threat to health, tobacco use also threatens development in every country on every level and across many sectors — economic growth, health, education, poverty and the environment — with women and children bearing the brunt of the consequences.

The theme for this year’s World No Tobacco Day, on 31 May, is "Tobacco – a threat to development". This year, WHO will launch a new report that highlights the great harm to the environment inflicted by tobacco growing, manufacturing, trade and consumption. For example, growing and producing tobacco uses 4.3 million hectares of land resulting in deforestation of 2-4%, and the pesticides and fertilizers used in tobacco growing can be toxic and pollute water supplies. Tobacco manufacturing produces over 2 million tonnes of solid waste each year. Up to 10 billion cigarettes are disposed in the environment every day. Cigarette butts account for 30-40% of all litter collected in coastal and urban clean-ups.

Tobacco farming also stops children from attending school and exposes them to hazardous chemicals. Children in tobacco-growing families often miss class because they are needed to work in the tobacco fields. Women are also disproportionately at risk of chemical exposure, as they make up 60-70% of the tobacco farming workforce.

Tobacco use hits the poorest people the hardest and exacerbates poverty. Spending on tobacco products often represents more than 10% of total household income – meaning less money for food, education and health care. Some 80% of the premature deaths attributable to tobacco use occur in low- or middle-income countries. These countries bear almost 40% of the global US$ 1.4 trillion cost of smoking from health expenditures and lost productivity.

Fortunately, we have powerful tools to fight the tobacco epidemic. The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, provides governments with clear, legally binding measures that they can introduce to reduce the harm caused by tobacco use. These include banning advertising, promotion and sponsorship of tobacco, effectively warning about the harmful effects of tobacco use, implementing tax or price policies and protecting people from exposure to second-hand tobacco smoke.

In line with WHO’s FCTC, WHO’s MPOWER measures support countries to reduce demand for tobacco, using methods that are practical, low-cost and high-impact. Tobacco taxation is a powerful tool for saving lives. Taxes reduce smoking rates and help government raise revenues to improve health and promote development. Increasing tobacco taxes and prices is one of the most effective, yet least utilized control measures globally. By increasing cigarette taxes worldwide by US$1, an extra US$ 190 billion could be raised for development.

We need to make sure that countries know that this tool exists and how to use it. Ministers of health are convinced by the evidence, and I ask them to be vocal in persuading ministers of finance, trade, foreign affairs and others not to be swayed by the unsubstantiated arguments of the tobacco industry.

Many countries have already shown tremendous progress in reducing tobacco use. Our challenge now is to help more countries follow suit, and to fight the efforts of the tobacco companies to hinder or counter progress that has been made by countries implementing strong measures.

Everyone can help play a role in stamping out tobacco and promoting development at the same time. People can commit to never take up tobacco products or to seek help to quit the habit. Governments can strengthen implementation of the WHO FCTC.

The tobacco industry is a vector of one of the greatest threats our society faces. It takes courage to antagonize powerful economic operators. If we fail to accept this responsibility, we will never make sufficient progress in health and development.

WHO stands ready to help governments introduce innovative approaches to tackle tobacco use. We have taken off our gloves and entered the ring on the side of the countries working to advance tobacco control, and we are going to fight tobacco tooth and nail.

If we rise to the challenge of beating tobacco by adopting measures that reduce demand for this deadly product, we can promote a healthier, more sustainable world.

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