Dr Dharmakanta Kumbhakar
(The writer can be reached at drkdharmakanta1@gmail.com)
India is the world's second-largest tobacco consuming country. According to the Global Adult Tobacco Survey-2 (GATS-2), 2016-17, about 28.6% of adults Indian (42.4% of men and 14.2% of women) currently consume tobacco either in smoking (cigarette, bidi, hookah, etc.) and/or smokeless forms (gutkha, khaini, pan masala, etc.). A few Indians use tobacco as toothpaste also. Gutkha and Panmasala have become increasingly popular among young people, especially school children and youth in India. In India, about 19.0% of men, 2.0% of women and 10.7% of all adults smoke tobacco while about 29.6% of men, 12.8% of women and 21.4% of all adults use smokeless tobacco. The number of women smoker is increasing in India. It is alarming that many others (38.7% at home, 30.2% at the workplace and 31.6% at public places like government buildings, healthcare facilities, restaurants, public transports, etc.) are exposed to passive smoking.
The problem of tobacco consumption in Assam is more complex than probably any other State in India. Apart from smoking cigarettes, bidis and pipes, tobacco is also chewed along with paan and betel nut with slaked lime in Assam. According to GATS-2, about 48.2% of Assam's adult population (62.9% of men and 32.9% of women) is addicted to tobacco. In Assam, about 25.3% of men, 0.8% women and 13.3% of all adults currently smoke tobacco while a high population, about 50.5% men, 32.5% women and 41.7% of all adults use smokeless tobacco. Assam also has a growing number of people over 15 years of age, who are addicted to smoking and other forms of tobacco consumption.
Tobacco exposure kills millions of people and ruins the health of millions more worldwide. It is associated with more mortality and morbidity than any other personal, environmental or occupational hazard. It is a common cause of addiction, preventable illness, disability and death. Tobacco exposure is currently responsible for 10% of adult deaths worldwide. Smokeless tobacco is an important etiological factor in cancers of the mouth, lip, tongue and pharynx. Smoking tobacco is responsible for a substantial majority of lung cancer and chronic obstructive pulmonary diseases. Most smokers die either from these respiratory diseases or from ischemic heart disease. Smoking also causes cancer of the upper respiratory and gastrointestinal tracts, pancreas, urinary bladder and kidney, and increases the risk of peripheral vascular disease, stroke and peptic ulceration. Moreover, news has come out that smokers are more likely to develop severe disease with Covid-19 compared to non-smokers. Maternal smoking is an important cause of fetal growth retardation.
In addition to the health hazards of mainstream, tobacco smokes, there are risks associated with exposure to passive smoking or environmental tobacco smoke (ETS). Researches show that ETS increases the risk of lung cancer, ischemic heart disease and acute myocardial infarction. The Environmental Protection Agency classified ETS as a known human carcinogen in 1992. ETS is especially hazardous for women, infant and young children. It is an important cause of fetal growth retardation and sudden infant death syndrome. Young children in households of cigarette smokers suffer from an increased risk of respiratory and ear infections and exacerbation of asthma.
The burden of tobacco-related disease and death is high in India. In India, tobacco-induced disease claims around 13 lakh people every year. Tobacco-related cancers account for half of all cancers in males and one-fourth of all cancers in females in India. The Northeast and Assam have also one of the highest incidence rates of tobacco-related cancers in the country. India has one of the highest rates of tobacco-related oral cancer in the world. Moreover, there is a significant economic burden in India due to resources invested in healthcare to treat tobacco-related diseases. Besides the treatment-related expenditure, the indirect cost due to absence from work, premature death, loss of working family member, etc. constitute a greater burden on the nation.
Realizing the health hazards of tobacco consumption, the Indian Government has implemented many anti-tobacco laws to control tobacco consumption amongst the public. India's anti-tobacco legislation, first passed in 1975, was largely limited to health warnings and has proved to be insufficient. A new piece of national legislation, COTPA, 2003, notified on February 25, 2004, represents an advanced law including banning smoking in public places, advertising and forbidding the sale of tobacco to minors. This Act covers most tobacco products like cigarettes, cigars, bidis, cheroots, pipe tobacco, hookah tobacco, chewing tobacco, pan masala and gutkha.
Recently, many states in India have taken additional steps such as bans on tobacco advertising, increasing taxation on tobacco products, ban on gutkha and manufactured smokeless tobacco products, regulation of the sale of tobacco products (Juvenile Justice Act imposes harsh penalties on the sale of tobacco products to minor and the Legal Metrology Act bans sale of loose bidis, cigarettes etc.), making sure all workplaces and public places are smoke-free, placing clean and 85% pictorial warnings on cigarette packets, plain packaging and generation of awareness against tobacco-related health hazards amongst the public for more effective tobacco control.
Though in recent years, India has seen developments in tobacco control, improper implementation of the anti-tobacco laws, low public awareness levels as also the lack of a sustained campaign against the tobacco menace are some causes of partial failure against tobacco control in India. The Government should implement harsh anti-tobacco laws and ban tobacco advertising, promotion, sponsorship. Tobacco tax should be increased to make them less affordable. The Government must protect people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces and public transport. The fight against tobacco, however, shouldn't be restricted to Government initiative alone, as the voluntary organization and media can be very effective here. As tobacco-related health hazards are preventable by quitting tobacco consumption, the Government, NGOs and media should start vigorous campaigns focusing on the health hazards of tobacco consumption and highlighting the bountiful benefits once the habit is kicked. One needs to quit tobacco to be a winner in life. Parents, teachers and doctors should motivate children and youth against tobacco consumption. Today, we the citizens of India along with the policymakers of the country should help in the achievement of a tobacco-free India so that we can protect the health of the citizens of India along with coming generations.