Towards making India tobacco-free

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com) 

India is the world’s second-largest tobacco-consuming country. According to the fifth National Family Health Survey (NFHS-5) for 2019–21, about 38.0 percent of men (28.8 percent in urban and 42.7 percent in rural India) and 8.9 percent of women (5.4 percent in urban and 10.5 percent in rural India) of age 15 years and older currently consume tobacco either in smoking (cigarette, bidi, hookah, etc.) or smokeless forms (gutkha, khaini, panmasala, etc.). Some Indians also use tobacco as toothpaste. Gutkha and panmasala have become increasingly popular among young people, especially schoolchildren and youths in India. The number of female smokers is also increasing.

The alarming factor is that many others (38.7 percent at home, 30.2 percent at the workplace, and 31.6 percent at public places like government buildings, health care facilities, restaurants, public transport, etc.) are exposed to passive smoking.

The problem of tobacco consumption in Assam is more complex than it is likely in any other state. Apart from being smoked in the form of cigarettes, bidis, and pipes, tobacco is also chewed along with paan and betel nut with slaked lime in Assam. According to the NFHS-5, about 51.8 percent of men (43.9 percent in urban and 53.3 percent in rural Assam) and 22.1 percent of women (16.2 percent in urban and 23.2 percent in rural Assam) of age 15 years and older consume tobacco in any form.

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 percent of adult deaths worldwide. Chewing tobacco is a determining etiological factor in cancers of the mouth, lips, tongue, and pharynx. Smoking tobacco is responsible for the majority of lung cancer and chronic obstructive pulmonary diseases. Smoking also causes cancer of the upper respiratory and gastrointestinal tracts, pancreas, urinary bladder, and kidneys, and increases the risk of peripheral vascular disease, stroke, and peptic ulceration. Moreover, news had come that smokers were more likely to develop severe diseases with COVID-19 compared to non-smokers. Most smokers die prematurely. Smokers usually die six to ten years earlier than their non-smoking counterparts. Maternal smoking is an important cause of foetal growth retardation. In addition to the health hazards of mainstream tobacco smokers, there are risks associated with exposure to passive smoking or environmental tobacco smoke (ETS). Research shows 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, infants, and young children. It is a major cause of foetal growth retardation and sudden infant death syndrome. Young children in households with cigarette smokers suffer from an increased risk of respiratory and ear infections and the exacerbation of asthma.

The burden of tobacco-related disease and death is high in India. Tobacco-induced diseases claim around 13 lakh people every year in India. Tobacco-related cancers account for half of all the cancers in males and one-fourth of all cancers in females in the country. India has one of the highest rates of tobacco-related oral cancer in the world. The Northeast and Assam also have one of the highest incidence rates of tobacco-related cancers in the country. The incidence of oral cancer in the Northeast and Assam is linked to chewing tobacco. Moreover, there is a significant economic burden in the country due to resources invested in healthcare to treat tobacco-related diseases. Besides the treatment-related expenditure, the indirect costs due to absence from work, premature death, loss of a working member in the family, etc., constitute a greater burden on the nation. Realising the health hazards of tobacco consumption, the Government of India 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 a ban on 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, panmasala, and gutkha.

Lately, many states in India have taken additional steps such as a ban on tobacco advertising, increasing taxation on tobacco products, a ban on gutkha and manufactured smokeless tobacco products, regulation of the sale of tobacco products (the Juvenile Justice Act imposes harsh penalties on the sale of tobacco products to minors, and the Legal Metrology Act bans the sale of loose bidis, cigarettes, etc.), making sure all workplaces and public places are smoke-free, placing clean and 85 percent pictorial warnings on cigarette packets, plain packaging, and generation of awareness against tobacco-related health hazards amongst the public for more effective tobacco control. Although in recent years, India has seen developments in tobacco control, improper implementation of the anti-tobacco laws, low public awareness levels, and a lack of a sustained campaign against the tobacco menace are some causes of the partial failure of tobacco control in India. The government should implement harsh anti-tobacco laws and ban tobacco advertising, promotion, and sponsorship. The tax on tobacco should be increased to make it 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, should not be restricted to government initiative alone; voluntary organisations and the media can also be very effective in this. 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 youths against tobacco consumption.

Today, we Indians, along with policymakers, should help in achieving a tobacco-free India so that we can protect the health of the citizens and that of coming generations.