Journal of Orofacial Sciences

GUEST EDITORIAL
Year
: 2012  |  Volume : 4  |  Issue : 2  |  Page : 79--81

Tobacco control in India: Where do we stand?


L Krishna Prasad 
 Principal, SIBAR Institute of Dental Sciences, Member, Dental Council of India

Correspondence Address:
L Krishna Prasad
Principal, SIBAR Institute of Dental Sciences, Member, Dental Council of India




How to cite this article:
Prasad L K. Tobacco control in India: Where do we stand?.J Orofac Sci 2012;4:79-81


How to cite this URL:
Prasad L K. Tobacco control in India: Where do we stand?. J Orofac Sci [serial online] 2012 [cited 2019 Oct 18 ];4:79-81
Available from: http://www.jofs.in/text.asp?2012/4/2/79/106189


Full Text

Some historians believe that the Native Americans used tobacco even before the first century B.C., for ceremonial and medicinal purposes. It was introduced to India in about the 16th century by the Portuguese traders. The use of tobacco in its various forms is now-a-days considered a global epidemic. This is because more than 50 years ago it was proved that tobacco smoking is the major causative factor for lung cancer and even other diseases.

Tobacco usage is a major preventable cause of death and disease worldwide, irrespective of whatever form it is being used. Consumption of tobacco is a major risk factor for mortality. [1] After China, India is the second largest nation in the world, with respect to tobacco production and also consumption. [2] Jha et. al., published a review showing an estimated 930 million of the world's 1.1 billion smokers to be living in developing countries. [3] In India alone, the number of smokers is around 182 million and an estimated one million Indians die annually due to the diseases caused by tobacco. [4] By 2020, tobacco consumption has been projected to account for 13% of all deaths in India. [1],[5]

Various forms of tobacco are used in India. It can be of two main types - smoking tobacco and smokeless/chewing type of tobacco products. The various smoking products are - cigarette, bidi, hookah, and other pipes like - chillum, chutta, dhumti, cherrot, and cigar. The smokeless/chewing type tobacco products currently used in India are - plain chewing tobacco, khaini, zarda, kiwam, bajjar/tapkheer (dry snuff), masheri/mishri, gul, gudhaku, tobacco toothpaste, and tobacco water. Products containing tobacco and areca nut are - paan with tobacco, gutka, mawa, and Manipuri tobacco.

Smoking is not only associated with oro-pharyngeal cancer, lung cancer, and even other cancers [6] but is also linked to dental diseases, cardiovascular diseases, tuberculosis, chronic respiratory diseases, and pregnancy outcomes. [7],[8]

Global Adult Tobacco Survey (GATS) is a global standardized survey designed to systematically monitor the adult tobacco use and tracking key tobacco control indicators. The latest GATS survey in India showed that the current tobacco use in any form was around 34.6% of adults, of which 47.9% were males and 20.3% were females. The tobacco smokers were 14.0%, out of which 24.3% were males and 2.9% were females. The smokeless tobacco users were 25.9% of adults, of which 32.9% were males and 18.4% were females. Average age at initiation of tobacco usage was 17.8 with 25.8% of females starting the habit before 15 years of age. Among minors (age 15-17), 9.6% consumed tobacco in some form.

The above mentioned statistics prove the higher prevalence of tobacco usage in Indian subcontinent. A study by Giovino GV et al., showed that tobacco consumption was disproportionately higher among low socio-economic groups. [9] These high tobacco usage statistics ring the bell of implementing various strategies to impose a ban on such a health hazard. In response to the globalization of the tobacco epidemic, the World Health Organization (WHO) led the negotiation of the Framework Convention on Tobacco Control (FCTC), the world's first public health treaty. [10] The FCTC provides a framework to "protect the present and future generations from the devastating health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke".

The FCTC supports the implementation of a broad range of evidence-based tobacco control policies that aim to reduce demand and supply with a primary focus on measures to reduce tobacco demand using both taxes as well as non-price measures. Specific binding obligations in the treaty include a comprehensive ban on advertising, promotion, and sponsorship of tobacco products, placement of warning labels covering at least 30 per cent of the front and back of all tobacco packaging, and protection of non-smokers from tobacco smoke in all public places.

In 2001, the first step to ban these products was taken, where-in, it was notified that no person shall, by himself or using any person on his behalf, manufacture for sale, store, sell or distribute chewing tobacco, pan masala, and gutka containing tobacco in any form under whatever name or description it is being sold in the State. But, the implementation of this ban to its fullest extent was thwarted by much litigation both from the manufacturers and also the vendors.

The Food Safety and Standards of India Act was implemented last year and its rules and regulations were notified, making it possible to implement such a ban within the provisions of the Act. Under Section 2.3.4 of the Regulations under the Act, "a product is not to contain any substance which may be injurious to health: Tobacco and nicotine shall not be used as ingredients in any food products".

Madhya Pradesh was the first to implement the ban since the new notification and subsequently other states including Kerala, Mizoram, and Gujarat have also banned gutka and pan masala. With the power of this law, the Tamil Nadu state also had implemented a total ban on the sale and manufacture of chewable tobacco products.

If at all any such ban has to be implemented, it will be jointly done by both the State Food Safety Wing and the State Tobacco Control Cell. Tamil Nadu heads the country in collecting fines for offences under the cigarettes and other tobacco products, under the Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution Act, 2003, with a sum of Rs. 67 lakhs.

The earliest efforts to control tobacco in India dated back to 1975 with the 'Cigarettes (Regulation of Production, Supply, and Distribution) Act', according to which, health warnings were placed on cigarettes alone and was, therefore, largely ineffective. But, with the 'Cigarettes and Other Tobacco Products Act' in the year 2003, India took a more aggressive stance on tobacco control. The bill was a result of the opinion by expert consultants who identified tobacco as a "demerit commodity" in India. [10]

According to GATS findings, only half of adults are aware that smoking causes stroke and many more people may be unaware about the connection between tobacco usage and the associated health hazards. This may be largely attributed to the illiteracy rate in many parts of India. Besides, most of the tobacco users according to various studies are from the low socio-economic group with minimal or no literacy. More effective education programs can attenuate the number of tobacco users in the coming generations.

The size and the heterogeneous picture of tobacco use across the country are the main obstacles. Implementation of laws in India is hampered due to various factors like corruption, political, and also social causes. For example, efforts to ban images of smoking in films, has since long, been challenged in the courts.

Recent strategies adopted by both the government and also the various private organizations have awaken a new dawn of hope in the fight of India against the pandemic-tobacco. The Ministry of Health and Family Welfare has taken up a major initiative to intervene with the tobacco production and usage. India is among the major producers of tobacco crop. Hence, the government has taken up the initiative to counsel farmers about the ill-effects of tobacco and the alternate crops which can help them gain equal money. The result today is that many farmers have turned towards an alternate crop production and the tobacco production has drastically come down.

Apart from this, the various mass education programs in the form of advertisements, depicting the ill-effects of tobacco usage has also helped a lot to gradually wane the habit of tobacco usage by the individuals. A total ban on the production of the various forms of tobacco, though not possible immediately due to the various litigations involved, the government and the non-governmental organizations have taken up the initiative to gradually reduce the number of tobacco users from the population. This may be a major step towards tobacco control in India.

With the increasing awareness among the masses, we may hope to see a tobacco-free India in the future.

References

1World Health Organization. Tobacco or Health: A Global Status Report. Geneva: WHO; 1997.
2Reddy KS, Gupta PC. Report on tobacco control in India. Mumbai: Ministry of Health and Family Welfare; 2004.
3Jha P, Ranson MK, Nguyen SN, Yach D. Estimates of global and regional smoking prevalence in 1995 by age and sex. Am J Public Health 2002;92:1002-6.
4Shimkhada R, Peabody JW. Tobacco control in India. Bull WHO 2003;81:48-52.
5Kumar S. India steps up anti-tobacco measures. Lancet 2000;356:1089.
6International Agency for Research on Cancer. Tobacco smoking: Monographs on the evaluation of carcinogenic risk of chemicals to humans. Lyons: IARC, 1985.
7Gajalakshmi V, Peto R, Kanaka TS, Jha P. Smoking and mortality from tuberculosis and other diseases in India: Retrospective study of 43000 adult male deaths and 35,000 controls. Lancet 2003;362:507-15.
8Critchley JA, Unal B. Health effects associated with smokeless tobacco: A systematic review. Thorax 2003;58;435-43.
9Giovino GA, Henningfield JE, Tomar SL, Escobedo LG, Slade J. Epidemiology of tobacco use and dependence. Epidemiol Rev 1995;17:48-65.
10Schwartz RL, Wipfli HL, Samet JM. World No Tobacco Day 2011: India's progress in implementing the framework convention on tobacco control. Indian J Med Res 2011;133:455-7.