Navneet Anand
Perhaps not many may be aware that over a year ago, Nagaland’s capital Kohima had declared itself to be a smoke-free city, becoming the fourth Indian city to do so after Chandigarh, Kottayam and Shimla. In March, this year, Shanghai became the third city in China, after Beijing and Shenzhen, to announce a 100 per cent smoke-free policy in public places and work spaces. For countries as big as India and China, the numbers of four and three may appear tiny as droplets and small step forward in tobacco control, yet one can take solace that some concrete action is underway. But is that enough? On World Tobacco Day we may raise some pertinent questions and try to find some answers.
Tobacco has been a bane for societies across the world. It brutally kills, and many – an estimated seven million per year, and the figure could go up to eight million by 2030. It has severe social, economic and productivity implications. In addition to death, tobacco causes suffering, agony, familial strains, degeneration of land and ecology due to enhanced usage of pesticides and fertilisers required in its cultivation – it is the sole reason for two million tonnes of waste and global deforestation of two to four per cent. Youths are falling victim to tobacco and it poses huge challenge on the future of Indian economy.
The World Health Organisation (WHO) notes, “Tobacco use costs national economies enormously through increased health-care costs and decreased productivity. It worsens health inequalities and exacerbates poverty, as the poorest people spend less on essentials such as, food, education and health care. Some 80 per cent of premature deaths from tobacco occur in low or middle-income countries, which face increased challenges to achieving their development goals.”
The enormity of the problem in India needs no reiteration. According to the Indian Council of Medical Research data, of the new 14.5 lakh cases of cancer every year, an estimated 30 per cent or about five lakh cases are triggered by tobacco, and this could grow to about six lakh by 2030. Have we done enough to contain this? Have we created a holistic framework to address this growing menace or our approach has been piecemeal? While the answers to these questions may not be easy – it is certainly easy to identify actors and factors which have ensured defeat of tobacco control programs.
The tobacco industry is one – while the sturdy cigarette industry may has put all its might, the smaller gutkha lobby is not meek either. They seem to have overcome ideas on stiff penalties and bans. Travel across Delhi, and any small or big town in the country and the long strings of pouches that dot its kirana and roadside pan shops tell you a grim story. The menace of chewing tobacco is spreading like wildfire, and it is especially distressing to see children and women too, consuming tobacco with an inexplicable penchant, especially in rural areas. While we have seen many interventions by Government as well as courts, the situation on ground doesn’t seem to have changed much. Certainly, a more concerted, and broader push, is needed including addressing the psychological and behavioural aspects.
Kapil Kumar of New Delhi’s BLK Super Speciality Hospital, in a recent study, concluded how with the right set of social and behavioural stimuli, up to six out of 10 people can quit smoking and chewing tobacco. Often, both the addicted and people in his social circumference give up on the idea of giving up the dependency on tobacco which aggravates and perpetuates the habit. Behavioural modifications through family-led interventions, mass social media campaigns, strong disapprovals by peers and colleagues are some suggested measures. This may also fall in the ‘Mpower’ framework of WHO’s ‘Tobacco Free Initiative’. M – Monitor tobacco use and prevention policies; P – Protect people from tobacco smoke; O – Offer help to quit tobacco use; W – Warn about the dangers of tobacco; E – Enforce bans on tobacco advertising, promotion and sponsorship; R – Raise taxes on
tobacco.
On the policy level, many countries are creating firewalls to ward off interference from the tobacco industry in Government tobacco control policy and India should be no different. Through increasing cigarette taxes worldwide by one dollar, an extra $190 billion could be raised for development. State Governments must also implement a ban on the sale of gutkha through stiff
punitive and legal measures.
