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World No Tobacco Day: The fight continues

Today marked World No Tobacco Day, but it was not only traditional tobacco products such as cigarettes that were in the firing line.

Rajasthan Chief Minister Ashok Gehlot used World No Tobacco Day to issue a ban on electronic nicotine delivery systems (ENDS), more commonly known as e-cigarettes or ‘vapes’. The devices can no longer be sold, stored, produced, or advertised in the state, online or otherwise. No similar steps were taken against the sale of tobacco products such as cigarettes, however – at the same time as it was revealed that 28.6 percent of Indian adults used some form of tobacco in the 2015-16 period (a six percentage point decrease from 2009-10).

World No Tobacco Day concept.
Fourteen percent of Indian adults use smoking tobacco products such as cigarettes on a daily basis.

“The number of smokers has declined in India, particularly among young people. More broadly, 8.1 million fewer Indians smoked during the 2016-17 period compared to 2010.”

Between 1998 and 2015, the number of smokers in India increased from 79 million to 108 million. At present, fourteen percent of adults use smoking tobacco. 25.9 percent of adults use smokeless tobacco.

Tobacco use is the fourth leading cause of death in the country. One million Indians lose their lives every year to the consequences of smoking. The exchequer also pays a tobacco toll. Bidis alone cost the country’s coffers Rs 800 billion, while the total costs of tobacco is estimated at 1.04 trillion. India’s burden of lung disease ranks among the highest in the world and it also shoulders a significant burden of other conditions related to tobacco use, including hypertension, heart disease, and head and neck cancers.

There is good news, however. The number of smokers has declined in India, particularly among young people. More broadly, 8.1 million fewer Indians smoked during the 2016-17 period compared to 2010. The 2015-16 National Family Health Survey (NFHS) assessed thirteen Indian states. It found that only two of the states surveyed recorded an increase in tobacco use: Manipur and Meghalaya. The rest all registered declines.

Anti-tobacco measures have been a central part of government responses to the menace of tobacco, both at the central and state levels. The Centre has pushed for graphic pictorial health warnings on tobacco product packaging and has succeeded in frustrating legal challenges by tobacco companies to prevent implementation of these steps. As of September last year, pictorial health warnings must cover 85 percent of the principal display area on packaging of tobacco products including cigarettes, bidis, and chewing tobacco. The images are accompanied by text warnings such as ‘tobacco causes painful death’ and a government toll-free ‘quitline’ number (1800-11-2356).

A woman smokes at the Kinari Bazaar in Agra, Uttar Pradesh.

“The reinstatement of Dr Harsh Vardhan as Union Health Minister is also encouraging news…[and] could herald a renewed effort by the Centre to implement anti-tobacco policies in India and push back against the tobacco lobby. This is especially important at a time when Big Tobacco companies have been implicated in sinister pushes to illicitly advertise their products, particularly to young people.”

At more local levels, steps have been taken by state governments and municipal authorities to curb tobacco use. Delhi, for example, has taken action against secondhand smoke to mitigate the health effects of exposure. It has also banned numerous forms of tobacco such as gutkha and pan masala.

The reinstatement of Dr Harsh Vardhan as Union Health Minister is also encouraging news, as Dr Vardhan was a stringent opponent of the tobacco industry during his abbreviated previous tenure in the post. He has advocated for increased taxes on tobacco products, led tobacco awareness programmes in his native Delhi, and was an early architect of the government’s push for more prominent health warnings.

Vardhan’s reappointment to the post could herald a renewed effort by the Centre to implement anti-tobacco policies in India and push back against the tobacco lobby. This is especially important at a time when Big Tobacco companies such as Philip Morris International have been regularly implicated in sinister pushes to illicitly advertise their products, particularly to young people.

A no-smoking sign pictured in Mumbai, India. Vigilance against tobacco has been the centre of policies by central, state and municipal government agencies.

“World No Tobacco Day offers a valuable opportunity to remember the public health scourge that is tobacco use and the manifold effects it has on public health…It is important, therefore, that vigilance against tobacco use and awareness about the dangers of smoking are conducted and promoted on a sustained, year-round basis – not just on an occasion observed once a year.”

E-cigarettes, as mentioned above, are in the Centre’s firing line arguably to a greater extent than traditional tobacco products. Last year the Union Health Ministry directed state governments to ban the devices and multiple states such as Rajasthan have followed suit. This is despite legal challenges resulting in the Delhi High Court staying the ban and the Union Trade Ministry declining to move on banning the import of e-cigarettes citing “no legal basis” upon which to do so.

World No Tobacco Day offers a valuable opportunity to remember the public health scourge that is tobacco use and the manifold effects it has on public health. With noncommunicable diseases (NCDs) surging in India, taking steps to reduce risk factors such as tobacco use is of vital importance to the health of the nation at large. It is important, therefore, that vigilance against tobacco use and awareness about the dangers of smoking are conducted and promoted on a sustained, year-round basis – not just on an occasion observed once a year.

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