At a time when a string of countries such as Ireland, Sweden, Finland, the UK, the US, Australia and Canada, and a few others have set “tobacco endgame” targets to get rid of the lethal product by a certain year, India is still sitting over the COTPA (Cigarette and Other Tobacco Products Act) Amendment Bill having stringent tobacco control provisions. It was expected to see the light of the day this Monsoon session of Parliament. But it couldn’t, as the session was adjourned sine die last week, four days ahead of schedule. Tobacco endgame goal is generally defined as a smoking prevalence of 5 per cent or less.
A battery of anti-tobacco advocates and health experts tells The Health Pioneer that the passage of the progressive legislation could be a way forward towards achieving endgame goals whenever announced by India.
They also pinned hopes on the Government’s assurance to many Parliamentarians on at least seven different occasions in Parliament for the introduction of the Bill.
Drafted by the Union Health Ministry, the long-awaited Bill has provisions such as:
- Disallowing retail sale of loose sticks of cigarettes.
- Prohibiting sale of tobacco products to persons below 21 years.
- Restricts advertising and promotion of tobacco products at Point of Sale (PoS).
- Ban on smoking designated zones at places like hotels, airports and restaurants.
Shweta Shalini
BJP Leader from Maharashtra
There is an urgent and immediate need for action to eradicate the tobacco menace, given that in India, over 13.5 lakh individuals per year face death due to the deadly product.
This is not a small number. If we want to make India, a world leader we must have healthy youth. But I feel that there’s a strong lobby working against the Government’s dream of becoming a world leader. If our youth and kids have ill health, India can never become a world Guru.
It’s good that smoking is completely banned in many public places and workplaces. The law, however, permits the establishment of smoking areas or spaces in airports, hotels having 30 or more rooms, and restaurants having a seating capacity of 30 or more. This gap needs to be plugged in.
A total ban on smoking in indoor public places will protect men and women from the harms of second-hand smoke, help smokers quit and reduce smoking among youth. Let's have healthy parents and children for a better India.
Over five and a half thousand teenagers in the country are getting addicted to tobacco products daily. It is time to strengthen the COTPA Act to end the conspiracies targeting these youth.
Dr Shalini Singh
Director, ICMR-National Institute of Cancer Prevention and Research, Union Health Ministry
There is a need to spread awareness about not only tobacco-related cancers but also a plethora of diseases caused by the harmful carcinogens in nicotine-laden products. The tobacco lobby is every next day coming up with new products to lure the youth and kids. For instance, now synthetic nicotine is being launched, which is as equally addictive as nicotine but does not fall under the purview of the COTPA Act.
Also, there is a need to design gender-sensitive cessation centres so that men or women are encouraged to quit the deadly habit while doctors should take the cudgel on behalf of their patients to save them from life-threatening products.
Dr Jagdish Kaur
Regional Adviser, Tobacco Free Initiative, WHO Regional Office for Southeast Asia
India’s tobacco control journey has been long and arduous. From the enforcement of CORPA 2003 to the implementation WHO FCTC strategies, there has been success on several fronts. India is likely to achieve the NCD Action Plan target of a 30 percent relative reduction in tobacco use prevalence by 2025. The country is preparing for the third round of the Global Adult Tobacco Survey. Having said that, Endgame is still a distant goal. Gaps in COTPA 2003 require to be addressed to improve the WHO MPOWER score. Best buys for tobacco control including raising tax on tobacco and enforcing bans on tobacco advertising, especially indirect and surrogate ads need urgent attention.
Priyank Kanoongo
Chairperson, National Commission for Protection of Child Rights (NCPCR)
There is a need to increase taxes on tobacco products as well as on films, OTT platforms, and other media that display the use of such items in any form. This will not only make these products out of bounds but the additional revenues earned can be used for the treatment and rehabilitation of those suffering from tobacco-related diseases.
The imposition of greater taxation on media that displays the use of tobacco will require people to pay more and help discourage the glorification of tobacco products. There is psychological warfare by the tobacco companies. They are targeting young children by positioning tobacco-related ads at their eye level at points of sale and promoting the sale of tobacco products such as gutkha and beedi, alongside sweets, candies, and toys.
Prof (Dr) Uma Kumar
Head of Rheumatology Department,
AIIMS, Delhi
The number of tobacco users is rising and it is scary to note that children between 13 and 15 years of age constitute 8.5 per cent of them. People generally think that smoking affects the lungs only, but the case is different, it affects every part and is one of the important risk factors for growing numbers of cases related to autoimmune diseases. First-hand smoke and second-hand smoke both are equally harmful to health. There is a rising smoking habit among women who think that it is in fashion. But they must know that it may result in infertility, cases of which is also rising these days. Also, smoking may lead to premature birth. Tobacco companies that make products like cigarettes and gutkha are specifically targeting teenagers and kids. They prominently display their advertisements near schools and colleges so that they are visible to impressionable minds. These should be completely banned. Doing away with Designated Smoking Areas (DSA) can be a game changer in the direction of the health of the vulnerable population and making India's public places 100 per cent smoke-free.
Dr. Rijo M John
Researcher, Rajagiri College of Social Sciences and Economist and Health Policy Analyst
With more than 100 million smokers in India, non-smokers are exposed to second-hand smoke at home, at work, and in public places. There is no known safe level of exposure to second-hand smoke, a deadly mix of more than 7,000 chemicals that are known to cause premature death and disease in children and adults who do not smoke.
Our recent study has shown that the annual direct economic costs attributable to Second-Hand Smoking in India amounted to Rs 567 billion. This accounts for 8 per cent of total annual health care expenditures on top of the staggering Rs 1773.4 billion ($27.5 billion) in annual economic burden from tobacco use.
Against such a scary scenario, India needs to take strong measures to reduce its large number of smokers and the economic burden of treating tobacco-related diseases. Increasing tobacco taxes is one of the most effective ways to reduce smoking, yet India has not had any significant tax increase on tobacco products for the past four years. The current tobacco tax collected in India from all tobacco products combined is less than the Rs 567 billion in health care costs caused by exposure to second-hand smoke.
Second-hand exposure continues to be high in India because of the gaps in India’s smoke-free law that still allow Designated Smoking Areas in public places like restaurants, bars, hotels, and airports.
Dr Archana Dhawan Bajaj
Gynecologist and Fertility Expert
Tobacco-induced infertility among couples is increasing at a disturbing pace in the country. Smoking and smokeless tobacco use can have a serious impact on the fertility of both men and women, and consequently the quality of life in pregnancy as well as negative health on the unborn child, miscarriage, and death. If a woman is a regular smoker, then it has a double adverse impact on a woman's fertility. Smoking can harm both the eggs and the uterus. It not only affects her egg quality but can also have an endometrial effect. Many studies too have shown that smoking can also affect sperm (which reduces fertility) and increase the risk of miscarriage and birth defects.
Smoking during pregnancy can put a would-be-mom at a higher risk of pregnancy complications, such as preterm labor and delivery. Smoking or passive smoke during pregnancy can also result in negative health outcomes for the unborn baby. From the male's perspective, the carcinogen quality of cigarettes, in general, affects the motility of the sperm and excessive smoking can lead to poor sperm count and other fertility problems.
Hence, if the couple is planning to conceive, it's better for them to shun the tobacco butt as early as possible.
Dr Vishal Rao
Oncologist and Member of Karnataka
Government’s High-powered Committee
on Tobacco Control
The majority of the long-term tobacco users commence tobacco use while they are adolescents. Every individual has the right to health and the right to smoke-free public places. Article 21 of the Indian Constitution guarantees this. So when a smoker ‘smokes’ in public places, he or she is not only spoiling his/her health but also threatening the lives of all those who are in that public place. This infringes the right of non-smokers to have a healthy lifestyle. We have to amend COTPA to make our public places 100 percent smoke-free.
Dr G K Rath
Oncologist and Former head, National Cancer Institute, AIIMS
Tobacco products are the major contributors to various cancers and other diseases. In India, tobacco-related cancers contribute nearly half of the total cancers in males and one-fifth in females. Cancers caused by tobacco can affect the lungs, mouth, pharynx (upper throat), nose and sinuses, larynx (voice box), esophagus (food pipe), liver, pancreas, stomach, kidney, ovary, bladder, cervix, and some types of leukemia.
It is very disappointing that while tobacco firms are targeting through various marketing strategies to children as young as ten years old, some Bollywood celebrities are “engaged in surrogate advertisements of health hazardous items like gutka.
Dr Alok Thakar
Professor of Otolaryngology & Head Neck Surgery, AIIMS, New Delhi
There has been rising oral cancer cases due to the unabated sale and consumption of tobacco products like a cigarette, beedi, khaini, tambaku, gutka, and zarda. Since these are yet to be regulated in the true sense and not many people are aware of their ill effects, it will increase the country’s health burden dramatically.
Dr Rahul Bhargava
Head of Hematology Department, Fortis Hospital, Gurugram, Haryana
As long as tobacco products are easily available and affordable for the poor and children, achieving the ‘Tobacco Free India’ mission will remain a dream. A lot of recent cancer cases are from rural India. Cigarettes form just one component. The bulk of tobacco addiction in rural India is due to chewable tobacco also.
Dr Rambha Pandey
Additional Professor, Radiation Oncologist, AIIMS, Delhi
Women are increasingly taking up tobacco consumption, viewing it as a ‘fashion symbol’. This is a very disturbing trend. The habit of smoking and chewing start at the age of 10-12 years among kids, and once they get into the habit, it is difficult to shun. We hope that the stringent COTPA amendments having provisions such as a ban on designated smoking zones will help in cutting down tobacco consumption among the public and thus suffering from cancer. People must be told that tobacco has no single benefit.
Dr Rakesh Garg
Additional Professor of Anaesthesiology, Critical Care, Pain and Palliative Medicine, AIIMS, Delhi
The link between tobacco consumption and cancer is very clear. There is a need to look into the financial toxicity caused by tobacco consumption resulting in cancer. A multi-pronged strategy focussing on awareness, higher taxes, and stringent laws is needed to make these killer products unaffordable and inaccessible to make India healthy.
SCARY FIGURES
After China, India has the second largest consumers (over 26 crore adults (15 years and above)) of tobacco, according to the Global Adult Tobacco Survey India, 2016-17. It leads not only to loss of lives but also has heavy social and economic costs. The total economic costs attributed to tobacco use from all diseases in India in the year 2017-18 for persons aged 35 years and above amounted to
`177,341 crore (USD 27.5 billion), as per the WHO. According to the Global Youth Tobacco Survey(GYTS)-2019, nearly one-fifth of students aged 13-15 years are using tobacco products in India. The nationwide survey of students revealed that 38% of cigarettes, 47% of bidi, and 52% of smokeless tobacco users picked up the habit before their 10th birthday [GYTS-4].
Tobacco has no benefits
The most prevalent form of tobacco use in India is smokeless tobacco and commonly used products are khaini, gutkha, betel quid with tobacco, and zarda. Smoking forms of tobacco used are bidi, cigarette, and hookah. Smoking can lead to cancer, heart disease, stroke, lung disease, diabetes, and chronic obstructive pulmonary disease including emphysema and chronic bronchitis. SLT also increases the risk of tuberculosis, certain eye conditions, and problems with the immune system including rheumatoid arthritis.
