Bridging gaps in no-tobacco campaign

The Indian Council of Medical Research (ICMR) data shows that tobacco-related cancers constitute 27% of all types of cancers in India. The ICMR says that the risk of developing cancer can be reduced by avoiding the consumption of tobacco in all its forms at any stage of life. The National Tobacco Control Programme (NTCP) is aimed at creating awareness about the harmful effects of tobacco consumption, reducing the production and supply of tobacco products, and ensuring effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003” (COTPA). With more than one and a half decades gone since the launching of the programme in 2007–08 during the 11th Five Year Plan, it is time to review the programme implementation in entirety to find out how effective it has been in reducing tobacco consumption. The NTCP is also aimed at helping people quit tobacco and facilitating the implementation of strategies for prevention and control of tobacco advocated by the WHO Framework Convention on Tobacco Control (WHO-FCTC). The WHO FCTC asserts the importance of strategies to reduce both demand and supply and provides a framework for tobacco control measures to be implemented at the national, regional, and international levels. This includes actions to protect public health policies from commercial and other vested interests of the tobacco industry, adopt price and tax measures to reduce the demand for tobacco and protect people from exposure to tobacco smoke, and regulate the contents of tobacco products, among others. The Assam government clamped down on smoking in public places but failed to enforce it. While smokers cause harm to themselves, they also expose non-smokers to the same health risks. The challenge is to take the no-tobacco message beyond the issuing of a gazetted notification. Scenes of a section of school- and college-going students smoking or consuming smokeless tobacco on the streets of cities, towns, and rural centres in the northeast region have become quite common, which is indicative of the fact that the no-tobacco campaign has either not reached them or has not been effective enough to convince them to quit tobacco consumption to protect themselves from its harmful impact. The “Tobacco Monograph,” published by the Division of Non-communicable Diseases of the ICMR, highlights that “the consumption of tobacco is a causal factor in at least 25 diseases, of which cancer, coronary artery disease, and chronic obstructive pulmonary disease are the major ones.” The ICMR Monograph points out that the cost to society due to three major diseases caused by tobacco consumption—cancer, coronary artery disease, and chronic obstructive pulmonary disease—in 1999 was Rs 27,761 crore, while the value of all tobacco products assessed in India in that year was to the tune of Rs 24,000 crore. These estimates were expected to demolish the popular perception that the tobacco industry makes an immense contribution to the country’s economy and provides industrial employment. However, the ever-increasing size of the tobacco industry, even after 15 years of implementation of the NTCP and scores of legislative measures by the central and state governments, speaks volumes about the contradictory ground realities. According to the India Brand Equity Foundation, India is the second-largest tobacco producer in the world after China and accounts for 9% of the global production with 0.45 million hectares under tobacco cultivation. Substitution of tobacco crops to achieve the objective of the WHO campaign Grow food, not tobacco, with alternative food crops to bring down tobacco production. A proposal to grow an alternative crop to substitute tobacco crops will have no takers if the alternative crop fails to provide better livelihood opportunities to growers, suppliers, and local traders, who are key stakeholders in the tobacco value chain. Reduction in demand for tobacco products, therefore, remains a vital intervention to bring down production and reduce supply in the domestic market, as well as tobacco crop substitution with alternative cash crops. Building awareness about the health hazards of tobacco consumption and passive smoking needs to be intensified to reach out to all vulnerable population groups and age groups. Innovative use of digital media and dissemination through social media can be useful, but reaching out to these groups in person through interactive awareness programmes in schools, colleges, public gatherings, at markets, and other group interactions can have a stronger impact. Awareness programmes also need to highlight how diseases caused by tobacco consumption affect individual productivity apart from increasing household health expenditure budgets and posing stumbling blocks to improving living standards. Care must be taken to ensure that such awareness programmes are two-way interactions that encourage questions and suggestions from the participants rather than one-way monologues that have no space for participants. Bridging gaps in no-tobacco campaign programmes and their implementation needs prioritisation in policymaking to achieve the objectives of reducing the disease burden on the states and the country and saving lives.