Seeking a tobacco-free society
Dr. Dharmakanta Kumbhakar
India is world’s second largest tobacco consuming country. Bidi is the most popular tobacco product used in India. Gutkha and Panmasala have become increasingly popular among the young people, especially school children and youth. Almost a third of Indians (57% of all men and 11% of all women) consume some form of tobacco (smoky and smokeless tobacco) and many use more than one type of tobacco product. About 34% Indian population consume tobacco products. Data reported by Cancer Patients Aid Association of India in 2004, reveals that the prevalence to due to cigarettes (20%), bidis (40%); the remaining 40% is consumed as chewing tobacco, panmasala, snuff, gutkha and tobacco toothpaste. There are around 110 million smokers in India. About 35% in men and 3% in women smoke in India. The number of women smokers is increasing in India. Bidis account for nearly 85% of total smoked tobacco in India. Bidis comprise 48 percent of the tobacco market, chewing tobacco 38 percent and cigarettes 14 percent. It is alarming that about many of Indian (52.3% at home, 29.9% at work places and 29% at public places) are exposed to passive smoking.
The problem of tobacco consumption in the North-East is more complex than probably any other State in India. Apart from smoking cigarettes, bidis and pipes; tobacco is also chewed along with paan or betel nut with slaked lime. About 39.3% of Assam adult population is addicted to tobacco. In Assam, according to the data available, it is found that about 34.9% of the male population smoke tobacco while a high rate of 48.2% chew tobacco. Assam also has a growing number of people over 15 years of age, who are addicted to smoking and other forms of tobacco consumption.
The use of tobacco kills millions of people and ruins the health of millions more. Consumption of tobacco products is associated with more mortality and morbidity than any other persol, environmental, or occupatiol exposure. It is a common cause of addiction, preventable illness, disability and death. The global tobacco epidemic kills nearly six million people each year, of which more than 600,000 are non-smokers dying from breathing second-hand smoke. Unless we act, the epidemic will kill more than eight million people every year by 2030. Tobacco use is the single most preventable cause of death globally and is currently responsible for 10% of adult deaths worldwide. Smokeless tobacco is an important etiological factor in cancers of the mouth, lip, tongue and pharynx. Smoking tobacco is responsible for a substantial majority of lung cancer and chronic obstructive pulmory diseases, and most smokers die either from these respiratory diseases or from ischemic heart disease. Smoking also causes cancer of upper respiratory and gastrointestil tracts, pancreas, uriry bladder and kidney, and increases risk of peripheral vascular disease, stroke and peptic ulceration. Materl smoking is an important cause of fetal growth retardation. High smoking rates contribute to a significant number of early deaths and high healthcare costs. World-wide there are one billion smokers, and three million die prematurely each year as a result of their habit.
In India, tobacco-induced disease claims around nine lakh people every year. Tobacco related cancers account for half of all the cancers in males and one-fourth of all cancers in females in India. At Tata Memorial Hospital, Mumbai, 43.1% in males and 14.1% in females are tobacco-related cancers. India has one of the highest rates of oral cancer in the world. Annual incidence of oral cancer is said to be 10 per 100,000 of males. As tobacco consumption is growing at a rate of 2-3% per annum in India, it is predicted that it will account for 13% of all deaths in India by 2030. Each year, smoking kills many Indians prematurely. Bidi and cigarette smokers die six to ten years earlier than their non-smoking counterparts. Health costs for tobacco-related illnesses are high.
Assam has one of the highest incidence rates of tobacco related cancers in the country. The incidence of oral cancer in north east and Assam is linked to chewing tobacco. As per Cancer registry report, the incidence of tobacco-related cancers out of total cancers in male and female in selected places of Assam are - Kamrup Metro district (49.7% and 24.1%), Dibrugarh district (51.6% and 22.8%), Cachar district (46.2% and 20.6%), BBCI (56% and 25.5%).
Realizing the importance of tobacco mece, its health hazards and seeking a tobacco-free society; the Indian Government has implemented many anti-tobacco laws to control tobacco consumption amongst public. India’s anti-tobacco legislation, first passed in 1975, was largely limited to health warnings and has proved to be insufficient. Delhi was the first to impose a ban on smoking in public, passing “Delhi Prohibition of Smoking and Non- Smokers Health Protection Act” in 1996. This act prohibited sale of cigarettes 100 meters from the school building and to minors. In 1999, Kerala High Court came out with a judgment prohibiting smoking in public places, including parks and highways and Goa banned smoking in public places through anti-tobacco laws. A new piece of tiol legislation COTPA, 2003; notified on February 25, 2004- represents an advanced law including banning of smoking in public places, advertising and forbidding sale of tobacco to minors. This Act covers most tobacco products like cigarettes, cigars, bidis, cheroots, pipe tobacco, hookah tobacco, chewing tobacco, panmasala and gutkha. Enforcement and compliance levels vary by state and city. Recently, many states in India have taken additiol steps such as bans on tobacco advertising, increasing taxation on tobacco products, ban on gutkha and manufactured smokeless tobacco products, regulation of the sale of tobacco products (Juvenile Justice Act- imposes harsh pelties on the sale of tobacco products to minor and Legal Metrology Act- bans sale of loose bidis, cigarettes etc.), making sure all workplaces and public places are smoke free, placing clean and 85% pictorial warnings on cigarette packets and generation of awareness against tobacco related health hazards amongst public for more effective tobacco control.
Though in recent years, India have been momentous developments in tobacco control; but, improper implementation of Anti-tobacco Act, low public awareness levels as also the lack of a sustained campaign against the tobacco mece are some causes of partial failure against tobacco control. The Government should implement harsh Anti-tobacco law and start more campaigns focusing on the health hazards of tobacco consumption and highlighting the bountiful benefits once the habit is kicked. They can take help of NGOs and medias. The fight against tobacco, however shouldn’t be restricted to Government initiative alone, as voluntary organization can be very effective here. We need a concerted campaign that can strike at the social and cultural influence that entices young people into becoming tobacco-chewers and smokers. Clearly, preventing the use of tobacco in various forms is the major concerns of society. NGOS, parents and teachers should motivate children and youth against tobacco consumption. Today, we the members of society along with policy makers should help in achievement of a tobacco-free society so that we can protect the health of the coming generations.
This year on “World No Tobacco Day” today, WHO and the secretariat of the WHO Framework Convention on Tobacco Control call all countries to celebrate the event with the theme “Get ready for plain packaging’. Plain packaging of tobacco products restricts use of tobacco packaging as a form of tobacco advertising and promotion. It limits use of attractive misleading packaging and labeling. No logos, colour, brand image or promotiol information on tobacco products packet can be used. Pack surfaces should be in a standard colour. It permits the manufacturers to print only the brand me in a mandated size, colour and font, and legally mandated information. Pictorial health warning must be on the packet covering 85% of surface area, so that consumers are informed about ill effects of tobacco. This will reduce the number of tobacco users reducing attractiveness of tobacco products and increasing effectiveness of health warnings. (firstname.lastname@example.org)