Dr Pankaj Chaturvedi
It is estimated that from 2010-2020, there will be about 1 million tobacco consumption related deaths a year in India and about 70% of these deaths will be before old age. Currently, tobacco is responsible for 1 in 5 of all male deaths in middle age. Men who are cigarette smokers lose ten years of their lives, mainly as a result of tuberculosis, respiratory and heart diseases, and cancer. Unlike alcohol, there is no safe level of smoking, and consumption of a few cigarettes / bidis per day increases the risks of dying prematurely by up to 50%. Nearly 50% of school children use tobacco products in northeast India. Another study reported that every day, 55,000 new children take up tobacco habits in India, whereas a mere 2% of Indian adults quit the habit; often only after falling ill.
The ill effects of tobacco
The International Agency for Research on Cancer of the World Health Organization has categorized tobacco as a category I carcinogen (confirmed human carcinogen). Tobacco smoke has 10 additional category I carcinogens (4-aminobehenyl, benzene, chromium, nickel, cadmium, etc.) and several dozen category II and III carcinogens. Is that not sufficient to ban tobacco?
The tobacco industry has consciously downplayed the ill effects of tobacco. On the contrary, it spends several billion dollars in portraying smoking as “cool”! In a country with glaring illiteracy and 26 official languages, warnings written in English makes no sense to the users unless prominently advertised in their native language.
Warning on packs of cigarettes is important
Opponents of pack warning argue that there is no need for a warning when the risk is obvious. They quote that the tobacco continues to be a consumer product despite 3 decades of health warnings on cigarette packets. Proponents claim that current warning (smoking is injurious to health) conveys very little information and they are cleverly designed so that it doesn’t stand out to the consumer. Most of us are used to hearing about several things that are ‘injurious to health’ such as chocolates, lots of sugar or salt, hot spicy food etc, so much so that we become immune to this ‘injurious to health’ warning. However, if one is warned about the real threats such as cancer, heart attack, stroke, emphysema, the effect will be manifold. The industry also needs to warn that use of low tar cigarettes, chewable products, snuff, filters or tippers does not reduce the risk. It is believed that prominent health warnings are potent deterrent for the first time users and non-serious users.
The health hazards of tobacco consumption
Most smokers wish they hadn’t taken to smoking, majority of them give up only after several unsuccessful attempts at cessation. Most consumers have knowledge of the association between cigarettes and several diseases but very few are aware of the degree of the risk: smoking kills about one out of two long-term users. Similarly, consumers are also ignorant of multitude of the specific health conditions caused by tobacco: cancers, stroke, heart attacks, impotence, emphysema and gangrene etc.
Passive smoking, relentlessly downplayed by the industry, needs to be addressed in the warning. Canada was the first country in the world to successfully implement such strong labeling and reporting measures. These warnings quickly spread around the world, and the Canadian system was adopted in almost all developed nations. Sensing that it will adversely affect the sales, Indian tobacco industry has been working hard to prevent such a law from being implemented in India.
Laws need to be understood and implemented
India has reasonably strong laws but the implementation and monitoring remain half-hearted. The Government of India passed the Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution Bill in 2003. However, advertisement of other consumer products with the same name as the tobacco product (surrogate advertisement) is rampant, smoking in public places remains unabated, and sale of tobacco to minors continues. Unfortunately, violators are rarely penalized.
Our society appears to be very tolerant of such violations and do not seem to consider it as an important public health issue. Gutka and pan masala (with or without tobacco) pose a bigger challenge in the current society than smoking. Their non-tobacco counterparts, with similar names, are being constantly advertised. Several states have tried to ban these products but the ban has been reversed by the courts on legal technicalities.
Tobacco dependence is a disease
Tobacco use is not just a habit disorder: the International Classification of Diseases (ICD-10) has now notified 'tobacco dependence' as a disease. Tobacco is the only legally available consumer product in the world that kills even when used as per the manufacturer's specifications.
The Indian tobacco industry, for the last 15 years, has consistently highlighted the same facts: India is the world's second largest producer of tobacco, tobacco cultivation provides livelihoods to over 6 million farmers, and the industry employs 20 million workers and contributes over 70 billion rupees to government’s earnings. Does any one care about 250 million tobacco users that are victims of the industry? If we had embarked on tobacco systematic de-growth strategies, by now the tobacco industry could have been diversified into other areas.
Health professionals in India can play a pivotal role in the fight against this epidemic. By making use of every opportunity to discourage the tobacco habit they can make significant contributions to tobacco control. All health professionals in India should possess the skill to help people quit tobacco and they need to lead by example and quit the habit themselves.
Dr Chaturvedi is an associate professor and head and neck cancer surgeon at the Tata Memorial Hospital, Mumbai
Source: Tobacco Free Bangalore