Jahnabi Hazarika, Sandra Albert
Tobacco use is one of the world’s biggest public health threats as it is a leading cause of preventable disease and death. Every year, May 31 is observed as World No Tobacco Day globally. This is an initiative of the World Health Organization (WHO) and the Secretariat of the Framework Convention on Tobacco Control (FCTC) to highlight the health risks associated with tobacco use. The FCTC encourages governments to adopt effective policies to reduce tobacco consumption. The WHO FCTC is a global public health treaty that has been signed and or ratified by 180 countries. India is a Party to the WHO FCTC since the Convention entered into force on February 27, 2005 and is legally bound to implement the provisions of this international treaty.
According to the WHO tobacco use accounts for more than 7 million deaths worldwide every year. In India nearly a million people die annually from causes related to tobacco use. Yet, India is the second largest consumer and third largest producer of tobacco. Apart from the smoked forms that include cigarettes, bidis and cigars, a plethora of smokeless forms of tobacco products are available in the country. To control tobacco use the Government of India enacted the Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act- COTPA in 2003. It is the principle law governing tobacco control in India. It is comprehensive, covering many aspects including but not limited to: restrictions on smoking in public places; prohibition of advertising, promotion and sponsorship; prohibition of sales to minors (below 18 years of age) and within 100 metres of educational institutions; packaging and labelling as prescribed under the law with appropriate pictorial warning and penalties on violations of the law. The Government of India now mandates 85% pictorial warnings on both sides of the tobacco product packages.
In order to facilitate the effective implementation of the Tobacco Control Law, to bring about greater awareness about the harmful effects of tobacco as well as to fulfil the obligations under the WHO FCTC, the Ministry of Health and Family Welfare, Government of India launched the National Tobacco Control Programme (NTCP) in 2007- 08. To curb the use of tobacco, warnings are also flashed on cinema and TV screens against its harmful effects across the country. Following a Supreme Court order of September 2016 on banning of chewing tobacco products, the Government of India had issued a complete nation-wide ban on sale of food products containing tobacco and nicotine as ingredients. These include Gutka, Paan Masala, Zarda and tobacco-based flavoured mouth fresheners. A dedicated national programme, legislations, enforcement of bans and sustained campaigns from time to time against tobacco use have shown its first sign of success. Data from National Family Health Survey 2015-16 (NFHS-4) shows a decline in the national figures for the use of all forms of tobacco from around 11% to 7% among women and from 57% to 45% among men, in the past decade.
But Meghalaya showed an alarming increase in the use of tobacco among men and women. NFHS-4 reveals that 32% of the women and 72% of the men use some form of tobacco in Meghalaya. The high prevalence of tobacco users in the North-east region was also evident in the Global Adult Tobacco Survey (GATS-India 2010) which showed Meghalaya to have a prevalence of 55%.
Most people know by now that tobacco use has harmful effects on health but the extent and severity is still not adequately understood. Apart from cancers, tobacco use is a major risk factor for cardiovascular diseases (heart attacks, strokes), diabetes and chronic respiratory diseases which are some of the leading causes of death worldwide. Any form of tobacco use, smoking or smokeless, can place a person at high risk for a wide range of cancers including cancers of the lung, larynx, mouth, oesophagus, pharynx, stomach, urinary bladder, kidney, liver, stomach, pancreas, colon, rectum, and uterus. Nicotine, one of the many harmful chemical substances in tobacco is the major cause of addiction. Non-smokers are exposed to second-hand smoke (passive smoking) which is the smoke a smoker breathes out or that comes from the tip of a burning cigarette. When this smoke is inhaled, it can directly affect the heart and blood circulation of the non-smoker and their health over time.
According to the latest National Cancer Registry Program, some of the highest incidence of cancer rates related to tobacco use in the country was observed in Meghalaya (male 65%, female 42%). In East Khasi hills district 70% cancers in men and 45% in women were attributable to tobacco use. Meghalaya also has the highest proportions of oesophageal (food pipe) cancers in the country. The East Khasi Hills district has highest rates of tongue cancer and hypopharynx cancers in the world.
In Meghalaya consumption of Kwai: areca nut consumed in the form of a quid wrapped in betel leaves with a touch of slaked lime is common among men and women. Prolonged use of areca nut can cause cancers of the mouth and oesophagus. The practice of smoking tobacco is rampant; frequently observed in market areas, public conveyances and even near educational institutes. It is important to understand that tobacco use is a threat to any person, irrespective of gender, age, race, cultural or educational background.
Apart from the health consequences, as stated by WHO tobacco hinders several aspects of sustainable development of a country. Therefore, this year’s theme for World No Tobacco Day 2017 is “Tobacco – a threat to development.” Tobacco use affects national economies through increased health-care costs and decreased productivity due to tobacco related diseases and premature mortality. Around 80% of premature deaths from tobacco occur in low- or middle-income countries. Premature death of a family member due to tobacco directly affects the emotional well-being of the family and also worsens their economic condition as treatment costs of tobacco related diseases are high. Tobacco growing, manufacturing and consumption has adverse environmental impacts. Health care costs from tobacco-related diseases by far outweigh the revenue generated through the sale of tobacco products.
Thus for a society free of tobacco related ailments there has to be concerted efforts by the Government and by civil society. Strengthening the existing laws along with effective implementation can help reduce tobacco use to a large extent. Awareness programmes and intensive campaigns on the health risks needs to be undertaken from time to time so as to reach all sections of society. Multi-sectoral action that results in a paradigm shift in the social acceptability of tobacco use is the need of the hour. While national programmes, awareness campaigns and laws can facilitate tobacco control, the ultimate decision rests on the individual. Behaviour change is not easy and people who are desirous of quitting smoking may need professional help (that goes beyond mere advice) to give up the habit.
As we observe World No Tobacco Day 2017, this is a good time for us to take stock of the health risks of tobacco at the individual level and our society as a whole.
(The writers are faculty at Indian Institute of Public Health-Shillong)