By Dr. Caleb Harris M.Ch.
A few years ago, I was invited by a professor from Shillong to attend a meeting at Kolkata to discuss on strategies to reduce tobacco risk and smoking cessation. He was inviting me on behalf of his friend, who he said represented an international organisation which deals with sustainable development. Smelling a rat, I did some background search on these organisations, only to discover that these were supported by global tobacco corporations and promote tobacco products which they claim are less harmful than regular tobacco. I politely declined the invitation but what intrigued me was the subtlety and the choice of invitees from Shillong, all of whom were involved in anti-tobacco activities. By involving us, they wanted to onboard avowed crusaders against tobacco, in their effort to peddle harmful products.
From the 1930s to the 1950s, tobacco advertisements featured doctors, with some even being endorsed by professional medical bodies. This was a ploy to create a sense of trust in the harmful tobacco products, with some ads being placed even in medical journals, to convince doctors to smoke. Luther Terry, in 1964, released the first Surgeon General’s Report on Smoking and Health which concluded that tobacco smoking causes lung cancer in men. This paved the way for control of advertisements for tobacco and the mandatory statutory warnings.
The tobacco industry responded with subtlety, presenting tobacco as a lifestyle product. Filtered cigarettes were marketed as a safer alternative, with reduced risk of cancer, and the ‘Marlboro Man’ was portrayed as the one to look up to. As a child, I was made to believe that ‘Four Square’ and ‘Wills’ were companies manufacturing cricket gear. TAPS- Tobacco Advertising, Promotion and Sponsorship- was a strategy employed by the industry to promote the use of a product which has no benefits. The print and electronic media were used effectively in promoting tobacco. In India, movie ‘stars’ were the greatest propagators of tobacco. In Tamil Nadu, several generations of youngsters aspired to imitate the ‘cigarette style’ of a particular actor. Across colleges, smoking was considered ‘cool’. This was the lie propagated by the tobacco industry-that it was cool to kill oneself.
Following the ‘War against Tobacco’ initiated in the United States of America over 50 years ago, there has been a worldwide awareness about the harmful effects of tobacco. The World Health Organisation(WHO) came up with a Framework Convention on Tobacco Control (FCTC) on Tobacco Control, and laws were enacted in several countries to control tobacco. In India, the COTPA (Cigarettes and Other Tobacco Products Act), has very strict provisions and, if implemented well, can be an effective tool in tobacco control. As per COTPA, smoking in public places, selling tobacco products to or by minors, or selling tobacco products within a radius of 100 metres from any educational institution is illegal. Establishments where tobacco products are sold must display messages like “Tobacco Causes Cancer” and “Sale of tobacco products to a person under the age of eighteen years is a punishable offence under law”.
Tobacco impacts the society in ways one cannot fathom. Apart from several cancers, tobacco causes several respiratory and cardiac illnesses. This can debilitate the person and reduce productivity. My evenings are spent playing badminton and living in a medical college campus, my co-players are students, some of whom are less fitter than me. Many of these smoke, thereby making them less fitter than someone much older than them. I have treated patients in their 20s who have developed cancers and spend time in the hospital, rather than a college or a playground. The prime of life is stolen from them.
Others have their lives curtailed. According to the World Health Organisation (WHO), each year, there is a death due to tobacco every 6 seconds. The statutory warnings on tobacco products say that tobacco kills but still many continue to consume. Probably this is due to the fact that tobacco is a ‘slow killer’. The number of deaths due to Covid-19 were much lesser but still there was panic everywhere, because there was immediate death of many patients.
In patients who do not die of tobacco, the impaired health affects the lifestyle. Ironically, while the tobacco industry portrays tobacco as the ultimate lifestyle product, all that it offers is a life of illness, poverty and death. The economic impact of tobacco use is often understated, with a lot of expenditure on a product which is of no benefit but harmful. It destroys the life of the user. Tobacco taxation has had the maximum impact on reduction of tobacco use around the world. In India, cigarettes are taxed under the highest GST bracket(28%) but several products such as beedis and chewable tobacco escape taxation. The industry markets tobacco in different ways, using deception. One of the ways is to sell a ‘mouth freshener’ along with which tobacco is offered free, in a separate unbranded packet.
World No Tobacco Day is observed on may 31 every year, since 1987. An initiative of the WHO, this year, the theme is “Unmasking the Appeal: Exposing Industry Tactics on Tobacco and Nicotine Products” and aims to focus on revealing the tactics the tobacco and nicotine industry use to make their products look attractive despite being harmful. The tobacco industry targets young children because they will continue to use tobacco for several years, and since many of these tobacco users live truncated lives, the industry needs younger people to join the user pool.
In Meghalaya, 47% of adults use tobacco, as compared to the national average of 28.6% according to the Global Adult Tobacco Survey (GATS 2016-17). Sadly, 33% of children aged 13-15 years use tobacco here. This is very alarming as these may end up living truncated lives. The Government of Meghalaya, through a joint effort of the Departments of Health and Education, has successfully implemented the ‘Tobacco Free Educational Institution’(ToFEI) program to curb use of Tobacco by school students. As part of this program, the school is expected to ensure that no tobacco product is sold in and around schools (up to a radius of 100 metres), no teachers (or other staff) use tobacco in the school and activities such as pledge against tobacco use are taken up on a regular basis by the students. The students have participated in rallies to spread awareness about the ill effects of tobacco around the state and have conducted a signature campaign to this effect too.
The thief comes only to steal and kill and destroy. The tobacco industry uses deception to steal people of the prime of their lives, destroy them and their families and kill them. We need to be aware and protect ourselves and our young ones from falling prey to the tactics of the tobacco industry. If tobacco is seen as a harmful product, it may lose its appeal and thereby bring down its use.
The writer is Surgical Oncologist NEIGRIHMS. Views expressed are personal: :Email [email protected]