By Tanishka Tiwari
Published on: January 5, 2024 at 10:05 IST
Tobacco use is a significant public health issue in India, with the poor bearing the brunt of the consequences. Tobacco control should be a primary priority, both as a public health issue and as a means of alleviating poverty.
Tobacco usage is firmly rooted as a cultural habit, and there are many different varieties of tobacco. We looked at various factors influencing tobacco consumption, such as socioeconomic level, marriage, population growth, marketing methods, and pricing. We also evaluated the economic and societal consequences of tobacco use, as well as the adverse health effects, particularly those caused by oral cancer.
India is the world’s second-largest tobacco consumer and third-largest tobacco producer. Tobacco usage currently costs India 1 million fatalities per year (about one-sixth of all tobacco-related deaths worldwide) and billions of dollars in directly linked health expenditures.
Tobacco usage will cause 13% of fatalities in India by 2020, according to current patterns. In India, the range of tobacco products used is more prominent than elsewhere, and it is connected with extra difficulties, such as a high burden of mouth malignancies from smokeless tobacco use.
The link between tobacco smoking and poverty is widely established; nonetheless, tobacco control efforts are applied universally, with little regard for the high-risk target group. Nearly 300 million people in India are impoverished. Tobacco is used by approximately 28.6% of the population.
Tobacco consumption among the poor has maintained, according to national representative surveys and community-based studies. The cyclical association between poor tobacco usage and poverty worsening due to tobacco-related diseases is also widely recognised.
Tobacco-related diseases are both a cause and a result of poverty. It is a social and cultural issue and multidimensional, encompassing biomedical, economic, and geopolitical issues. Tobacco smoking is expected to have disastrous implications in India.
Tobacco control initiatives have the potential to disrupt the cycle. Tobacco control should be prioritised as a health concern and a means of poverty reduction. Despite all attempts, tobacco smoking is a significant health issue worldwide, with one-third of the Indian population using tobacco.
To provide focused assistance, it is vital to assess both the tobacco epidemic and the governing policies. This article aims to synthesise available scientific research on tobacco use in India to determine the extent of the problem and review tobacco control laws and their impact at the micro- and macro-levels of tobacco control in India.
Control of Smoking and Anti-Smoking Laws
Smoking is one of the primary health concerns that endangers human health worldwide. It affects the cardiovascular and respiratory systems, resulting in lung cancer, heart attacks, asthma, strokes, impotency, and other symptoms.
Passive smokers face numerous health hazards because the smoke emitted by a smoker’s cigarette includes three times as much nicotine, tar, and ammonia. The Supreme Court ruled in the landmark case of Murli S. Deora v. Union of India1 that public smoking and tobacco use is a severe health danger that has resulted in lakhs of deaths and economic losses, both directly and indirectly.
The Hon’ble Court also addressed the problem of smoking in public places and the negative consequences it has on passive smokers & issued an order prohibiting smoking in public places.
“Tobacco is universally regarded as one of the major public health hazards, and it is directly or indirectly responsible for an estimated eight lakh deaths in the country each year.It has also been discovered that the treatment of tobacco-related ailments and the loss of productivity caused by them costs the government nearly Rs. 13,500 crores per year, which more than covers all of the benefits accruing in the form of money and employment provided by the tobacco sector,” stated the Bench Justices MB Shah & RP Sethi.
Around 182 million (16.6%) of the world’s 1.1 billion smokers live in India. In 2004, an estimated 1065 million Indians died each year from diseases related to tobacco use–about 2500 every day. Tobacco is expected to account for 13% of all fatalities in India by 2020. India passed the Cigarettes (Regulation of Production, Supply, and Distribution) Act in 1975 to address such a dangerous habit. This Act made it mandatory for all cigarette packaging to include a warning that smoking is harmful to one’s health.
The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (‘COTPA’) replaced this Act in 2003. The goal of this regulation was to safeguard residents, particularly vulnerable groups such as children, from being exposed to toxic tobacco smoke unintentionally. Its goal was also to keep young people and children from becoming addicted to tobacco. The statute also governs cigarette advertising, production, and distribution.
Section 4 of the COTPA prohibits smoking in public places.2 The owner, management, or person in control of a public place is required by Rule 3 of the Prohibition of Smoking in Public Places Rules, 2008 (2008 Rules) to ensure that no one smokes there. There should also be no matchbox or ashtray.
A board with warning notices in certain specifications should be conspicuously placed at the public place’s entrance(s). The authority’s phone number should be published if someone wants to register a complaint against someone smoking in public. If this authority does not take action, the authorities may be penalised.
Section 5 of the COTPA prohibits cigarette and tobacco manufacturers, sellers, distributors, and others from advertising their products. Nobody should be a part of or financially gain from an advertisement that directly or indirectly promotes smoking.3
The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Rules, 2004 (2004 Rules) require public places to display signage that says ‘No Smoking Area’ under the Rules’ specifications.
For example, each board must include one of the applicable warnings from ‘Tobacco causes cancer’ or ‘Tobacco kills’ in the Indian language. If a smoking area is permitted in a hotel or restaurant, it should be physically separated from the non-smoking section so that the public does not have to pass through it to get to the non-smoking area.
Every package of cigarettes that is manufactured/supplied/distributed/sold/imported must bear a warning label. The warning must be visible and written in English or other Indian languages. The warning should be placed in the packet’s largest panel. The package shall also state the tar and nicotine levels of the cigarette, which must not exceed the allowable limits. Any vendor or maker who fails to offer the warning or information about the nicotine and tar content may face jail and/or a fine.
Individuals or characters in television shows are not permitted to display tobacco products or discuss their use. However, there are certain exceptions to this general norm.
- It does not apply to old Indian films, foreign films, or television shows made before this notification went into effect.
- It does not affect the broadcast of Indian or international documentaries and health advertisements that discuss the benefits of tobacco use while also emphasising the dangers of tobacco use.
However, these films and programmes must include caution regarding the dangers of utilising these products. There must also be a disclaimer by the performer, which must be presented in the cinema at the film’s beginning, middle, and finish.
In the case of old television shows, an anti-tobacco health warning scroll will always be displayed on the screen during the relevant moments.
- The Rule does not apply to live television coverage of news, interviews, sports, or cultural events where there is an inadvertent coverage of the use of tobacco products.
- It also does not apply to new Indian or international films or television programmes in which tobacco product usage is required to represent “a real historical figure or a historical era or classified well-known character.” This must be supported by compelling editorial justification.
These films and television shows will include disclaimers and a warning scroll. No exhibition of tobacco product brands or close-ups of tobacco items is permitted during these shows.
On the other hand, the entertainment sector was unhappy with the limitations on its creative freedom. Between 2006 and 2011, talks, consultations, and even cases were filed over actors smoking in new films.
The Rules were revised in 2012, and new films are now permitted to depict smoking on-screen, but only with health warnings, health spots, and a strong reason by the editors as to why the actor is smoking.
Given that Bollywood has such a significant influence on the lives of the youth and can influence them, the film industry must closely adhere to these regulations or it will encourage more smoking habits.
Tobacco Control Legislation
Tobacco control activities can help to lessen the disproportionate cost that tobacco use places on the poor, hence reducing the typically more significant gaps in health outcomes between rich and poor people. There is complicated legislation regulating various sorts of tobacco usage, which is implemented to varying degrees around the country at various administrative levels.
India is the world’s third-largest tobacco producer. Tobacco is estimated to provide a living for over 6 million farmers and 20 million industrial workers in India and to give more than 70 billion rupees (T1 billion; $1.5 billion) to government earnings. However, the Indian Council of Medical Research (ICMR) stated that the economic benefits surpassed the healthcare costs of tobacco usage in India.
In 2000, the Council calculated that the annual cost of tobacco-related ailments was 270 billion rupees. This shows that the revenue is just 25.9% of the total health-care expenditure attributable to tobacco use. The council also expects that the health costs of tobacco in India will rise if tobacco consumption continues to rise.
In 2003, the central and state governments enhanced tobacco control legislation in several areas of concern. This includes improved quantification of tobacco’s health risks, expanded knowledge of diseases associated with tobacco use, higher global awareness of tobacco’s adverse consequences, and increased scientific evidence of tobacco as a cause of mortality.
The Cigarettes Act, first passed nationally in 1975, was primarily limited to the statutory warning ‘Cigarette Smoking is Injurious to Health’ to be displayed on cigarette packs and advertisements. Still, it did not include non-cigarettes and proved ineffective.
The Prevention and Control of Pollution Act, 1981 designated smoking as an air pollutant, and the Motor Vehicles Act, 1988 made smoking in public vehicles unlawful.
The Government of India invoked a section of the Prevention of Food Adulteration Act, 1955, in 1990 to issue a health warning claiming that chewing tobacco is harmful. Under the Drugs and Cosmetics Act of 1940, the Central Government prohibited selling tobacco-containing toothpaste and tooth powder in 1992.
The Cable Television Networks Amendment Act, 2000 restricted the transmission of tobacco and spirits commercials nationwide.
The Cigarettes and Other Tobacco Products Act (COTPA) of 2003 replaced the Cigarettes Act of 1975, including cigars, beedis, cheroots, pipe tobacco, hookah, chewing tobacco, pan masala, and gutka.
The COTPA went into effect in 2003; it prohibits direct and indirect advertisements of tobacco products, smoking in public places, the sale of tobacco to minors, and smoking within 100 yards of educational institutions; it also requires the display of pictorial warnings and the testing of tar and nicotine content in all tobacco products. This comprehensive law established tobacco control measures, and state governments banned gutka and pan masala between 2001 and 2003.
India signed the WHO Framework Convention on Tobacco Control (FCTC). As a signatory to the treaty, the Indian government has been at the forefront of adopting a proactive and aggressive tobacco control strategy and was elected coordinator of the WHO South East Asia Region (SEAR). Following the FCTC’s signing, tobacco control has had a substantial paradigm shift.
To implement tobacco control laws and fulfil WHO-FCTC commitments, the Ministry of Health and Family Welfare, Government of India, launched the National Tobacco Control Programme (NTCP) in 2008, covering 42 districts of 21 Indian states/union territories, with the following activities planned: training and capacity building; information, education, and communication (IEC) activities; tobacco control laws; and reporting survey and surveillance. Tobacco-related education for kids has expanded.
Implementation of tobacco control policies and surveillance
Tobacco control in India is extensive and complicated. Policy implementation is a big issue. The country’s tribal population exceeds 100 million, with topographical and infrastructure issues.
According to studies, Scheduled Tribes consume the most tobacco. As a result, the primary disadvantage of laws is their failure to be implemented. LMICs account for barely 1% of worldwide tobacco control funding. This low budget and insufficient human resources required for tobacco control, in comparison to the enormity of the problem, is a significant impediment to effective and efficient tobacco control.
The tobacco industry’s strategies to target the vulnerable population, women and youth, as well as a lack of awareness of the possible difficulties and particular health concerns linked with tobacco usage, contribute to increased tobacco consumption in developing countries.
Health workers have an essential role in tobacco control but have been underutilised (WHO). Looking at GATS 2010 and GATS 2016, guidance from health experts has been inspiring and motivating regarding smoking cessation. But are they adequately trained? According to studies, most health professionals believed lower tobacco use had minor consequences.
Although the Indian people are aware that tobacco is dangerous, personalisation of possible harm and knowledge of more specific repercussions of tobacco use are low. Although anti-tobacco warning statements are printed on the packets, not all subpopulations understand them since intensive health education is required.
Kerala state in India has considerably superior health indices than the national averages and is closer to developed countries, with a high literacy rate. Despite this societal framework, the prevalence rate is comparable to that of India.
The Government of India has grown more involved in India’s tobacco problem, but, tobacco control must be accomplished in collaboration. The primary factor in control is the implementation of legislation. Integrating tobacco control with health activities will maximise the use of human and financial resources while removing significant barriers to tobacco control. National and state-level coordination mechanisms must be established to monitor and effectively execute tobacco control legislation.
Conclusion
In India, the enforcement of anti-tobacco regulations has made tremendous progress, resulting in improved awareness about the harmful effects of tobacco and a decrease in tobacco consumption. The enforcement of strict rules has been critical in protecting public health and decreasing exposure to second-hand smoke.
However, difficulties in successfully implementing and enforcing these regulations exist. The extensive availability of tobacco products, clandestine trading, and the tobacco industry’s influence all pose obstacles to attaining the intended results. Furthermore, educating marginalised people and challenging the cultural acceptability of tobacco use are continuous issues.
India needs sustained efforts to boost its tobacco control measures:
- Improving enforcement measures and increasing penalties for noncompliance.
- Investing in comprehensive tobacco control programmes, such as tobacco cessation clinics and vulnerable-population awareness campaigns.
- To further the anti-tobacco message, we are collaborating with civil society organisations, health experts, and educational institutions.
- Implementing novel techniques to offset the tobacco industry’s effect, particularly among young people.
To summarise, India has made commendable progress in enacting anti-tobacco laws and regulations. To attain the ultimate aim of a tobacco-free society that protects the health and well-being of its residents, however, continuous efforts combined with multi-sectoral collaborations and creative ways are required.
References
- Assessment of Tobacco Consumption and Control in India
- how-does-indian-law-regulate-smoking
- anti-smoking-laws-in-india/
- tobacco_control_legislation_in_india__past_and.16.aspx
Endnotes
1. (2001) 8 SCC 765
2. The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, s.4, No.32, Acts of Parliament, 2003 (India)
3. The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, s.5, No.32, Acts of Parliament, 2003 (India)
