Smoke Signals
By Swapna Majumdar
Women's Feature Service
In India, tobacco kills 800,000 people every year.
Voices of protest have led to a draft bill to control consumption
of cigarettes and tobacco in the country, which is pending before
Parliament. But with the tobacco industry contributing Rs 70,000
million (1US $ = Rs 47) as revenue to the exchequer and Rs 10,780
million as export earnings and providing employment to over four
million people, it is anybody's guess about when the bill will be
passed or effectively implemented.
New Delhi, (India) -- Statutory warnings on cigarette
packets state that smoking is injurious to health.
But just how injurious is it?
Consider these facts. In India, according to the Indian Council
for Medical Research (ICMR), tobacco kills 800,000 people every
year. But this a little-known fact, according to the report of
the expert committee on the Economics of Tobacco Use (ETU)
instituted by the Indian Ministry of Health and Family Welfare.
The report, submitted in February this year, adds that although
people are becoming aware of the ill-effects of smoking in terms
of morbidity and mortality, they cannot be expected to be able to
evaluate the epidemiological implications of smoking.
Moreover, the tobacco industry ensures that consumers do not get
to know. In India, 2,200 persons die every day from tobacco-related
diseases; but the tobacco industry maintains that providing a
statutory warning on cigarette packets is enough. The mega-industry
also swears by the 'freedom of choice' contention.
According to the ETU report, the importance of tobacco in the
Indian economy can be judged from the fact that it contributes
about Rs 70,000 million (1US $ = Rs 47) as revenue to the
country's exchequer and Rs 10,780 million as export earnings.
In addition, tobacco provides employment to over four million
people. India is the third largest producer of tobacco after
China and America. It is also the sixth largest exporter of
tobacco and accounts for six per cent of the global tobacco trade.
However, buried under this flurry of statistics, lie other facts
that tell a story that the tobacco industry wishes could be
smoked away. A study conducted last year by ICMR revealed that
each patient suffering from a tobacco-related disease costs the
country Rs 2.5 million through direct medicinal costs,
absenteeism for treatment and loss of income due to premature
death.
Considering that ICMR estimates that 142 million men and
72 million women above the age of 15 years are tobacco consumers,
the money that these people notionally cost the economy works out
to a tidy packet. To this if one were to add the growing number of
passive smokers, then it becomes quite clear that tobacco puts an
enormous strain on economic resources and hampers productivity.
In fact, the ICMR finding that the partial financial costs of
some tobacco- related diseases are large enough to exceed the
tobacco industry's annual financial contribution completely
demolishes the economic benefit theory propounded by the tobacco
industry.
But most tobacco consumers remain ignorant of these disturbing
facts, and the tobacco industry continues to flourish. According
to experts, the market for tobacco in India is worth Rs.200 million
and is rising in proportion to the burgeoning population.
Worldwide, the situation is no better. According to a 1999 World
Bank study, smoking is already killing one in every 10 adults
worldwide. By 2030 - perhaps even a little sooner - this
proportion will be one in six. In other words, 10 million deaths
per year -- this is more than any other single cause of death.
Courtesy : UNICEF
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It is estimated that, globally, tobacco is responsible for about
3.5 million deaths every year. This figure is expected to
increase to more than 10 million annually during the 2020s.
What this means is that about half a billion of today's world
population would eventually be killed by tobacco.
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The reasons for this are not difficult to find - the adverse
health effects of tobacco consumption take a long time to surface,
so even though smokers know about the hazards, there are no
immediate reasons for them to give up smoking.
In India, it is not only cigarettes that are being consumed by
such a large proportion of the population. According to data
from the Tobacco Board, smokers of the more potent bidis
(a coarser handmade version of cigarettes) constituted 54 per
cent of tobacco consumers in 1999, 24 per cent were consumers of
chewable tobacco and the remaining were smokers. The Tobacco
Board also estimates that the percentage of smokers is likely to
rise to 33 per cent by the year 2020.
There has been persistent pressure by groups like the Voluntary
Health Association of India (VHAI), the National Organisation for
Tobacco Eradication (NOTE), HRIDAY and the World Health
Organisation, the result of which has led to a draft legislation
to control consumption in the country. Called the 'Cigarettes and
Other Tobacco Products (Prohibition of Advertisement and Regulation of
Trade and Supply and Distribution)' Act 2001, it seeks to
"prohibit the advertisement of, and to provide for the
regulation of trade and commerce in, and production, supply and
distribution of cigarettes and other tobacco products".
The draft Bill envisages: a total ban on advertisement of
cigarettes and other tobacco products as well as a ban on
tobacco companies sponsoring sports and other cultural events;
regulations on the sale of tobacco; no person allowed to carry or
trade in cigarettes or other tobacco products unless every package
carries the specified warning. Moreover, no person shall import
cigarettes or other tobacco products for distribution or sale in
India unless every package has a specified warning. And no person
will directly or indirectly produce, supply or distribute
cigarettes unless every package supplied, distributed or produced
indicates the tar and nicotine contents per cigarette.
The Bill was introduced in Parliament in February this year
but has not been approved so far. Yet it has had
an impact. For instance, it has led to the withdrawal of a major
cigarette company from the sponsorship of the Indian cricket team.
In addition there has been a reduction in the visibility of
advertisements of these products both on television and in
newspapers. However, no figures are available at the moment
detailing the quantum of reduction in expenditure of such
advertisements.
Besides the proposed central legislation, some states have taken
measures at their own level. Delhi, Kerala, Maharashtra and Goa
led the way by enacting legislation in 1999 to ban smoking in
public places (including beaches in Goa), selling tobacco to
minors and advertising tobacco products. Smoking is also banned
in hospitals, dispensaries, educational institutions, and
domestic flights, air-conditioned coaches in trains, in
suburban trains and air-conditioned buses run by the government.
The problem of enforcement, however, has diluted these efforts.
Unfortunately, nobody wants to wage court battles because of the
inherent delays and long drawn processes involved in going to
court. So if there are no complaints, there is no action.
Experts also maintain that a more effective way of addressing
this problem would be by spreading awareness. Professor S. Reddy
of the cardiology department, All Indian Institute of Medical
Science (AIIMS), New Delhi, for instance, believes that
schoolchildren are the best ambassadors of the anti-tobacco
campaign.
And Reddy believes in practising what he preaches so in order to
promote health education, he formed a voluntary association with
other doctors and medical students of AIIMS in 1992. Called
Health Related Information Dissemination Amongst Youth (HRIDAY,
meaning 'heart' in Hindi) this association has united students
of 63 schools through the Students Health Action Network (SHAN).
SHAN fired its first salvo in 1999 by presenting a memorandum
to the Indian Prime Minister signed by 25,000 school students
urging effective action to usher in a tobacco-free society
starting with a complete ban on tobacco advertising. According
to Reddy, students are particularly important to this campaign
because of the increase in smoking amongst teenagers.
And Reddy has reason to think this way. According to ICMR figures, of 100 teenagers smoking
today, 50 will eventually die of tobacco related disease. In fact,
according to World
Health Organisation (WHO) projections,
India will have the highest rate of rise in tobacco-related deaths by the year 2020.
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According to figures, of 100 teenagers smoking in India today, 50 will eventually die of tobacco- related disease. And according to the World Health Organisation projections, India will have the highest rate of rise in tobacco-related deaths by the year 2020.
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Statistics also show that two-thirds of the smokers in the country begin the habit young. By the time they realise the health risks, they are already addicted to smoking. Doctors contend that addiction to nicotine is stronger than addiction to other drugs popular with addicts like heroin, marijuana and cocaine.
There are 25 tobacco-related diseases known today. These include cancers of the lung, oral cavity, pharynx, oesophagus, pancreas, bladder, cervix and leukaemia. In India, tobacco-related cancers constitute about half of the total cancers among men and about one-fifth of total cancers among women. Besides these, nicotine increases blood pressure, exacerbates asthma, causes impotence, infertility, heart attack and stroke.
The largest number of deaths from tobacco-related diseases are due to heart attack and not, as is commonly believed, lung cancer or any other forms of cancer.
At another level, anti-tobacco campaigners are demanding public
advertisements which point out that tobacco contains carcinogens
like polyaromatic hydrocarbons; nicotine which is an addictive
drug; radioactive compounds; a drug used in warfare; toxic metal
like arsenic and nickel; and tobacco smoke contains carbon
monoxide. The powerful tobacco industry is trying to hit back by
claiming that certain brands of cigarettes contain lower levels
of tar and nicotine. But research in the West has already come to
the conclusion that there is no safe cigarette. Those who smoke
low-nicotine cigarettes draw on the smoke deeper to ensure they
get their nicotine high. Luring smokers with the concept of `light'
cigarettes being safe cigarettes, is just another means of
keeping them hooked.
Amidst these differing opinions, there is one thing that is clear: the only way that the anti-tobacco campaign can make a mark is if there is a stringent enforcement of legislation. This can take place if politicians agree to disagree with the arguments of the tobacco industry. The first step they can take in this direction is by passing the Tobacco Bill and paving the way for greater health consciousness. And till that happens, there are going to be an increasing number of Indians - like others in the rest of the world - blowing their life away in smoke.
If that does not sound frightening enough, consider the 1999 World Bank Study, which states that smoking is already killing one in every 10 adults worldwide. By 2030 - perhaps even a little sooner - this proportion will be one in six. In other words, 10 million deaths per year -- this is more than any other single cause of death.
The reasons for this are not difficult to find - the adverse health effects of tobacco consumption take a long time to surface, so even though smokers know about the hazards, there are no immediate reasons for them to give up smoking.
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