Abstract:
This is a comprehensive review of the various aspects of tobacco control, with a particular focus on the Indian scenario. It includes information on the tobacco habits prevalent in India, health and environmental risks caused by tobacco consumption, passive smoking, tobacco control legislation in India, and the way forward for effective tobacco control. Tobacco is one of the leading preventable causes of death, killing almost six million people worldwide every year. Turning this completely avoidable manmade epidemic into an end in itself should be our topmost priority. The global tobacco epidemic is killing more people than TB, HIV/AIDS, and malaria put together. This epidemic can be overcome by understanding the devastating consequences of tobacco consumption, learning about the effective tobacco control measures in the home country, understanding the national programmes and legislation in place, and then taking decisive action to stop the epidemic and move towards a tobacco free world. India is the 2nd largest consumer of tobacco in the world, and accounts for about one-sixths of the world’s tobacco-related deaths India’s tobacco problem is unique in that tobacco is consumed in many forms, from smokeless to smoking. We need to better understand the tobacco challenge in India, spend more time on what works, and explore the impact of socio-cultural diversity and the cost effectiveness of different tobacco control approaches.
Introduction:
Every year, tobacco use causes the death of approximately 6 million people worldwide. According to WHO estimates, 100 million premature tobacco-related deaths occurred worldwide in the twentieth century and if current trends continue, it is expected that this number will reach 1 billion by the twenty-first century. According to Jha et al., smoking will cause about 1 million deaths annually in India by the early twenty-first century. According to Gupta et al., tobacco-related mortality among Indian males and females is estimated to be around 23.7 percent among men aged 35-69 and 83.7 percent among women aged 35-69 years. In another cohort study from south India, tobacco chewing was associated with a mortality risk of 0.86-0.94 and a mortality risk of 1.22-1.44 respectively, while smoking was associated with mortality risks of 1.31-1.39 and 1.36-2.08 respectively.
According to the NFHS-3 survey conducted in 2005-06, tobacco consumption is more common among men, rural people, illiterate people, poor and vulnerable people. According to the GATS (Global Adult Tobacco Survey) conducted among persons aged 15 years and above in 2009–10, 34.6 % of the adults are current tobacco users (47.9 % males & 20.3 % females). 14 % of the adult’s smoke tobacco (24.3 % males & 2.9 % females) and 25 % smokeless tobacco (32.9% males & 18.4 % females). According to GATS (Global Youth Tobacco Survey (2009), among the students aged 13-15 years, 14.6 % students are tobacco users. The tobacco problem in India is very multifaceted, with a wide range of smoking forms and a wide range of smokeless tobacco options. Many tobacco products are manufactured in cottage & small-scale industries, with different mixtures and manufacturing processes. Bidis are mostly produced in the unorganized sector, while cigarettes are mainly produced by large-scale industries. The World Health Assembly (WHA) adopted the WHO Framework Convention on Tobacco Control (FCTC) in May 2003, with India being the 8th country to ratify on February 5, 2004. The WHO FCTC is an international public health treaty developed in response to the global tobacco epidemic. The aim of the treaty is to reduce the burden of tobacco-related diseases and deaths. Legislation has long been recognized as the most important factor in achieving meaningful tobacco control results. The WHO Framework Convention adopts scientific evidence-based policies that have been proven to reduce tobacco consumption. The Convention does not prescribe a specific law, but instead provides guidance for national and international measures to promote smoking cessation and discourage nonsmokers from engaging in the habit. The success of the WHO Framework Convention (FCTC), which, as of July 2009, had more than 160 Parties representing 86% of the global population, shows the global political will to make tobacco control much more comprehensive and successful. The World Health Organization (WHO) has created a set of policies to help countries follow the WHO Framework Convention on Tobacco Control (FCTC). The MPOWER package includes six key tobacco control strategies: monitoring tobacco use, preventing tobacco use, protecting people from tobacco, helping people quit tobacco, warning people about tobacco, banning tobacco advertising, promoting and sponsoring, and raising taxes on tobacco.
Since 1975, India has been required to have a health warning on every cigarette package and advertisement. This law, known as the COTPA, was passed by the Indian Parliament in April 2003 and became law on May 18, 2004. The law applies to all tobacco products in any form and is applicable to the entire country.
COTPA-2003 includes the following key provisions:
- Cessation of Smoking in Public Places (including Indoor Workplaces) (Effective 2nd October 2008)
- Prohibition of Advertising, Direct and Indirect (Point-of-sale Advertising is allowed)
- Prohibition of Sponsorship and Promotion of Tobacco Products
- Prohibition of Sale to Minorities (Tobacco Products cannot be sold to Minorities under the age of 18 and Cannot be sold within 100 yards of any Educational Institution)
- Regulation of Health warnings in Tobacco Products Packages (English and one additional Indian Language)
- Including pictorial health warnings in Tobacco Packages.
- Regulation and Testing of Tar and Nicotine Content of Tobacco Products and Declaration on Tobacco Products Packages.
National Tobacco Control Programme
The National Tobacco Control Programme (NTCP) was launched by the Government of India (GOI) under the XIX Five Year Plan to implement Tobacco Control Laws, raise awareness on the harmful effects of Tobacco and to comply with the obligations under the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). The Cabinet Committee on economic affairs (CCEA) approved the NTCP on 28 January 2010. The NTCP will set up tobacco product testing laboratories and provide baseline estimates of the prevalence of tobacco and the status of implementation of Tobacco Control Law. The pilot phase will cover 42 districts in 21 states.
The activities of the NTCP are:
Smoke Free Places
Smoking is completely banned in many public places and workplaces such as healthcare, educational, and government facilities and on public transport. The law, however, permits the establishment of smoking areas or spaces in airports, hotels having 30 or more rooms, and restaurants having seating capacity for 30 or more. With respect to outdoor places, open auditoriums, stadiums, railway stations, bus stops/stands are smoke free. Sub-national jurisdictions may enact smoke free laws that are more stringent than the national law.
Tobacco Advertising, Promotion and Sponsorship
Advertising through most forms of mass media is prohibited. There are some restrictions on tobacco sponsorship and the publicity of such sponsorship.
Tobacco Packaging and Labelling
Health warning labels are pictorial and text; cover 85 percent of the front and back panels of the tobacco product package parallel to the top edge; and are rotated every 12 months. Misleading packaging and labelling, including terms such as “light,” and “low-tar” and other signs, is prohibited.
Cigarette Contents and Disclosures
The law does not grant the authority to regulate the contents of cigarettes. The law does not require that manufacturers and importers disclose to government authorities information on the contents and emissions of their products.
Sales Restrictions
The law prohibits the sale of tobacco products via vending machines and within 100 yards of any educational institution. In addition, several states ban the sale of single cigarettes and gutka and other forms of smokeless tobacco. There are no restrictions on internet sales or the sale of small packets of cigarettes or other tobacco products. The sale of tobacco products is prohibited to persons under the age of 18.
E-Cigarettes
The law prohibits the production, manufacture, import, export, transport, sale, distribution, and advertising of e-cigarettes. There are no restrictions on the use of e-cigarettes.
Heated Tobacco Products
The sale of heated tobacco products (HTPs) is prohibited. Existing smoking restrictions apply to HTPs. The law bans the direct and indirect advertisement and promotion of both tobacco inserts and devices.
The Impact of New COTPA Amendment Bill 2020
A state’s decision can have a huge impact on the lives of its citizens. But, if it’s done for a good cause, such as the protection of human health, this coercion can be acceptable and even beneficial. The COTPA Amendment bill 2020 has been introduced with several changes. It proposes to raise the age limit for selling and consuming tobacco from 18 to 21. If implemented, it could make selling loose cigarettes a criminal offense punishable by imprisonment for up to 7 years. While the 2020 Bill does impose a heavier penalty, it’s reasonable to argue that a sentence of 7 years is disproportionate. For example, selling loose cigarettes at small and micro-scale businesses could be a disproportionate punishment. The punishment in this case is the same as that of negligently causing death or any other serious crime. FRAI has strongly criticized the bill, saying that it doesn’t entirely rule out the possibility of expanding black markets, but it could also be a disaster for small-scale stores. The consequences of tobacco smoking in India are expected to be dire. The government has only recently started to address the issue and initiated a legislative process to tackle this societal scourge. However, in order to be effective, the legislation will need to go beyond what is included in the draft Bill, such as raising customs duties on all tobacco products, and closing legal gaps related to advertising. If the tobacco epidemic is to be contained in India, it will require strong political leadership on the part of the government, as well as extensive public education. A deep understanding of political economics will be required for any future comprehensive tobacco control law. As the world’s 3rd largest agricultural tobacco producer, slowing down this sector will require not only political determination and ongoing commitment, but also a thorough analysis of all relevant stakeholders. Public health awareness and awareness-raising campaigns against tobacco, educating and sensitizing all health care professionals about tobacco control and cessation, including tobacco in medical undergraduate curricula, nursing curricula, various conferences, scientific meetings and workshops, etc. In the long run, if all health care providers get involved in tobacco control and prevention, it will make a big difference. By expanding tobacco control programs to the edges of society, making them more affordable and socially acceptable, millions of existing tobacco users will be able to quit.
Conclusion:
Tobacco use is a major public health problem in India, with an estimated 275 million tobacco users in the country. The Government of India has enacted a number of tobacco control laws in an effort to reduce tobacco use and its harmful effects. These laws have had some success, but more needs to be done to protect the health of the Indian people from the harmful effects of tobacco. One way to strengthen tobacco control laws in India is to increase the size of health warnings on tobacco product packaging. The current health warnings are small and easy to ignore. Larger health warnings would be more effective in deterring people from using tobacco products. Another way to strengthen tobacco control laws is to ban the sale of flavoured tobacco products. Flavoured tobacco products are especially appealing to young people, who are more likely to start using tobacco if they are flavoured. Banning the sale of flavoured tobacco products would help to reduce tobacco use among young people. The minimum age for tobacco purchase should also be raised to 21 years. This would make it more difficult for young people to get their hands on tobacco products. Finally, more funding should be provided for the National Tobacco Control Programme (NTCP) and the State Tobacco Control Programs (STCPs). These programs provide information and resources to help people quit smoking and create smoke-free environments in public places. More funding would allow these programs to reach more people and make a greater impact on reducing tobacco use in India. By strengthening tobacco control laws and implementing these recommendations, India can make further progress in reducing tobacco use and its harmful effects.
References:
https://ntcp.mohfw.gov.in/acts_rules_regulations
https://blog.ipleaders.in/policies-tobacco-control-india/
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ARTICLE WRITTEN BY JANGAM SHASHIDHAR.
