Tobacco and Health – Overview for India
5.1 Introduction
Tobacco appears to be as old as human civilization. Today, India is the biggest tobacco markets in the world, ranking third in total tobacco consumption, first and second being China and the US respectively. The death toll from tobacco consumption is now around 4.9 million people a year. If this current pattern continues, the number of deaths will increase to 10 million by the year 2020.
Tobacco consumption is considered to be a global health hazard and is associated with significant morbidity and mortality. Tobacco affects almost all the vital organs of human body and may become a cause of Cardio-vascular diseases, Cancers of multiple organs, respiratory problems, metabolic problems and delayed wound healing etc.
Of the estimated 1.3 billion smokers worldwide, 84% live in developing and transitional economy countries. Tobacco and poverty form a vicious circle. Tobacco tends to be consumed more by poor and it contributes to poverty through loss of income and productivity due to ill health and premature death. The child labour involved in tobacco farms and factories are denied schooling and grow up illiterate. Children and adults working in tobacco farms suffer from Green Tobacco Sickness (GTS), caused by dermal absorption of nicotine through contact with wet tobacco leaves. The tobacco workers are exposed to organophosphate pesticides, which are highly toxic and can lead to serious neuro-psychiatric symptoms.
In India, it is estimated that there are more that 250 million tobacco users out of which about 8,00,000 die every year due to tobacco related illnesses. About 19 persons per lac are having oral cancer and recently women and children are also taking up these habits. According to 1998 survey, in the urban area 23.2% of the males and 4% of females were found to be having tobacco habits whereas in the rural areas the proportion of population was 33.6% and 8.8% in males and females respectively.
5.2 The Status of Tobacco Usage by Health Professionals
Health professionals play a major role in tobacco control, but unfortunately tobacco consumption in this group is quite high. Health professionals who consume tobacco themselves are often less likely to engage in tobacco control than their non-tobacco using counterparts. Recognizing the need for assessing tobacco use and related data for students and practitioners of the health professions and the lack of standardization of such surveys, the World Health Organization (WHO), the Centres of Disease control and Prevention (CDC), USA and the World Professional Agencies of Physicians, Dentists, Pharmacists and Nurses developed the Global Health Professional Survey (GHPS). The GHPS involves anonymous and confidential self-administered questionnaires for third year students of health professions. The responsibility for the GHPS for Dental Students has been given to the South-East Asia. Regional Office (SEARO), of the WHO’s Tobacco Free Initiative, based in New Delhi, India. The results of the GHPS for dental students conducted in India in 2005 estimated Life-time prevalence of cigarette smoking for third year dental students in India is 12.1%.Other tobacco use including bidi and gutka among dental students is 4.9 %. Male students are significantly more likely than female students to smoke cigarettes. The Health Professionals agreed, and it was included in the code of practice, that they should be a role model to others. By promoting smoke-free workplaces and a smoke-free culture they should set the example to follow by their patients.
5.3 Tobacco and Indian Legislation
In response to increasing scientific evidence and awareness of the adverse health effects of tobacco consumption, Legislation for tobacco control started taking shape in mid 1970s in India.
In 1975, Government of India enacted ‘The Cigarettes Act’ that required the manufacturers to display a statutory warning that ‘Cigarette smoking is injurious to health’ on all cartons and packages of cigarettes. However, this act did not accomplish much as it was not comprehensive in its coverage and was feeble in its provisions. Thus, the Parliamentary Committee on Subordinate Legislation in its 22nd report (Dec.1995) recommended certain important modifications including, strong and rotatory warning in regional languages on tobacco products; ban on direct as well as indirect advertisement of tobacco products; prohibition of smoking in public places etc. Enactment of Tobacco Board Act, also in 1975, was done to research, market and develop the tobacco crop and trade. The act focused on establishing a single authority (the Central Govt.) which could deal with various aspects of the tobacco industry in an integrated and efficient manner.
During the last 3 years various State Governments have tried to impose ban on tobacco products sale but unfortunately it could not be effective due to legal hurdles. After undergoing a series of substantive suggestions, the legislation entitled ‘The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 has taken its final form. This act intends to protect and improve public health, includes a wide range of evidence based strategies to reduce tobacco consumption. Currently the Bill is under discussion and part of it has been passed by the parliament.