Dr. Nishikant Singh
Tobacco is well-acknowledged social and health evil, and is considered as one of the leading preventable causes of premature death, disease and disability worldwide, including India. According to WHO (2016) estimates, tobacco use is around 1 billion people globally: eight out of ten tobacco users live in the low and middle-income countries; and the direct use of tobacco kills about 5 million people every year. While talking about smoked tobacco, estimates suggest that smoking causes about 71% of lung cancer, 42% of chronic respiratory disease and about 10% of cardiovascular diseases. In addition, smoking harms not only the health of smokers but also the health of non-smokers who are exposed to second-hand (passive) smoke. Studies reveal that smoking prevalence is highest in high income countries but the divergence of this unhealthy behaviour are increasing in many low and middle-income countries as well. This also indicates that the proportion of deaths from tobacco use may increase in low and middle-income countries including India.
Historically, Indians were not aware of the use of tobacco in ancient times. It was not indigenous to the country, however it was introduced by Portuguese about 400 years ago. Eventually, it became embedded in the native culture and gradually India became the foremost consumer as well as the producer of tobacco in the world. However, it is also true that India had played a leadership role in the prohibition of tobacco products to promote public health. In 1975, the Government of India ratified the Cigarettes Act (Regulation of Production, Supply and Distribution). But due to lack of legal framework, these sorts of amendments could not be forcefully enacted. In 1992, under the Drugs and Cosmetics Act 1940 (Amendment), tobacco use was banned in all dental products. The Cable Television Networks (Amendment) Act 2000 prohibited tobacco advertising in publications including state controlled electronic media and cable television. In 2003, the government enacted the Cigarettes and Other Tobacco Products Act (COTPA). The provisions of the act included prohibition of smoking in public places, advertisements of tobacco products, sale of tobacco products to and by minors (persons below 18 years), ban on sale of tobacco products within 100 yards of all educational institutions and mandatory display of pictorial health warnings on tobacco products packages. In 2004, the Government ratified the WHO Framework Convention on Tobacco Control (WHO-FCTC), which enlists key strategies for reduction in demand and supply of tobacco. This was a major leap forward for the tobacco control initiatives in the country. However, with state governments primarily implementing various provisions under COTPA, effective enforcement of tobacco control legislation remains a major challenge.
Keeping the importance of these burning issues and in the overall interest of public health, as envisaged under article 47 of the Constitution, the Modi Government felt urgency in the matter and brought the Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Ordinance, 2019, which was promulgated on the 18th day of September, 2019. The said Ordinance inter alia provides for the following, namely-
It provides for declaration that it is expedient in the public interest that the Union should take under its control the Electronic Cigarette Industry;
It prohibits the production, manufacture, import, export, transport, sale or distribution of electronic cigarettes or advertisement of the use of the said electronic cigarettes;
It prohibits the storage of the stock of electronic cigarettes in any premises by the owner or occupier of such premises;
It empowers the authorised officer to enter and search the premises having the packages of electronic cigarettes and seize such stocks or any components thereof;
It empowers the Central Government to dispose of the stock seized after completion of the proceedings before the court; and
It provides for punishment for contravention of provisions of the Act with imprisonment which may extend to one year or with fine which may extend to one lakh rupees or with both.
Following this, the Honourable Prime Minister Narendra Modi addressed the nation in his monthly radio programme “Mann ki Baat” and said:
It was a “myth” that e-cigarettes posed no danger. We all know that tobacco addiction is very harmful for human health and coming out of this addiction is also very difficult. People who consume tobacco in any form suffer problems like cancer, diabetes, blood pressure, among others. The addiction for tobacco is primarily due to the presence of nicotine in it. For youth, nicotine is very harmful and can have drastic impact on mental growth.”
(Prime Minister Narendra Modi said in his Mann ki Baat broadcast. September 29, 2019, Mann ki Baat.)
With this stepping stone, India maintained the spirit of “Vasudhaiva Kutumbakam” as India is a signatory to the WHO Framework Convention on Tobacco Control which was developed in response to the globalisation of the tobacco epidemic. In 2014, the WHO Framework Convention on Tobacco Control invited all its signatories to consider prohibiting or regulating the use of e-cigarettes in their countries. In addition, India has joined the club of over 30 countries including Thailand, and Singapore, which have established the remarkable improvement in public health scenario and banned the production, trade, and advertising of e-cigarettes. This step presents a noteworthy example to other developing and developed nations especially in South and Southeast Asia, to address the public health challenges in their countries.
In view of tobacco control being a major public health challenge in India, the Government has enacted and implemented various tobacco control policies at national and sub national level. After banning the ENDS (Electronic Nicotine Delivery Systems), the next major challenge to public health is to regulate the use of smokeless tobacco (SLT) which is highly prevalent not only among the men but also among women. The recent data from National Family Health Survey (NFHS) 2015-16 and Global Adults Tobacco Survey (GATS-India) 2016-17 also shows that the use of SLT is very high among both, women and men while comparing it with the use of smoked tobacco in India. SLT induced spitting in public places present a complex challenges to public health particularly in context to Tuberculosis. Further, number of disease and health issues exist ranging from maternal health to mental health, which specifically affect the women and youth population because of the tobacco consumption, warrant the immediate and targeted interventions. Though, the initiative for ban on spitting was already undertaken by our Honourable Prime Minister Shri Narendra Modi and called for nation-wide cleanliness drive on 15th August 2014 through the clean India Mission (Swachha Bharat Mission), there is lot to do in this direction.
Tobacco use in India is projected to have devastating consequences and its impact is particularly devastating among the poor, so this is the right time to put the wise restriction or even complete and progressive ban on production, distribution and advertising of SLTs and smoked tobacco. Effective tobacco control policy which is dependent on balanced implementation of demand and supply reduction strategies should be a top priority for improving public health issues as well as effective and indirect method to reduce poverty. Along with more research on tobacco control, there is need to raise the taxes on all tobacco products to increase prices and generate revenue for tobacco control. Further, restricting the import of tobacco products, advertising anti-tobacco messages and related harms on ration-cards, identity cards, driving licenses and other utility bills could be the effective mechanism to curb the tobacco consumption especially among lower and middle income population. Lastly, establishing the coordinating system for tobacco control at central and state levels, mobilizing the people through mass education and community empowerment would be essentials for tobacco control strategies and understanding the epidemiology of tobacco related health burden in the country.
(Dr. Nishikant Singh, is currently working as Scientist “C” (Non-Medical) at ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, Department of Health Research, Ministry of Health and Family Welfare, Government of India.)