World No Tobacco Day: India's Fight Against the Silent Killer

Context:

Tobacco consumption remains a major public health challenge in India, contributing significantly to the disease burden, premature mortality, and economic loss. To address this, World No Tobacco Day is observed every year on 31st May, to raise awareness about the health risks of tobacco and advocate for effective policies to reduce its use.

Tobacco Usage in India:

• India has the second largest number of tobacco users in the world.

• As per Global Adult Tobacco Survey (GATS):

  • Around 28.6%–29% of all adults in India use tobacco.

  • 42% of men and 14% of women are tobacco users.

• Age-wise prevalence:

  • Men (50–64 years): 52.8%

  • Women (65+ years): 18.6%

• Smokeless Tobacco (SLT):

  • India accounts for 70% of the world's SLT users.

• Smoked Tobacco:

  • Bidi is more common than cigarettes, especially in rural and low-income areas.

• Rising Cigarette Usage:

  • India has seen the highest increase in global cigarette market share.

• Regional Trends (NFHS-5):

  • Most states saw a decline in male tobacco use.

  • However, Sikkim, Goa, Bihar, Gujarat, Himachal Pradesh, and Mizoram reported an increase.

Health Impacts of Tobacco:

• Major risk factor for 5 of the top 10 global causes of death:

  • Ischemic heart disease, stroke, COPD, lower respiratory infections, lung cancers (WHO).

• Chemical content: Tobacco smoke contains over 7,000 chemicals, including 250+ toxic or cancer-causing substances.

• Cancer Risks:

  • Tobacco (smoked and SLT) is linked to lung, oral, stomach, head & neck, and pancreatic cancers.

  • India ranks first globally in male cancer incidence and mortality (The Lancet).

  • In India, oral cancer is more prevalent than lung cancer among men.

• Other Health Effects:

  • Skin damage, vision and hearing loss, reduced fertility, and erectile dysfunction.

• Life Expectancy Loss:

  • Each cigarette shortens life by 20 minutes.

  • A 60-year-old smoker typically has the health profile of a 70-year-old non-smoker.

• Loss of Productive Years:

  • Affects middle-age years rather than the end of life.

Economic Impact:

• Tobacco use imposed a cost of ₹1.77 lakh crore (about 1.04% of GDP) in 2017–18.

• Smoking: 74% of this cost.

• SLT: 26% of this cost.

Government Initiatives:

• COTPA, 2003:

  • Bans smoking in public places, tobacco sale near educational institutions, and advertisement of tobacco products.

• National Tobacco Control Programme (NTCP), 2007–08:

  • Aims for effective COTPA implementation across states.

• mCessation Programme:

  • SMS-based tobacco cessation support (send QUIT to 56161).

• Tobacco-Free Educational Institutions (ToFEI):

  • Prohibits tobacco sales/use within 100 yards of educational institutions.

• FSSAI Regulation (2011):

  • Bans tobacco and nicotine in food items (e.g., gutka).

• Prohibition of Electronic Cigarettes Act, 2019:

  • Bans e-cigarette production, sale, import/export, and advertisement.

• Pictorial Health Warnings:

  • 85% of tobacco packaging must carry graphic warnings.

• Media Rules:

  • Mandatory anti-tobacco spots (30 seconds) in films and OTT platforms.

  • COTPA 2023 Amendment mandates health disclaimers in online content.

• Monitoring Surveys:

  • GATS and NFHS conducted periodically to track trends.

• MPOWER Measures (WHO-FCTC):

  • Provides guidelines to reduce tobacco demand effectively.

Challenges in Tobacco Control:

• Weak Enforcement: Poor implementation of public smoking bans.

• Multiple Forms: Easy access to tobacco in various forms normalizes its use.

• Illegal Trade: Continued sale of banned e-cigarettes and gutka.

• Industry Tactics:

  • Pricing strategies, policy lobbying, dense shop networks.

• Price Ineffectiveness:

  • Rising incomes outpace tax hikes, keeping tobacco affordable.

• Tax Shifting: Companies absorb taxes to avoid price increase.

• Loose Sales: Single cigarette sticks still sold despite health warnings (banned in 88 countries, not India).

• Cultural Normalisation: Higher smoking rates in urban areas (5%) than rural (3%).

Way Forward:

India faces a dual burden of tobacco-related cancers and TB prevalence, making tobacco control both urgent and complex.

Recommended Measures:

• Increase Taxes: WHO recommends taxing tobacco at 75% of MRP.

• Raise Minimum Retail Price: Prevent under-shifting by tobacco firms.

• Ban Loose Sales: To ensure exposure to warning labels and reduce impulsive buying.

• Plain Packaging: Reduces product appeal and promotes awareness.

• Enforce Vendor Restrictions: Especially near tea stalls to break the “chai–sutta” culture.

• Boost Cessation Services: Expand public screening and counselling programmes.