Its high time India kicked the butt

It's high time India kicked the butt

Every year, on May 31, the World Health Organization and global partners celebrate World No Tobacco Day. Though cigarettes are becoming costlier by the day, the fact also is that smoking and smokeless tobacco kills nearly 6 million people worldwide – one death every 6 seconds – each year

Swati Subhedar

Swati Subhedar   31 May 2019 1:36 PM GMT

Swati Subhedar and Shivani Gupta

"I didn't even know chewing tobacco is so dangerous. Only after I fell sick did I realize that it could have killed me. Now, I beg people not to smoke or chew tobacco," said Rekha Mishra, 80, a resident of Hari Gaon village in Lakhimpur district, Uttar Pradesh. She was undergoing cancer treatment at Civil Hospital in Lucknow.

"Every cigarette reduces your life span by 14 minutes. It increases probability of lung cancer by 20-25 times, and heart attacks by 2-3 times. It also increases chances of sudden death by three times," said Dr Ashutosh Dubey, medical superintendent at Civil Hospital, Lucknow.

If you consume tobacco in any form, please read this story carefully.

If you don't, we still suggest that you read this. Your lives are at stake too.

According to the World Health Organization (WHO) study, tobacco kills half of its users. Smoking and smokeless tobacco kills nearly 6 million people worldwide – one death every 6 seconds – each year.

40% of Indian adults are exposed to second-hand tobacco smoke at home. These are people who don't smoke themselves, but are vulnerable to various diseases because someone at home does. Despite regulation on public smoking, 30% adults are found exposed to second-hand tobacco smoke at work, says another WHO study.

Every year, on May 31, the World Health Organization (WHO) and global partners celebrate World No Tobacco Day (WNTD). The annual campaign is an opportunity to raise awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form.

"If we have to keep our cities tobacco free then we have to start from our homes. About 60 lakh people die in India due to direct or indirect intake of tobacco every year," said Prof. MLB Bhatt, vice chancellor of King Georges' Medical University, Lucknow.

Tobacco kills, but who cares?

According to a recent report by the Indian Council of Medical Research (ICMR), tobacco accounts for about 30% of all cancers in men and women in India. Mouth cancer is the most common among men followed by lung cancer. Tobacco-related cancer accounts for 42% of all male deaths due to cancer and 18.3% of all female deaths.

"Tobacco accounts for one-third of total number of cancer cases. 20% of heart related diseases occur due to tobacco consumption. Tobacco consumption is also responsible for 65 types of other diseases. The average age of the person consuming tobacco automatically reduces by 10 years," added Bhatt.

Dr Ashutosh Dubey, medical superintendent at Civil Hospital, Lucknow, said: "Cigarette smoke releases 4,000 types of chemical elements -- Nicotine and tar are the main ones. Various researches have proved that 580 out of 4,000 chemical elements are carcinogenic."

He added: "Majority of tobacco smokers die due to heart attacks. Tobacco consumption makes men impotence and women have to deal with infertility and other issues related to reproduction. Mouth ulcers, bad breath and wrinkles are common issues. Smoking at home could lead to family members, especially infants, suffering from pneumonia, breathing problems, asthma and lung problems."

What is rural India smoking?

According to Global Adult Tobacco Survey 2 (GATS 2), released by the Ministry of Health and Family Welfare last year, every tenth adult in India smokes tobacco — 11.9% in rural areas and 8.3% in urban areas.

The most commonly used tobacco product in India is khaini, that is used by every ninth adult (11.2%). The next most commonly used tobacco product is beedi, smoked by 7.7% of adult Indians. Gutkha ranks third (6.8%) and betel quid with tobacco ranks fourth (5.8%).

Beedis are the most commonly consumed tobacco product by the poor. Beedis alone contributed to 5.8 lakh deaths in the country in 2011, according to last available data.

According to estimates, the beedi industry is worth ₹7,000-7,500 crore in India. The industry has the largest number of factories in Chhattisgarh, Bihar, West Bengal, Karnataka and Madhya Pradesh. There are nearly 2,000 beedi manufacturing companies in India. Out of 8 million beedi people who work in these factories, nearly 70% are women who belong to tribal and rural areas. The women engaged in beedi-rolling are paid ₹88 for rolling a thousand beedis.

Most of the manufacturing units in villages don't even provide basic safety to women who roll beedis with their bare hands. "I have been working in this bidi making factory since past 3 years. Though I wash my hands before going home, but my hands smell of tobacco all day. I have a 2-year-old at home. My doctor tells me that my health, and because of me, my kid's health is at stake because of direct exposure to tobacco," said Sanoti Kavde while rolling beedi with her bare hands in a factory in Durg, Chhattisgarh.

What does the law say?

A 'Cigarette Package Health Warnings: International Status Report' was released by the Canadian Cancer Society last year. It documents global progress on plain packaging. India has been ranked fifth in the listing of countries that have pictorial health warning on tobacco products.

A notification by the Health Ministry on September 24, 2015, for implementation of the Cigarettes and other Tobacco Products (Packaging and Labeling) Amendment Rules, 2014, came into force on April 1, 2016. These prescribe larger pictorial warnings, covering 85% of packets on tobacco products.

The current pictorial warnings on both sides of all packets of cigarettes, beedis and all forms of chewing tobacco products in India came into effect in 2016 on the direction of the Rajasthan High Court and, subsequently, the Supreme Court of India.

However, the cigarette manufacturing companies, including the multinational corporations and small beedi-making units were not amused. Major cigarettes manufacturers, including ITC, Godfrey Philips and VST, had shut all their factories in the wake of the ruling.

The companies, which are members of Tobacco Institute of India and account for more than 98% of the country's domestic sales of duty paid cigarettes, had claimed the estimated production revenue loss of over Rs 350 crore per day for the tobacco product manufacturers.

All India Beedi Industry Federation, a body of over 240 manufacturers controlling over two-third of total branded beedi production, said the loss due to stopping production will be around Rs 200 crore daily.

'Budgeting' of cigarettes

Last year, after almost six years, tobacco industry got a breather of sorts when Finance Minister Arun Jaitley did not announce any change in taxation or anti-tobacco initiatives. It had come as a big relief to cigarette companies which have seen a staggering 202% tax growth since 2011-12.

The price of cigarettes has risen significantly in recent months, but that has not deterred the country's smokers much. And the prices could rise even further. Broking house India Infoline believes there is room for further price hikes, an estimated 8% hike in each of the next two years until March 2021.

Cigarette prices have been consistently rising since 2014, largely due to rise in the government levies that aim at pushing people to quit smoking. Companies then pass on the rise in duties to smokers.

The good news is that the number of smokers in India has come down drastically in the last decade. According to one estimate, India will have halved the proportion of smokers in the twenty years by the end of 2020.

How to create awareness in rural India?

Dr Ravi Mehrotra, Director of National Institute of Cancer Prevention and Research, said: "The market for e-cigarettes and other such devices is growing rapidly, with the industry bringing in a diverse set of products through a variety of channels."

In a white paper released recently, it was noted that e-cigarettes and other such devices contained not only nicotine solution, which was highly addictive, but also harmful ingredients such as flavoring agents and vaporizers.

While it's relatively easy to create awareness in urban India, what about rural India?

"In rural India, 69% of non-smokers suffer because of passive smoking, which is as harmful as active smoking. Smoking tobacco affects a smoker by 30%, but the person who inhales it passively, it affects him 70%. In other words, infants and women in villages suffer the most," said Surya Kant, pulmonologist at King Georges' Medical University, Lucknow.

He added, "In urban India, people greet you with biscuits and beverages. But in rural India they greet you with beedis. Elders often ask children to lit beedis for them. Kids, in turn, ask their mothers to lit a beedi from a chulha. She has to take 2-3 puffs in order to lit it. In villages, most of the youngsters start smoking before they turn 18."

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