If the Health Minister can’t do this, who can? - Dr Anbumani Ramadoss

If the Health Minister can’t do this, who can?

Anbumani Ramadoss

[To read this in Hindi language , click here ]

“I am responsible for the health of the nation”

Tobacco and alcohol together make a perfect recipe for early death

Creativity as an art should be used for improving lives instead of taking them

Healthy criticism and freedom of speech, I always thought, were the strengths of a mature society. As an individual, I have always welcomed criticism – in fact accepted it graciously for it is a participatory process and helps improve performance. But criticism loses credibility when targeted against an individual only because he dares to speak courageously and with conviction against social evils. I have been a victim of this uncalled-for criticism.

Global appreciation

My campaigns against tobacco, alcohol, and junk food have drawn flak within the country, although globally the efforts of the Health and Family Welfare Ministry have been appreciated. I have said time and again that 40 per cent of the health problems in India are due to the use of tobacco in its various forms. Tobacco and alcohol together make a perfect recipe for early death. As the Health Minister of a nation of a billion people, I am responsible for their health and well-being. After the ban on advertisements promoting the use of tobacco products and alcohol, there was a huge debate on banning smoking on screen. I sometimes wonder whether asking personalities not to glamorise smoking and drinking was such an unreasonable demand that the entire film industry should be up in arms against me.

Over a million deaths in India occur due to tobacco use and, according to a World Health Organisation (WHO) study, 15 per cent of school children in India use tobacco. Experts also say smoking scenes in movies are more effective than direct forms of tobacco advertisements. Surveys have shown that 52 per cent of youngsters start smoking after being influenced by movies.

It is, therefore, not difficult to imagine the kind of impact smoking in films has on our youth, particularly in the context of more brand visibility of cigarette companies in films. India produces the largest number of movies in the world (900 in 2001). In the 1950s, 30 per cent of films had smoking scenes with the percentage touching 89 in 2004. It is equally important to consider the characters depicted as smokers in the movies. In the 1950s, only villains or the ‘bad guys’ smoked on screen. Now, 76 per cent of the smoking scenes are by heroes and lead characters. Is it unreasonable if at least this influence on our youth could be reduced?

Godfrey Philips Red and White Bravery Awards are given to 10 people for saving 10 lives but, ironically, the tobacco company causes the death of three million people worldwide annually!

No different is the case of alcohol use. In the past 15 years, alcohol production has increased from 900 million litres to 2.3 billion litres, making India the largest consumer of alcohol in the Southeast Asian region. India alone consumes 65 per cent of the region’s total production. The average drinking age has come down from 28 years to 19 years. Experts predict that it will further come down further to 15 years in the next 5-7 years.

India’s strength is its 600 million people below the age of 30. They are our assets for nation building. They are also at risk of getting addicted to tobacco, alcohol, drugs, and junk food that is extremely unhealthy. I categorically state that all four are potential killers. Two-thirds of India’s deaths are linked to tobacco, alcohol, and junk food. Do these figures not give my critics enough food for thought?

To prevent these youngsters from becoming a liability to their families and the nation, they need to be made aware and educated. Alcohol not only destroys individuals but also families. One-third of road accidents are alcohol-related. Let us not behave like ostriches. It is time we addressed these issues boldly.

Creativity as an art should be used for improving lives instead of taking them. Today drinking is characterised as macho, youthfulness, and acceptability in elite social circles. Yes, India is growing economically – its social indices are showing an improvement. Let a small campaign and a little awareness give it a fillip. Tamil actor Rajnikant’s two latest movies were smoke-free and both were the biggest hits in the history of the Indian film industry. I wish some of the celebrities could come forward to tell the people that a can of Pepsi/Coco-cola contains 5-7 spoonfuls of sugar and a packet of chips contains 500 calories, and also its adverse impact on the health of its users.

We do not overlook the impact Amitabh Bachchan has had on our Pulse Polio campaign as a brand ambassador, or the contribution of our celebrities in promoting several campaigns under the National Rural Health Mission. It would be a service to humanity if this impact were replicated in removing social evils.

WHO has also warned that India is moving from a pattern of communicable disease to non-communicable diseases like cancer, diabetes, cardio-vascular ailments, and mental health disorders. All these are linked heavily to alcohol, tobacco, and junk food. The recent Lancet study linking India with early heart attacks is alarming (Treatment and outcomes of acute coronary syndromes in India: a prospective analysis of registry data by Denis Xavier, etc. al., The Lancet, Vol. 371, April 26, 2008, pages 1435-1442).

Still, surrogate advertisements have increased with the latest platform being the Indian Premier League cricket matches, which have a massive viewership. The Indian Cinematography Act, 1952 prohibits glamorising smoking in movies but the law is violated and there is not a word of protest from anywhere. An efficient Censor Board would not be keeping quiet on the glamorising of alcohol and tobacco and the vulgar depiction of obscenity in movies.

The Health and Family Welfare Ministry has already taken several measures to curb this menace because the situation warranted this. The Centre has allocated Rs. 450 crore for the National Tobacco Control Programme under the 11th Five Year Plan. It has initiated a smoke-free workplace policy and set up a Tobacco Regulatory Authority. Besides, it is in the process of making a pictorial warning mandatory on tobacco products. The District School Tobacco Programme also focuses on creating awareness against the adverse impact of the use of tobacco and alcohol. We have initiated a National Programme on Prevention and Control of Diabetes, Cardio-Vascular Diseases and Strokes. These are mostly lifestyle diseases related to smoking, drinking, and unhealthy food habits.

Some people have the tendency of cribbing that the Health Ministry has not done much in the basic rural health scenario. The United Progressive Alliance government under the stewardship of Prime Minister Manmohan Singh and UPA chairperson Sonia Gandhi conceived the National Rural Health Mission (NRHM), the biggest programme in the history of the health sector in India. Its goal is to reduce IMR, MMR, TFR, and the disease burden, increase nutrition, sanitation, the provision of clean drinking water etc. where 75-80 per cent of the budget of the Union Health Ministry is spent.

WHO, U.N. bodies like UNICEF, UNFPA, UNAIDS, and UNOPS, and Jeffrey Sachs, Director of the Earth Institute, Columbia University have acknowledged the improvement in the public health care delivery system in rural areas because of the implementation of NRHM; and, in fact, have suggested to other developing countries to replicate NRHM. This year, out of the total budget of Rs. 16,500 crore for the Health Ministry, nearly Rs. 12,200 crore have been allocated to NRHM. About 5.44 lakh accredited social health activists (ASHAs) have been appointed and the number of auxiliary nurse midwives (ANMs) increased from 1.40 lakh to 1.75 lakh. The number of nurses has been increased from 22,000 to 32,000 in primary health centres (PHCs) and doctors from 20,000 to 30,000. The number of specialists rose from 3500 to 6500 in the last two years. There is evidence of a substantial increase in institutional deliveries – 55 lakh women were covered under Janani Suraksha Yojana for institutional deliveries. There has also been an Improvement in immunisation coverage throughout the country. More than 9000 PHCs made 24x7 functional.

Among the other achievements of the Health Ministry, I can cite many but would like to point out the important ones: the establishment of a Central Drug Authority on the lines of USFDA for eradicating spurious and adulterated drugs and increasing the quality of all pharma products; the establishment of the Central Food Authority for bringing in global quality standard for food in India; the National Programme on Speech and Hearing; the National Emergency and Trauma Programme; and the new Department of Health Research. The 10th Plan allocation was Rs. 42,000 crore. A huge increase in the 11th Plan allocation to Rs. 1,36,000 crore would show the determination of UPA Government to improve the health sector.

The Integrated Disease Surveillance Programme (IDSP), the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), the National TB Control Programme, the HIV/AIDS Control Programme, the National School Health Programme, the National Programme on Human Organ Transplantation (which focuses on cadavaric transplant), Health Insurance for the Poor, the Clinical Establishment Act to streamline all hospitals and laboratories to Indian Public Health Standards, the recognition of foreign PG degrees of English-speaking countries, the Golden Triangle Project, and the allocation of Rs. 120 crore to carry out research in Ayurveda, Siddha, Homoeopathy, Unani, Yoga and Naturopathy, etc. testify to the focussed performance of the Health Ministry. What could not be achieved during the last 40 years in the health sector has been achieved in a four-year period by the UPA government.

Doing my duty

I am just doing my duty as a Health Minister to protect the lives of millions of innocent young men and women who will be affected by these killers. I refuse to be cowed down by industry-sponsored campaigns and articles. The media too have an important role to play in creating awareness. I urge them to highlight the various achievements of the Health Ministry, which will help the Government to reach the people in a focussed manner.

If the Health Minister should not address these issues, then who should?

(Dr. Anbumani Ramadoss is the Union Cabinet Minister for Health and Family Welfare।)

Published in The Hindu, Sunday, 11 May 2008

[To read this in Hindi language , click here ]