Invest In Health, Not In Tobacco

The World Health Organization (WHO) has selected "The WHO Framework Convention on Tobacco Control" as the theme of this year’s World No Tobacco Day, which will take place on Tuesday, 31 May 2011. On World No Tobacco Day 2011, and throughout the following year, WHO will urge countries to put the treaty at the heart of their efforts to control the global epidemic of tobacco use.

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the world's foremost evidence-based tobacco control treaty endorsed by 170 countries, which reaffirms the right of all people to the highest standard of health and provides new legal dimensions for cooperation in tobacco control.

According to the WHO, tobacco use is a major preventable cause of death and disease, causing 1 in 10 deaths among adults worldwide. This year, more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease. That does not include the more than 600,000 people – more than a quarter of them children – who will die from exposure to second-hand smoke. The annual death toll from the global epidemic of tobacco use could rise to 8 million by 2030.

 India is the second largest consumer of tobacco products and third largest producer of tobacco in the world.  Approximately 0.9 million deaths occur in India due to diseases related to tobacco use.  Majority of the cardiovascular diseases, cancers and chronic lung diseases are directly attributable to tobacco consumption.  Almost 40 percent of tuberculosis deaths in the country are associated with smoking.

In fact, according to ICMR, 50% of cancers among men and 25% among women in India are related to tobacco use. Nearly 90% of oral cancers are related to the use of chewing tobacco. States with high prevalence of smokeless tobacco also face the challenge of high burden of oral cancer. Besides oral cancer, smokeless tobacco use is also associated with cancers of food pipe, pancreas, kidney throat and stomach. There is also increased risk of death from cardiovascular diseases among smokeless tobacco users.

The report of the first Global Adult Tobacco Survey (GATS) – India 2010, released in October 2010, presents a dismal scenario indeed. Its results prompted our Minister of Health and Family Welfare, Sri Ghulam Nabi Azad to remark that while livelihood of tobacco growing farmers cannot be endangered, we must work towards moving farmers and farm workers out of the tobacco industry.  ‘We cannot indefinitely tolerate a public health hazard in the name of protecting livelihoods’.

But mere rhetoric would not do. The government would have to free itself from the overpowering control of the tobacco industry and come out openly against their nefarious activities, and at the same time implement the Anti tobacco laws in letter and spirit.

Out of the nearly 70,000 men and women (aged 15 years and above) which GATS India surveyed, 34.6% were found to consume some form of tobacco--47.9% of males and 20.3% of females. A majority of the females used smokeless tobacco. Users of smokeless tobacco (26%) far outstripped smokers (14%).

More than 50% adults were exposed to second hand smoke at home and 29% at public places. This warrants a stricter enforcement of the ban on smoking in public places, which came into being on October 2, 2008. At the same time smokers will have to respect the health of their family members, if not their own, and stop spewing poisonous smoke in their homes.

The most alarming finding of the survey was that the average age of initiation was 17.8 years, with nearly 26% females getting hooked on to tobacco, even before the age of 15 years.
Moreover, nearly 10% minors (15-17 years) consumed tobacco in some form, and were able to purchase them easily, despite COTPA 2003, which forbids minors from selling and buying tobacco products.

Although 61% adults noticed the health warnings on tobacco packs, only 31% thought of quitting tobacco because of the warning label. Clearly this immediately calls for more effective scary and gory pictorial warnings, but we will have to wait till the end of this year for that.

Even in the city of Lucknow, according to a survey conducted by the Department Of Oral And Maxillofacial Surgery, CSMMU, 22.37% residents of the city consumed some form of tobacco. A vast majority of them—69.4% ate gutkha, 17.8% were smokers and 12.9% consumed paan masala. Also, about 3400 people were found to have clear symptoms of oral pre cancer.

 Prevalence of Smokeless tobacco use is high in North East region and states like Bihar, Jharkhand,and Orissa. The rising popularity of smokeless tobacco, (which is falsely considered a safe alternative to smoking cigarettes) amongst men, women and adolescents alike, is indeed a cause for alarm. It is socially more acceptable, particularly in the case of women, to chew various forms of tobacco, as compared to smoking cigarettes. Smokeless tobacco is highly addictive, comes in various forms like gutka, khaini, zarda, paan masala, and is sold cheaply in small sachets. Although the Supreme Court has since banned the use of plastic sachets, it has done little to ban the poison inside them. Goa, seems to be the only courageous state which has banned chewing tobacco. Others need to follow suit.

Enforcement of tobacco control laws is as (rather more) important as enacting them, especially when kids and teenagers are at the receiving end of misleading but attractive advertisements of various forms of tobacco. Sale of tobacco products to and by the minors is a serious offense will have to be dealt with strictly. Similarly, tobacco shops which abound within a 100 yards vicinity of educational institutions need to dismantled immediately. It is just not enough for District Tobacco Control Cells to flaunt the fines collected from the smokers,and to repeat parrot like that the city will be made smoke free.

Dr Ishwar Saran, who heads the Lucknow District Tobacco Control Unit, seems to gloat over that ‘the ban has been successful. Last year we collected Rs 18000 as fine. This year we have already collected Rs 6000. By November 2011, Lucknow will be smoke free’. 

How that will happen is anybody’s guess, when this year in 5 months they could find just 30 smokers in public places. Concerted efforts will have to be made to ensure proper enforcement of laws, and to motivate people, especially youngsters, to quit tobacco. There is no point in making cities smoke free alone. They will have to be made tobacco free.

Dr Paritosh Pandey, Head and Neck Surgeon, Lucknow Cancer Institute, rightly feels that ‘Health is a blessing of which few appreciate the value; yet upon it the efficiency of our mental and physical powers largely depends. Our impulses and passions have their seat in the body, and it must be kept in the best condition physically. The single most important way to achieve this is to Stop Smoking, Stop Tobacco. If one continues to smoke, s/he will have ‘the emperor of all maladies’ -- cancer.’

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email:, website:

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Citizen News Service (CNS), India/Thailand
CNS Tobacco Control Initiative, India
Wikio News, Africa