Stronger action warranted against smokeless tobacco and 'bidi': Report

Download the Summary Report: What more should India do to stop smokeless and smoking tobacco use? here
Stronger measures should be in place to control smokeless tobacco and 'bidi' smoking as majority of tobacco use in India is in those forms, while India strengthens measures to control cigarettes. A report released in Lucknow on 16 August 2011 (download here) made a set of recommendations to Ministry of Health and Family Welfare, Government of India, to strengthen programmes addressing smokeless tobacco use and 'bidi' smoking in India.

"More resources should be earmarked for advocacy initiatives to sensitize politicians, government officials and seek inter-ministerial collaboration to streamline and harmonize control of all forms of tobacco use with other health and development government programmes" said Shobha Shukla, a co-author of the report who leads CNS Tobacco Control Initiative and also is part of Indian Society Against Smoking, Asha Parivar. Shobha has taught at Loreto Convent Inter College for over thirty years and is a noted gender, human rights and health activist.

"Law enforcers are not strictly implementing existing tobacco control laws. Unless we increase monitoring and evaluation of tobacco control laws at all levels, and enforce existing laws optimally, not much will be achieved in terms of desirable public health and social justice outcomes. Existing tobacco control laws must be stringently implemented at all levels" added Shobha Shukla.

"Laws to control all forms of tobacco use among children and young people must be enforced strictly without delay. Government notifications and other legal requirements should be completed without any further delay. It is important to reduce number of children and young people who initiate any form of tobacco use in all settings (urban, rural)" said Rahul Kumar Dwivedi, a youth activist with ISAS, Asha Parivar who coordinates the Citizens for Healthy Lucknow (CHL) Initiative.

"No form of tobacco must be sold within 100 yards of any educational institution – this law must be implemented without delay. No form of tobacco must be sold by/to minor children/ young people. Law must be strictly enforced and training, monitoring and evaluation should be robust to ensure proper compliance" added Dwivedi while enumerating specific recommendations made by this report.

"Since bidi smoking and chewing tobacco are major forms of tobacco consumptions in India, tobacco control measures specific for these two forms of tobacco use should be stronger, strictly implemented and closely monitored for optimal public health outcomes. For instance, stronger pictorial health warnings should be printed on bidi and chewing tobacco packs, taxes on bidi and chewing tobacco, cessation programmes sensitive to bidi and chewing tobacco, regulating content, manufacture and sale of bidi and chewing tobacco, ensuring the ban on their sale within 100 yards of any educational institution is in place and teachers, healthcare providers, law enforcers and other adult professionals do not use these forms of tobacco while on duty must be ensured among other required measures" said Professor (Dr) Rama Kant, a World Health Organization (WHO) Director-General's Awardee 2005 and President-elect, Association of Surgeons of India (ASI) 2012.

"Government-run and civil society’s Tobacco control programme must join hands with environment advocates in the government and civil society at large – to strengthen anti-spitting laws and pollution caused by gutkha or chewing tobacco sachets. Chewing tobacco in public places should account as cognizable offense as it sends out wrong and misleading messages for children and young people, and cause environmental pollution and health hazards to others due to spitting. Stricter measures to ban/ regulate sale of tobacco containing tooth cleaning powder should be in place. Stronger pictorial warnings emphasizing tobacco as one of its contents ban on sale to or by minor, increasing taxes, and cessation programmes should be in place to control this form of tobacco use" said Prof Rama Kant who has earlier served as Chief Medical Superintendent of Gandhi Memorial and Associated Hospitals, King George's Medical College (KGMC).

Other recommendations made in this report include:
- Strong measures to control hookah bars and parlours are needed. Bombay High Court order and other measures are not enough to control hookah parlours across the country. Clear policy directives and legal framework should be defined at the earliest to curb hookah use and restrict their access or availability to minors. The sale of Hookah in open market is another serious cause of concern. Sale of hookah should be strictly regulated and banned to/ by minors just in case of other tobacco forms.

- Regulating content, manufacture, sale of non-tobacco forms of chewing pan-masala or sweet supari or candy cigarettes is important and policy and legal measures should be taken to control these pre-cursors to tobacco use and also because they cause serious health hazards on their own too

This report was published by the CNS Tobacco Control Initiative, Asha Parivar, and Indian Society Against Smoking (ISAS). ISAS and CNS facilitated a time-limited focused online consultation (16-31 July 2011) on Tambakoo Kills electronic discussion forum (eForum) and blog and interviewed a diverse range of young people on 6th August 2011 in Lucknow.

Senior tobacco control advocate Dr Mira Aghi's article made a strong case why India cannot neglect smokeless tobacco use while strengthening response to controlling smoking forms of tobacco. Dr Aghi’s article is available online here.

Guiding question was: "What do you think are key measures India can take to improve responses to control all forms of tobacco - smokeless and smoking both?"


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Citizen News Service(CNS), India/Thailand
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