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The Indian government has left no stone unturned in the fight against tobacco consumption. Rajasthan, Punjab and Uttar Pradesh have been successfull in this initiative.
They say that everything has its pros and cons. Well, it doesn’t always hold true, at least not in the case of tobacco. The only legal drug in most parts of the world, tobacco is conquering all and siphoning life worldwide. In 2008, the World Health Organisation (WHO) named tobacco as the world’s single greatest preventable cause of death. Globally, the regulating bodies are realising the need to curb this harmful substance and are devising various initiatives to control it. To address the global burden of tobacco, the World Health Assembly in 2003 unanimously adopted the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC). In force since 2005, the main objective of the WHO FCTC is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. Ratified by 180 Parties as of March 2015, the WHO FCTC currently covers about 90 per cent of the world’s population.Though it seems unbelievable when one sees the current rate of tobacco consumption, it has significantly reduced. Comparing Global Adult Tobacco Survey (GATS) I (2009-10) and GATS II (2016-2017), it is derived that the prevalence of tobacco use in India has been cut down by six percentage points.
The graph shows relative reduction of tobacco users from GATS I to GATS II
India has come a long way in controlling the use of tobacco.There have been significant measures taken up by the Central government as control initiatives.
The introduction of GST, imposing 28 per cent GST tax with an additional five per cent cess levied on branded cigarettes, has been positive step taken by the government. These strategic measures are considered an effective means of reducing tobacco consumption and curtailing its demand.
The Ministry of Health and Family Welfare (MoH&FW) has also launched the National Tobacco Control Programme (NTCP) in 2007- 08 in 42 districts of 21 States/Union Territories of India. Under the programme, Tobacco Cessation Centres (TCC) were setup to provide counseling to tobacco users for quitting the tobacco addiction. Recently, Union Minister of Health and Family Welfare conferred the WHO Director-General’s Special Recognition Award for global tobacco control. On the occasion JP Nadda, Health Minister, MoH&FW informed that the government has implemented large pack warnings with 85 per cent pictorial health warnings on both the sides, strengthened cessation facilities with the launch of the toll-free National tobacco Quitline and mCessation services and have made substantial investment under the 12th Five Year Plan for expansion of NTCP. He further added that India has also put a ban on smokeless tobacco products and has strengthened the implementation of the tobacco free film and television policy.
With an alarming 27 crore users, tobacco consumption in India is still second largest in the world. Although Central Government is putting in all the efforts, a collective endeavour by the State governments and NGOs will help repress the consumption.
State initiatives
In 2003, The Cigarettes and Other Tobacco Products Act (COTPA) was introduced which dealt with prohibition of advertisement and regulation of production, supply distribution and trade and commerce of tobacco products. With this parliamentary act, WHO ushered member states to implement measures to provide non-smokers protection from involuntary exposure to tobacco smoke. Many initiatives have been taken up by individual states in collaboration with NGOs to impose regulations.
Rajasthan
The Government of Rajasthan is working on NTCP, which is currently being implemented in all 34 districts of the State. A state level coordination committee has been constituted in order to ensure that coordinated efforts are made by all key departments including Home, Medical & Health, Finance, Agriculture, Rural Development, Panchayati Raj, Law, Education, Forest & Environment. Various campaigns have been initiated which aim at deterring the demand, creating awareness and assisting to quit. Dr Rakesh Gupta, President, Rajasthan Cancer Foundation has stated that the state levies highest tax of 65 per cent on all tobacco products which will discourage the demand. In February, 2017 a campaign was carried out all over the State in which marathon race/ rallies were held in all blocks & districts to create awareness and a total of 1.78 lakh challan were made in a single day. This largest mass mobilisation campaign was recorded in World Records India. Separate income head for depositing the challan money collected has been created by the state government. Total 1.99 lakh challan were made and Rs 28.04 lakh was collected in 2016-17. Tobacco cessation centres are also made operational in 16 districts in which 12,282 tobacco users were counselled during 2016-17. Besides this, toll free Quitline (PAHAL) was made operational through 104 (medical advice service) and 108 (emergency helpline) for providing cessation help to tobacco users wishing to quit. Naveen Jain, Mission Director, National Health Mission (NHM), stated that funding for these programmes comes from the state government and pointed out that the NGOs can get access to the state funding to initiates control drives. Dr SN Dholpuria, State Nodal Officer, Tobacco Control Programme informed about another drive which includes charging penalties for public smoking and Rajasthan has fined 2.38 lakh violators which is maximum for any state across India..
Punjab
Under COTPA, all 22 districts of Punjab have been declared as tobacco smoke free districts on the basis of compliance study by PGI Chandigarh. Various campaigns have been executed at all levels- state, district and village. A month long ‘World No Tobacco Day’ campaign was launched flagging off the publicity van that visited more than 110 towns of all the districts of Punjab and also covered more than 250 schools to create awareness among the people, especially the youth, about the ill effects of tobacco through posters, audio and video clips.
Dr Rakesh K Gupta, Mission Director, NHM, revealed that the state of Punjab has lowest prevalence of tobacco use in country. Tobacco use among men has declined from 33.8 per cent (NFHS-3) to 19.2 per cent (NFHS-4) and in women from 0.8 per cent to 0.1 per cent during last 10 years, which is lowest among all the states of the country. Tobacco Control Cell, Punjab is now aiming to put an end to tobacco by further reducing prevalence of tobacco use to five per cent by year 2025.
In regards to the policy of no smoking in public, 26,909 people were penalised in year 2016-17 and 5,087 April-May 2017. The state also observes a ‘Punjab State No Tobacco Day’ which is celebrated on November 1, with different theme each year.
Uttar Pradesh
In Uttar Pradesh, NTCP has been implemented in 75 districts. Satish Tripathi, State Consultant, NTCP gave details on the various enforcement activities active in the state, one of which includes state’s association with selected 70 NGOs. These NGOs will cater to 70 schools each (approx 10 lakh students) to create awareness about the ill-effects of tobacco in an year. To further reduce the consumption of tobacco, he shed light on the ban on loose cigarettes. There have been cessation centres set up in 72 districts to help people quit tobacco consumption and the state will urge more officers to counsel against tobacco.
NGOs and organisations:
Different stakeholders are collaborating with the state and Central Government in order to weed out tobacco. The government is driving these initiatives through prominent NGOs and organisations including hospitals and cancer institutes. For instance, training programmes in Rajasthan are run by Rajasthan Cancer Foundation in various districts for capacity building. Under this programme four people are appointed, namely district tobacco control consultant, counsellor, social worker and a data manager. These doctors, once trained, will create awareness among tobacco users, about treatment options available and to empower subordinate staff.
Another drive ‘Coalition Against Tobacco’ is a representative body formed by the collaboration of more than 40 NGOs which hold the view of taking a proactive stance of nipping the trouble of tobacco in the bud. The coalition has written an open letter to Narendra Modi, Prime Minister, India, on the occasion of World Environment Day elucidating the negative environmental impacts of cultivation and processing of tobacco.
Recommendations
Despite immense effort being put up collectively, there still remain a lot of hurdles to be overcome. Multiple challenges need to be turned around in order to create a tobacco less environment and curb NCDs caused by tobacco. Jain highlighted the revenue involved as a major obstacle to imposing a higher tax. And even though the government is imposing high tax in some states, many other face the resistance from tobacco lobbies and are helpless. There is a need for measures to be taken to handle these activities. A few measures have been taken up internationally for instance, Bloomberg & Bill Gates launched the Anti-Tobacco Trade Litigation Fund, which is a joint effort to combat the tobacco industry’s use of international trade agreements to threaten and prevent countries from passing strong tobacco-control laws. India has also signed a treaty with WHO which states that Government of India will not interact with tobacco industry. If at all it is necessary, it will interact in a transparent manner. This has to be efficiently implemented to reduce the stronghold of tobacco players. Deepak Misra, Executive Director, Socio Economic and Educational Development Society (SEEDS), an NGO involved in creating awareness on the ill-effects of tobacco consumption, suggested that the supervision of training programmes along with the drives conducted should be improved. He added that recruitments drives should be carried out against the positions available in NTCP to increase the workforce. Dr Gupta, NHM also mentioned the fact that taxes on tobacco products in India fall way below the rate recommended by the World Bank, which is 65 per cent to 80 per cent of retail price.
The tobacco epidemic is devastating– but preventable and the fight against tobacco must be engaged forcefully and quickly. Going forward, the government might consider these recommendations in accordance to bringing an end to tobacco manufacturing as well as consumption.