New Delhi: Every year, tobacco consumption—the largest preventable cause of death worldwide—kills more people than tuberculosis, malaria and AIDS combined, according to Global Adult Tobacco Survey (GATS).
On the occasion of World No Tobacco Day, 31 May, the World Health Organization (WHO) and anti-tobacco campaigners are saying the influence wielded by the industry is the most important factor resulting in ineffective control measures across the world.
Influential tobacco companies are using lobbying and intimidation to water down stronger tobacco control measures advocated by public health activists, WHO said.
Director general Margaret Chan called on “national leaders to be extra vigilant against the increasingly aggressive attacks by the industry which undermine policies that protect people from the harms of tobacco”.
“In recent years, multinational tobacco companies have been shamelessly fuelling a series of legal actions against governments that have been at the forefront of the war against tobacco,” Chan said in a press statement. “The industry is now stepping out of the shadows and into courtrooms.”
By 2030, WHO estimates tobacco will kill more than eight million people every year, with four out of five of these deaths occurring in low and middle-income countries. Tobacco is a major risk factor for non-communicable diseases (NCDs) such as cancer, cardiovascular disease, diabetes and chronic respiratory diseases. NCDs account for 63% of all deaths worldwide.
Among non-smokers, exposure to second-hand smoke is estimated to kill another 600,000 people a year. Almost half of all children regularly breathe air polluted by tobacco smoke and more than 40% of children have at least one smoking parent. While globally smoking trends are on the decline, India is not only the second largest producer and consumer of tobacco, mortality related to it is also rising.
According to latest GATS, 2,700 Indians die every day and one million annually due to tobacco consumption. As per GATS, 47.9% of men and 20.3% of women currently use tobacco in some form or the other.
According to public health experts, the issue of industry interference became most apparent during the implementation of pictorial warnings on cigarette packets.
“This has been a long battle for us starting in 2006 when the industry was told to use skull and crossbones on the cigarette packet so that even uneducated people would understand that the product was dangerous,” said Monika Arora, director of non-profit organization Hriday-Shan and an expert on tobacco-control research. “In the past six years, RTI (right to information) papers have revealed that pictorial warnings were changed owing to industry pressure. Even now, the pictures are blurry and the packets still do not communicate health conditions other than lung cancer.” Kerala and Madhya Pradesh are the only two Indian states that have banned the manufacture and sale of smokeless tobacco products.
Rajeev Dalal, an industry analyst with audit and advisory firm Ernst and Young India, said the Indian government has been much more strict than others while the industry has been far more tractable than it’s given credit for. “The Indian government has taken strong action to enforce smoking bans and the industry has been largely compliant,” he said. “We are the only country where smokeless tobacco consumption is more than cigarette consumption. In case of cigarettes, our industry uses longer filters compared with other countries. The industry also pays very high taxes, whereas the smokeless tobacco industry, being unorganized, is not taxed.”
The 2005 Framework Convention on Tobacco Control (FCTC), the world’s first public health pact, was aimed at reducing tobacco use and exposure to harmful smoke by regulating tobacco products, advertising and sponsorship. In 2008, WHO recommended a package of cost-effective tobacco controls under FCTC called the MPower package, which included measures to reduce tobacco use for every nation.
The solutions include enacting comprehensive smoke-free laws; strong implementation of bans on tobacco advertising, promotion, marketing strategies and sponsorships; pictorial warnings on all tobacco products; strong programmes assisting smokers to quit and a steep increase in the price of tobacco products and taxes.
If implemented as recommended by WHO, the guidelines are seen reducing global adult smoking rates by nearly 44% in 20 years. As a part of the 12th Five-Year Plan, the Indian government is looking to integrate tobacco control measures into other national health programmes addressing non-communicable diseases (NCDs). The question facing India is whether these steps will be enough to offset the mortality caused by NCDs as India may lose an estimated $237 billion in 2004-15 due to premature deaths caused by NCDs such as tobacco consumption, according to Shoba John, who serves on the board of the Framework Convention Alliance.