When the National Family Health Survey-4 data in the 13 States surveyed showed that tobacco use among men has fallen from 50 per cent in 2005-06 to 47 per cent in 2015, most activists welcomed the trend but have decided to take it with a pinch of salt.
“Let us see what the Global Adult Tobacco Survey (GATS) India report that will be released this year has to say,” observed Dr Prakash C Gupta, Director, Healis –Sekhsaria Institute for public health. Of course, the results are welcome as they show a decrease in tobacco use prevalence, and demonstrate the effectiveness of tobacco control policies implemented during the last few years. Dr Gupta, however, cautioned that absolute numbers are still increasing and there is a need to intensify efforts in advancing tobacco control policies.
Smoking kills over one million people in India annually and is the fourth leading cause of non-communicable diseases (NCD) such as cancer and heart diseases, which account for 53 per cent of all deaths in India. According to the NFHS-4 data not just tobacco use, but also alcohol consumption among men has fallen from 38 per cent to 34 per cent. Over the last decade, consumption of alcohol among men has fallen in Madhya Pradesh, Bihar, Uttarakhand, Haryana, West Bengal and Meghalaya.
“There is encouraging news in this study, but we still have much more work to do to help people quit,” said Dr Pankaj Chaturvedi, head and neck cancer surgeon at Mumbai’s Tata Memorial hospital and among the founder members of Voice Against Tobacco group that includes cancer survivors. “It is significant that there is a downward trend but really there has been no dramatic decrease. What about smokeless tobacco users, bidi smokers, khaini chewers and others who are using it continuously?’’ he asked.
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Increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and sustaining hard-hitting media campaigns are crucial to reduce smoking rates, he added. He also pointed out that the cigarette-smoking rate among adults in the U.S. dropped from 20.9 percent in 2005 to 17.8 percent in 2013, according to new data published by the Center for Disease Control and Prevention. The report also shows the number of cigarette smokers dropped from 45.1 million in 2005 to 42.1 million in 2013, despite the increasing population in the U.S.
India became a party to the WHO Framework Convention on Tobacco Control (FCTC) on February 27, 2005. Since then India has implemented a series of measures leading to the current status of increased social awareness. Soon after signing the WHO FCTC, smoking was completely banned in many public places and workplaces in India — with the new law permitting establishments to create smoking zones within restaurants, airports and hotels having 30 or more rooms.
The Indian government has also clamped down on promotion of tobacco consumption, with a complete ban on advertising under the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA).
There is still the issue of passive smoking. An estimated 10 per cent tobacco related deaths are caused due to passive smoking, said Dr P M Bhujang, President of Association of hospitals in Maharashtra. India was home to 12 per cent of the world’s smokers. When the number of active smokers rises it is also coupled with the threat of passive smoking. Over 40 per cent of children have at least one smoking parent and according to WHO data, children accounted for 28 per cent of the deaths attributable to second home smoke. So a lot still needs to be done to bring down smoking rates, he added.
What is of relevance about the NFHS 4 data is that it has been released when India has stepped up the momentum to implement stricter tobacco laws. From April 1, 2016, the government will implement ‘plain packaging’ as directed by the Allahabad High Court, following a writ petition on the matter. A cancer survivor’s petition for plain packaging of tobacco products has been accepted by the Supreme Court. Umesh Narian Sharma, a 66-year-old advocate of Allahabad High Court who smoked cigarettes, had filed the PIL as four years ago he was diagnosed with tongue cancer. His tongue had to be removed and he cannot speak anymore. He also got cancer in his jaws. According to doctors, he carries a high chance of relapse after surgery at Tata Memorial hospital. The advocate now wants to protect future generations and hence filed a petition for plain packaging of tobacco products as the current pictorial warnings were not adequate, Chaturvedi said.
Currently tobacco products in India have 40 per cent of pictorial warnings on one side. As per the International WHO treaty –FCTC to which India is a signatory- pictorial warnings should be a minimum of 30 per cent on both sides.
Thus, a lot of work remains to be done in a campaign mode. This is essential, especially to prevent easy access to adolescents, said Dr Monica Arora from the Public Health Foundation of India.