India tops ‘no tobacco’ labelling, says WHO. But what about second-hand smoking?

What does the report say?

In the fifteen years since the MPOWER measures were first introduced, 5.6 billion people in the world – or 71% of the entire population – are protected by at least one of the measures. This has increased from just five per cent of the population in 2008.

The number of countries implementing at least one MPOWER measure has increased from 44 countries in 2008 to 151 in 2022, according to the report. At least four countries – Brazil, Turkiye, the Netherlands, and Mauritius – have implemented all the measures. Eight other countries are just one policy away.

(Designed by Abhishek Mitra)

“WHO urges all countries to put in place all of the MPOWER measures at a best-practice level to fight the tobacco epidemic, which kills 8.7 million people globally, and push back against the tobacco and nicotine industries, which lobby against these public health measures,” said Dr Ruediger Krech, WHO, Director for Health Promotion.

With a focus on second-hand smoking, the report says that almost 40 per cent of countries now have completely smoke-free indoor public spaces.

The report has some bad news as well. There are at least 44 countries in the world that still do not implement any of the MPOWER measures. There are also 53 countries that still do not completely ban smoking in healthcare facilities. And, only half of the countries have smoke-free workplaces and restaurants.

The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, warns of the dangers of e-cigarettes. In the report, he said, “But progress so far is being undermined by the tobacco industry’s aggressive promotion of e-cigarettes as a safer alternative to cigarettes. Young people, including those who never previously smoked, are a particular target. In fact, e-cigarettes are harmful to both the people using them and those around them, especially when used indoors.”

Why is it important to bring down exposure to second-hand smoke?

The recently released report focuses on second-hand smoking in order to protect bystanders from second-hand smoke by creating smoke-free public areas and also de-normalising the act of smoking in society.

Of the estimated 8.7 million tobacco-related deaths each year, 1.3 million happen in non-smokers exposed to second-hand smoke as per the Global Burden of Disease 2019 quoted by the report. Second-hand smoke has been linked to almost 400,000 deaths due to heart disease, over 250,000 deaths due to chronic obstructive pulmonary disease, over 150,000 deaths due to stroke and lower respiratory disease each, and over 100,000 deaths due to diabetes.

The report also adds that severe asthma, respiratory tract infections, and sudden infant death syndrome are all more common among children exposed to second-hand smoke. Around 51,000 deaths in children and adolescents under the age of 20 years are linked to exposure to second-hand smoke.

How does India fare in the initiatives?

When it comes to India, the report states that the country has the highest level of achievement when it comes to putting health warning labels on tobacco products and providing tobacco dependence treatment.

With 85 per cent of cigarette packs carrying health warnings both in front and back, India figures among the top 10 countries in terms of the size of health warnings on packs of tobacco products. The cigarette packets in the country also carry a toll-free number for a quit line.

The report notes how India has banned the sale of e-cigarettes. It adds that while there is a comprehensive prohibition on tobacco advertising for tobacco products in India, 31 million F1 fans were still exposed to tobacco company messaging and e-cigarette branding while watching the Drive to Survive series and F1 races.

What do experts say?

One of the biggest steps in the works is implementing warnings on OTT platform content when actors are seen using tobacco products. “This would make India the first country in the world to do so. And, it is needed. Movie theatres already display such warnings but they are missing when it comes to OTT platforms. During the pandemic, there was a huge increase in the number of people subscribing to OTT platforms. This content is also readily available to children which means the warnings also have to reach them. The initial warnings on movies were brought in because children and adolescents were seeing their icons smoking on screen and taking it up,” said Binoy Mathew, an expert in tobacco regulation from the Voluntary Health Association of India.

He said that India already has a comprehensive law on tobacco control, but some amendments are needed in the 20-year-old law. “There is a need for the law to ban the loose sale of cigarettes. What we see is that many people, especially college students, buy one or two cigarettes instead of the whole pack which might cost R 350-400. This means they are not exposed to the health warning and quit-line at all.”

He felt there was also a need to increase fines for smoking in public places. “Right now, the fine is just Rs 200. That does not deter people anymore.” He even argued for completely doing away with designated smoking areas with restaurants even serving food and drinks in such areas. “Besides, we still see people selling packs of cigarettes from neighbouring countries that do not carry the 85 per cent health warning.”