Red ink or black death?

India, as usual, figures in the report for the wrong reasons. It is emphatic in its judgment: "The biggest and sharpest increases in the disease burden are expected in India and China, where the use of tobacco has grown most steeply." That should be a good reason for any government concerned with the health of its citizens to seize the opportunity gifted to it by the Rajasthan High Court, on whose directive Nirman Bhavan got cracking on gutka. Responding to a PIL, the court had directed the authorities to establish whether chewing tobacco is injurious to health, and that if it is proved to be so, gutka should be banned without any further reference to it. All that the committee set up by the Directorate-General of Health Services did was reiterate what has been known since1902, when a British doctor at the General Hospital, Madras, first linked chewing tobacco with oral cancer. Yet, New Delhi is letting an opportunity slip by.

The reason is the same as that which stymied the comprehensive anti-tobacco legislation mooted by the P. V. Narasimha Rao dispensation. The economic ministries see red ink the moment health professionals plead for tobacco control. The finance ministry throws up its hands in despair at the thought of the nation’s excise kitty being poorer by over Rs 3,500 crore each year if controls are introduced (as if anyone is calling for an immediate and complete ban on tobacco, which in itself is an impossible proposition). The commerce ministry raises the bogey of export earnings loss. The agriculture ministry cries hoarse about the plight of tobacco farmers. And the labour ministry bemoans the impending doom staring at the seven million tobacco industry workers. In the face of such opposition, Nirman Bhavan goes back to doing what it is best at — sitting on itshands, raising one occasionally to lift the endless cups of sarkari tea that move on its conference table.

The health ministry must know better than others that the economic argument doesn’t work. One of its agencies, the Indian Council of Medical Research, in fact, has been spending years tabulating the health costs of tobacco. Its preliminary calculations reveal that patients of tobacco-related cancers, coronary heart disease and chronic obstructive lung disorder were spending Rs 2,750 crore a year on diagnosis and treatment in the early ’90s. This is a generous estimate, for it does not account for the element of government subsidy in the public health-care system or the loss of wages due to chronic illness. And this figure is only going to rise if the WHO projections are proved right by a government whose left hand stops its right from moving. So, not only is the nation paying for the health fallout of tobacco use, but also its scarce resources are being spent to subsidise institutions like theCentral Tobacco Research Institute, which was allocated Rs 284 million in the Eighth Plan. Even its forex-earning capacity is limited — at present, it contributes a minuscule 0.8 percent, but with tobacco consumption in the established market economies going down because of heightened awareness, there’s not going to be much of a market left for the commerce ministry to get exercised about. Similarly, tobacco’s contribution to agriculture is offset by its cost to environment, because the process of curing tobacco is fuel-intensive and leads to many trees being felled — it is said for every 300 cigarettes produced in this world, someone, somewhere has killed a tree.

Anyway, doomsday scenarios just don’t work because it is no one’s case that tobacco production and consumption be banned forthwith. For starters, New Delhi, acting on the mandate of the Rajasthan High Court, can issue notices to the gutka industry to wind down production in five years. That will give the industry enough time to move itsresources to other sectors. New Delhi can also ask its financial institutions to withdraw their stake in cigarette companies (it is estimated to be 39 percent) within a specified time-frame. It’ll be an investment for the health of the nation. But what is needed now is the political will to tax the bidi industry according to the deleterious health costs of its products. Today, a bidi costs a tenth of a cigarette, but delivers the same amounts of tar and nicotine. So, why shouldn’t the two cost the same? The tax component of tobacco products, in fact, must be pegged to their tar and nicotine content. Will that be too much to expect, Mr Finance Minister?