A few years ago, I remember reading a heart-wrenching letter written by a father, who was dying with lung cancer, to his young son. It was published in one of the leading newspapers in Toronto, Canada. The father asked his son to forgive him for his selfishness. Unlike other fathers, he would not be there for his son at several important milestones in his life, simply because of a craving that he had been too stubborn to give up. It is estimated that tobacco kills approximately 11,000 people everyday. It has become the second major cause of death worldwide. It is estimated that by the year 2020, 7 out of 10 deaths because of tobacco will occur in our part of the world. How many more lives will be destroyed before we wake up and begin to think of those who love and depend on us?The realisation that inhalation of side-stream smoke from the lit end of a cigarette placed the person sitting in the vicinity of the smoker at equal, if not greater risk, was in many ways a turning point. What was earlier considered a private, or at most a family matter, was now of concern in the public domain. Passive smoking affected everyone, whether you were a smoker or not. Today, we have legislation all over the world that seeks to restrict, if not prohibit, smoking in public spaces. But what has perhaps had the greatest impact in bringing down rates of smoking, certainly in America and Canada, has been the zero tolerance that many people today openly display towards smokers. Unfortunately, this is not the norm in our part of the world even though India is a signatory to the WHO Tobacco Treaty which came into force on the 27th of February 2005.Tobacco companies are having a field day in India and China. They are taking advantage of the fact that there is a glaring lack of awareness among the general public here about the ill effects of tobacco. What is to be lamented is that even now we do not have an effective and widespread health education campaign aimed at reducing tobacco use. Cancer Care India (CACI), an umbrella organisation of cancer support groups, has recently launched a nation-wide cancer awareness programme, which focuses on tobacco. The urgency to do this derives from the fact that more than 50% of cancers among males in this country are in sites that are directly related to tobacco use (oral cavity, throat, voice box, lung). Besides, tobacco is implicated in the incidence of coronary heart disease, cerebro-vascular disease and chronic obstructive lung disease. By becoming a signatory to the WHO Tobacco Treaty, India now has an obligation to take concrete steps to highlight the dangers of tobacco use as well as curb the promotion of tobacco in any manner. While putting a tax on cigarettes and making them more expensive is one way of doing this, in our context it will not achieve very much as the majority smoke bidis and also chew tobacco.Besides, the addictive nature of nicotine in tobacco, the advertisements that depict smoking as a glamorous lifestyle choice and the social side of tobacco all make it hard to resist. In America today, lung cancer has become the number one cancer among women, overtaking breast cancer. There is no reason to believe that tomorrow, in the urban centres of India, we shall not follow suit.The connection between poverty and tobacco use is particularly pernicious in a developing country such as India, as the burden of ill health and the premature death of a primary breadwinner, usually spells doom for the entire family. The nation, too, has a great deal to lose in terms of number of productive man days lost and expenditure on public health. It is time to take stock of the situation and start thinking beyond excise revenues.The writer is president of CanSupport (caring for people with cancer)
