Sep 11, 2008

India - Leads 'Anti-Tobaco Initiative'

India has been one of the global leaders in negotiating the World Health Organisation (WHO) treaty on Framework Convention on Tobacco Control (FCTC) and in taking effective measures to control the use of tobacco products. It is now playing an equally important role in negotiating another treaty that would check illegal trading of tobacco products across the international borders, says Douglas Bettcher, Director, Tobacco Free Initiative, in an interview to The Hindu. The Initiative, established in July 1998, focusses international attention, resources and action on the global tobacco epidemic. How do you think India has fared in campaigning against tobacco use across the world?
India has been one of the leaders in negotiating the World Health Organisation’s first treaty on tobacco control. The U.N. Framework Convention on Tobacco Control (FCTC) — as it is known — is now one of the most successful treaties in United Nations history and it now has over 160 countries as its member states, covering 85 per cent of world population.
India is now active in negotiating the next treaty under the U.N. Framework Convention on Tobacco Control. This would lead to a protocol on the elimination of illegal trading of cigarettes. Unauthorised sale of cigarettes across international borders poses a serious security threat as money from its sales is laundered, with some suggestions of this being linked to terrorist groups and also a huge loss of revenue to the countries because no taxes are paid.
Second, these also threaten public health as these products are cheaper and highly appealing to young people. They are cheap but do not carry any warnings and do not comply with any health guidelines or laws.
The idea is to develop an international protocol to increase cross-border collaboration between countries to eliminate smuggling and illegal business of legal as well as counterfeit cigarettes. The second round of negotiations will be held in October, and the parties are now in the process of negotiating the actual text of the protocol.As far as national anti-tobacco laws in India are concerned, how effective has the implementation been?
India has moved forward in announcing a ban on smoking at all public places from October 2 including restaurants, bars and workplaces. Similar measures have been successful in countries like Uruguay, Ireland, U.K. and over 90 per cent of the population is supportive of these measures.
In fact, the tobacco industry usually comes out with the propaganda that such steps would hurt their business, but research shows that the number of countries that have implemented the ban have displayed no such trends.
The mandatory use of pictorial warning on tobacco product packages from December 1, is another major step towards the implementation of the anti-tobacco laws enacted in India some years ago.
Globally, most smokers are really not aware of the range and forms of tobacco. Right now, the fact is, that tobacco epidemic is clustered in the poorest of the poor and this applies to India also where the prevalence rate is high among poor and poorly educated groups. So, it is important to inform public about the dangers of tobacco-use and that is why we are implementing warning and particularly, pictorial warnings are specially effective in sending across the message among the semi-literate and illiterate populace who may not get the message directly from the tobacco package if it is written. I am also encouraged to know that India will review pictorial warning to see how effective these have been. But in India these warnings were toned down after protest from various stakeholders in the tobacco industry. The Health Minister wanted more stringent pictorial warnings.
Yes, but important is the review of warnings. As has been said, the warnings will be reviewed after a year. This year can be used for revaluation of the warnings. Focus groups and public opinion polls can play a role in revaluation. This can help in ascertaining whether something more needs to be done. It is also encouraging to see that India is going ahead with the pictorial warnings and the government will air and advertise tougher messages.The problem in India is that a large number of interest groups are opposed to strong messages.
There is absolutely no loss of jobs in the tobacco sector due to tobacco control measures because economic adjustment is a gradual process. Interest groups in many countries — tobacco companies, the farming groups profess an apocalyptic scenario like a drop in the business. But this has not been the case. The World Health Organisation with the World Bank made an estimation sometime back that showed if the prevalence of tobacco is reduced by 1 per cent every year every country over the next 25 years, with population increases the prevalence might come down but the number of smokers will only slightly come down, business will be hardly affected. The loss of jobs in the tobacco-sector is not being caused by tobacco control measures but by the companies increasing their mechanisation endeavours to make productions go up and save money by enhancing efficiency, and reducing payments to farmers. What you said is true of the organised industry. But those involved in beedi manufacture are neither organised nor do they use any machines.
But the demand for the tobacco products is going to come down only over a long time. Economic adjustments will happen gradually and not overnight, no matter whether it is cigarettes or beedis or any other product. These are apocalyptic scenarios of a sudden collapse of industry and not borne out by studies. This will be a gradual evolution over decades. How difficult would it be for a country like India to shift from tobacco farming to an alternative like medicinal farming because it involves huge infrastructure.
There is no one specific alternative to tobacco farming and manufacturing of its products. There are going to be different alternatives depending on different markets. One of the issues is the ongoing food crisis. We see a shortage of food commodities which is leading to under nutrition. It makes no sense to use millions and millions of hectares to grow an addictive drug when the same land can be used for growing nutritive crops. We, at the United Nations family, also need to look at the concept of crop diversification. Tobacco companies are also promoting the concept of ‘informed choices’ to counter the official anti-tobacco awareness campaigns. How does one deal with this situation?
The notion of ‘informed choices’ that the tobacco companies promote is really not valid because research shows 80 per cent of smokers want to quit but because they are hooked on to an addictive product used in cigarettes, they find it difficult to give up. Then, non-smokers, too, have rights. Smoke contains 60 deadly cancer-causing compounds, causes heart disease and other diseases among non-smokers. They need to be protected from the harmful effects of passive smoking.What other measures are being taken by the WHO to promote a smoke-free world and what should India’s role be in it?
This year the WHO wants to promote the concept of ‘MPOWER.’ It stands for cost-effective and effective measures to reduce tobacco consumption.
Unless we act efficiently now, the world may potentially lose a billion people due to tobacco-related diseases … completely needlessly. Right now 4.5 million people are dying per year — 70 per cent in the developing countries with the figure projected to increase to 8.3 million in 2030 with 80 per cent in developing countries — again a completely preventable epidemic. The reason we see for this is that the smoking rates have decreased in many of the developed countries and the big tobacco multinational companies are targeting countries like India to develop their replacements. We have to halt the action.
The ‘m’ represents effective monitoring about tobacco use, ‘p’ is prevention of exposure to tobacco use — we at the highest level are advocating a ban on smoking at all places, ‘o’ is offering help to quit smoking. This is individual assistance to quit. As we implement advertising ban, and impose heavier taxes, we will be changing population behaviour — people will be induced to quit. India has announced setting up of cessation clinics but we would like to see a national 24 hour ‘quit line’ for those wanting to give up smoking that should be linked to cessation counselling clinics and then subsequently to the primary health centres. The ‘w’ is warning about the dangers of tobacco use. Globally, most smokers are really not aware of the range and forms of tobacco and they need to be educated about it, while ‘e’ stands for enforcement of ban on advertising promotion and sponsorship. Under ‘r’ WHO would like to see hiking of taxes and prices. Here India needs to strengthen its laws.

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