Achieving dream of a tobacco-free India

Tobacco consumption in India is unique, with a large section of the population using it in a chewable form. Cigarettes and bidis are other popular options. Irrespective of how it is consumed, tobacco is not only addictive, but also the single largest cause of preventable deaths globally.

With more than 7,000 chemical compounds, many of which are toxic as well as carcinogenic, tobacco is known to cause over 25 diseases. Despite its well-known health hazards, the use of tobacco continues to be a cause for concern in India. A Global Adult Tobacco Survey (GATS-2) 2016-17 report shows that India remains the second-largest consumer of tobacco products at about 81 lakhs users.

Estimates suggest that a 30-year-old who smokes five cigarettes a day would lose over Rs 1 crore on the habit by the time he is 60. Where 67% of the population is below the poverty line, this is expensive both for the individual as well as the country.

Despite a reduction in cigarette smoking, another dreaded alternative called e-cigarettes is emerging. Also called vaping, they work by heating a liquid to generate an aerosol, usually made of nicotine, propylene glycol, glycerine, and flavourings. Nicotine-free e-cigarettes are also available.

Tobacco is a threat in more ways than one. It exacerbates poverty, decreases productivity, is a contributor to poor household food choices, and an indoor air pollutant, all at once. Through several campaigns against smoking, India was able to create awareness and reduce smoking, moving from 123rd rank in 2012 to the 136th position in 2014.

In 1999, Kerala became the first state to ban smoking in public places. The movement gained momentum and the state of Chandigarh followed suit by becoming a ‘smoke-free’ city in 2007. However, it was only in 2008 that a nationwide ban on smoking in public places was imposed, and designated smoking zones were allotted.

India has also implemented six preventive and prohibitive methods recommended by the WHO in 2008 to empower tobacco users in battling the habit:

• Monitor tobacco use and prevention policies

• Protect people from tobacco use

• Offer help to quit tobacco use

• Warn about the dangers of tobacco

• Enforce bans on tobacco advertising, promotion and sponsorship

• Raise taxes on tobacco

In another recent initiative, the health ministry mandated that any tobacco product packet will come with scarier and morbid pictorial warnings, grim messaging, and a toll-free telephone number for help in quitting. The warnings read, “Tobacco causes painful death” in white lettering on a red background. The words “Quit Today call 1800-11-2356” appear in white on a black background.

A long way to go

Despite all the above measures, there is much ground yet to be covered. Tobacco consumption is a deeply ingrained behavioural, emotional, and social activity for many in the country. While some people are in denial, others do not wish to acknowledge the fact that they are addicted. Those who wish to quit lack sufficient support and alternatives that can help them tide over the withdrawal symptoms. Healthcare professionals should work closely with those who are addicted, monitoring and supporting them in their efforts.

Another point to be considered is that people often take a moral route in addressing those who consume tobacco. A case in point is women smokers, who are branded as indulging in inappropriate behaviour. Instead of doing so, what needs to be made clear is that smoking is unhealthy and can cause numerous health complications, even to those exposed passively.

Tobacco de-addiction needs to be undertaken on a war-footing, but sensitively, so that it can happen smoothly and without causing other alternative addictions. Moreover, along with the public warning messages and other statutory warnings, there is also a need to restrict access to this substance. Every second store sells cigarettes and other tobacco-based products, there is no restriction on their sale, and even younger children, therefore, have easy access to it.

Getting addicted may be easy. However, de-addiction and convincing people to give up tobacco is a combination of time, perseverance, persistence, and understanding. While laws, legislations, and prohibitory warnings can help, the idea should not be to instill a sense of fear in people or provoke them. If anything, these should motivate them towards making healthier life choices and quit this deadly habit for good — their own and that of their loved ones.

(The writer is Medical Director, Portea Medical)