Tobacco Control a Distant Goal in India: Who Is To Be Blamed for the Epidemic?

“Who asked you to consume tobacco? Do you not know it can cause harm?” This is something almost every person with a tobacco-related illness is asked. The suffering because of the illness is compounded by the blame and guilt that the patient has to endure. Patients with smoking-related cancers experience high levels of stigma that often lead to depression, anxiety, and stress. But is it right to blame the person for consuming tobacco? Is it okay to imply that the person “deserved” to get the disease for continuing tobacco use despite knowing its harmful effects?SRK, Akshay Kumar & Ajay Devgn Served Notices For Endorsing Tobacco BrandVinod (name changed), a 45-year-old security guard, told me, “Tobacco helps me stay awake at night.” Nicotine, a chemical present in tobacco, is a stimulant and suppresses sleep. Tobacco consumption also suppresses appetite, elevates mood, and helps reduce stress. Considering these effects of nicotine, would it be easy for someone like Vinod to quit tobacco? “Bete ki padhai ke liye paiso ka intezam karna hai. Mehengai bhi toh itni ho gai hai ajkal (I have to arrange money for my son's education. There is so much inflation now),” said Vinod.The packet of tobacco, costing only Rs 5 or so, becomes an escape from everyday struggles for Vinod. Countless other Vinods – rickshaw pullers, manual workers, sanitation workers, etc – find respite in tobacco. Smoking is equally prevalent in doctors. Is lack of awareness then really the missing link to tobacco control? Or are tobacco farmers the root cause of the problem? If they stop cultivating tobacco then there would not be any tobacco available to buy. However, the tobacco farmers are misinformed and possibly as innocent as those who are consuming it. The Federation of All India Farmers Association (FAIFA), a non-profit federation established in 2015, is spearheading the misinformation campaign to promote tobacco farming.The federation aims to protect “millions of tobacco farmers in India, whose livelihood is threatened by the extreme tobacco control regulations in the country.”Separating Nicotine from Tobacco: A Public Health Story for India’s Amrit KaalFAIFA mentions a study conducted by the Government of India’s Central Tobacco Research Institute (CTRI) in 2004 on its website claiming that, as per the study, there is “no single crop which is an economically viable alternative to FCV (Flue-Cured Virginia) tobacco.” However, multiple studies conducted by the CTRI have shown that economically viable options for FCV tobacco exist. In fact, a 2007 report mentions multiple case studies of farmers successfully shifting to the cultivation of other crops. The net return per hectare was reported to be higher after shifting from tobacco to the cultivation of other crops.FAIFA website also mentions that the tobacco crop is grown on marginal soils, where no other crop can be grown by farmers. However, as per a World Health Organization report, tobacco rapidly depletes soil nutrients. Therefore, its cultivation requires high amounts of fertilisers. As tobacco is grown mostly without rotation with other crops, it is prone to pests and disease outbreaks, thus necessitating a high use of chemicals (insecticides, herbicides, fungicides, and fumigants) too. These chemicals and fertilisers are not only harmful to the environment but also to the farmer’s health.Moreover, excessive use of these chemicals further impacts the quality of the soil pushing the farmers into “debt traps.” A study indicated that more farmers take crop loans for growing tobacco than for other crops. Since these loans are taken from tobacco traders, the farmers are forced to grow tobacco. This creates a vicious cycle. It thus becomes imperative to question that, despite there being economically viable alternatives to destructive tobacco farming, why is it still being supported by the government?Karnataka Set To Ban Hookah Bars, Raise Minimum Age for Tobacco ConsumptionOn paper, India has some of the most stringent tobacco control initiatives – The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) 2003, the National Tobacco Control Program (NTCP), and the Prohibition of Electronic Cigarette Act (PECA) 2019. India is also one of the signatories of the WHO’s Framework Convention on Tobacco Control (FCTC). Despite these, as per the recent Report on Tobacco Control in India, following a dip in 2014, the area under tobacco cultivation has progressively increased over the past years.At the same time, tobacco has become increasingly affordable over the past 10 years, thanks to poor taxation policies. Even though existing data shows a declining trend in tobacco use, a survey to study tobacco use was last conducted only in 2019. The recent Household Consumption and Expenditure Survey Report, in fact, shows that Indians, both rural and urban, are spending more on pan masala, tobacco, and other intoxicants – hinting at a possibility of an increase in tobacco consumption in India.Along with the above – socioeconomic and psychological risk factors of tobacco consumption, misinformed and trapped tobacco farmers, and poor implementation of tobacco control programs and policies – surrogate advertisements are contributing to an unending epidemic of tobacco use in India. OTT Shows Must Carry Anti-Tobacco Warnings: What's Health Ministry's New Rule?Tobacco companies have used celebrities, time and time again, to indirectly advertise tobacco products either through surrogate products, for example, cricketers Virendra Sehwag and Kapil Dev advertising the elaichi products of a famous tobacco brand, or directly through movies and TV shows. Movie stars have exploited the “celebrity worship” culture in India to promote the use of tobacco through their films. Studies have reported that watching tobacco use in movies is associated with tobacco use in adolescents.To connect with their audience, the tobacco companies also exploit cultural themes.Actors Ajay Devgn, Shah Rukh Khan, and Akshay Kumar in the Vimal Elaichi advertisement pay tribute to brotherhood. Their slogan “Zubaan ek ho toh dil bhi ek hone chahiye, bolo zubaan kesari” appeals to the emotional side of their audience and urges hearts to connect. What does elaichi or connecting hearts have to do with a stained tongue or a “kesari zubaan”? That the aim of these advertisements is not to sell elaichi or pan masala, is supported by the fact that the amount spent on these advertisements is estimated to be much more than what the companies earn from selling the product. It is not a surprise that pan masala companies spend close to 60 percent of their annual budget to grab advertisements in Indian Premier League, an event with millions of viewers. By connecting the positive emotions associated with India’s most loved sport and celebrities with the tobacco brand, the brand expands its market to push people to consume tobacco, albeit legally. The cost of treating the diseases that result from tobacco use is known to push families into generational poverty. Do the celebrities, who claim to be unaware of the impact of their advertisements, feel advertising tobacco, directly or indirectly, is really worth the paycheque?FIT Quiz: How Much Do You Know About the Dangers of Using Tobacco?Collective action is therefore needed to end this epidemic. The government needs to put the health of its people above the monetary gains from tobacco sales in the country, which forms only a fraction of the economic loss of Rs 1.7 lakh crore that the country incurred due to tobacco-related diseases and deaths in 2017-18. Effective implementation of tobacco control initiatives is urgently needed. At the same time, the social determinants of health like hunger and poverty, which push people into tobacco addiction, need to be addressed.Access to tobacco cessation services also needs to be improved at the same time. Tobacco cessation activities at the ground level should be conducted with as much zeal as those promoting its use. The celebrities also need to realize their moral responsibility towards their fans and not exploit them for personal gains. Lastly, farmer unions need to come together to pull fellow farmers out of the trap of tobacco farming and demand that the government fulfill its responsibility of investing in research for alternative crops and livelihood for tobacco farmers and others employed in the tobacco industry.(Dr Parth Sharma is a public health physician, researcher, and founder of Nivarana.org, a public health information and advocacy platform. This is an opinion piece and the views expressed are the author's own. The Quint neither endorses nor is responsible for them.)Video | Is Hookah Just As Harmful as Smoking Cigarettes? An Expert Decodes

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Tobacco Control a Distant Goal in India: Who Is To Be Blamed for the Epidemic?

Collective action is needed to end this epidemic. The government needs to put people's health above monetary gains.

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