This section presents actionable insights for practitioners from our collaboration of experts.
Tobacco use is a major preventable cause of mortality and morbidity, with close to 7 million people succumbing to tobacco-associated deaths globally every year. This entirely preventable, man-made epidemic kills more people than tuberculosis, HIV/AIDS, and malaria combined. Aside from morbidity, research shows that for every smoker that dies, at least 30 people live with a serious smoking-related illness. Another study by ICMR revealed that 50% of all male cancers and 25% of all female cancers in India can be attributed directly to tobacco consumption.
In order to protect and safeguard the health of its citizens, the Government of India developed the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) in 2003. In 2004, the WHO Framework Convention on Tobacco Control (FCTC) was ratified, which lists strategies to reduce the demand for and supply of tobacco. To further strengthen tobacco control provisions under COTPA, the National Tobacco Control Program (NTCP) was launched in 2008. However, despite multiple efforts taken by the government and NGOs, generation after generation continues to use these products and suffer devastating economic, physical, and psychological consequences.
Gaps in Legislation
A recent WHO Report on the Tobacco Epidemic (GTCR) from 2019 observes that India, despite having adopted best practices in health warnings on packs and cessation, falls under the ‘Moderate’ category in all other areas, having made no progress since 2008. A key reason for this stagnation is the “glaring gaps” in tobacco control legislation. At present, even though the law prohibits direct and indirect advertisements of tobacco products, the definition is ambiguous and vague, and it does not exhaustively cover all forms of sponsorship, advertising, and promotion. Due to this limitation, the tobacco industry brazenly continues promoting its product via social media, point of sale displays and advertising, and event sponsorships. This continuous exposure to tobacco products normalizes smoking and is linked to early initiation into smoking and difficulty for regular smokers to quit. Furthermore, COTPA and the Ministry of Health and Family Welfare (MoHFW) provides specifications for Designated Smoking Areas (DSAs) to prevent exposure to secondhand smoke, an endeavor that has proven to be ineffective.
Another worrying trend is the premature initiation of tobacco products during adolescence. With research showing that most users become addicted before the age of 21, the current legislation having 18 as the minimum age for purchasing tobacco products is problematic. The law also permits the buying of single sticks or loose tobacco, causing sales to rocket and resulting in consumers not being regularly exposed to health warnings on the pack. Moreover, COTPA does not regulate the contents of cigarettes, which leaves tobacco industries free to use flavor-enhancing substances, such as mint, vanilla, and cinnamon. This marketing gimmick reduces the harshness of cigarette smoke, making experimentation and addiction more likely while creating an impression that the product is less toxic than it really is. Research also shows that even though awareness regarding the dangers of smoking is high among the masses, an understanding of the potential personal harm and consequences it poses is less, since most individuals hold either incomplete or incorrect knowledge. This trend is prevalent especially among vulnerable populations like youth. Furthermore, the anti-tobacco text warnings may not register with all consumers because of poor literacy levels.
A study found that LMICs spend a mere 1% of the global tobacco control spending. A minimal budget and lack of human resources pose another major barrier. Adding on to these inadequacies, the sin tax on tobacco in India is only 38%, compared to the WHO recommended level of at least 75%.