Context

Tobacco is a leading cause of preventable diseases and deaths worldwide. Its impact extends beyond those who consume it, affecting those involved in its cultivation and production. In India, the tobacco epidemic poses significant health, environmental, and economic challenges. Understanding current trends in tobacco use and implementing effective control measures is crucial to combat the influence of the tobacco industry.

The Scale of Tobacco Consumption in India

India ranks second only to China in terms of the number of tobacco consumers, with an estimated 260 million users as of 2016-2017. This widespread consumption places a heavy burden on the nation's health system. Moreover, the health of over 6 million individuals employed in the tobacco industry is at risk due to skin absorption of tobacco, which can lead to various health issues.

Environmental Impact of Tobacco Cultivation

Tobacco cultivation is highly detrimental to the environment. It is an erosive crop that quickly depletes soil nutrients, necessitating the use of more fertilizers, which further degrades soil quality. Additionally, tobacco production contributes significantly to deforestation. Processing one kilogram of tobacco requires up to 5.4 kilograms of wood, exacerbating the problem. The production and consumption of tobacco generate nearly 170,000 tonnes of waste annually in India, adding to the environmental burden.

Economic Burden of Tobacco

The economic impact of tobacco in India is substantial. A 2021 study estimated that the country incurred losses exceeding ₹1.7 lakh crore due to the health effects of tobacco consumption during the fiscal year 2017-2018. In comparison, the Union Budget allocation for health in the same year was ₹48,000 crore. Furthermore, the cleanup of tobacco waste costs approximately ₹6,367 crore annually. These figures do not account for the additional costs of soil erosion and deforestation caused by tobacco cultivation.

Status of Tobacco Use in India

The Global Adult Tobacco Survey (GATS), Global Youth Tobacco Survey (GYTS), and India’s National Family Health Survey (NFHS) provide insights into tobacco use in India. GYTS focuses on tobacco use among students aged 13 to 15, while GATS and NFHS cover individuals over 15 years of age. These surveys indicate a general decline in tobacco use among the studied populations. However, an exception is the increase in tobacco use among women by 2.1% between 2015-2016 and NFHS 2019-2021. It is important to note that no surveys have been conducted since the COVID-19 pandemic, which may have influenced tobacco use patterns.

Awareness and Control Programmes

India is a signatory to the WHO’s Framework Convention on Tobacco Control (FCTC), launched in 2005. This initiative aims to reduce global tobacco use by helping countries develop strategies to control both the demand and supply of tobacco. India has had laws regulating tobacco sales since 1975, with significant amendments in 2003 through the Cigarettes and Other Tobacco Products Act (COTPA). This act governs the production, advertisement, distribution, and consumption of tobacco with 33 detailed sections.

In 2007, India launched the National Tobacco Control Program (NTCP) to improve the implementation of COTPA and FCTC, raise awareness about the harms of tobacco use, and assist people in quitting. Tobacco taxation is another globally accepted method to control tobacco use and is implemented in India. However, enforcement of existing measures is lacking. For example, smokeless tobacco products often fail to comply with COTPA packaging guidelines, and smuggled tobacco products remain poorly regulated. The fines for COTPA violations have not been updated since 2003, making them ineffective as a deterrent.

Challenges in Tobacco Control

The challenges in tobacco control are multifaceted. The COTPA bans direct advertisements but has ambiguous regulations on indirect advertisements. This loophole allows for surrogate advertisements that use proxy products, like elaichi, to promote tobacco brands indirectly. Such advertisements were notably visible during the ICC Men’s Cricket World Cup 2023, where famous cricketers endorsed surrogate products for tobacco brands. These advertisements pose a significant issue as they subtly encourage tobacco use.

Proposed amendments to COTPA in 2015 and 2020 aimed to address these issues by regulating surrogate advertisements, including films and video games in the definition of ‘advertisement,’ and increasing fines for advertisement violations. The 2020 amendment proposed mandatory licensing for the production, supply, and distribution of tobacco products. However, neither of these bills was passed.

Effectiveness of NTCP

The NTCP’s effectiveness has been questioned. A 2018 study published in the journal BMJ Tobacco Control found no significant reduction in bidi or cigarette consumption between NTCP and non-NTCP districts. Factors contributing to this ineffectiveness include insufficient staffing, poor resource allocation and utilization, and lack of effective monitoring mechanisms.

Tobacco Taxation and Affordability

Efforts to control tobacco through excise duties have faced challenges such as tax evasion, smuggling, illicit manufacturing, and counterfeiting. The transition to the Goods and Services Tax regime has inadvertently made cigarettes and smokeless tobacco products more affordable. A 2021 study in BMJ Tobacco Control highlighted that these products had become more affordable over the past decade. Economist and tobacco policy analyst Rijo M. John estimated that the tax burden on cigarettes, bidis, and smokeless tobacco products is much lower than the FCTC’s recommendation of at least 75% tax.

Industry Lobbying and Government Involvement

The tobacco industry’s lobbying efforts significantly impact tobacco control measures. Effective lobbying has led to continuous exemptions of cess on bidis and smaller tobacco manufacturers. Government officials, both current and retired, often engage with the tobacco industry. For instance, a retired Indian Administrative Services officer joined the board of Godfrey Phillips as an independent director in 2022. Moreover, the Central government holds a 7.8% stake in ITC Ltd., India’s largest tobacco company. This involvement has led to India’s worsening score on the tobacco interference index, which measures the degree of tobacco industry interference in governance.

Conclusion

COTPA, PECA, and NTCP offer a robust framework for controlling tobacco production and use in India. However, these measures need stricter implementation and higher tobacco taxes in line with FCTC recommendations, inflation, and GDP growth. Government support is crucial in helping tobacco farmers transition to alternative crops, thereby protecting livelihoods. Up-to-date data on tobacco use trends are essential to effectively combat the evolving strategies of the tobacco industry. Without such data and stringent enforcement of control measures, effective tobacco control in India will remain an elusive goal.

Source - The Hindu