Although there are strict regulations banning or limiting the use and ingredients used in tobacco products, the implementing institution is yet to play a pro-active role in controlling tobacco abuse.

Stacked pile of cigarette packetsImage for representation | PTI
Voices Tobacco Ill-effects Thursday, June 02, 2022 - 13:07

By Dr Kanimozhi NVN Somu and Aarthy Madanagopal

Tobacco production and export is a huge industry in India. According to the Union Finance Minister, as of 2021 the tax revenue from GST, excise duty, compensation cess on tobacco for the last three years stood at Rs 53,750 crore. India is also one of the leading tobacco exporting countries, with exports of leaf tobacco and tobacco products contributing around Rs 6,000 crore annually in terms of foreign exchange to the government. However, little attempt has been made to control and check the abuse in the tobacco industry; tax evasion, illicit tobacco trade and gutka scam have remained a continuous and uncontrolled peril.

Socio-economic inequities on tobacco consumption

The ill-effects of tobacco is not a mystery to us. According to a WHO report, about 1.3 million deaths occur every year due to tobacco-related illness. There are about 273 million tobacco users, and India is the second largest producer and consumer of tobacco globally. Although there are strict tobacco usage and advertisement policies, and health systems to treat tobacco addiction, we have not made substantial progress in recent years.

An estimate of total economic costs attributed to tobacco use from all diseases in India in the year 2017-18 for persons aged 35 years and above is Rs 1,77,341 crore (USD 27.5 billion). According to the Centre for Disease Control, smoking can lead to cancer, heart disease, stroke, lung disease, diabetes, chronic obstructive pulmonary disease including emphysema and chronic bronchitis. Smoking also increases risk of tuberculosis, certain eye conditions, problems of the immune system including rheumatoid arthritis.

Tobacco usage is reported higher among the economically weaker sections of society. A deeper problem is what type of smoking practices they engage in. Studies show that people from wealthy backgrounds, having stable employment and proper education smoke cigarettes, and people engaged in temporary work, guest workers and those who live in poor economic conditions are exposed to beedi smoking which is more dangerous. The reason is, beedi is cheaper and easily available.

To control tobacco-related health problems and reduce the social harm due to tobacco addiction, India introduced a series of policies and programmes after becoming a signatory to the WHO Convention on Tobacco Control, 2005. The National Tobacco Control Programme (NTCP) was implemented in 2007-08 in 21 states. The object of the programme was to (i) create awareness about the harmful effects of tobacco consumption, (ii) reduce the production and supply of tobacco products, (iii) ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA), (iv) help people quit tobacco use, and (v) facilitate implementation of strategies for prevention and control of tobacco advocated by the WHO Framework Convention of Tobacco Control.

The National Tobacco Control Cell (NTCC) at the Ministry of Health and Family Welfare (MoHFW) is responsible for overall policy formulation, planning, implementation, monitoring and evaluation of the different activities envisaged under the NTCP. The main programmes undertaken by the cell were establishing tobacco testing laboratories, carrying out monitoring & evaluation, creating public awareness on the harmful impact of tobacco, and research on alternative livelihoods for those employed in the tobacco industry. According to Thought Arbitrage Research Institute (TARI), as of 2019, there were about 4.57 crore persons employed by the tobacco industry. The industry contributes about Rs 11,79,498 crore to the economy.

The success of the programme was felt immediately – the 2009-10 Global Adult Tobacco Survey (GATS) reported 34.6% tobacco users. And the number dropped to 28.6% during the 2016-17 GATS II. However, in the subsequent years very little progress has been made due to a surge in new forms of smoking practices. As a result, there are some new challenges confronting India.

Policy implementation gaps

1. Brand stretching of Smokeless Tobacco (SLT)

The 200 million SLT users in India represent about two-thirds of the global SLT users; India continues to be the leading SLT producer and consumer. Every year, more than 3,50,000 people die due to SLT-related diseases in India.1

Brand stretching is a terminology used when smokeless tobacco products are recreated using flavours, scents and sweeteners (for e.g., sweet paan, mouth freshener) that contain sweetened areca nut as a key ingredient. This is more dangerous as the consumers are unaware of the ill-effects of the edibles when consumed regularly. However, brand stretching is prohibited under Section 5 of COTPA and Article 13 of the WHO FCTC, and therefore registration of any tobacco brand for non-tobacco products should be prohibited by the trademark authorities requiring prohibition on manufacture and sale of a non-tobacco product having any similarity or imitation with any existing tobacco brand. The sale of products that contain nicotine after processing and mixing other food agents must be strictly regulated by FSSAI.

2. Lack of strict compliance laws for brand stretching and advertisement of SLT

SLT is used in regular consumer products like toothpaste and plastic sachets (gutka). However, there is no government control or check to effectively curb the sale or advertisement of these products. Although COTPA and FSSAI have strict regulations banning or limiting the use and ingredients used in such products, the implementing institution is yet to play a pro-active role in controlling tobacco abuse, particularly among vulnerable populations like adolescents, women and marginalised communities.

3. Lack of tobacco ban at point of sale

Section 5(2) of COTPA includes a specific exception for point of sale advertising. The MoHFW has sought to place restrictions on that exception through G.S.R. 345(E), which established strict rules for the display boards that are used for advertising at the entrances of shops where tobacco is sold. The rules limit their size and prohibit the use of photos of tobacco product brands; brand names; other promotional messages; and illumination. In practice, it is reported that the restrictions in G.S.R. 345(E) are not enforced and some advertising occurs at most points of sale. As a result, while there are some restrictions, point of sale advertising is not prohibited.

Similarly, Section 4(5) of G.S.R. 137 (as amended) states that the owner of a store where tobacco products are sold shall not display tobacco products in such a way that they are visible, so as to prevent easy access of tobacco products to persons below the age of 18. It is unclear whether this provides for a complete ban on the point of sale product displays. In addition, Sec. 5(1)(d) (as amended by G.S.R. 619(E)) contains a provision that tobacco products are not to be displayed in a manner that enables easy access of tobacco products to persons below the age of 18, without any mention of visibility. Because there are two conflicting rules, the regulatory status code “Uncertain” is given. In practice, product displays occur at most points of sale.

Advertising and promotion via toys that resemble tobacco products may fall within a general prohibition on promotion provided in COTPA Sec. 5(3) or may fall within a prohibition on indirect advertising if tobacco brand names or logos are utilised. It is not clear, however, that COTPA drafters intended to address this issue.

To align with FCTC Art. 13 and the FCTC Art. 13 Guidelines, the law should prohibit all tobacco advertising and promotion, and display of products, including at point of sale.

4. e-cigarette usage among adolescents not monitored nationally in India

A survey conducted on adult vapers in India identified that from about 71% of the consumers who participated in the survey, about 30% used it to quit smoking and about 41% to reduce smoking. Following this, the Indian government banned the import, manufacture, sale, advertisement, storage, and distribution of e-cigarettes in September 2019. Although India started off with multiple programmes to control tobacco consumption and addiction, the quitting rate is the second lowest among GATS countries (according to GATS 2016-17 report). Therefore, we need additional policies to reduce and control addictive smoking habits.

5. Lack of regulation on Electronic Nicotine Delivery Systems also known as ENDS (flavours and liquids ban and regulation), no pictorial health warnings on ENDS

It is true that India has banned electronic (e-cigarettes) completely since September 2019. However, many policy and health experts do not agree with the ban. In countries like the US and UK, studies and data have shown that the usage of vaps and e-cigarettes among teenagers is only a fad. And the level of actual smoking or tobacco use has come down drastically. In other countries like Indonesia, Malaysia, China and the Philippines, laws have been introduced to strictly regulate the use of e-cigarettes instead of a total ban, realising the negative effects it might lead to, for example, illegal trade and unsupervised consumption among young adults and adolescents. Therefore, the total ban introduced by India without a plan to treat unsupervised consumption is a shallow thought that could possibly result in huge economic burden in treating the affected population.

Recommendations

1. Increase tax on tobacco and other smoking products: A Group of Ministers (GoM) has been constituted through the GST Council to revise rates, if necessary. But at the moment there is no proposal to increase tax on tobacco products;

2. Increase tax on tobacco industry;

3. Introduce alternate livelihood plan for persons employed in tobacco farms, factories, and industry;

4. Frame regulations to curb illegal trade of cannabis or marijuana infused e-cigarettes; and,

5. Introduce strict pictorial health warnings on gutka and other smokeless tobacco products

Note:

1. Yadav, Amit et al. “Smokeless tobacco industry’s brand stretching in India.” Tobacco control vol. 29,e1 (2020): e147-e149. doi:10.1136/tobaccocontrol-2019-055382

Dr Kanimozhi is a DMK Rajya Sabha MP from Tamil Nadu, and Aarthy Madanagopal is a lawyer and policy analyst working on social and economic policies.

Views expressed are the authors’ own.

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