BUTT of concern

With more than 5,500 adolescents taking to tobacco everyday and an estimated one million deaths annually, the Union Ministry of Health is determined to extend the ban on smoking to all private and public workplaces from October 2. Aditi Tandon reports on tobacco addiction in India

Shah Rukh Khan recently announced his wish to quit smoking both on and off screen. His commitment means several youngsters, who try to emulate film stars, will be inspired to stub it out.

In the Herculean task of curbing the use of tobacco, every small effort counts. So when superstar Shah Rukh Khan recently announced his wish to quit smoking both on and off screen, the hopes of anti-tobacco campaigners were revived and their crusade against smoking gained momentum. The film icon’s commitment meant several youngsters in the country would be inspired to stub it out. Tobacco is known to kill 104 Indians every hour.

Several steps have been taken by the government over the years to ‘de-motivate’ smokers. The ban on smoking in public places has existed for a long time now. From October 2, the Union Health Ministry proposes to make it more stringent and extend it to all private and public buildings. The findings of various global surveys on tobacco use and determinants have led Indian Health Secretary Naresh Dayal to admit: "The control of tobacco consumption has become a major public health challenge in India due to the burden of non-communicable diseases. The overall tobacco consumption has increased over the past five years despite strong government initiatives in adopting the WHO Framework Convention on Tobacco Control (FCTC) and enactment of the Anti-Tobacco Law, 2003. Ignorance among medical and dental students, too, is a matter of concern." With the present smoking patterns, about 500 million tobacco users will eventually die. More than half of these will be today’s child and teenaged smokers. This is where, the campaigners feel, our filmstars can help.

Studies in the West have conclusively shown that limiting the exposure of adolescents to smoking scenes in movies helps prevent a sizeable number from reaching for the cancer stick. It was perhaps this realisation that made Union Health Minister Anbumani Ramadoss appeal to Amitabh Bachchan and Shah Rukh Khan to give up smoking on screen. The minister, in his efforts to check tobacco imagery in films, had earlier brought a law to regulate such scenes. This move was challenged in the court by filmmaker Mahesh Bhatt, with support from the Film Certification Board chairperson Sharmila Tagore. Tagore shared the view of Bhatt and many other film personalities (including Aamir Khan and John Abraham) that such a regulation would amount to putting curbs on creative freedom and artistic expression.

It may be recalled here that the Motion Pictures Association of America recently banned Will Smith-starrer Hancock because of a scene, featuring the male lead seated on a rock, and puffing. The film returned to the movie theatres only after the smoking scenes were deleted.

At the heart of this intolerance is the fact that worldwide 4.5 million persons die annually because of tobacco use, which kills more people than malaria, TB and HIV/AIDS put together. WHO estimates that this figure would be 10 million by 2030; of which seven million deaths would be in China and India.`A0

The Indian film industry is yet to accept this challenge, though many celebrities from other fields have fallen in line. The latest to join the rank of non-smokers is Olympic medallist boxer Vijender Kumar from Haryana, who apologised last month for having modelled for a cigarette ad. He has vowed never to smoke or drink. "I am now an icon and I understand my responsibility towards the youth," the boxer added.

But there are many other celebrities who act as brand ambassadors for tobacco companies. This glamour element has the potential to initiate many adolescents into smoking, feel experts.

In India, many tobacco users start as young as 10. More than 5,500 adolescents join the rank of tobacco users daily in India, adding to the four million consumers under the age of 15. The early initiation age is a pointer to the urgent need to plan effective interventions to safeguard this vulnerable group.

While social acceptability of the use of tobacco among older persons may be declining, its use among the young is on the rise. In a recent study among Delhi students (aged 11 to 14 years), 9.3 per cent said they had experimented with smoking in the absence of interventions.

More distressing are the findings of the recent India Global Youth Tobacco Survey among 2,183 students (aged 13 to 15) from 50 schools in 15 states. A whopping 87.5 per cent said they had purchased tobacco products without restriction. Supported by the WHO and Centre for Disease Control, USA, the survey revealed that one in 10 students had used tobacco in some form and the percentage of current users was 4.5.

Less than six in 10 students reported having learnt about the dangers of tobacco use, says Monika Arora of Hriday, who wrote the survey report. The report revealed that three in 10 students thought smoking/chewing tobacco made boys look more attractive.

Another fact brought out by the Global Health Professional Students Survey is that many Indian medical and dental students found smoking fashionable; 28.2 per cent of them have smoked at some point of time while 11.2 per cent smoke currently.

A study by the Centre for Global Health Research, University of Toronto, released in March 2008 found that India loses 9.9 lakh people every year due to smoking. By 2010, this number would be 10 lakh. As many as 70 per cent of these will be between the ages 30 and 69, the most productive age group for any population. While 38 per cent of smoking deaths would occur due to TB, 32 per cent would occur due to lung cancer.

"Half of these deaths would be among the poor and illiterate population, underscoring the need of pictorial warnings on tobacco products," says Dr Prakash Gupta, author of the study: "We found that most tobacco users, who had seen these warnings, said they would think twice before smoking. India needs such warnings as its quitting rate remains the lowest in the world," he says. While in the UK, 40 per cent of the smokers quit in the last 10 years following anti-tobacco laws and massive taxation policy, in Indonesia, which tops the nicotine map, 15 per cent quit in the same period. But in India only two per cent adults quit smoking after falling sick.

Alarmed by these trends, the Health Ministry says it will bring pack warnings by November 30. It has also issued instructions on this issue to tobacco firms. But experts still feel the two pictorial warnings, which have been finalised — lungs and scorpion — are ineffective than the ones proposed earlier, including deformed babies, cancerous tumours, rotting teeth and diseased throats.

"The government has failed to meet its international obligations on tobacco control. An empowered group of ministers presided over a technical matter involving pack warnings though without commissioning any study and justified its decision to weaken health warnings, saying a million jobs were tied up in the tobacco industry," observes an Indian Medical Parliamentarians Forum policy brief on the subject.

The brief urges them to review the images in 12 months — a provision under the WHO Framework Convention on Tobacco Control, which requires ratifying nations to implement warnings to cover at least 30 per cent of the display area on cigarette packs. India will cover 40 per cent, but whether that would be effective, remains to be seen. Sources in the Health Ministry say warnings should not have been weakened, "We get Rs 10,000 crore from cigarettes as central excise duty. A part of that revenue could have been easily diverted for those who will lose their jobs."

One study says that even if internationally recommended warnings are effectively implemented at least 22,000 premature deaths could be averted in India. But oncologist Dr Dhirendra Narain Shah admits: "Existing laws are not properly implemented, reasons being corruption, lack of political will and a high rate of tobacco prevalence among policy implementers and the media."

The problem will have to be addressed on all fronts, with awareness of the challenges. Australia, with its 10 best tobacco control practices in the world, could manage only one per cent reduction in tobacco use in one year. India, the second largest tobacco producer in the world, consumes 80 per cent of the total tobacco used. So it certainly needs to look beyond a ban on smoking in public places.