Ban tobacco use to combat cancer

With every puff of cigarette, a smoker inhales 7000 chemicals of which up to 70 are known carcinogens. When these dangerous chemicals enter the bloodstream, they have the potential to alter the DNA and expose the smoker to a heightened risk of multiple types of cancers. Apart from being responsible for almost nine of every 10 cases of lung cancer, tobacco can cause cancer almost anywhere in the body. According to estimates, up to 16 types of cancers can be directly attributed to tobacco consumption. World Health Organisation estimates that tobacco kills more than 7 million people each year — up to half of its users.

According to data of the Indian Council of Medical Research (ICMR), cancer incidence doubled in India over the past 26 years, with breast, cervical, oral cancer, and lung cancers together constituting 41% of the cancer burden. Tobacco smoking causes lung, esophageal, larynx, mouth, throat, kidney, bladder, pancreas, stomach and cervical cancer. Oral tobacco causes oral, esophageal and pancreatic cancers. Tobacco is also the single most known and preventable cause of cardio-vascular deaths.

The good news is that tobacco which constitutes a major risk factor for cancer is a completely preventable risk factor. Bad news is that despite a series of campaigns and introduction of pictorial warnings on tobacco products, tobacco consumption remains rampant in India. Almost a third of Indians — 57% of all men and 11% of all women — consume some form of tobacco and many also use more than one type of tobacco product.

Measures to curb tobacco use

Over the past 10 years, India has taken a series of welcome measures to curb the use of tobacco. These include a ban on tobacco related advertisements, a ban on smoking in public places as well as making sale of tobacco products to minors an offence. Similarly, despite protests by artistes and film makers, it was made mandatory for scenes depicting smoking in movies to tag along a disclaimer about its harmful impact.

One of the most significant interventions has been the introduction of 85% pictorial warnings on the packaging of tobacco products. A report released recently by the Canadian Cancer Society which documents global progress on tobacco package warnings, ranks India 5th in the global list of countries that have pictorial health warning on tobacco products. Graphic pictorial warnings are known to have an impact on the minds of tobacco users, especially those who are illiterate and cannot read the written health warning. Studies carried out in Brazil, Canada, Singapore and Thailand has provided clear evidence that pictorial warnings significantly increase people's awareness of the harms of tobacco. Graphic pack warnings also discourage children from beginning smoking.

While the introduction of all these measures in the face of protests by the tobacco industry underline the government’s commitment to curb tobacco consumption, much more needs to be done in India which houses the world’s second largest population of tobacco users after China.

Scale up tobacco taxes

Tobacco taxes have been an area of much debate and discussion. High taxes on tobacco products are a cost-effective way to reduce tobacco use, especially among young and poor people. A tax increase that raises tobacco price by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low and middle-income countries. Studies of price elasticity in India find that a 10% increase in tobacco prices is estimated to reduce bidi consumption by 9.1% and cigarette consumption by 2.6%. Since tobacco is an addictive product, taxes should be high enough to raise the retail price by a large margin. WHO recommends that the taxes should be at least 70% of the retail price. However, despite their inclusion in the GST demerit list of highest tax slab, taxes on tobacco products are still much below the WHO recommendation. Bidis which constitute the most common tobacco product used in India continue to remain affordable. The government must fight off pressure from influential tobacco lobbies to impose a high tax rate on all tobacco products — cigarettes, bidis, and gutka — to discourage consumers from purchasing them.

Institutional help

Recently, India became the first country in the SAARC region to start printing a Quit-Line number on tobacco products. A highly welcome step, this complements the pictorial warnings by offering help to people who want to it. However, it is not enough. Since tobacco is an addiction, its users require help to kick the habit. We must provide greater institutional support to help users kick the butt. This must include ‘Quit Tobacco’ centres at colleges, hospitals as well as offices to provide professional help and advice to people seeking to quit tobacco use. Involving primary healthcare physicians in this endeavor can help reach out to a large number of tobacco users.

Awareness campaigns

Mass media campaigns are effective in reducing tobacco consumption and influencing youth to stop using tobacco. The government must rope in influential youth icons — cricket and Bollywood stars — to act as influencers in its campaign to cut tobacco use. At the same time, tobacco campaigns must focus on informing the youth that smoking is not cool and is hardly a sign of machismo, often perceived by them.

(The writer is Managing Director, Paras Healthcare)