# Presentation: 304435

## Tobacco cultivation has a history of about 8000 years.
Europeans were introduced to tobacco when Columbus landed in America in 1492.
Portuguese traders introduced tobacco in India during 1600. Tobacco became a valuable commodity in barter trade and its use spread rapidly.
Gradually tobacco got assimilated into the cultural rituals and social fabric due to presumed medicinal and actually addictive properties attributed to it.

- Tobacco cultivation has a history of about 8000 years.
- Europeans were introduced to tobacco when Columbus landed in America in 1492.
- Portuguese traders introduced tobacco in India during 1600. Tobacco became a valuable commodity in barter trade and its use spread rapidly.
- Gradually tobacco got assimilated into the cultural rituals and social fabric due to presumed medicinal and actually addictive properties attributed to it.

## Introduced initially in India as a product to be smoked, tobacco gradually began to be used in several other forms. 
The entry of European colonial powers into India spurred the import of tobacco into India.
Investment in production and export came later during the British rule.
The policies of strong governmental support for tobacco agriculture, initiated during British colonial rule, have continued after Independence.

- The entry of European colonial powers into India spurred the import of tobacco into India.
- Investment in production and export came later during the British rule.
- The policies of strong governmental support for tobacco agriculture, initiated during British colonial rule, have continued after Independence.

**Increase in Tobacco Production during British rule**

##  Types of tobacco use in India

_***Smoked forms of tobacco use***_
*Bidis, Cigarettes, Cigars, Cheroots, Chuttas, Dhumti, Pipe, Hooklis, Chillum, Hookah.*
_***Smokeless forms of tobacco use***_
*Paan (betel quid) with tobacco, Paan masala with tobacco*
*Tobacco, areca nut and slaked lime preparations,  Mainpuri tobacco, Mawa, Khaini, chewing tobacco, snus, gutkha**** ***
*- **	**Tobacco products for application: Mishri, Gul, Bajjar, Lal dantmanjan, Gudhaku, Creamy snuff, Tobacco water, Nicotine chewing gum.*

## Tobacco in Indian Economy -I

- Tobacco cultivation has sustained despite social disapproval because of domestic demand (beedi tobacco) and the international market (flue-cured Virginia tobacco).
- Tobacco plays a significant role in the Indian economy as it contributes substantially in terms of excise revenue, export revenue and employment.
- India is the world’s second largest producer of tobacco and also the second largest consumer of unmanufactured tobacco. It is a major exporter of unmanufactured tobacco.
- The total social costs of tobacco products exceed the direct outlay on them, owing to morbidity, mortality and negative externalities associated with the consumption of tobacco products.

## Tobacco economy in the post-Independence period 

| Year | Area 
(x1000 hectare) | Production
(million kg) | Excise revenue (Rs in  million) | Export revenue 
(Rs in  million)  | Tobacco consumption (million kg) |
| --- | --- | --- | --- | --- | --- |
| 1950–1951
1960–1961
1970–1971
1980–1981
1990–1991
2000–2001
2001–2002 | 360
400
450
450
410
290
- | 260
310
360
480
560
490
601 | 258
540
2284
7553
2,6957
8,1824
- | 150
160
320
1400
2630
9034
8885 | 245
328
367
360
474
470
- |
| Source: Tobacco Board 2002; Directorate of Tobacco Development 1997  |  |  |  |  |  |

## The costs inflicted by tobacco consumption extend much beyond the direct users to cover secondary smokers as well as non-users, and are spread over a period much beyond the period of actual consumption of tobacco.
The recognition of the costs of tobacco has been obfuscated and made opaque by the unethical tactics and practices of the tobacco lobbies.
Total cost entailed by three major tobacco-related diseases is estimated to be about USD 7.2 billion for the year 2001-02.

- The recognition of the costs of tobacco has been obfuscated and made opaque by the unethical tactics and practices of the tobacco lobbies.
- Total cost entailed by three major tobacco-related diseases is estimated to be about USD 7.2 billion for the year 2001-02.

**Tobacco in Indian Economy -II**

## Prevalence of Tobacco Use

- Tobacco use prevalence : 51.3% males & 10.3% females (1995 -1996) and 46.5% males and 13.8% females (1998 -1999)
*National Sample Survey 52nd Round and National Family Health Survey-2*
- 55.8% of males currently use tobacco (12 - 60 years of age)
*National Household Survey of Drug and Alcohol Abuse, 2002*
- Tobacco use prevalence among males is higher compared to females and among older age groups compared to the younger age groups.
- The prevalence of tobacco use is higher in rural population compared to that in urban areas.
- India has a huge problem of widespread smokeless tobacco use among women, particularly among disadvantaged women.
- The prevalence of tobacco use in pregnant women is similar to that in non-pregnant women of the same age.

## TOBACCO CONSUMPTION IN NORTH INDIAN MALES IS INVERSELY RELATED TO EDUCATIONAL LEVEL AND PROFESSIONAL STATUS: RESULTS OF THREE CROSS SECTIONAL SURVEYS

| Educational Level | Urban 
n=1456
Age: 34-65 | Rural 
n=1070
Age: 35-64 | Industrial
n=2273
Age: 22-58 |
| --- | --- | --- | --- |
|  Illiterate | 61.4% 	 |  83.3% | 78.6% |
| Semi-Literate | 48.6% | 88.1% | 73.7% |
| Undergraduate	 | 41.3% | 70.3% | 52.8% |
| Graduates / Postgraduates | 22.3% | 44.2% | 35.6%
 |
| Period of Surveys: 1990-1998		
                                                          Reddy K S  et al, 2000 |  |  |  |

| Professional Class | Urban 
n=1456
Age: 34-65 | Rural 
n=1070
Age: 35-64 | Industrial
n=2273
Age: 22-58 |
| --- | --- | --- | --- |
|  Professional/Big Business/Landlord | 17.6% | 33% | 24.8% |
| Clerical/Middle level Business/
Middle level farmer	 | 32.1% | 61% | 36% |
| Skilled labourer/Small businessman / Marginal landowner  | 57.1% | 81% | 45.2% |
| Unskilled and semi skilled labourer | 64.1% | 82.4% | 63.5% |
| Period of Surveys: 1990-1998         
Prabhakaran D et al ,2000)
 |  |  |  |

## Tobacco is used by the youth all over India with a wide range of variation among states.
Two in every ten boys and one in every ten girls use a tobacco product.
Initiation to tobacco products before the age of 10 years is increasing.
There are currently about 240 million tobacco users aged 15 years and above (195 million male users and 45 million female users) in India.

- Two in every ten boys and one in every ten girls use a tobacco product.
- Initiation to tobacco products before the age of 10 years is increasing.
- There are currently about 240 million tobacco users aged 15 years and above (195 million male users and 45 million female users) in India.

**Tobacco Use Among Youth in India**

## Tobacco Toll in India

- 700, 000 deaths per year due to smoking
- 800, 000 to 900, 000 per year due to all forms of tobacco use/ exposure
- Fastest trajectory of rise in tobacco related deaths forecast for the next 20 years
- Many of the deaths (>50%) occur below 70 years of age

## Health effects of tobacco in India

- The relative risk for death due to tobacco use in cohort studies from rural India is:
- 40%-80% higher for any type of tobacco use;
- 50%-60% higher for smoking;
- 90% higher for reverse smoking;
- 15% and 30% higher for tobacco chewing in men and women, respectively;
- 40% higher for chewing and smoking combined.
- Overall, smoking alone currently causes about 700,000 deaths per year in India.

## BEEDI SMOKING IS EVEN MORE DANGEROUS

**Cohort of 52568 individuals (**_**> **_**35 years); follow-up of 5-6 years**
** ****Ratios of excess deaths in tobacco users**
**    ****	****100 male non-smoker deaths              :  139 male cigarette smoker deaths**
**    ****	****100 male non-smoker deaths              :  178 male beedi smoker deaths**
**    ****	****100 female non-tobacco user deaths : 135 female oral tobacco user  deaths**
**                                                    **
***- ******Mumbai Cohort Study; Gupta et al, WHO Bulletin, 2000***

## Studies in India have shown that tobacco use in its various forms is directly responsible for increase in cardiovascular diseases, cancers of the oral cavity, espohagus, pharynx etc, and chronic obstructive lung disease, TB, poor reproductive health outcomes, oral precancerous lesions and green tobacco sickness.

**Tobacco Use and Related Diseases**

## TOBACCO AND TUBERCULOSIS

**Prevalence of TB is about 3 times as great among the ever-smokers as among the never-smokers.**
- The heavier the smoking, either cigarettes or bidis, the greater the prevalence of TB among smokers.
**Mortality from TB is 3 to 4 times as great in ever-smokers as in never-smokers.**
- Smoking contributes to half the male deaths from TB in India and a quarter of all male deaths in the middle age (25-69 years); of these 200,000 deaths, half occur in men who are in 30’s, 40’s or early 50’s.

## Origin Of Tobacco Control Efforts In India-I

- India’s Journey from appreciating potential of tobacco production to emerging as a leader in global tobacco control efforts:
- Increasing scientific evidence about mortality and morbidity attributable to tobacco use provided impetus for legislative action in India for tobacco control (Mid 1970s)
- Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975
- 	Health Warning on Packages and Advertisements of Cigarettes : “Cigarette Smoking is Injurious to Health”

## Origin Of Tobacco Control Efforts In India-II

- Tobacco Board Act of 1975 brought tobacco under a single Jurisdiction (The Central Government)
- Civil society groups, media and other agencies played a vital role in raising public awareness of tobacco-related health issues (1980s and 1990s)
- 	This led to:
- Civil litigation and favorable verdicts by courts
- Demands for tobacco control in Indian Parliament
- Increased pressure on government to impose restrictions
- Resolutions of World Health Assembly in 1986 and 1990 urged member states to impose stronger legislative measures to protect people from dangers of tobacco
- Regional and national consultations on “Tobacco or Health”, convened by government of India (Ministry of Health) and WHO in 1991

## Battle for Tobacco Control in India

- Activism and advocacy efforts by civil society organization in India
- Strong role played by Indian judiciary
- Role of media in building positive public opinion on tobacco control
- Commitment by the Government of India (Ministry of Health and Family Welfare) towards effective tobacco control efforts
- Support of well informed Parliamentarians and Policy-makers

- Tobacco industry’s continuous resistance to strong tobacco control laws or regulations
- Violation of regulations by the industry (e.g. ad ban)
- Economic issues related to tobacco production and tobacco control, distorted by the industry.
- Over emphasizing employment issues in connection with tobacco control
- Industry’s efforts to create fears of adverse impact of tobacco control on poor

**Anti-Tobacco Influences**

**Pro-Tobacco Influences**

## Land Mark Events – I1970s to 2005

**1975:** Cigarettes (Regulation of Production, Supply and Distribution) Act
**1980:** Central and State Governments imposed restrictions on tobacco trade and initiated efforts for comprehensive legislation for tobacco control
**1990:** Central Government issued directive for prohibiting smoking in public places, banned tobacco advertisements on National Radio and T.V. channels, advised State Governments to discourage sale of tobacco around educational institutions and mandated display of statutory health warning on chewing tobacco products.
**1991:** Regional and National Consultations on “Tobacco or Health”
**1991:** Central Government directed the Central Board of Film Certification to comply with the Cinematograph Act of 1952

## Land Mark Events – II1970s to 2005

**1995:** The Parliamentary Committee on Subordinate legislation of the Tenth Lok Sabha examined the rules framed under Cigarette (Regulation of Production, Supply and Distribution) Act, 1975 and made specific suggestions for stronger provisions to achieve better results in tobacco control
**1995:** Expert Committee on the economics of tobacco use constituted by the Central Ministry of Health.
**1999:** High Court of Kerala announced ban on smoking in public places
**1999:** Ministry of Railways banned sale of cigarettes and beedis on railway platforms and in trains
**2000:** Central Government banned tobacco advertisements on cable television
**2001:** Supreme Court of India mandated a ban on smoking in public places.

## Land Mark Events – III1970s to 2005

**2001:** Ministry of Railways imposed ban on sale of gutkha on railway station, concourses, reservation centres and in trains
**2001:** The National Human Rights Commission of India (NHRC) convened a South-East Asia Regional consultation on ‘Public Health and Human Rights”, and advocated tobacco control as an essential measure to protect human rights.
**2001-2003:** Ban on Gutkha production and sale of gutkha and paan masala containing tobacco or not containing tobacco in states of Tamil Nadu, Andhra Pradesh, Maharashtra, Madhya Pradesh, Bihar and Goa using the provision of the Prevention of Food Adulteration Act.
**2003:** The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003

## Indian Law- At a Glance

**Key Provision of cigarettes and other tobacco product Act, 2003**
- Ban on smoking in public places (including indoor workplaces)
- Ban on direct and indirect advertising of tobacco products
- Point-of-sale advertising is permitted
- Ban on sales to minors
- Tobacco products cannot be sold to children <18 years
- Tobacco products cannot be sold within a radius of 100 yards of educational institutions
- Pictorial health warnings
- English and one or more Indian languages to be used for health warnings on tobacco packs
- Testing and Regulation: Ingredients to be declared on tobacco product packages (Tar and Nicotine)

## Implementation of Indian Law - I

**Prohibition of smoking in public places**
- mandates display of board containing the warning ”No Smoking Area- Smoking  Here is an Offence”
- Hotels & Restaurants should ensure:
- physical segregation of smoking and non-smoking areas
- these areas should be labeled as ”Smoking Area/Non-smoking Area”
- proper location of smoking and non-smoking areas
**Prohibition of advertisement of cigarettes and other tobacco products**
- Point of sale advertisement not to exceed two boards
- This board should contain health warnings “Tobacco Kills or Tobacco Causes Cancer”
**Prohibition of Sale to Minors**
- Display board containing the warning “Sale of tobacco products to a person under the age of 18 yrs is a punishable offence” to be put at point of sale

**Rules Notified and Enforced from May 1, 2004**

## Implementation of Indian Law-II

**Rules notified and enforced from December 1, 2004**
**Prohibition on Sale of Cigarettes and other Tobacco Products around Educational Institutions**
- Board outside the premises to be displayed stating that sale of cigarettes and other tobacco products in an area within a radius of 100 yards of educational institution is strictly prohibited
- Distance of 100 yards shall be measured radically starting from the outer limit of boundary wall or fence of the institution.

## Proposed Indian Health Warning on Gutkha Pack

**Proposed Indian Health Warning on Gutkha Pack**

## Proposed Indian Health Warning on Cigarette Pack

**Proposed Indian Health Warning on Cigarette Pack**

## Implementation challenges being faced

**Violation of Ad ban through:**
- Surrogate methods (Red & White Bravery Awards-GPI)
- Brand stretching (Wills Life Style Apparel-ITC)
- Sponsorship of events (Formula 1 news in print media-Marlboro)
**Violation of ban on smoking in public places due to:**
- Lack of awareness among stakeholders (managers of restaurants, hotels etc.)
- Low compliance levels among the management of public places
- Low motivation at Health Ministries at State Level
**Violation of provision allowing point-of-sale advertisement**
- Display board specifications being violated
- Health warning area specified on this board has been reduced by the industry

## Other measures that need to be taken to strengthen tobacco control

**Tax Net to be Uniform**
- Current financial budget (2005-06) increased specific (excise) rate on cigarettes by about 10% and a surcharge of 10% ad valorem duties on other tobacco products (gutkha, chewing tobacco, snuff and pan masala)
- Bidis to be brought under similar tax regime to avoid cost influenced product choice by youth and poor
**Ban on Gutkha by Centre**
- State governments to request the Centre to impose such a ban (as per Supreme Court judgment)

## FCTC Implementation in India

- The Indian Act enactment preceded the adoption and enforcement of the FCTC
- Indian Legislation needs to be upscale to comply with the provisions of FCTC
- Tax and price measures to be implemented to reduce tobacco consumption
- Duty free sales to be tackled by Ministry of Finance
- Prohibiting use of misleading terms to label tobacco products
- Mobilize stakeholders, engage civil society to promote and strengthen education, communication, training and public awareness on tobacco control issues
- Promote effective measure for tobacco use cessation
- Elimination of all forms of illicit trade in tobacco products including smuggling, illicit manufacturing and counterfeiting
- Sale to and _by_ minors
- Curb cross-border advertising
- Promote economically viable alternatives for tobacco workers, growers and individual sellers (as appropriate)