Tobacco menace in IndiaTobacco menace in India

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Dr. Dharmakanta KumbhakarMobile No. 98645-17168                                                      Email:drkdharmakanta@yahoo.com

Almost 34 percent Almost 34 percent  Indians (57% in  men and 11% in women) consume tobacco either in smoking (cigarette, bidi, hookah etc.) and/or smokeless forms (guthka, khaini, panmasala etc.), the latter being more common. Few Indian uses tobacco as toothpaste also. Gutkha and Panmasala have become increasingly popular among the young people specially school children and youth in India. About 35% in men and 3% in women smoke in India. The number of women smoker is increasing in India. It is alarming that about many of Indian (52.3% at home, 29.9% at work places and 29% at public places) are exposed to passive smoking.

The problem of tobacco consumption in Assam is more complex than probably any other state in India. Apart from smoking cigarettes, bidis and pipes; tobacco is also chewed along with paan or betel nut with slaked lime in Assam. About 39.3% of Assam adult population is addicted to tobacco. In Assam, about 34.9% of the male population smoke tobacco while a high rate of 48.2% chews tobacco. Assam also has a growing number of people over 15 years of age, who are addicted to smoking and other forms of tobacco consumption.

The habit of tobacco consumption kills millions of people and ruins the health of millions more. Tobacco exposure is associated with more mortality and morbidity than any other personal, environmental or occupational exposure. It is a common cause of addiction, preventable illness, disability and death. Smokeless tobacco is an important etiological factor in cancers of the mouth, lip, tongue and pharynx. Smoking tobacco is responsible for a substantial majority of lung cancer and chronic obstructive pulmonary diseases. Most smokers die either from these respiratory diseases or from ischemic heart disease. Smoking also causes cancer of upper respiratory and gastrointestinal tracts, pancreas, urinary bladder and kidney, and increases risk of peripheral vascular disease, stroke and peptic ulceration. In addition to the health hazards of mainstream tobacco smokes, there are risks associated with exposure to side stream smoke; also called passive smoking or environment tobacco smoke (ETS). Research shows that ETS increases the risk of lung cancer, ischemic heart disease, and acute myocardial infarction. The environmental protection Agency classified ETS as a known human carcinogen in 1992. ETS is especially hazardous for infant and young children. It is an important cause of fetal growth retardation and sudden infant death syndrome Young children in households of cigarette smokers suffer from an increased risk of respiratory and ear infections and exacerbation of asthma.

In India, tobacco-induced disease claims around ten lakh people every year. Tobacco related cancers account for half of all the cancers in males and one-fourth of all cancers in females in India. At Tata Memorial Hospital, Mumbai, 43.1% in males and 14.1% in females are tobacco-related cancers. India has one of the highest rates of oral cancer in the world. Annual incidence of oral cancer is said to be 10 per 100,000 of males. As tobacco consumption is growing at a rate of 2-3% per annum in India, it is predicted that it will account for 13% of all deaths in India by 2030. Each year, smoking kills many Indians prematurely. Health costs for tobacco-related illnesses are high in India.

Assam has one of the highest incidence rates of tobacco related cancers in the country. The incidence of oral cancer in north east and Assam is linked to chewing tobacco. As per Cancer registry report, the incidence of tobacco-related cancers out of total cancers in male and female in selected places of Assam are- Kamrup Metro district (49.7% and 24.1%), Dibrugarh district (51.6% and 22.8%), Cachar district (46.2% and 20.6%), BBCI (56% and 25.5%).

Realizing the health hazards of tobacco consumption, the Indian Government has implemented many anti-tobacco laws to control tobacco consumption amongst public. India’s anti-tobacco legislation, first passed in 1975, was largely limited to health warnings and has proved to be insufficient. Delhi was the first to impose a ban on smoking in public, passing “Delhi Prohibition of Smoking and Non- Smokers Health Protection Act” in 1996. This act prohibited sale of cigarettes 100 meters from the school building and to minors. In 1999, Kerala High Court came out with a judgment prohibiting smoking in public places, including parks and highways and Goa banned smoking in public places through anti-tobacco laws. A new piece of national legislation COTPA, 2003; notified on February 25, 2004- represents an advanced law including banning of smoking in public places, advertising and forbidding sale of tobacco to minors. This Act covers most tobacco products like cigarettes, cigars, bidis, cheroots, pipe tobacco, hookah tobacco, chewing tobacco, panmasala and gutkha. Enforcement and compliance levels vary by state and city. Recently, many states in India have taken additional steps such as bans on tobacco advertising, increasing taxation on tobacco products, ban on gutkha and manufactured smokeless tobacco products, regulation of the sale of tobacco products (Juvenile Justice Act- imposes harsh penalties on the sale of tobacco products to minor and Legal Metrology Act- bans sale of loose bidis, cigarettes etc.), making sure all workplaces and public places are smoke free, placing clean and 85% pictorial warnings on cigarette packets, plain packaging and generation of awareness against tobacco related health hazards amongst public for more effective tobacco control.

Though in recent years, India have been momentous developments in tobacco control; but, improper implementation of Anti-tobacco Act, low public awareness levels as also the lack of a sustained campaign against the tobacco menace are some causes of partial failure against tobacco control. The Government should implement harsh Anti-tobacco law and start more campaigns focusing on the health hazards of tobacco consumption and highlighting the bountiful benefits once the habit is kicked. They can take help of NGOs and Medias. The fight against tobacco, however shouldn’t be restricted to Government initiative alone, as voluntary organization can be very effective here. We need a concerted campaign that can strike at the social and cultural influence that entices young people into becoming tobacco-chewers and smokers. Clearly, preventing the use of tobacco in various forms is the major concerns of society. NGOS, parents and teachers should motivate children and youth against tobacco consumption, so that we can protect the health of the coming generations.