New Delhi: The World No Tobacco Day, which is observed worldwide on May 31, aims to create awareness about the health risks associated with tobacco use and advocate efficient policies to decrease its consumption.
For India, 'World No Tobacco Day' assumes much more significance following the fact that the country is the third largest tobacco producing nation and second largest consumer of tobacco worldwide. Tobacco use is estimated to cause more than 1.3 million deaths in India annually.
"Chewing tobacco is a major concern for India as well as other Southeast Asian countries rather than smoking and electronic tobacco products which is a major concern for western and European countries," Dr K Madan Gopal, senior public health advisor at National Health Systems Resource Centre (NHSRC), a premier think tank for health ministry told ETV Bharat.
History & Significance:
It was in 1987 when World Health Organization (WHO) passed a resolution and called for April 7, 1988 to be "a world no-smoking day" marking the 40th anniversary of the organization. Following the massive success of the no-smoking day, WHO took another resolution in 1988 and created World No Tobacco Day to be observed every year on May 31.
The World No Tobacco Day plays an important role in raising awareness about the health risks associated with tobacco use including the dangers of smoking. It tries to highlight that use of tobacco as it incites several health issues such as oral cancer, heart disease, stroke, respiratory illnesses and many more.
Theme of World No Tobacco Day 2024
"Protecting children from tobacco industry interference" is the theme for World No Tobacco Day this year. It emphasises the need to protect future generations and ensure that tobacco consumption continues to reduce.
WHO’s concern as young generation is attracted to electronic products
Easy availability of electronic products is also a major global concern. According to an estimate of WHO, 37 million children aged 13–15 years use tobacco, and globally, in most countries that have measured it, use of the industry's electronic products is more prevalent among young people. The range of products the industry uses to appeal to youth has expanded significantly, from cigarettes, cigarillos and shisha to newer products like e-cigarettes, heated tobacco products and nicotine pouches. Flavoured products and additives, sleek designs and child-friendly packaging and imagery make addictive products even more appealing to youth.
WHO’s Recommendations
Despite significant progress in reducing tobacco use, the emergence of e-cigarettes and other new tobacco and nicotine products present a grave threat to youth and tobacco control. WHO urges governments to protect young people from the uptake of tobacco, e-cigarettes and other nicotine products by banning or tightly regulating these products.
WHO recommendations include creating 100 per cent smoke-free indoor public places, banning flavoured e-cigarettes, bans on marketing, advertising and promotion, higher taxes, increasing public awareness of the deceptive tactics used by the industry and supporting youth-led education and awareness initiatives.
Indian Perspective
"Tobacco consumption causes serious ill effects to health. Tobacco consumption is the leading single preventable cause of death globally. India is the third largest tobacco producing nation and second largest consumer of tobacco worldwide. Tobacco use is estimated to cause more than 1.3 million deaths in India annually," said Dr VK Pail, member, NITI Aayog.
According to a latest report of Indian Association of Preventive and Social Medicine (IAPSM), globally tobacco is responsible for 70 lakh (7 million) deaths and kills around 12.8 persons annually in India (more than TB, AIDS, malaria combined) and 3,500 deaths daily.
"Tobacco use is a major risk factor for the four main non communicable disease (NCDs) - cardiovascular disease, cancer, chronic lung disease and diabetes, which puts people with these conditions at higher risk of developing severe serious illness when affected by Covid-19," said Dr Suneela Garg, national president of IAPSM.
IAPSM, founded in 1974, is a "not for profit" organization of specialists in Epidemiology, Health Management, Health Promotion, and Family Medicine advocating for education, research, and programs of Community Medicine.
Prevalence of Tobacco use in India
As per Global Adult Tobacco Survey 2016-17, conducted by the Ministry of Health & Family Welfare, 28.6 per cent of adults (15 year and above) in India use tobacco in any form. There are about 27 crore tobacco users including 20 crore smokeless tobacco users and 10 crore smokers. At least, 3.2 crore adults smoke as well as use smokeless tobacco. The prevalence of tobacco use is highest in Tripura and lowest in Goa.
Prevalence of tobacco use in West Bengal, Uttar Pradesh, Madhya Pradesh, Jharkhand, Chhattisgarh and northeastern States is higher than the national average of 29 per cent.
Significantly, after the IAPSM gave several suggestions to the health ministry including engagements of the community medicine department in all states for further reducing tobacco burden in their respective regions, the government has started implementing the suggestions.
"In all AIIMS, nodal officers for tobacco control have been appointed and the process is on in a phase manner in other government colleges. Government is also forming committees of committed faculty to sensitise staff and students about initiatives," said Dr Garg.
Types of tobacco products consumed in India
A myriad of forms of tobacco is produced and consumed in India. Each state has many local forms of tobacco. The smoking forms of tobacco include Bidis, Cigarettes, Cigars, Cheroots, Chuttas, reverse chuttas, Dhumti, reverse dhumti, Pipe, Hooklis, Chillum and Hookah. The major smokeless forms of tobacco includes Pan (betel quid) with tobacco, Pan masala with tobacco and Gutkha, Tobacco and slaked lime (Khaini), Snus, tobacco water (Tuibur) Tobacco, areca nut and slaked lime preparations: Mainpuri tobacco, Mawa. Tobacco products for oral hygiene and dentifrice include Mishri, Gul, Bajjar, Laldant Manjan, gudakhu, creamy enuff.
As per health ministry data, Khaini, Bidi and Gutkha are the three commonly used tobacco products in India.
Health effects of Tobacco use
Tobacco use is a major risk factor for Cancer, Cardiovascular Diseases (CVD), Diabetes, Chronic Lung Disease, stroke, infertility, blindness, Tuberculosis (TB), Oral Cavity etc. Smoking tobacco (cigarettes, Bidi etc) and Second-hand Smoke (SHS) contain over 7,000 chemicals and at least 70 of these can cause cancer. Likewise smokeless tobacco like gutkha, khaini, zarda also contains about 3095 chemicals, among them 28 are proven carcinogens.
Workers engaged in tobacco cultivation suffer from an occupational illness known as 'Green Tobacco Sickness (GTS)'. GTS is an acute form of nicotine toxicity resulting from absorption of nicotine through skin and usually occurs several hours after continuous exposure to green tobacco leaves. The illness is characterised by headache, nausea/vomiting, giddiness, loss of appetite, fatigue, weakness, and sometimes, fluctuations in the blood pressure (BP) or heart rate.
Initiatives of the Government of India for tobacco control
The Government of India has enacted the Cigarette and Other Tobacco Products Act 2003 (COTPA) to protect people from harmful effects of tobacco use and exposure to SHS.
Section 4 of the Act, bans smoking in public places. Different other Sections of the Act imposed ban on direct and indirect advertisement of tobacco products including sponsorship and promotion, ban on sale of tobacco products to and by minors (less than 18 years of age), ban on sale of tobacco products within 100 yards of educational institutions. The Act also mentioned the display of pictorial warnings on tobacco products packages.
"The government is doing its part. It has also imposed penalties for violation of COTPA. But, people should be responsible not to encourage such products and put into effect bans that are imposed on such products,” said Dr Madan from NHSRC.
Tobacco and other forms of gutkas like Rajnigandha, Panparag etc are easily available everywhere and at a cheap cost, he said.
Dr Madan said that in several places in India tobacco consumption starts from 10-12 years of age. "The children go to the pan shop and get tobacco very easily. And as they start consuming tobacco, they get used to pan, gutkha and other forms of addiction," he said.
