Sunday, September 19, 2021

Tobacco plus Corona = Accelerated Death

‘Quit tobacco to be a winner’ is theme of this anti-tobacco day on May 31.

We are all baffled by covid19 pandemic that is killing few thousands every day, but we are ignoring the continuous pandemic- tobacco that is killing around 40 lakh people every year in India alone. Combination of two pandemics make death more certain for smokers afflicted with corona virus or accelerate their death.

We should not be proud for being the third largest producer of Tobacco, rather be ashamed of causing 42 per cent of deaths due to tobacco in the world.

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Tobacco did not originate in India but was brought into by Portuguese. Tobacco smokeless contribute more cancer than the other products. It is estimated that 3500 Indians die every day because of tobacco in India, equal to 25 Jet planes are crashing in a country. Most common preventable cause of death is tobacco.

source: https://www.tobaccofreekids.org/problem/toll-global

Some of the baffling facts about the consequences of tobacco use are:

  1. 100 million people died from tobacco use in the 20th century. If current trends continue one billion people will die from tobacco use in the 21st century. (Eriksen M et al. The Tobacco Atlas. Fifth Ed. Atlanta, GA: American Cancer Society; 2015.)
  2. Tobacco use kills up to half of all lifetime users. On average, smokers lose 15 years of life. (WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva: World Health Organization; 2008.)
  3. Tobacco kills more than 8 million people each year.1 Of these deaths, 1.2 million are caused by secondhand smoke exposure. (Tobacco Fact Sheet. World Health Organization; 26 July, 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/tobacco.)
  4. Tobacco-related illnesses account for 1 in 10 adult deaths worldwide. By 2030, 80% of those deaths will be in low- and middle-income countries.
  5. Smoking is estimated to cause about 1.4 trillion USD in economic damage each year. (U.S. NCI and WHO. The Economics of Tobacco and Tobacco Control. NCI Tobacco Control Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda: U.S. DHSS, NIH, NCI, and Geneva: WHO; 2016.)
  6. Bidi and cigarette smokers die 6 to 10 years earlier than their non-smoking counterparts.

It’s shocking to know that around 850 crore cigarettes are sold in India per  year and around 26 crore 70 lakh people smoke, while around 40 lakh people die in India.

It is revealed that 26. 7 crore people consume tobacco in India, 42 per cent are men and 14.2 % are women. Every year ten lakh people die because of tobacco, 9.26 lakh die due to secondhand smoke, 20 lakh die by smokeless tobacco, which is 74 per cent of global deaths of smokeless tobacco. In 2016 around 85 billion cigarettes were sold in India.

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Western media bombard on smoking tobacco because smokeless tobacco is not their problem. It is India’s problem. Unfortunately, the smokeless tobacco is no tabu, and accepted by family members.

Its an enemy to medical profession and society and it is unrecognized pandemic, says Dr. Subramanyeshwar Rao, an senior oncology expert.

India became a Party to the WHO Framework Convention on Tobacco Control on February 27, 2005, later changed it to 31 May to spread awareness about dangers of tobacco.According to the World Health Organisation (WHO), “When the news came out that smokers were more likely to develop severe disease with COVID-19 compared to non-smokers, it triggered millions of smokers to want to quit tobacco.”This year, the theme is ‘Quit tobacco to be a winner’. 

In 1987, the Member States of the World Health Organisation created World No Tobacco Day to draw its attention towards the tobacco epidemic. They also wanted to focus on the preventable death and disease tobacco causes.

Tobacco Control Legislation

The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA) is the principal comprehensive law governing tobacco control in India. In 2004, the Ministry of Health and Family Welfare exercised the powers granted to it in Section 31 of COTPA by promulgating a first set of rules, which, with respect to smoke free and tobacco advertising issues, have been stayed by court order or superseded.  With respect to general enforcement of COTPA, G.S.R. 1866(E) lists certain officers who are authorized to carry out the entry, search, and seizure provisions of the Act.

Following the passage of COTPA in 2003, various rules and GOs were passed for implementing COTPA address smoke free policies or provide useful definitions. The Railways Act, 1989 also regulates smoking on trains. Several orders and rules were issued to regulate sale, advertising etc, extending restrictions to tv, print and outdoor media, under Cable Tv Networks (Regulation) Act, 1995 etc. The Guidelines issued pursuant to Section 5B(2) of the Cinematograph Act of 1952, require the Central Board of Film Certification to ensure that certain types of smoking scenes do not appear in movies.

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Packaging and labelling provisions are included in several implementing rules enacted following COTPA’s passage in 2003. G.S.R. 985(E) changes the rotation period of the health warnings from one year to two years and re-establishes the warnings published in G.S.R. 182(E). (G.S.R. 985(E) caused the diseased lungs and scorpion health warnings to continue in effect.  On October 15, 2014, the government introduced new larger warnings via G.S.R. 727(E) that, among other things, increased the warning size from 40 percent of one side of tobacco product packaging to 85 percent of both sides of tobacco packaging and amended the rotation scheme prescribed in G.S.R. 985(E). The government implemented new rounds of warnings on September 1, 2018 (G.S.R. 331(E)) and December 1, 2020 (G.S.R. 458(E)). Provisions prohibiting misleading descriptors and obscuring the health warnings on the package remain in G.S.R. 182(E) unaltered.

No Smoking in Public places

In India smoking is completely banned in many public places and workplaces such as healthcare, educational, and government facilities and on public transport. But the law permits the establishment of smoking areas or spaces in airports, hotels having 30 or more rooms, and restaurants having seating capacity for 30 or more. With respect to outdoor places, open auditoriums, stadiums, railway stations, bus stops/stands are smoke free. States are free to use within their jurisdictions to enact smoke free laws that are more stringent than the national law.

Advertising through most forms of mass media is prohibited. There are some restrictions on tobacco sponsorship and the publicity of such sponsorship.

Restrictions on media

It is regulated that the health warning labels are pictorial, and text should cover 85 percent of the front and back panels of the tobacco product package parallel to the top edge; and are rotated every 12 months. Misleading packaging and labelling, including terms such as “light,” and “low-tar” and other signs is prohibited.

Cigarette Contents and Disclosures

It is unfortunate that the law does not grant the authority to regulate the contents of cigarettes. There is a need for such public law to control the tobacco commerce in the interest of public health. At present the law does not require that manufacturers and importers disclose to government authorities information on the contents and emissions of their products. But it is basic requirement. When a cigarette maker wants a consumer to purchase his product, it is his duty to give complete information about contents, their proportion, the ill-effects of its use.

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No sale within educational institutions

The law prohibits the sale of tobacco products via vending machines and within 100 yards of any educational institution. Educational institution is a public place, hence prohibition against use of tobacco products applies there.  In addition, several states ban the sale of single cigarettes and gutka and other forms of smokeless tobacco.

It is unfortunate that there are no restrictions on internet sales or the sale of small packets of cigarettes or other tobacco products. This should be taken up seriously and a common agreement must reach to ban tobacco ads on internet. The sale of tobacco products is prohibited to persons under the age of 18.

E-Cigarettes

The law prohibits the production, manufacture, import, export, transport, sale, distribution, and advertising of e-cigarettes. It is a paradox that there are no restrictions on the use of e-cigarettes. Without restricting use of cigarettes, the prohibition on production does not work. There should be a ban on both production and use, for effective control.

The Governments either at centre or states are interested in income from tobacco business, as vices are considered to be best sources of income for them. While Governments withdraw from business, saying Government has no business to be in business but confine to public welfare, they facilitate tobacco business at the cost public welfare. It is astonishing that rulers do not bother even if millions are getting killed every year due to tobacco, and give them ‘freedom’ to die, though such right is specifically declared by Supreme Court not part of right to life. Though promotion of public health is directive principle of state policy, governments do not bother to make and implement tobacco-prohibiting legislations.

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Prof. M. Sridhar Acharyulu
Author is Dean, Professor of law at Mahindra University at Hyderabad and former Central Information Commissioner. He published a number books in English and Telugu.

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