The World Health Organisation (WHO) estimates that tobacco killed 100 million persons in the 20th century, more than the two world wars combined. Even more alarming is the projected tobacco related death toll for the 21st century. A billion persons are likely to die from >tobacco related diseases in this century, according to WHO. About half of these deaths will occur in middle age and 80 per cent of global deaths from tobacco will be in the low and middle income countries. Currently, over six million die each year due to tobacco use.
India is expected to have the highest rate of rise in tobacco related deaths, over the next three decades. At present, a million lives are lost annually due to smoking. Since deaths due to tobacco chewing and other non-smoking forms of consumption as well as the lives claimed by passive smoking have not been well quantified, the total count of tobacco related deaths will be more than a million per year.
Recent surveys reveal that 35 per cent of Indians over 15 years of age consume tobacco. While the number of men with the tobacco habit has remained around 48-50 per cent over the last decade, the number of women consumers has doubled from 10 per cent to 20 per cent. In the age group of 13-15 years, 14.6 per cent of children regularly consume tobacco. In the schools of Delhi and Chennai, class six students were observed to be consuming tobacco more frequently than those in class eight, suggesting that the age of initiation is becoming younger. The gap between boys and girls is narrowing. Oral tobacco consumption is especially high among women and girls. Across the country, bidis are smoked more than cigarettes but oral tobacco products now top them all.
The list of diseases linked to tobacco grows by the day. While heart attacks and cancers lead the list, lung diseases, gangrene, cataracts, impotence, infertility and still births are known to result from tobacco use. Over the past two decades, evidence has accumulated to show that smokers are more likely to develop and die due to tuberculosis. Tobacco users are also more likely to develop diabetes, because of acquired insulin resistance.
Tobacco is not merely a health hazard. It is also a threat to the environment. ‘Curing’ of raw tobacco leaf requires burning of wood fuel, leading to deforestation. Paper used for packaging adds to that. Tobacco cultivation is water intensive, uses a high volume of pesticides and causes soil erosion. With millions of undernourished children and hungry people across the world, should the world be wasting four million hectares of arable land on tobacco instead of growing food crops?
Tobacco is linked to poverty, both as cause and consequence. Across the world, India included, poor and less educated persons consume tobacco more frequently than the affluent or well educated. It also leads to or aggravates poverty, through death or disability of wage earners in a family. It diverts household income from food, education, health care and other needs. While it offers employment in agriculture and industry and raises revenue for the government, health care costs of tobacco related diseases exceed the economic returns from tobacco, according to studies commissioned by the Indian Council of Medical Research. It is this link to poverty that made the World Bank alter its position on tobacco and call for ‘reversing the epidemic’.
Curbing supply
Tobacco is a marketed malady and an advertised addiction. Court cases and Senate hearings in the U.S. have shown how the tobacco industry has cynically suppressed or denied evidence of health harm or addiction. The industry has consistently opposed or evaded regulation and continues to devise new means of maximising private profit unmindful of the horrendous effects of tobacco on human welfare.
There is no alternative to the elimination of tobacco as a product for human consumption in any form. Countries across a wide spectrum of development have shown how effective regulatory measures can reduce tobacco consumption and its health burdens — >Australia , New Zealand, Ireland, Canada, Uruguay, Brazil, Thailand and Bhutan are among the outstanding examples. However, this global threat now calls for a concerted global thrust to lift the dark shadow of tobacco from the 21st century.
As the world awaits the adoption of Sustainable Development Goals (SDGs) in 2015, we must recognise tobacco as a grave threat to humanity’s aspirations for progress and wellbeing. Whether we are concerned about health, environment, food security, water security or poverty reduction, we have to work for a tobacco free society. Otherwise, tobacco will frustrate all prospects of sustainable development.
Treaty in place
In 2003, the World Health Assembly adopted the world’s first public health treaty negotiated under the auspices of WHO. The Framework Convention for Tobacco Control (FCTC) has now been ratified by 176 countries. India, which led from the front during the FCTC negotiations, enacted a comprehensive legislation for tobacco control in April 2003. Regulatory measures prescribed under the law include a ban on smoking in public places and indoor work places, prohibition of advertising and promotion of tobacco products, pictorial warnings on tobacco packs, ban on sale to minors and regulation of movies to counter the effects of scenes depicting tobacco use. The recent ban on ‘gutkha’ is a major step forward.
However, much needs to be done to strengthen enforcement of those measures and to effectively communicate the dangers of tobacco to people. The benefits of quitting the habit are many and must be made known to tobacco users, who must be assisted in giving up the deadly habit through community based cessation services. Both WHO and World Bank advocate raising taxes, to increase tobacco product price, as the most effective intervention to reduce tobacco consumption. India must use this path to discourage tobacco consumption and raise revenue for developmental activities, including provision of alternative livelihoods to persons engaged in tobacco farming and manufacture. These measures need to be accompanied by a sustained awareness campaign, using both electronic and social media, to discourage the use of tobacco in any form. Such a campaign must particularly target the young generation, in schools and in colleges. Associating celebrities with this campaign as role models may be an effective means of getting the message across: “Tobacco kills”.
(Dr. R.K. Pachauri is director, TERI, Dr. K. Srinath Reddy is president, Public Health Foundation of India, and Shyam Saran is a former Foreign Secretary and currently chairman, National Security Advisory Board.)
