Statutory warnings on cigarette packets state that smoking is injurious to health. But just how injurious is it? Consider these facts: In India tobacco kills 800,000 people every year, according to the Indian Council of Medical Research (ICMR). But the tobacco industry ensures that consumers do not get to know this reality. In India, 2,200 persons die every day from tobacco-related diseases; but the tobacco industry maintains that providing a statutory warning on cigarette packets is enough. The mega-industry also swears by the 'freedom of choice' contention.
According to a recent report of the Economics of Tobacco Use (ETU), sponsored by the Indian Ministry of Health and Family Welfare, the tobacco industry contributes about Rs 70,000 million (1US$=Rs48) as revenue to the country's exchequer and Rs 10,780 million as export earnings. In addition, tobacco provides employment to over four million people.
India is the third largest producer of tobacco after China and the USA. It is also the sixth largest exporter of tobacco and accounts for six per cent of the global tobacco trade. The market for tobacco in India is worth Rs 200 million and is rising in proportion to the burgeoning population.
However, buried under this flurry of statistics lie other facts that tell a story that the tobacco industry wishes could be smoked away. A study conducted by ICMR in 2000 revealed that each patient suffering from a tobacco-related disease costs the country Rs 2.5 million through direct medicine costs, absenteeism for treatment and loss of income due to premature death. Considering that ICMR estimates that 142 million men and 72 million women above the age of 15 years are tobacco consumers, the money that these people notionally cost the economy works out to a tidy sum. To this if one were to add the growing number of passive smokers, then it becomes quite clear that tobacco puts an enormous strain on economic resources and hampers productivity.
In fact, ICMR has found that the partial financial costs of some tobacco-related diseases are high enough to exceed the tobacco industry's annual financial contribution - completely demolishing the economic benefit theory propounded by the tobacco industry. The situation is no better worldwide. According to a 1999 World Bank study, smoking is already killing one in every 10 adults. By 2030 ' perhaps even a little sooner ' this proportion will be one in six. In other words, 10 million deaths per year ' this is more than any other single cause of death. It is also estimated that, globally, tobacco is responsible for about 3.5 million deaths every year. This figure is expected to increase to more than 10 million annually during the 2020s. What this means is that about half a billion of today's world population would eventually be killed by tobacco.
In India, it is not only cigarettes that are being consumed by such a large proportion of the population. According to data from the Tobacco Board, smokers of the more potent 'bidis' (a coarser handmade version of cigarettes) constituted 54 per cent of tobacco consumers in 1999. Twenty-four per cent were consumers of chewable tobacco and the remaining were cigarette smokers. The Tobacco Board also estimates that the percentage of smokers is likely to rise to 33 per cent by the year 2020.
There has been persistent pressure by groups like the Voluntary Health Association of India (VHAI), the National Organization for Tobacco Eradication (NOTE), Health Related Information Dissemination Amongst Youth (HRIDAY, meaning 'heart' in Hindi) and the World Health Organization (WHO), the result of which has led to a draft legislation to control consumption of tobacco in the country. Called the 'Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Supply and Distribution)' Act 2001, it seeks to "prohibit the advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products".
Although the Bill is still pending before a Select Committee of the Parliament, it has already had an impact. For instance, it led to the withdrawal of a major cigarette company from the sponsorship of the Indian cricket team. In addition, there has been a reduction in the visibility of advertisements of these products both on television and in newspapers. The problem of enforcement, however, is ever-present. Unfortunately, nobody wants to wage court battles because of the inherent delays and long drawn processes involved in going to court. Experts also maintain that a more effective way of addressing this problem would be by spreading awareness. Professor S Reddy of the cardiology department, All Indian Institute of Medical Science (AIIMS), New Delhi, for instance, believes that schoolchildren are the best ambassadors of the anti-tobacco campaign.
And Reddy believes in practicing what he preaches. So in order to promote health education, in 1992, along with other doctors and medical students of AIIMS, he set up the voluntary association, HRIDAY. This association has united students of 63 schools through the Students Health Action Network (SHAN).
SHAN fired its first salvo in 1999 by presenting a memorandum to the Prime Minister, signed by 25,000 schoolchildren, urging effective action to usher in a tobacco-free society starting with a complete ban on tobacco advertising. According to Reddy, students are particularly important to this campaign because of the increase in smoking amongst teenagers.
And Reddy has reason to think this way. According to ICMR figures, of the 100 teenagers smoking today, 50 will eventually die of tobacco-related disease. In fact, according to WHO projections, India will have the highest rate of increase in tobacco-related deaths by the year 2020. Statistics also show that two-thirds of the smokers in the country begin the habit young, before they realize the health risks involved.
There are 25 tobacco-related diseases known today. These include cancers of the lung, oral cavity, pharynx, oesophagus, pancreas, bladder, cervix and blood. In India, tobacco-related cancers constitute about half of the total cancers among men and about one-fifth of the total cancers among women. Besides these, nicotine increases blood pressure, exacerbates asthma, causes impotence, infertility, heart attack and stroke.
One thing, however, is clear: the only way that the anti-tobacco campaign can make a mark is if there is stringent enforcement of legislation. This can take place if politicians agree to disagree with the arguments of the tobacco industry. The first step they can take in this direction is by passing the Tobacco Bill and paving the way for greater health consciousness. And till that happens, there is going to be an increasing number of Indians blowing their life away in smoke.