On March 31, the Centre gave the tobacco industry the green signal to sell its deadly wares without the prominent health warnings which were to be notified on April 1. The health ministry decided to defer the mandatory placement of pictorial and text warnings that occupy 85% of the packaging on all tobacco products.
This was prompted by the recommendations of a parliamentary panel which called for a review of both the scientific evidence on the health effects of tobacco and the economic impact of such a regulation.
In the public debates that followed several key themes emerged: First, conflict of interest, involving an MP, who owns a large beedi factory, participating in its deliberations and contributing to its recommendation to defer the warnings; second, questioning of the tobacco-cancer link, by some members of the committee; third, the need for prominent pictorial health warnings; fourth, obligations under the Indian and international laws, and fifth, the spurious choice between people’s health and loss of employment for those engaged in tobacco farming or manufacture.
Some of these issues can be easily dealt with. The conflict of interest involving the beedi baron is too transparent to require a comment. To better appreciate his concern for his employees, it would be helpful to know how many workers in his Rs 250-crore business have risen above the poverty line.
The challenge to scientific evidence on the harmful effects of tobacco echoes the early tactics of the tobacco industry in denying a link between smoking and cancer or heart disease. In most parts of the world, the industry has given up that pretence when confronted by a compelling body of evidence from its own internal documents.
Yet, we are now asked whether there is such a link by learned MPs.
When challenged, the question was reframed to ask if there was Indian evidence on beedis as distinct from western evidence on cigarettes. Indeed, there is compelling evidence of a link between cancer and heart disease even for beedi smoking from studies conducted by credible Indian institutions for over three decades.
It is a pity that the sceptics did not first seek information from the health ministry before stopping the clock on the health warnings or making public pronouncements that better fit the Flat Earth Society. “All smokers don’t get cancer and some non-smokers do. So where is the link?” questioned some MPs. This again had been answered in the past.
Smokers, as a group, are at a greater risk of serious disease and death than non-smokers. It is that ratio of higher risk that steers the scientific conclusion of harm and guides public policy.
Every car that drives through a red light does not have an accident and some cars which stop at a red light may get hit from behind. Nevertheless, a car which speeds through a red light is far more likely to have an accident than a car that stops. This estimation of risk, based on large numbers, is analogous to risk estimates for smoking and disease.
“Why the big warnings? We already have a 40% warning, that should suffice” was another poser. Bigger is better for attention and impact. Who would know that better than politicians who resort to 30-foot cardboard cut-outs during poll campaigns? They do not distribute passport size photos to capture voter attention. In a country, where the poor are the most frequent consumers of tobacco — especially beedis — and also have the lowest levels of literacy and education, prominent pictorial health warnings are the most effective mode of communicating the health risks of tobacco.
The current pictorial warnings count for 20% of the front and back surfaces combined. As such, it is less than the 30% minimum recommended by the Framework Convention on Tobacco Control (FCTC) to which India is a signatory. Further, many countries have adopted or are moving to warnings around 80%. Australia, Ireland and Britain have introduced plain packaging and prominent pictorial warnings for all tobacco products.
New Zealand will follow soon. Similar legislation has been proposed as a Private Member’s Bill in the Parliament by BJD’s Jay Panda.
It is painful when the argument of “free adult choice to smoke” is trotted out by some political leaders. Tobacco is an advertised addiction and marketed malady that traps people in a deadly habit when they are not fully aware of the risks. If ‘free informed choice’ is indeed the principle being upheld, why shy away from large pictorial warnings?
To say that these warnings will adversely affect business is a tacit admission that people may make the right choice to stay away from tobacco if risk is effectively communicated.
Then there is the biggest smokescreen of all: The bogey of lost employment. Success in tobacco control will bring down prevalence rates over several years — not days. As the population grows, even a decreasing prevalence will still mean large absolute numbers of unfortunate tobacco addicts who will keep the industry alive, even as tobacco deaths mount.
It is also self-contradictory to say that we abide by the Indian tobacco control law of 2003 and the FCTC both of which have the goal of reducing the prevalence of tobacco consumption and, at the same time, stall any tobacco regulation on the ground that it will reduce tobacco consumption.
Is it the intent of tobacco’s defenders that the industry must be perpetually protected and tobacco consumption forever maintained at a high level because it provides employment? Must the poor continue to spend money on tobacco to provide profit to the industry?
Of course, we need to provide economically viable alternative farming options and occupations to tobacco farmers and workers. These will come through affirmative action and not through alibis that perpetuate the trade and threat of tobacco. Such transition has to be steered by the government with initial market-supported mechanisms.
Beedi workers too cannot remain yoked to poverty to churn out wealth for the industry. They need to be assisted in moving to more gainful and socially beneficial occupations. Political will can create the momentum for concerted multi-sectoral action, to save both lives and livelihoods.
That many lives are lost prematurely due to tobacco must not be forgotten. Who holds the brief for the million-plus Indians who die every year from tobacco-related diseases? Who will act to protect the future of young Indians who are being lured to become new tobacco victims? That duty falls upon MPs to rise above party affiliations and sectoral interests to fulfil their commitment to the people. Parliament must take the lead in designing a viable plan for ushering a tobacco-free society in India by 2035, with an immediate start.
That is the legacy the present MPs must leave for their children, grandchildren and all of India.
K Srinath Reddy is president, Public Health Foundation of India
The views expressed by the author are personal