The health ministry is caught between a rock and a hard place after committing to implement 85% pictorial warnings on tobacco packages from April 1 before the Rajasthan high court, which will hear the case on April 1.
A parliamentary committee on subordinate legislation has recommended the size of the pictorial warnings be whittled down to 50%. The committee is headed by BJP MP from Maharashtra, Dilip Gandhi, who last made headlines for saying no Indian study linked tobacco with cancer, and that tobacco improves digestion.
India will host the Conference of the Parties (COP7) to the United Nations Framework Convention on Tobacco Control in Delhi in November this year and backtracking on the 85% commitment will make it appear to be succumbing to pressure from the tobacco industry.
“The recommendations of the parliamentary committee are not binding but we cannot turn a blind eye to the demands of farmers and the millions dependent on the tobacco industry,” said a health ministry official, who did not want to be named. “Reducing the size to 60% is being debated, but we need a nod from the PMO.”
There is no safe level of tobacco use. Tobacco is as addictive as heroin and cocaine, and is the only legally sold substance that kills when used as directed, killing one person every six seconds. It is the leading cause of oral cancer – of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and throat – which is the number one cancer among men in India, followed by lung cancer.
Apart from cancers, smoking is a major risk factor for chronic bronchitis, heart disease and stroke.
And it does not spare even the fittest. Holland and Barcelona football legend Johan Cruyff, who smoked 20 cigarettes a day till his open heart surgery in 1991, died of lung cancer on Thursday within six months of being diagnosed.
In India, 275 million people use tobacco, which causes a million deaths – 2,800 a day – each year.
Bigger is better
Large pictorial pack warnings work by reducing the number of children who begin smoking and increasing the number of smokers who quit, says the World Health Organization.
“Health warnings on tobacco products are the most cost-effective tool for educating on the health risks of tobacco use, and we have several studies from India to prove it,” said Dr K Srinath Reddy, president, Public Health Foundation of India. “There is a need to strengthen and target the health messages in a better way to ensure they reach all smokers, including those buying loose cigarettes and bidis.”
Pictorial warnings deter smoking, especially among the young and in countries with low literacy, found a study by the All India Institute of Medical Sciences in the journal Tobacco & Nicotine Research.
“Large graphic warnings also transcend language barriers in countries like India, where different languages and dialects are used across states,” said Dr KK Agarwal, general secretary of the Indian Medical Association.
The tobacco industry is opposing large pictorial warnings saying it will have devastating consequences on the millions dependent on the sale of these products.
India ranked 136 among a ranking of size of health warnings on tobacco packs, according to a 2014 Canadian Cancer Society report
Nepal (90%), Thailand (85%), Pakistan (85%), Sri Lanka (80%) and most recently Myanmar (75%) have notified large pictorial warnings over the past year.
Bangladesh has given its nod to pictorial warning covering 50% area on the upper side of the package and it is expected to be implemented this year.
In 2015, Burkina Faso (60%), Namibia (60%) and Chad (70%) in Africa passed regulations to introduce pictorial health warnings on tobacco packages.
In Brazil, health warnings are required to cover 100% of either the front or back of the package.