The recently released global tobacco report 2023 of the World Health Organisation highlighted that the worldwide rate of the prevalence of smoking had dropped from 22.8 per cent in 2007 to 17 per cent in 2021. In its ninth global tobacco report, the UN health agency added that without this decline, there would have been additional 300 million smokers now.
The report brings out that almost 40 per cent of countries now have completely smoke-free indoor public places. The WHO lauded the efforts of Mauritius and the Netherlands in implementing all its recommended measures at the best practice level, which only Brazil and Turkey had accomplished hitherto. In India, while implementing the measures has proven useful to an extent, there is a pressing need to curate and amend laws in line with the habits and practices of the Indian public. While the WHO strategy focuses on preventing smoking tobacco products, in India, the problem with tobacco also includes chewable products.
Global tobacco report and MPOWER Strategy
WHO introduced MPOWER, a set of six cost-effective and high-impact measures that help countries to reduce demand for tobacco. These were launched in 2008 as part of the Framework Convention on Tobacco Control (WHO FCTC). These include:
- Monitoring tobacco use and prevention policies.
- Protecting people from tobacco smoke.
- Offering help to quit tobacco smoking.
- Warning about the dangers of tobacco.
- Enforcing bans on tobacco advertising, promotion and sponsorship.
- Raising taxes on tobacco.
The report highlights that seven out of ten people are protected by at least one tobacco control measure. It also focuses on creating smoke-free environments to help people breathe clean air and shield the public from deadly second-hand smoke. Further, it aims to denormalize smoking, motivate people to quit tobacco usage and help prevent young people from picking up the habit or even using e-cigarettes.
Understanding country-specific needs to control tobacco harm
According to the Indian medical fraternity, the strategies of MPOWER are not enough to control the effects of tobacco harm in India. It is because of the usage of chewable tobacco in India.
Speaking to Happiest Health, Dr Pankaj Chaturvedi, head and neck surgeon, deputy director, Centre for Cancer Epidemiology at Tata Memorial Centre, Mumbai, said that for Indian requirements, MPOWER needs to be titrated to the Indian needs. “It is less applicable to the practices seen in India. Apart from the effects of smoking and passive smoking, we must also focus on the effects of chewing tobacco and spitting in public.”
Dr US Vishal Rao, country director, head neck surgical oncology and robotic surgery and Dean for Centre of Academic Research at HealthCare Global (HCG) Cancer Centre, Bengaluru, agrees with Dr Chaudhury. “The local factors, habits, dynamics and tobacco industry interference are to be put together. The proposed amendments to the Cigarettes and Other Tobacco Products Act (COTPA) 2003 include factors crucial for the Indian context. These are not relevant to many other countries, but crucial in India,” says Dr Rao.
Chewable tobacco is a significant concern in India
Dr Chaudhury shares that the MPOWER strategy works best in countries where smoking is the most common form of tobacco consumption. In such places, it brings in taxation, prevents second-hand smoke and stresses the need for designated smoking areas. “India has done well on these grounds, and smoking in public places is prohibited. With warnings on cigarette packs, people smoke less at home. However, the biggest problem in India is chewable tobacco. It is the commonest form of consumption — and accounts for 80 per cent of tobacco products sold,” Dr Chaudhury points out.
He adds that though the usage of gutka and flavoured tobacco is prohibited, one needs to focus on controlling the use of areca nut and smokeless tobacco products available in two different sachets. “India needs to evolve a strategy on tackling pan masala, a carcinogen and surrogate of chewing tobacco,” says Dr Chaturvedi.
Tobacco surrogates are not banned
Dr Chaturvedi points out that though there is a ban on advertisements of tobacco products, the restrictions do not cover tobacco surrogates. “Pan masala comes in two forms, the one with tobacco and without tobacco. The former is banned in most states. But the latter is also harmful and carcinogenic — and unfortunately, it even gets endorsed by celebrities” added Dr Chaturvedi.
India’s requirement in terms of tobacco control are hugely different and requires measures beyond what MPOWER suggests, points out Dr Chaturvedi. Dr Rao adds, “One of the most powerful but under-utilised weapons in the war against tobacco is taxation. Another urgent need is to bring in an amendment in the COTPA act that includes the prohibition of all forms of tobacco.”
What also bothers the experts is the availability and usage of tobacco products in small pouches and those available at home. These escape taxation restrictions, too. Further, both Dr Rao and Dr Chaturvedi highlight that the sale of loose cigarettes is a defeated clause. “The pictorial warning on cigarette packets (covering 85 per cent of the packaging surface) is meaningless if loose cigarettes are being sold. We need to sensitise the vendors obtaining the license to sell tobacco products to know the effects the product causes,” emphasises Dr Rao.
Takeaways
- According to WHO’s recent global tobacco report, only four countries have implemented the MPOWER strategy’s tobacco control measures effectively.
- MOPWER includes six cost-effective and high-impact measures that help countries to reduce the demand for tobacco.
- According to Indian doctors, the strategy does not tackle the problems associated with chewing tobacco, a major burden in India. Hence, it is crucial to bring in amendments to the COTPA Act.
