On the evening of September 23, people in India heard Prime Minister Narendra Modi announce during his Mann Ki Baat radio programme that his government had banned e-cigarettes. He emphatically voicing his concern about the growing craze for e-cigarettes and the harmful effects they had on users.
The decision was applauded by India’s public health community as an exemplary measure towards protecting public health. The same morning, however, a national newspaper reported that an official of the Tobacco Board of India was travelling to Washington to attend a tobacco industry-sponsored conference. This was one more incident that exemplified the lack of a coherent government approach towards tobacco control policies and programmes.
After protests from the health ministry and civil society members, the Tobacco Board official cancelled his trip. But it showed that the government has not been able to reconcile the larger concerns of public health harms caused by the tobacco industry versus the economic gains it believes it harvests from the tobacco trade.
Vector of premature death
Tobacco products are the only consumer products that can kill half of its consumers even when used exactly as intended by manufacturers. The harms to public health are now globally recognised. The tobacco industry is a vector of premature death. One in every ten adult premature deaths – a little more than one million deaths a year in India – is attributable to smoking.
Considering the global nature of the industry responsible for this problem, the World Health Organisation in 1995 proposed its first international treaty, the Framework Convention on Tobacco Control. This highly successful treaty has now been ratified by 181 countries. Among the few major exceptions are the USA (which hardly ratifies any treaty), tobacco industry strongholds (Indonesia, Argentina, Cuba) or places where tobacco companies stash their money (like Switzerland).
The convention has a dedicated provision that, if implemented can protect government policies, from the assault of the tobacco industry. This is Article 5.3 of the convention, which states that “there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests”.
Low Indian ranking
Earlier this month in New York, a global assessment of the tobacco industry interference and the response to governments to it was reported for the period January 2017 to December 2018. India’s ranking is quite abysmal: it was 23rd out of 33 countries surveyed. Although India has achieved much in tobacco control, this report has highlighted the areas that need urgent attention.
The basic issue is interference by the tobacco industry. The interference starts from the stage of discussion and formulation of any tobacco control policy. Later, when a policy has been formulated and notified, there is legal assault from the industry in the form of lawsuits. Since 2003 (the time when India’s Tobacco Control Act came into force), the tobacco industry has filed nearly 700 litigations against the government.
As a countermeasure, between 2012 and 2019, the governments of 14 Indian states have developed rigorous policies to protect themselves from interference of the tobacco industry based on Article 5.3 guidelines. These policies were developed and adopted after the Karnataka High Court ordered the Central government to stop the Tobacco Board of India from participating in a tobacco industry event in September 2010. It also directed Central government to adopt a policy to protect itself from tobacco industry interference.
The government has dragged its feet on this and currently its ministries and departments have no restriction on engaging with the tobacco industry. An absence of such a policy makes it much harder to advance the Framework Convention on Tobacco Control.
Targetting young people
Big Tobacco, on the pretext of targeting its deadly products to existing tobacco users, pays more attention on targeting potential users of its products, particularly young people and minors. New products like electronic cigarettes entered India’s market rather surreptitiously. They come in more than 400 flavours such as crème brulee, strawberry and mango which makes it a perfect lure for youth. When India announced a ban through an ordinance, the nascent e-cigarette industry went forum shopping (a practice adopted by litigants to get their cases heard in a particular court that is likely to provide a favourable judgment) and got a multinational company to back it.
Due to the tobacco industry’s behaviour as a rogue industry, government seems reluctant to regulate it or adopt stringent measures to eradicate tobacco use. Moving forward from the e-cigarette ban, the Indian government can do more to improve public health by phasing out tobacco use and curbing the tobacco industry.
Tobacco control is not just a health argument but also an economic one. The annual economic costs of just bidi smoking amount to approximately 0.5% of India’s GDP (Rs.80,550 crores in 2017, or Rs.100,385 crores in terms of 2018-’19 current GDP), while excise tax revenue from it is only 0.5% of its economic costs. Tobacco use has ruined families, eaten into household incomes and trapped communities in a cycle of poverty. These devastations have not been accounted for.
For Prime Minister Narendra Modi and his government to succeed in ending the scourge of diseases caused by tobacco, hard decisions are required.
Dr Prakash Gupta is an internationally recognised epidemiologist and recipient of the Luther Terry Award (2010). He is the Director of Healis-Sekhsaria Institute of Public Health, Mumbai and is Visiting Scientist at the Harvard School of Public Health.