Shortly after the government announced a nationwide lockdown to prevent the spread of the coronavirus in March, the Indian Council of Medical Research’s Department appealed to the public to “refrain from consuming the Smokeless Tobacco products and spitting in public places during the... epidemic”.

Following this directive on April 4, several states ramped up the penalty for spitting in public places. Since time immemorial, governments have found it difficult, if not impossible, to regulate so-called vices such as smoking, drinking and gambling. Can a blanket ban on spitting actually end expectoration in public places?

Perhaps India could take a lesson or two from the manner in which the United States handled its tuberculosis crisis in the late 19th century. After the country realised that the “sputum vector” – or “promiscuous spitting” – was the sole cause of spreading tubercular germs among the population, it launched the American Tuberculosis Crusade. Officials grappled with a key question: how to strike an intelligent balance between two competing demands – safeguarding public health against the extremely dangerous tubercle bacillus while restricting individual freedom to spit.

The broad lesson learnt in the US was that the “public civilising goal” of inculcating “spitting etiquette” is unattainable if the state depends ony on enacting laws against public expectoration and applying its coercive power to curb the practice in public places.

From being regarded as “unmannerly” albeit “benign” to labelling the practice of spitting as a harmful, unhygienic and unsanitary habit to ultimately categorising it as a crime requires a well thought-out, pragmatic and bottoms-up strategy rather than a narrow, top-down approach.

Persuasive tactics

In the US, achieving the difficult balance necessitated a strong legislation backed by persuasive tactics such as public dissuasion as well as techniques like grassroots campaigns, mass awareness and education efforts. After all, regulating individual habits actually requires changes in public attitudes and behaviour. As such, a strict, narrow medical/legal approach that focuses on controlling expectoration seemed politically popular but was not socially acceptable.

A 1910 study of 74 American cities with anti-spitting laws showed that only 36 had made any arrests and only 13 made more than 20 arrests. Only New York city reported 2,513 arrests – 73% of the national total. Consequently, it was widely observed that rule-making is only one of many steps towards inculcating spitting etiquette.

In the US, it was noted that spitting resulted from “indifference on the part of the citizens of a community, a lack of civic pride, and a failure to appreciate the danger from the unrestrained practice of this vile habit”.

An underground tuberculosis treatment facility in Kentucky's Mammoth Cave, started in 1842. Credit: James St. John, CC BY 2.0 via Wikimedia Commons

It was extremely important for the Americans to understand the contagious nature of the spitting habit and that the public’s health and well being superseded the right of an individual to spit indiscriminately.

In order to build a national consciousness and to curb the deadly practice, the public health departments of all states adopted a toolbox of strategies, with New York taking the lead. Tactics included measures of public education such as New York’s leaflet that recommended health-conscious behaviour among the residents; the use of newspapers to identify and condemn spitters; and encouraging citizens to disseminate the anti-spitting diktat within their communities. Further, mobile advertisements on street cars, taxis and buses helped create a conversation around the hazard.

Moreover, hundreds of private civic associations and social networks like the National Tuberculosis Association, the Women’s Health Protective Association and Federation of Women’s Clubs that were dedicated to the cause of ending the practice of spitting lobbied aggressively with municipal governments to strictly implement anti-spitting legislation. This led to the creation of “Sanitary Squads”, a group of health officers deployed to conduct random raids in public places to fine and arrest spitters.

In the end, it took cultivating a culture of good hygiene together with an anti-spitting legislation to get Americans to stop spitting.

Webs of influence

When it comes to efficient, effective regulation, it is useful to recognise the concept of “webs of influence” advanced by J Braithwaite and P. Drahos. They sought to understand how tools other than governmental sanctions could help in influencing the behaviour of citizens. If the Indian government seeks to build widespread public acceptance of the anti-spitting rule, it should influence public opinion by getting religious and community leaders, politicians, entertainers, teachers, the press and the medical fraternity to make the public aware of the dangers of expectorating in public places.

It is important for the government to adopt a two-edged sword against the practice of spitting. It must strictly regulate the sale of spit-inducing smokeless tobacco products such as gudakhu, gul, khaini, mishri, supari, paan masala, zarda and guthka. It should also identify popular faces that will actively propagate healthy habits.

In addition, it would be worth investing in anti-spitting infrastructure like spittoons in public places and also encouraging people to use receptacles like disposable cups and handkerchiefs. The long-term benefits of investing in the anti-spitting infrastructure as well as spreading awareness are way higher than the short-term costs of setting it up.

As the Australian legal academic Arie Freiberg has pointed out, “The state’s role in regulation must be understood as a continuum.” As such, the government’s anti-spitting rule is only the starting point. There is an urgent need to create awareness about how spitting out chewed tobacco products results in deadly germs being scattered around.

The government can help citizens understand the link between spitting and the danger it causes to public health by adopting a prescriptive approach instead of a prohibitive mechanism like how the US tackled tuberculosis. After all, relevant information, disclosure and awareness coupled with appropriate legislation enable citizens to make cleaner and hygienic choices.

Prerna Dhoop is a human rights lawyer based in Kolkata. Vandana Dhoop is an independent research consultant.