|Year : 2014 | Volume
| Issue : 1 | Page : 2-3
Death knell for tobacco in 21 st century
Surender N Gupta1, Naveen Gupta2
1 Department of Health and Family Welfare, Government of Himachal Pradesh, Himachal Pradesh, India
2 Freelance Researcher in Epidemiology and Ayurveda, Kangra, Himachal Pradesh, India
|Date of Web Publication||15-Apr-2014|
Surender N Gupta
Department of Health and Family Welfare, Government of Himachal Pradesh, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta SN, Gupta N. Death knell for tobacco in 21 st century. Int J Health Allied Sci 2014;3:2-3
The countdown for tobacco has started and it must go up in smoke now in 21 st century, which should be the last phase for tobacco related deaths and diseases. Alarming statistics by WHO reflect that tobacco killed 100 million persons in the 20 th century, and it is anticipated to kill a billion in the 21 st century. Now it is also shocking revelation that tobacco killed 6 million persons globally and this toll will further escalate to 8 million annually between 2025 and 2030.  Tobacco degrades the environment by extensive deforestation and paper use for packaging. It is also a crop, which consumes nutrients and water at a faster rate than most other crops and causes soil erosion. It employs extensive use of pesticides. It requires an extensive use of pesticides. In the context of the evolving post-2015 development agenda of the UN, tobacco needs to be viewed not only as a threat to health but also as an enemy of sustainable development. In a world that is increasing threatened by food insecurity, can we waste four million hectares of arable land on killer crop? The world over, the poor consume tobacco more frequently and tobacco consuming families sink into the deeper layers of poverty. Threat of tobacco is a big obstacle in the reduction of the global poverty. By 2030, over 80% of all tobacco related deaths will be in low- and middle-income countries. 
The Framework Convention for Tobacco Control (FCTC) was formed to neutralize the tobacco threat in 2003. It was one of the first public health treaties developed by WHO, which proposed many measures to contain the prevalence of tobacco menace round the globe. A total of 177 countries ratified this treaty. The United States, Argentina, Indonesia and Switzerland are among the notable exceptions. One of the extremely important tobacco containment measures recommended by WHO are (i) shooting up the taxes, comprehensive ban on all forms of tobacco advertizing, sponsorship and promotion under section 5 (TAPS); smoke free public and workplaces u/s 4 of Cigarettes and Other Tobacco Products Act, 2003 (COTPA). Cessation services to help people quit the habit and strong health warning. Apparently, several countries have made use of one or more suggested measures but very few have effectively fired the salvos to reduce the menace of tobacco. Raising taxes has been observed to be the most effective intervention since consumption of tobacco and its products is inversely proportional to the price hike. This effect is especially strong in persons with low disposable incomes - the poor, young persons and many women.  South Africa tripled the excise tax on tobacco and halved its tobacco consumption in an 11-year period. Philippines recently spiraled up tobacco tax sharply and 70% of the increased revenue so generated would be utilized to fund universal health coverage in the country. Higher level of enforcement has produced higher compliance in the developed countries like Ireland,  Scotland  and Ontario city.
India has done well in some areas of tobacco control but needs to do much more in other areas. Uttar Pradesh, in 2003, bans all forms of tobacco advertising other than at the point of sale. Through the combined efforts of the government, civil society and the judiciary - sometimes in concert and sometimes, in conflict - direct advertising have been curbed. Surrogate advertising is still resorted to by a recalcitrant tobacco industry that seeks to defy, delay or dilute any regulation. The tobacco industry cannot be tamed - it has to be timed out. The restrictions placed on the depiction of tobacco consumption in cinema or on television are way ahead of the rest of the world. But in Himachal Pradesh, the smoking is a part of culture in cold hills. Bidis and cigarettes are often offered in marriages and local functions as a mark of respect. Britishers used to smoke cigar as a status symbol. Shimla, the queen of hills, was very famous for PAN shops . As per the Global Adult Tobacco Survey (GATS) 2010, 33% males and 3.8% females smoke in the state. But for last over two years much water has flowed down the hills in controlling and containing the tobacco products all round. Department of Community Medicine, Indira Gandhi Medical College, Shimla and Population Research Center, Himachal Pradesh University, Shimla conducted the End line Compliance Survey independently, which observed 85.42% compliance under section 4 of COTPA in Himachal Pradesh. Out of the twelve districts in the state, Bilaspur stands first with score as 93% and the biggest Kangra district rolls down to the bottom with score as 80%. On basis of scientific/technical survey, Himachal Pradesh has been validated as the smoke-free state. On 3 rd July, 2013 the state was declared as Smoke Free. The journey from smoke-free state to tobacco-free state has now started. 
India is also a soft pedaling, in the use of taxation to push down tobacco consumption. Bidis, which are virtually more dangerous than any other tobacco products are virtually out of the tax net and oral tobacco too has received the light-touch treatment. The cigarette segment needs to be taxed heavily. A rocketing price of tobacco products, across the board, will nose dive the consumption while differential treatment will result only in product or brand switching. The recent punch on 'gutkha' the smokeless tobacco is also one of the leading forms of tobacco consumption in the country. It is a much needed strategy to contain this menace. Children and women are especially vulnerable victims of this habit, which is the leading cause of oral cancer. However, the enforcement of this ban needs to get stronger, as also the ban on smoking in public places. Pictorial health warnings on tobacco product packs u/s 7 of COTPA too need to be more aggressive and hitting hard. Like Australia, India needs to mandate plain packaging, to shed off the promotional effect of colorful tobacco packs.
The United Nations (UN) and the WHO have set a target of 30% reduction in the prevalence of tobacco consumption by 2030. Tasmania has announced a 'Tobacco-Free Millennium Generation' policy, wherein no one born after 2000 will be ever sold tobacco legally. Singapore is likely to follow suit. Bhutan has already banned the sale of all tobacco products. Some countries have been more ambitious and have set a target of reducing such prevalence to less than 5% - New Zealand and a group of Pacific Island Nations (2025), Finland (2030), and Scotland (2034). With what we know now, we have a duty to protect the present and future generations from many harms of tobacco. We need strategies to make the 21 st century the very last period in human history where a person dies of a tobacco-related disease or a tree is killed to produce 300 cigarettes.
There are now palpable and anxious concerns that the decline in tobacco consumption will be slower than needed, even if all countries effectively implement the FCTC. Kenneth Warner, a global leader in tobacco control, cautions us: "Barring more effective tobacco control, global smoking prevalence will remain between a fifth and fourth of all adults for at least the next 20 years. Unless something dramatically different occurs, smoking will continue to be Public Health Enemy as number one for decades to come, killing millions of people every single year". Hence, the calls to ring the 'death knell', so that we can finally declare endgame on the tobacco epidemic round the globe.
| References|| |
|1.||World Health Organization, WHO report on the global tobacco epidemic, 2008, The MPOWER package, Geneva: WHO; 2008. p. 8-15. |
|2.||Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rav Cancer 2009;9:655-64. |
|3.||Gupta SN, Gupta N, Gupta S, Sharma N. German measles outbreak appears in tobacco affected and unvaccinated border hilly districts of Northern Himachal-presented as poster in International Conference On Public Health Priorities In 21 st Century: The Endgame for Tobacco held from September 10-12, 2013 at Hotel Taj Palace, New Delhi, India; 2013. |
|4.||Office of Tobacco Control, smoke free workplaces in Ireland-one year review. Ireland: Office of Tobacco Control; 2005. |
|5.||Harrison R, Hurst J, Smoke free success: ASH Scotland presents the Scottish experiences, Ediburgh: ASH Scotland; 2007. |
|6.||Gupta SN, Sharma N, Gupta N. Building Tobacco free and Creating eco-friendly environment in hills of Himachal Pradesh; as oral presentation in International Conference On Public Health Priorities in 21 st Century: The Endgame for Tobacco held from September 10-12, 2013 at Hotel Taj Palace, New Delhi; 2013. |