Tobacco Menace

Mains Syllabus: GS II - Issues relating to development and management of Social Sector/Services relating to Health

Why in the News?

World No Tobacco Day is observed around the world every year on 31 May.

What is the status of tobacco usage in India?

• Tobacco Usage - India has one of the highest numbers of tobacco users globally, with 28.6%–29% of all adults in the country.

• High Male Users - According to Global Adult Tobacco Survey (GATS)GATS data, nearly 42% of men and 14% of women in India use tobacco.
• Prevalence is highest among men aged 50–64 (52.8%) and among women aged 65+ (18.6%).
• Smokeless Tobacco Usage - (SLT)Home to 70% of the world’s smokeless tobacco (SLT) users, SLT is preferred over smoked tobacco.
• Smoked Tobacco - In smoked tobacco, the bidi is favoured over cigarettes, especially in rural and low-income groups.
• Increase in Usage of Cigarettes - Despite the preference for bidis, India has seen the largest increase in the market share of cigarettes globally.
• Regional Usage - Most Indian states have seen a decline in the NFHS-5 survey in male tobacco use, except for Sikkim, Goa, Bihar, Gujarat, Himachal Pradesh, and Mizoram.

What are the impacts of tobacco usage?

• Common Health Risk Factor - Smoking is the most common risk factor for the five of the top 10 causes of mortality in the world.
• According to the World Health Organization, these include ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections and trachea, bronchus and lung cancers.

Smoked tobacco products contain over 7,000 chemicals including at least 250 known to be toxic or to cause cancer, the WHO states.

• Cancer - Both SLT and smoked tobacco drastically increase cancer risk, particularly for lung, head, neck, stomach, and pancreatic cancers.
• India ranks first globally in male cancer incidence and mortality rates.

Over 1.3 million lives are lost every year to cancers caused by smoking tobacco across seven countries, including India, according to a study published in The Lancet's eClinical Medicine journal

• Among tobacco-related cancers in males, lung cancer leads globally, while in India, lip and oral cancers top the list, followed by lung cancer.
• Affects Body Function – Smoking also causes skin damage, hearing and vision loss, impact fertility and cause erectile dysfunction.
• Reduction in Life Expectancy - One cigarette can steal 20 minutes of your life expectancy, researchers in the U.K. estimate.
• Loss of Productive Years - Smoking primarily eats into the relatively healthy middle years rather than shortening the period at the end of life, which is often marked by chronic illness or disability.
• So, a 60-year-old smoker will typically have the health profile of a 70-year-old non-smoker.
• Economic Burden - Along with the health burden, tobacco use imposed an economic cost of 1.04% of India’s GDP (Rs. 1.77 lakh crore) in 2017-2018.
• Smoking accounted for 74% of these costs, while SLT use made up 26%.

What are the challenges in controlling tobacco menace?

• Lack of Enforcement - Implementation of ban on public smoking remains patchy and so the public smoking has been rising.
• Variety of Forms – The widespread availability of tobacco in various forms makes them easily accessible and normalize their use, particularly among young people and vulnerable populations.
• Illegal Sale – Despite the various ban tobacco products, the illegal manufacturing, distribution and sales of electronic cigarettes and smokeless tobacco are flourishing.
• Tobacco Industry’s Influence — Through policy interference, pricing tactics to maintain affordability, targeted marketing, dense tobacco shop networks ensure widespread tobacco accessibility.
• Ineffectiveness of Price Deterrence - Unlike in other countries where higher prices have deterred smoking, rising disposable incomes in India, particularly among the 450 million middle class have outpaced tax increases.
• With increased purchasing power, tobacco products continue to be affordable.
• Under Shifting of Taxes - Tobacco industry absorbs a portion of a tax increase instead of fully passing the increase on the prices to consumers to keep it affordable.
• Unit Sales - To enhance affordability, cigarettes are often sold as single sticks - a practice banned in 88 countries but not in India.
• Tobacco affordability undermines the government efforts in reducing tobacco usage.
• Cultural Normalization - Tobacco use has become socially acceptable as a result of cultural normalisation, with urban regions having higher cigarette smoking rates (5 %) than rural areas (3 %).

What needs to be done to control the tobacco usage?

• India faces a dual challenge of significant health and economic burdens from tobacco-related cancers and the complexities of lung cancer screening in a TB-endemic country.
• This underscores the urgent need for evidence-based anti-tobacco policies as a primary prevention strategy.
• Reducing the Affordability - Regular tax hikes that outpace income growth can make tobacco products unaffordable, discouraging their use
• As recommended by World Health Organization, all tobacco products can be taxed at 75% of its MRP to effectively deter use.

The Tobacco GST rate for all types of its products is 28%, except for tobacco leaves which is taxed at 5%.

• Price Fixation - Along with tax increase, a minimum retail price can also be set and increased to prevent the under shifting tactics of tobacco industries.
• Banning Loose Sales - Banning single-stick sales can reinforce health warnings and curb impulse purchases.
• Packaging Control - Enforcing plain packaging with prominent health warnings can also reduce tobacco’s appeal.
• Robust Enforcement - Sales near tea stalls needs to be restricted through regular inspections and penalties to help break the ‘chai-sutta’ association.
• Public Outreach - Prioritising cancer screening, tobacco-cessation programmes can further bolster tobacco control efforts, ultimately creating a comprehensive approach to tackle tobacco use.

Reference

The Hindu | Tobacco affordability fuelling cancer epidemic in India

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