Mr. Nilesh Jain, Managing Director, Harm Reduction Research and Innovation Center (HRRIC)
“Today, India is the 2nd largest producer of tobacco with an estimated annual production of around 800 million kilograms and it provides livelihood to 45.7 million people in the country”. But when we talk about the consumption of tobacco, we refer it as an epidemic harming a lot of lives. Why?
India has one of the world’s heaviest tobacco-related health burdens and is one of the five focus countries selected to be part of the Bloomberg Initiative to Reduce Tobacco Use. It has almost 200 million people who use Smokeless Tobacco and is witnessing over 350,000 deaths every year. More than its enormous toll of disease, suffering, and death, tobacco use also burdens the Indian economy. As per the studies, the total economic costs attributable to consumption of smokeless tobacco products alone due to all diseases in the year 2011 for persons aged 35-69 yr was ₹ 233.6 billion. In comparison, the excise tax revenue collected from smokeless tobacco in that year amounted to only ₹ 12.6 billion. The most common use smokeless tobacco product, Khaini is consumed by 104 million adults (males and females) followed by gutka, consumed product by 51 million adult males. This massive tragedy will worsen if we don’t act. According to GATS-2, India has the lowest quit rates and though there is an overall decline in use, the prevalence of the tobacco-related disease is becoming a major cause of concern for public health.
Addressing the issue
There are a lot of frameworks suggested by international organizations which provide an evidence-based framework for the government to reduce tobacco use. Through cost-effective policy and programmatic interventions, the organizations are trying to reduce demand for tobacco products and the death, disease, and economic costs resulting from their use. But it has been observed that these interventions are underused. Some of the interventions suggested include significant tobacco tax and price increases; bans on tobacco industry marketing activities; prominent pictorial health warning labels; smoke-free policies and population-wide tobacco cessation programs to help people stop smoking. Studies suggest that These interventions are designed to reduce the disproportionate health and economic burden that tobacco use imposes on the poor.
As per the union budget of 2020, the National Calamity Contingent Duty (NCCD) on tobacco products like hookah, jarda, smoking mixtures for pipe and cigarettes, chewing tobacco and snuff is increased. In the current economic environment, researchers suggest that this will aggravate the pressure on the legal tobacco industry, encourage illegal trade and adversely impact tobacco farmer earnings whose livelihood is closely connected with the legal tobacco industry. Unless these policies are not effectively implemented, the results of the increasing taxes and duties, in not a viable option.
Along with this, the three main state-sanctioned interventions implemented include encouraging cold-turkey quit attempts, cessation services and counseling, and nicotine replacement therapy (NRT). Studies show that nationwide quitlines and media outreach have a 95 percent failure rate of willpower-led cessation. In addition to this, the tobacco cessation clinics are inadequate, with just 19 functional at present and the effectiveness of NRTs is close to 7 percent. This makes us question whether the current strategy for the implementation of the interventions is optimal to combat the current scenario of the tobacco epidemic?
Tobacco Harm Reduction: The way forward
We can thus say, the impact on overall public health is largely uncharacterized, let alone the consideration of introducing reduced-risk products (RRPs) or alternate less harmful products. Although, governing bodies and medical organizations feel obligated to advocate for nothing less than total cessation but in the wake of the current scenario where the implementation of effective interventions is a challenge, tobacco harm reduction can be an effective tool. This pathway requires only the moderate effort of sensible regulation for the market and users’ who desire for a healthier life. Reduced risk products like snus can be used to empower users. Snus as an alternative has the potential to deliver enormous harm reduction benefits as demonstrated in Sweden, particularly in reducing the incidence of lung cancer and cardiovascular disease of which smoking is a known cause, where the product can be marketed and sold to adult smokers widely.
In light of this situation, India must also provide a scientific basis for the legislation of snus. Such a strategy will support innovation and research in harm reduction and thereby, address public health concerns