Price tobacco out of the market……Harmala Gupta
Forty per cent of cancers in India relate to tobacco use. These are easily preventable
Forty per cent of cancers in India relate to tobacco use. These are easily preventable
Whatever men do women can do better. Sadly, this extends to tobacco use as well. The recent survey undertaken by the Global Adult Tobacco Survey (GATS) reveals that the percentage of women using tobacco in India has risen sharply in five years, from 11.5 per cent in 2005 to 20.3 per cent in 2010, while there has been a 10 per cent drop in tobacco use among men for the same period. Obviously, a tobacco control programme, in order to be effective, must be sensitive to issues of gender and age. It is surprising that this has not happened so far as the writing has been on the wall for quite some time.
A few decades ago, we saw a substantial fall in the rates of lung cancer among men in the US as the incidence of smoking among them began to fall. Ironically, the lung cancer rates for women began to rise during the same period as more and more women began to smoke. The factors identified as responsible for this increase included the need to assert independence, stress on the job, desire to stay slim, etc. More than anything else, however, it was the clever advertising campaigns conducted by tobacco companies, which had cottoned on to the gender and age related aspects of tobacco use before any one else had, that were most responsible for this increase. What is interesting in the Indian case though, is that most tobacco tends to be chewed rather than smoked.
To quote statistics again from GATS, of Indias 274.9 million tobacco users, 163.7 million chew it and the numbers have reached an all time high. This is not unexpected when you consider that we have a paan and supari chewing culture in many parts of the country that embraces tobacco. Children are exposed to it, and not surprisingly, tobacco use and the addiction it engenders starts at an early age. What have facilitated this process further are clever marketing techniques and advertising. Gutka packets have become smaller and therefore more accessible and cheaper, and more fragrant. The user, too, is depicted as some one who is sociable and the life of the party. In fact, so pervasive and widespread is the habit, that a friend who recently climbed Mt Kilimanjaro for CanSupport remarked that the only litter he saw while on the mountain trail were three empty packets of gutka!
again, I believe a case can be made for tobacco control programmes in our part of the world to be more sensitive to issues of gender, region, cultural practices, etc., when it comes to smokeless tobacco. For example, it does not stretch the imagination too much to argue, that in a conservative society, where a woman who smokes is frowned upon, chewing tobacco is likely to become an option as it will raise the least hackles. It is a moot point whether pictorial warnings being currently used on cigarette packets will achieve the objective of frightening off current and prospective users. The experience of the anti-tobacco campaign worldwide shows that making tobacco products more and more expensive for the consumer, especially the youth, has been the more effective way of cutting down on smoking, besides education. How this can be achieved in the case of tobacco that is being offered in more attractive, smaller and cheaper packets remains to be seen. There are also other factors that need to be considered.
The tobacco industry has a long reach that extends to the topmost echelons of political decision-making. The inducements they can offer to toe their line are many as they are flush with funds. One way in which this lobby has been fought in the US is to slap several class action suits on them, demanding hefty compensations for the ill-effects on health caused by tobacco use. The intention is to hurt them where it matters most their profits and to make them accountable for their actions. Another way is to reduce the production of tobacco itself by offering alternative employment and income earning opportunities to farmers and those working in the tobacco industry. Once again, this depends on the will and commitment of the government to the health of its people.
For those who are already using tobacco, we need to have more de-addiction products and facilities that are cheap and easily accessible. Educating people about the ill-effects of tobacco is also a must. As those of us who work in the field of cancer know, almost 40 per cent of cancers in India are preventable as they are related to tobacco use. This is not just about reducing the cost on the exchequer but about saving lives, often in their prime. One way of getting to women perhaps, besides informing them of the obvious risks to their own health, is to inform them that their habit is likely to impact their children in a negative way by making them future tobacco addicts. We can only hope that the maternal instinct will be strong enough to overpower the desire to feed their own craving. If not, we are facing a great health catastrophe.
The writer is president of CanSupport which runs free supportive services for cancer patients in the National Capital Region.