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doi:10.1038/nindia.2015.42 Published online 6 April 2015

Tobacco studies put India on edgy ground

Sophie Cousins



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Tobacco control in India took a step backwards last week after the government put on hold the much-awaited implementation of health warnings on tobacco products. A pro-tobacco Member of Parliament also stirred up a controversy claiming there were no scientific studies in India to suggest that smoking caused cancer and that tobacco actually had “medicinal” properties. 

April 1, 2015 was meant to mark the introduction of health warnings over 85% of tobacco packs – up from the existing 40%.

The conflicting voices come right after an international conference on tobacco control in Abu Dhabi last month (March 2015) where health experts, cited a plethora of new scientific studies, urging India to introduce more stringent regulations on use of all tobacco products and to resist pressure from the tobacco industry.

“India has made steady progress with good political will,” Dr Douglas Bettcher, director of the department for prevention of non-communicable diseases (NCDs) at the World Health Organisation (WHO), said at the World Conference on Tobacco or Health (WCTOH). “[But] India hasn’t reached the highest level of protecting the deadly effects of smoking yet.” 

Smokeless tobacco menace

According to a study discussed at the conference, India has the highest number of smokeless tobacco users in the world. Researchers from the department of health sciences at the University of York and from the Hull York Medical School covered more than 100 countries to estimate the burden of disease due to smokeless tobacco consumption among adults over 15 years of age.

The study, yet to be released, puts the total number of deaths due to smokeless tobacco use at 428,736 deaths and a loss of 10,048,453 disability-adjusted life years (DALYs) in 2010. Bangladesh and Myanmar had the highest prevalence of smokeless tobacco use among males and females.

“…This is a global problem, not just an Asian problem,” co-author of the study, Kamran Siddiqi from the University of York, told Nature India. He said different forms of smokeless tobacco carried a varying risk of oral, pharyngeal, esophageal, pancreatic cancers as well as fatal myocardial infarction and stroke.

Nandita Murukulta, India director for the World Lung Foundation said many women in India believed smokeless tobacco had medicinal qualities. “The reality is, there are reproductive health harms. We need to change the social acceptability, creative a supportive environment and increase the risk perception.”

The International Institute for Population Sciences in Mumbai has found that 18.4% of Indian women used smokeless tobacco, 15% being daily users. Prevalence was highest among rural women older than 64 years in the northeastern part of the country. “In the northeast, there is the prevalence of tribal communities,” Mousumi Gogoi, lead author of the study, said. “If someone comes to your home, you have to offer them a smokeless tobacco product. If you don’t, it would be considered very disrespectful.”

;Dorothy Hatsukami, associate director of cancer prevention and control for the Masonic Cancer Centre at the University of Minnesota, called for smokeless tobacco to be incorporated into tobacco control measures. “The implementation of effective inventions and policies are substantially weaker for smokeless tobacco compared with cigarettes. We need to make smokeless tobacco a priority in tobacco control,” she told the conference.

Economic burden of tobacco

In another study jointly commissioned by India’s ministry of health and World Health Organisation (WHO), researchers found that the economic burden due to tobacco-related diseases during 2011 in India was around Rs 10, 4500 crores (approximately US $22.4 billion). This was an alarming amount of money, almost 12% more than India’s combined state and central government spending on healthcare, according to senior research scientist Sarit Kumar from the Public Health Foundation of India (PHFI).

“This is 1.16% of the country’s GDP. It’s a huge burden,” he said. “This burden falls on the poor because they are more likely to consume tobacco,” Kumar said.

The researchers from PHFI, Indian Institute of Technology, Jodhpur and Indian Institute of Public Health, Delhi recommend a comprehensive tobacco control policy. They also suggest prohibition on sale and manufacture of smokeless tobacco and taxation of all tobacco products at similar rates.