Kerala: India’s first tobacco ad-free state

Rema Sundar, Tobacco Free Kerala

Kerala has become the first state in India to become tobacco advertisement free. This major milestone for public health in the country represents strong government commitment, a favourable policy framework, accountability, and engagement by various departments to achieve robust enforcement.

The first step was successfully abolishing tobacco advertisements at the points-of-sale – an effective and easy option used to create a sustained reminder about these dangerously addictive products. According to the Global Adult Tobacco Survey 2009-10,  44.2%, 70.9% and 72.3% of Kerala adults above 15 had seen advertisements on cigarettes, bidis and smokeless tobacco respectively.

Kerala is home to 34 million people. The state’s Chief Minister Mr Oommen Chandy has said, “Public health has been and will be our priority. Over the last four years, we have undertaken far-reaching tobacco demand and supply reduction measures such as a ban on pan masala and gutkha containing tobacco or nicotine, an increase in tobacco product taxes, and successful completion of the drive to remove advertisements at the points-of-sale in the state.”

The Public Health wing of the Kerala Health Services Department spearheaded the extensive campaign that resulted in removal of tobacco advertisements from 95.3% of points-of-sale over an 18-month period across 14 districts of the state. Kerala Police joined forces in this mega effort.

Dr AS Pradeep Kumar, a medical doctor with a PhD in tobacco control and then Additional Director of Health Services (Public Health) who coordinated this effort, said a three-phase activity plan was developed with District Medical Officers at the core. “Sensitisation programmes were conducted with emphasis on Section 5 of COTPA for district officers at the state capital. (COTPA is India’s tobacco control law; Section 5 bans all forms of direct or indirect tobacco product advertising). District officers in turn trained and authorised personnel attached to Primary Health Centres” he added.

The districts were given the freedom to customise according to their local needs. “This, in turn, raised the level of commitments and ownership taking. At the state level, we supported the districts by framing guidelines, monitoring and advising course corrections,” said Dr Kumar.

The process that started during World No Tobacco Day 2013 saw both integrated and intense drives that effectively pooled the services of health personnel from district to primary health centre level. Over 1,30,000 points-of-sale were inspected in drives held in two phases, from June to December 2013, and in January 2014, and notices issued to erring outlets. Notices mandated that advertisement boards, stickers, or posters be removed within 7-10 days. Wherever ads were not removed, they were confiscated. Police assisted as needed. Regular monitoring continued until October 2014.

An evaluation study by an external agency reported an overall compliance of 95.3% – 98.5% of points-of-sale free of any advertisement hoardings and 96.7% of points-of-sale free from stickers and print advertisements. The evaluation team, with 90 trained volunteers,m observed 22,344 points-of-sale across the state. Kerala Voluntary Health Services, a civil society organisation with nearly four-decade-long experience in research and field implementation in Kerala conducted the evaluation study. The team looked out for hoardings, posters, stickers, display of cost, display of tobacco products or any other promotional material at points-of-sale.

In November 2014, Kerala was declared the first tobacco ad-free state in India. Sustainability of the achievement is being ensured by integrating it with ongoing inspections by the Health Department in the state.