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India

India: steep decline in tobacco consumption in India reported in second Global Adult Tobacco Survey (GATS 2017)

23 Jun, 17 | by Becky Freeman, Web Editor

Authors: Chaturvedi Pankaj , Sarin Ashima, Seth Sanjay, Gupta PC

On 8th June 2017, results from the second Global Adult Tobacco Survey (GATS 2) of India were released. GATS is a global standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators. India is the world’s largest democracy, and the second largest consumer and third largest producer, of tobacco. Tobacco control results from India take on a global significance in terms of impact on total mortality and disease burden.

For a large and diverse country like India, effective tobacco control has always been a daunting task. In the last five years, the country has witnessed a number of legal battles between the government and the tobacco industry. At one point, a parliamentary committee supported the tobacco industry and sought dilution of certain tobacco control measures. The powerful tobacco lobby tries to delay or derail attempts to reduce tobacco use prevalence. According to media reports, the Health secretary and Health ministers were removed from their posts in part because of their support of tobacco control measures. GATS 2 is can be viewed as a report card of the Government’s action on tobacco control.

GATS 2 was a household survey of 74,037 persons, aged 15 or more, conducted in all 30 states of India and two union territories in 2016-17. The first GATS was conducted in 2009-10. GATS 2 results found a 6% decline in tobacco use prevalence, from 34.6% in GATS 1 to 28.6% in GATS 2. The decline in prevalence was equivalent to a 17% relative decrease, and the number of tobacco users has reduced by about 8.1 million. The GATS 1 data released in October 2010 reported an estimated absolute number of 275 million tobacco users in India. The 2017 National Health Policy of the Government of India had set a target of relative reduction in current tobacco use by 15% by 2020; a target which has now been exceeded. The next target is a 30% reduction by 2025.

This period also witnessed the emergence of new contributors outside the Ministry of Health providing additional powerful tools for tobacco control. The Ministry of Women and Child Development amended the Juvenile Justice Act to make the sale of tobacco to minors as a non bailable offence punishable by 7 years of rigorous imprisonment and a fine of up to 100,000 Indian Rupees (US1550). The Department of Consumer Affairs amended the Legal Metrology Act to prohibit sale of loose cigarettes, which currently accounts for over 70% of the country’s total cigarette sales.

Meanwhile, a regulation under the Food Safety Act (2011) prohibited addition of tobacco and nicotine to any food substance. Through public interest litigation, this regulation enabled the Supreme Court to order a nationwide ban on gutka (a combination of flavored smokeless tobacco and areca nut). In addition, more than a dozen states have independently prohibited flavored smokeless tobacco products – an important step given gutka is a risk factor for oral cancers.

Voice of Tobacco Victims (VoTV), a campaign led by doctors and tobacco victims, played a pivotal role in the getting gutka/smokeless tobacco banned and taxes hiked on various tobacco products in India. The campaign has won awards and recognition from several organizations such as the World Health Organization, British Medical Journal, and the Campaign for Tobacco Free Kid. While most believed that prohibition would not work, VoTV was convinced that it would lead to decreased accessibility and affordability translating into reduced youth initiation. The 360-degree campaign involved advocacy, a legal battle, media, and research. The VoTV network also reached several medical societies and hundreds of individual doctors to increase engagement in tobacco control advocacy.

Despite tremendous resistance and litigation from the tobacco industry, the Ministry of Health imposed an 85% pictorial warning on tobacco packets from 1st April 2016. A significantly higher proportion of adults considered quitting because of the warnings on tobacco products (61.9% current cigarette smokers thinking about quitting smoking GATS 2 versus 38% in GATS 1). The tobacco tax hikes also contributed to reduction in prevalence, with individual expenditure on cigarettes and bidis having tripled since GATS 1.

GATS 2 reported a reduction in smokeless tobacco users from 25.9% to 21.4%. It also affirmed that a smokeless tobacco ban would not lead to switching to smoking. Smoking prevalence between the two GATS survey declined from 14% to 10.7 %, despite the ban on gutka/smokeless tobacco.

Summary of GATS 2 tobacco use

Pattern of tobacco

  • 6% of adults aged 15 and above (267 millions) used tobacco in any form
  • 199 million use smokeless tobacco, 100 million smoke tobacco and 32 million smoke as well as chew tobacco.
  • The most commonly used tobacco products are khaini (a type of smokeless tobacco) 85 million users and bidi (hand rolled cigarette) 67 million users.
  • 199 million users live in rural area and 68 million in urban

Significant changes compared to GATS 1

  • 17% relative decrease in tobacco prevalence
  • Tobacco use among 15-24 year olds showed relative reduction of 33% and for 15-17 year olds there was a 54% reduction.
  • The age of initiation of tobacco use increased by 1 year ( 17.9 to 18.9).
  • While there was a decrease in second-hand smoke exposure in public places (6%) and at home (13%), there was no decrease in workplaces.
  • 9% (83 % to 92%) more believed that second-hand smoke is harmful
  • 7% (89% to 96%) more believed that smokeless tobacco is harmful

Areas of concern

  • 68% of smokers, 17% of bidi smokers, and 50% of smokeless tobacco users purchase loose tobacco.
  • 30% of those who work indoors are exposed to second-hand smoke
  • 23% adults are still exposed to SHS at public places.
  • Nearly 10% of people still notice some form of tobacco advertisement.
  • Despite the gutka ban, 51 million people were still able to buy gutka

We must commend Government of India for their commitment to Tobacco Control. We also recognize the efforts of several national/international NGOs, academic institutions and civil society activists who have contributed to this impressive result. GATS 2 demonstrates that the tobacco control strategies in India are going in the right direction. For continuing improvement, the country needs further strengthening of policies, particularly enforcement of tobacco control laws.

Kerala: India’s first tobacco ad-free state

4 Sep, 15 | by Marita Hefler, News Editor

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.

Can prohibition work? The case of India’s smokeless tobacco ban

27 Aug, 15 | by Marita Hefler, News Editor

Pankaj Chaturvedi, Sanjay Seth, Prakash C Gupta, Ashima Sarin 

Tata Memorial Hospital, Mumbai

‘Bans don’t work’ is a common response to measures to restrict or outlaw tobacco supply. Libertarians decry such measures as excessive ‘nanny state’ intervention; others point to the USA experience of alcohol prohibition in the 1930s, often held up as a failed experiment (although the truth is more nuanced; as a public health measure, prohibition was more effective than conventional wisdom holds).

Today, India is proving that prohibition can have a place in public health. Gutka, an industrially manufactured smokeless tobacco product has now been banned in the majority of the country, with encouraging results.

Gutka is made from crushed areca nut, tobacco, catechu, slaked lime and sweet or savory flavorings or fragrance. In December 2014, a former gutka industry owner went public with revelations that harmful chemicals are used as cheap substitutes for flavouring. He turned whistle blower after he was affected by mouth cancer, which necessitated facial surgery, chemotherapy and radiation treatment.

Spurred by attractive packaging in single-dose plastic packs affordably priced at 2-3 cents/pack, and widespread marketing targeted at children and adolescents, the gutka market has rapidly expanded in the last decade to be worth more than US$8 billion. The growth of the industry has caused havoc with public health, especially oral health.  According to the Global Adult Tobacco Survey (GATS) India 2009-10, around 13% of males and 3% of females used gutka in India. Among young people aged 15-24, smokeless tobacco use was 23% for males, and 8% for females. Oral cancer is increasing, especially among youth. Use of smokeless tobacco usage is a key risk factor for cancer (mainly oral, oesophageal, and pancreatic), stroke, ischaemic heart disease,  type 2 diabetes, adverse reproductive and developmental effects such as stillbirth, preterm birth and low birth weight.

The legal basis for the gutka ban was the Food Standards and Safety Act notified in 2011, section 2.3.4 of which specified that “Product not to contain any substance that may be injurious to health: tobacco and nicotine shall not be used as ingredients in any food product.”At the direction of the Supreme Court, the Ministry of Health and Family Welfare (MoHFW) constituted a high level Expert Committee to collate the evidence on harmful effects of smokeless tobacco and areca nut. In February 2011 the Ministry submitted this report, commonly called National Institute of Health and Family Welfare (NIHFW) Report to the Supreme Court. Several Civil Society NGOs urged the highest court to ban the manufacture and sale of all products found to be injurious to health by the NIHFW health report.

Momentum for the gutka ban, however, came from tobacco victims themselves; survivors of cancers of mouth and throat, widows and families of tobacco victims. Known as  ‘Voice of Tobacco Victims’ (VoTV), the campaign featured patients and their family members, supported by their treating oncologists and public health researchers, telling their stories of initiation and addiction to gutka and consequences of disease, financial ruin and agony.

Started in 2011, the target audience for the VoTV was top policy makers, bureaucrats, social influencers, media and politicians. The appeal from patients made direct emotional connections; politicians and bureaucrats made promises and media gave prominent coverage to stories. The VoTV doctors and staff provided scientific evidence, made the advocacy demands very specific, and followed up with bureaucrats and politicians until the objective was met. Ultimately, the first gutka ban was declared by the state of Madhya Pradesh on 1st April 2012. Thereafter, state after state notified the ban. For some states who refused to implement bans, public interest litigations were filed and High Court judgments forced them to declare gutka ban. By the end 2012, 14 of India’s 29 states had notified the ban and in April 2013, the Supreme Court directed all states to comply.

The extent of enforcement of the ban varies a great deal across states, but there have been some common findings by studies. The first major impact assessment report came in 2014, from a study conducted by the Johns Hopkins University Bloomberg School of Public Health and the World Health Organization. Surveys were conducted with 1,001 current and former gutka users and 458 tobacco product retailers in seven states (Assam, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra and Orissa) and Delhi. Interestingly, 90% of respondents desired that the government should ban the manufacturing, sale and distribution of other forms of smokeless tobacco.

According to the study, there was virtually no retail outlet where pre-packaged gutka was on display. Ninety two percent of respondents supported the ban and 99% agreed that bans are good for the health of India’s youth. Of the respondents who continue to use illegal pre-packaged gutka, half reported they consume less since the bans. 80% believed that ban will motivate them to quit, and nearly half of attempted to do so. Of the respondents that quit since the bans, a substantial proportion in each state (from 41- 88%) reported that they “quit using gutka because of the ban”. The study was a rapid survey in 7 states, rather than a nationally representative survey.

Post the bans, however, most gutka manufacturers started selling two packets: one the same mixture but without tobacco; and, a small packet containing just tobacco, often given free. Users were urged to combine and mix the ingredients of two packets to create their own gutka. This innovation adversely affected the purpose and consequent impact of the ban and was possible due to weak enforcement of the law. However, 11  states took the remedial step to ban the sale of processed and packaged smokeless tobacco and flavored areca nut products.

A concern for public health policy makers and researchers was to determine if gutka chewers switched to smoking following the ban. Studies have consistently shown that there is almost no switch over to smoking. In fact, the whole campaign for gutka ban, aided by other tobacco control measures, seems to have impacted sales of all forms of tobacco. According to the Index of Industrial Production (IIP) data, output of tobacco, declined by 12.1% in March 2015 from a year ago.

The Euromonitor report on Smokeless Tobacco in India  published in December 2014, revealed that up to 2010, volume sales as well as value sales of smokeless tobacco were increasing, was more or less stagnant in 2011 and by 2013, there was 84% decline in volume sales and 82% decline in value sales compared to the peak in 2010. Further, compared to 2012-13 figures Euromonitor predicted the decline in sale volume to be 85% and value to be 80%. Euromonitor clearly attributed this decline to gutka ban. Also, for the first time in the history of cigarette industry in India, volume sales have started declining.

These findings assume even greater importance when looked along with economic impact of tobacco use in India.  According to report by MOHFW, health care losses due to treatment of tobacco-related illnesses were US$16.5 billion [Rs.1.04 trillion] in 2011. In comparison, in 2013-14, the Government’s earnings from tobacco taxes were US$2.83 billion [Rs.17,800 crores].

The findings here reaffirm the fact that investment into tobacco control policies represent a win-win situation for government, public health and the people and families of tobacco users or potential users. India’s experience shows that prohibition may be a credible tobacco control option in certain situations. In this case, the product was primarily manufactured in one country and cross border supplies could be reasonably controlled. In addition, the ban appears to have led to denormalisation of gutka. By declaring the product as illegal, the consequential massive earned media in the country convinced the public (90%+ approval ratings) that banning this product was good for public‘s health. This also countered the massive brand equity makers had built up around their gutka brands – the “stench” of a banned product led to erosion of the brand values (although possibly for this reason, makers have increased surrogate ad budgets – to revive their brands). The ban has effectively disrupted supply, especially reducing access to children.

India: Government consultation to strengthen National Tobacco Control Law

9 Feb, 15 | by Marita Hefler, News Editor

 

Amit Yadav & Monika Arora, Public Health Foundation of India

Two months after announcing larger and stronger pictorial health warnings on all tobacco products, and 10 years after ratifying the WHO Framework Convention on Tobacco Control (FCTC), the Ministry of Health and Family Welfare, the Government of India is proposing to amend and strengthen the national tobacco control law (COTPA 2003), to better align with both the FCTC and international best practice. As part of pre-legislative consultation, the government is seeking input from key stakeholders and the general public. Comments and views about the Amendment Bill will be accepted until 15 February 2015.

The proposed amendments include:

  • Protection of tobacco control policies from the tobacco industry: One objective of the proposed law is “to protect the development and implementation of public health policies with respect to tobacco control from the commercial and other vested interests of the tobacco industry,” to comply with Article 5.3 of the FCTC.
  • Amendments to the definitions to avoid ambiguity: Key terms like advertisements, indirect advertisements, medium, promotion, public place, sponsorship, trademark and tobacco industry have been clearly defined under the published draft amendments.
  • Protection from exposure to tobacco use: The draft amendment proposes to prohibit smoking in all public places but allows designated smoking areas at international airports. Since smokeless is a prominent form of tobacco use in India, this section of the Bill includes prohibition on use of any kind of tobacco products in public places.
  • Prohibition on tobacco advertisement, promotion and sponsorships (TAPS): Draft amendments comprehensively prohibit TAPS, including surrogate advertisements and brand extensions. COTPA 2003 allowed advertising at point of sale and on packs. The draft Bill proposes to remove these concessions. It also prohibits sale of any article resembling tobacco products and distribution of free samples of tobacco products. It also prohibits sponsorship, through any mark or trademark or brand name of cigarettes or other tobacco products.
  • Prohibition on corporate social responsibility by tobacco companies: The Amendment Bill prohibits any promotion of tobacco products through contribution or otherwise, or through an activity under corporate social responsibility, by or of a company engaged in the manufacture or production of cigarettes or any other tobacco products.
  • Protection of minors from exposure to tobacco: The proposal increases the age of access from 18 to 21 years, while also proposing to prohibit sale of tobacco products in loose and single sticks.
  • Packaging, labeling and product regulation: The proposed Bill mandates pictorial warnings on the principal display areas similar to provision of COTPA 2003, but also mandates disclosure of content information (and emissions of each cigarette) on tobacco product packages.
  • Increased penalties on violation of the law: Pecuniary penalties for compoundable offences will be increased from the present INR 200 (USD 3.3) to INR 1,000 (USD16.5). Other offenses in the Bill are proposed to be “cognizable” and pecuniary penalties therein are increased by about 10 times from the current ones.
  • Licence cancellation for violation: To ensure compliance with the provisions, the amendment Bill authorizes competent authority to suspend or cancel license of the manufacturer or producer, importer, supplier, distributer or seller, for a period as the competent authority may deem fit.

The proposed amendments will go a long way towards advancing tobacco control in India. However the draft Bill still requires further strengthening to be in line with global best practices. This pre-legislative consultation period provides an excellent opportunity to tobacco control experts in India to review challenges faced in enforcement of COTPA 2003 and feed those experiences into drafting the current Amendment Bill. It is important to make the Bill comprehensive and robust to avoid its exploitation by the tobacco industry.

A PDF of the proposed Amendment Bill is here: COTPA Amendment Bill-2015 or access it through the Ministry of Health & Welfare website here: http://www.mohfw.nic.in/showfile.php?lid=3032

Feeback can be provided by 15 February 2015 to: 

Shri R. S. Negi

Under Secretary (Tobacco Control)

Department of Health and Family Welfare

Room No-425 ‘C’, Nirman Bhawan

New Delhi-110011

Email: ntcp.mohfw@gmail.com or rsnegi22@yahoo.in

India: Powerful ‘Voice of Tobacco Victims’ campaign wins BMJ health advocacy award

30 Oct, 14 | by Marita Hefler, News Editor

 

Pankaj Chaturvedi, Prakash C Gupta, Sanjay Seth, Ashima Sarin

Voice of Tobacco Victims

Voice of Tobacco Victims Campaign (VOTV) was launched on 31st May 2009 by a dozen cancer survivors of Tata Memorial Hospital, Mumbai under the leadership of Dr Pankaj Chaturvedi. The campaign aims to make Tobacco Victims (cancer survivors and their relatives) the public face of the anti-tobacco campaign and get them justice. There are more than 300 patients and their relatives who are engaged in battling a powerful industry that sold them cancer and suffering. Most are cancer patients who were treated by Dr Chaturvedi in Tata Memorial Hospital, Mumbai. They are supported by 168 motivated oncologists all over India who are performing exemplary voluntary advocacy with highest policy makers. 

Led by cancer survivors, VoTV conducted a sensitization programs for the Chief Ministers, Members of Parliament, State legislators, Police Departments, Education Departments, Food inspectors and other government officials. We took up the matter in several High Courts and the Supreme Court, where Dr Chaturvedi made a deposition in front of Justice Singhvi in Ankur Gutka matter. 

The Campaign played a pivotal role in the Gutka ban introduced throughout India, ban on all forms of flavoured, scented, packaged chewing tobacco in 9 states and the ban of flavoured supari (pan masala without tobacco) in Maharashtra. They were also instrumental in tax increases in several states. Prior to the recent budget, 300 doctors wrote to the Honorable Prime Minister to raise taxes on tobacco. 

VoTV team is also working with state governments for better implementation of tobacco control laws. VoTV has been instrumental in India’s most graphic campaign for awareness in society. The clip is shown in all cinema halls and TV channels. 

VOTV youtube

 

 

 

 

 

 

 

 

VOTV films are available on Youtube here.

Some patients filed compensation cases in the consumer court, actions that have rocked the tobacco industry.

VoTV has been recognised by the World Health Organization as an outstanding campaign. Dr Chaturvedi was nominated as a Global Cancer Ambassador by the American Cancer Society, invited as a speaker in special United Nations Summit, and served on various committees for the Ministry of Health. The campaign also received the Judy Wilkenfield Award by Campaign for Tobacco Free Kids, Washington. Most recently, on September 22, 2014, Dr Chaturvedi and VoTV won the British Medical Journal Awards in the Health Advocacy category.

According to several studies and Euromonitor, the campaign has contributed to a 26% reduction in volumes of chewing tobacco and 3% in cigarette volume. I am sure it will translate into reduction in prevalence of tobacco usage and eventually reduce the tobacco related mortality.

For more information visit www.votvindia.org

About tobacco in India:

  • In India, there are 275 million tobacco users – that means every third Indian adult uses some form of tobacco. It is the number one cause of preventable death.
  • Tobacco is responsible for nearly 50% cancers in India and 90% of mouth cancers. Half of the mouth cancer patients die within 12 months of diagnosis.
  • Around 1 million Indians die from tobacco-related diseases each year in India. This epidemic kills more people than tuberculosis, accidents, homicides, suicide, AIDS and malaria combined.
  • Among kids aged 13-15, 4 percent smoke cigarettes and almost 12 percent use other types of tobacco products. As with elsewhere in the world, children are the new consumer base for the industry.
  • Tobacco costs and enormous amount due to death, disability and diseases. According to government figures, the total revenue from tobacco excise makes up 17% of the health care cost.
  • While essential food items have become expensive over decades, tobacco has become cheaper every year.
  • The main form of tobacco consumption in India is chewing and bidis. These two industries are run by only a few dozen families in India.

VOTV award

Dirty Secrets… The Smoke-Less Affair

12 Jun, 14 | by Becky Freeman, Web Editor

Post written by Shalini

90% of oral cancer cases among Indian men are attributable to tobacco consumption, according to the World Health Organization.

Since 2010, India has been engaged in a major war against smokeless or oral tobacco products, including a ban on gutka. Gutka is a popular oral tobacco product that is a highly addictive concoction of more than 3000 chemicals, including heavy metals like lead and ingredients found in coal tar. Gutka was sold for as cheap as a rupee or two, making it by far the cheapest smokeless tobacco product available.

As a journalist, I had the opportunity to cover both sides of the story. The smokeless tobacco industry in India proved to be a rich lobby but one that ultimately lost the legal war.. Its most profitable product is now banned. But while that ban was struggling to make its way to each state in India, the industry endlessly debated the legality of the law. The Indian tobacco industry also argued that while restrictions were being tightened on the domestic industry, the multinationals that manufacture mostly cigarettes were facing no such restrictions on their deadly products. The industry argued against cancer surgeons, public health activists, the health ministry, even cancer victims. Perhaps unsurprisingly, the industry continues to circumvent the ban in many innovative ways.

But what interests me is one particular argument the industry made against the ban on gutka. The industry questioned the link between chewing tobacco and cancer. They have been quoted as saying that cancer can be caused by pollution, pesticide residues in the environment and even chillies! They questioned, how can a doctor or any public health activist or the government prove that cancer was caused by chewing tobacco? Oral cancer surgeons and cancer institutes across the country had already written to the Prime Minister, stating that cancer wards are burgeoning with victims of tobacco, especially oral tobacco and imploring the government to ban such products. But the industry wasn’t satisfied.

But I have now found some answers that will be satisfying, from the industry’s own internal documents.

Here’s an industry document (BATES number: 521034348-52103435) from the Tobacco Legacy Documents labelled as a ‘privileged’ and ‘internal correspondence’ from the year 1979 – a letter written to the Brown & Williamson Tobacco Corporation, detailing what was discussed at a meeting of the ‘Smokeless Tobacco Council’ on health research.

And here’s what it confesses. I quote:

“…the prevailing theory is that the best position for the STC (Smokeless Tobacco Council) is on the question of the effect on the human body of the whole product and to identify various constituents, many of which might be defined as tumorigenic in other contexts would weaken the industry’s position. In other words, it is “the other side’s” duty to produce allegations that certain constituents result from the use of smokeless tobacco and are harmful.”

It is important to note here that the (European) Smokeless Tobacco Council is a lobbying group that campaigns against the European Union’s ban on oral tobacco products. There’s a similar body in both the US, and in India  the SLTF or the Smokeless Tobacco Federation, which acts as the mouthpiece of the industry.

In this document, it is clear that the Smokeless Tobacco Council’s own health research had found back in 1979 that not one but many of the constituents in its products were cancer causing. And, that they knew it all along.

When it says it is “the other side’s” duty to produce allegations – it is cleverly putting the responsibility of proving the charges on whoever tries to challenge them. In this case, doctors, cancer surgeons, victims and governments – across the world. And they have been doing this for more than three decades.

While the smokeless tobacco industry in India is said to have ‘domestic’ roots, it is interesting to note that these companies sell their products in many other countries including the US. The Indian industry adopted the same argument, strategy and method of dealing with the allegations that smokeless products were causing a public health epidemic.

Another related internal document (Bates number: 521034371-521034372) shows that the cigarette company Brown & Williamson Corporation made a contribution of five thousand dollars to the Smokeless Tobacco Council, while choosing to not become a member. The cigarette companies took an interest in the smokeless products and knew how harmful they were, but decided to not let out the evidence. What has been typically happening in India is that each time the issue of health harms is raised, the smokeless tobacco companies and the cigarette companies turn to blame the other. They also come together at times that best suit them, for example when protesting against taxes or pictorial warnings. But once the pictorial warnings were issued, the smokeless industry fought with the government, saying the cigarette industry got away with watered down warnings. The cigarette industry was in on the smokeless industry’s secrets.

206 million Indians consume smokeless tobacco products and nearly 5 million Indian children are already addicted to them, according to the Global Adult Tobacco Survey (GATS) and Global Youth Tobacco Survey (GYTS). That’s more than the population of Brazil, or the population of Egypt, or Mexico. That’s as many lives at risk of painful and fatal cancers. That’s many little children whose lives are at stake. That’s an industry which makes money out of filling coffins. Of ruined lives.

That’s a dirty secret, indeed.

Shalini has worked as a television health journalist for 9 years, with CNN-IBN (Indian affiliate of CNN International) in India. She has covered disease outbreaks, medical breakthroughs, and has extensively reported on public health epidemics like tobacco control. At present, she is working with the Public Health Foundation of India.

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