Over the years, production of tobacco has moved from the tobacco fields of the United States to developing countries — the result of inexpensive leaves and lax agricultural policies that allow farmers to use chemicals banned in the West. This trend has created opportunities for developing countries like India, which is now the world’s second largest producer of tobacco after China.
Akash is a fourteen-year-old tobacco user who recently started treatment for oral cancer at the Rajiv Gandhi Cancer Institute. He says he started smoking and chewing tobacco and pan (beetle leaf) due to peer pressure. He tells The Diplomat, “All my friends chewed so I had to do it too. I didn’t like it at first. Although I didn’t see it happening, eventually I became addicted.”
Akash started chewing tobacco around four or five years ago. His parents were not aware of their son taking tobacco until he showed signs of illness and had to be taken to the hospital. Akash is not alone. There are about 75,000 to 80,000 new cases of oral cancer each year in India – the world's highest incidence. According to Dr. Rajiv Chopra, who specializes in treating oral cancer patients, around 2,000 people die every day in India from tobacco related illnesses.Enjoying this article? Click here to subscribe for full access. Just $5 a month.
A 1998 survey of 1,800 boys aged 13 to 15 from across the socioeconomic spectrum found that up to 20 percent were already using three to five packs of gutka daily. The extremely low prices of tobacco products in India make them widely available to consumers of all ages and income levels. Clearly, something must be done.
In the hopes of addressing this issue, on September 12, an international conference on tobacco was held in New Delhi called The International Conference on Public Health Priorities in the 21st century: the Endgame for Tobacco. Panelists from different organizations and advocacies fighting the use of tobacco presented their work at the event. Among them were the International Tobacco Control Policy Evaluation Project, which released findings suggesting that India’s ban on smoking in public places is neither comprehensive nor routinely enforced.
Gaps in tobacco legislation, poor enforcement and inadequate efforts by doctors to discourage patients from using tobacco are obstructing India’s efforts to curb its consumption, according to a survey on the impacts of a decade’s worth of legislation.
The conference intended to discuss strategies to achieve a target of bringing tobacco consumption down by 30 percent by 2025. According to speakers at the conference, India is home to an estimated 275 million tobacco users. Dr. Chopra suggests, “To deal with this issue, we need to strictly prohibit tobacco advertisements like we did earlier in 2004.”
India’s tobacco problem is worsening each year, despite the introduction of laws meant to control the situation in the past. It follows that experts have started to question the effectiveness of these laws.
In August, the state of Maharashtra enacted a five-year ban (the longest permitted by law) on the production, sale, transport and possession of gutka (the most widely used form of tobacco in India). The ban had little effect. Gutka is still widely available in small packs as ubiquitous in the state as chewing gum. According to Dr. Chopra, the gutka business still earns about $30 million in the state.
Several other states have imposed similar bans, but little has changed. Boys like Akash are common throughout India, with many shops freely selling gutka to boys as young as six.
Kimberly Rhoten, a research fellow at the Centre for Health Law, Ethics and Technology at Jindal Global Law School, is conducting research in five districts of the state of Haryana that analyzes the effectiveness of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA), 2003. This legislation applies to all products containing tobacco in any form, including cigarettes, cigars, bidis, gutka, pan masala (containing tobacco) and snuff, among others, and extends to the whole of India. The COTPA Act stipulates a number of measures, from a ban on public smoking to enforcing a ban on sales of all tobacco products to anyone under 18 years old.
Rhoten explains that the Indian government has struggled with the issue of tobacco control for more than 20 years. It started with judicial questions surrounding issues such as the right to health, and later evolved into statutory questions about how to draft, pass and implement tobacco control reforms.
“COTPA passed several key provisions including: banning smoking in public, requiring pictorial health warnings on tobacco products, and banning the selling by or purchasing by minors,” Rhoten tells The Diplomat. “The 2008 reform laws amended the 2003 act to include fines. Of the sections examined in the Centre's study, all were violated in Haryana; in some cases, even by law enforcement.”
What is of particular concern to COTPA, and is not unique to tobacco reform, is enforcement, explains Rhoten. Several sections of COTPA require enforcement on the community level, which includes preventing smoking in public spaces. These attempts to control tobacco are impossible without the active participation of local police.
Rohten says, “Unfortunately, enforcement of COTPA varies across the country, allowing sellers and buyers to violate COTPA with impunity. Reforms at the supply level are needed to address tobacco use in a country where enforcement at the demand level fails.” Taxation and limits on production are two possible ways to reign in the industry at the level of supply.
Alas, the inefficient implementation of laws already in place is not only frustrating anti-tobacco campaigners, it is also taking a rapid toll on the population, putting at stake the lives of young boys like Akash.
Kiran Nazish is a Pakistani-based columnist for The Pulse and a correspondent for LaStampa. Follow her on twitter @kirannazish.