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The Indian Tobacco Control Act: A Public Health Imperative. Dr. K.S. Reddy Hony Executive Director, HRIDAY. CIGARETTE SMOKE CONTAINS 4000 POISONS. 1 tobacco related death every 6 seconds. WHAT IS AT STAKE?. = 10 million annual deaths by 2030.

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The indian tobacco control act a public health imperative

The Indian Tobacco Control Act: A Public Health Imperative

Dr. K.S. Reddy

Hony Executive Director, HRIDAY



1 tobacco related death every 6 seconds
1 tobacco related death every 6 seconds

WHAT IS AT STAKE?

= 10 million annual deaths by 2030

1 Billion deaths in 21st Century


Global tobacco toll
Global Tobacco Toll

  • Tobacco toll rising globally: 5 million in 2002 to 10 million in 2030- WHO

  • Developing Countries increasingly vulnerable: 7 million deaths in 2030- WHO

  • 700 million children worldwide are forced to passively breathe tobacco smoke

  • 1.69 million due to cardiovascular diseases

  • 1.47 million due to all tobacco related

    (0.83 million due to lung cancer)

  • 1 million due to chronic obstructive pulmonary disease.


Health consequences of tobacco use
Health Consequences of Tobacco Use

  • Tobacco chewing in its various forms is directly responsible for cancers of the oral cavity, oesophagus, pharynx, cervix, penis.

  • Beedi and cigarette smoking cause oral, pharyngeal, oesophagael, laryngeal, lung, stomach, gallbladder, urinary bladder and penile cancers.

  • Tobacco use is a major known risk factor for cardiovascular diseases.

  • Tobacco smoking is responsible for over 82% of chronic obstructive pulmonary disease.

  • Tuberculosis is a major cause of death in India and it is three times as great among smokers than non smokers.

  • Men who smoke have a lower sperm count and poorer sperm quality than non smokers

  • Tobacco use is also associated with oral precancerous lesions such as leucoplakia and other oral mucosal lesions.


Tobacco and cancers
TOBACCO AND CANCERS

  • Lung

  • Mouth (oral)

  • Throat (Pharynx & Larynx)

  • Food Pipe (Oesophagus)

  • Urinary Bladder

  • Other Sites


Cardiovascular risks of smoking
CARDIOVASCULAR RISKS OF SMOKING

100% Increase in Risk

Stroke; CHD; Impotence

300% Increase in Risk

Death from undiagnosed CHD

> 300 % Increase in Risk

Peripheral Arterial Disease

400 % Increase in Risk

Aortic Aneurysm


Other diseases
OTHER DISEASES

  • Chronic Bronchitis

  • Emphysema

  • Asthma

  • Cataract

  • Tuberculosis

  • Diabetes

  • Still Birth and Low Birth Weight

    > 25 Diseases


The indian tobacco control act a public health imperative

PASSIVE SMOKING (ETS)

  • Second Hand Smoke increase risk of

    • Cancer by 30%

    • Heart attack by 25%

      in spouse of the smoker

  • Increased risk of asthma and lung disease in children


  • Economic effects of tobacco use
    Economic Effects of Tobacco Use

    • The total social costs of tobacco products exceed the direct outlay on them, owing to morbidity, mortality and negative externalities associated with the consumption of tobacco products.

    • The costs inflicted by tobacco consumption extend much beyond the direct users to cover secondary smokers as well as non-users.

    • The recognition of the costs of tobacco has been obfuscated and made opaque by the unethical tactics and practices by the tobacco lobbies.

    • Worldwide recognition of the perils of the pandemic of tobacco have led to the recognition of tobacco as a demerit good, i.e. a public ‘bad’.



    Economic costs of tobacco
    ECONOMIC COSTS OF TOBACCO

    Health Care: Just for 3 diseases

    (Coronary Heart Disease; Cancer; Chronic Lung Disease)

    Health Care cost in 2002 – 2003 was Rs. 308.33 Billion (USD 7.2 Billion)

    Tobacco also has: Environmental costs & Social costs


    Prevalence of tobacco use among the youth india
    PrevalenceOf Tobacco Use Among The Youth - INDIA

    Global Youth Tobacco Survey (GYTS) conducted among school going youth (aged 13-15) during 2000-2004 in India:

    • Ever tobacco use : 25.1%

    • Current tobacco use: 17.5%

    • Current smokeless: 14.6%

    • Current smoking: 8.3%

    • Current cigarette smoking: 4.2%

    Results support the need to prevent youth from initiating tobacco habit and provide the evidence base for the provisions of Indian Tobacco Control Act, 2003


    The indian tobacco control act a public health imperative

    Differences in prevalence of tobacco use between sixth-grade and eighth-grade students

    (n=11642) : MYTRI STUDY

    - (The Lancet, 2006; 367: 589-594


    Government initiatives towards tobacco control laws to curb the problem
    Government Initiatives towards Tobacco Control Laws to Curb the Problem

    • Cigarettes Act is passed with first statutory health warning, 1975

    • States like Delhi, Goa and a few more had created their own tobacco control laws

    • Kerala High Court and Supreme Court had given momentous decisions in favour of tobacco control policies

    • Prevention and Control of Pollution Act included smoking in the definition of air pollution, Motor Vehicles Act of 1988 made it illegal to smoke in a public vehicle and Cables Television Network Amendment Act of 2000 prohibited the transmission of tobacco commercials on cable TV across the country.

    • The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), a comprehensive tobacco control legislation, comes into force on 1st May 2004

    • India ratified FCTC on 5th February 2004.


    The cigarettes and other tobacco products act 2003 significance to public health
    The Cigarettes and Other Tobacco Products Act, 2003: Significance to Public Health

    • Section 4: Ban on Smoking in Public Places

    • Secondhand smoke (passive smoking) of smoke causes many diseases like lung cancer, respiratory diseases, heart disease, breast cancer, asthma, bronchitis. In some cases, it can trigger severe, even life-threatening reactions in individuals.

    • Children are the worst affected. It causes sudden infant death syndrome.

    • People working, especially in the food service industry are affected.

    • Ban on smoking in public places would prevent damage to the health of non smokers and smokers


    Contd
    Contd.. Significance to Public Health

    • Section 5: Ban on Advertisements of Tobacco Products

    • In India children and the youth have been greatly influenced by tobacco advertisements, especially those for cigarettes and gutka which definitely harms their health.

    • Advertisements and placing of the product at a low height and next to candies at points of sale is a strategy they use to give undesirable exposure and access to children.

    • A study found that children who had seen sports events being sponsored by a tobacco company were more likely to start smoking. This was during the period when a cigarette company sponsored cricket matches.

    • Many tobacco industries are promoting tobacco products to target women.

    • This provision would prevent women and children from being influenced by glamorized advertisements of tobacco products.


    The indian tobacco control act a public health imperative
    TRENDS IN WEIGHTED CIGARETTE CONSUMPTION PER CAPITA IN COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    Source: World Bank Report, 1999


    Contd1
    Contd COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN..

    • Section 6: Prohibition of Sale of Tobacco Products to and by Minors

    • Many children in India experiment with tobacco at an early age and become addicted thereafter.

    • Individuals who use tobacco from a young age are more likely to suffer from serious diseases earlier than others and die prematurely

    • Sale by a minor gives a message to that child, as well as to other children, that it may be all right to use tobacco.

    • Adolescents out of school are more likely than other youth to sell tobacco.

    • This would restrict access of tobacco products to youth and children


    Contd2
    Contd.. COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    • Section 7: Specified Health Warning Labels on all Tobacco Products

    • Images help smokers visualize the nature of tobacco-related diseases and convey health messages in a clearer way.

    • Pictorial health warnings are intended to serve as visual cues to prompt smokers to take action to quit. They are designed to shock people into realizing that smoking kills and causes serious illness.

    • Pictorial warnings also make the health warnings accessible to those who are illiterate.

    • They are effective tool in conveying health risks to the tobacco users. It also has an impact on intention and ability to quit.

    • In countries like Brazil, Canada and Thailand many pictorial warnings have helped in decreasing consumption of tobacco products


    Contd3
    Contd.. COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    • Section 7(5): Every tobacco package to have nicotine and tar contents along with the maximum permissible limits

    • Nicotine and tar are carcinogens

    • Nicotine and tar contents along with permissible limits should mentioned on the packages

    • Having them on the package would help people making an informed choice


    Contd4
    Contd COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN..

    • Increasing Tax and Price of Tobacco Products

    • Price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons.

    • Implementing tax policies and price policies, on tobacco products would contribute to the health objectives aimed at reducing tobacco consumption.

    • This measure acts as a demand reduction measure for tobacco products.


    Impact on smokers alive in 1995

    PRICE INCREASE OF 10% COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    IMPACT ON SMOKERS ALIVE IN 1995

    Change in Change in

    Grouping number of smokers number of deaths

    (millions) (millions)

    Low/middle -36 -9

    Income

    High Income -4 -1

    World -40 -10

    Source: World Bank Report, 1999


    The indian tobacco control act a public health imperative

    TOBACCO COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    Evidence is available from many countries (including LMIC) that

    Taxation

    Ad Bans

    Smoke Free Policies

    Health Warnings

    ARE EFFECTIVE

    48.1% of mortality averted in UK (1981-2000) is attributable to reduced smoking(Unal B et al. Circulation 2004)

    POWER OF POLICY FOR CHRONIC DISEASE PREVENTION


    Tobacco control policies work
    TOBACCO CONTROL POLICIES WORK COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN

    • Ban on smoking in bars: 80% reduction in salivary cotinine levels of bar staff

      (BMJ 2005; 331:1117-22)

    • Graphic warning labels have impact on smoking cessation

      (Tobacco Control 2003; 12:391-95)

    • Reduced incidence of admissions for myocardial infarction after public smoking ban

      (BMJ 2004; 328:977-80)


    Thank you

    Thank You COUNTRIES WITH A COMPREHENSIVE BAN COMPARED WITH NO BAN