On 25 May 2018, the Global Adult Tobacco Survey fact sheet for Goa (GATS 2) was released. The GATS survey is considered the gold standard for systematically monitoring tobacco usage on a comparative basis, across states as well as countries to design, implement and evaluate tobacco control interventions. The survey was conducted in collaboration with the WHO and the CDC Atlanta, with the Tata Institute of Social Sciences as the implementing agency. Between August 2016 to February 2017, persons aged 15 years and above from randomly selected households were interviewed in thirty states and two UTs, with a sample size of 76000. GATS 2 was a follow on from GATS 1 conducted between 2009-10, to assess the impact of interventions.
Goa reported the lowest prevalence of tobacco usage overall. Smoking decreased between GATS 1 and GATS 2 by 0.6%; not considered statistically significant. Smokeless tobacco usage increased by 1.9%. Warning labels made 65.6% of cigarette smokers, 28.6%of bidi smokers and 37.3% of smokeless tobacco users consider quitting. Though tobacco advertising reaches out to about 28.7%, awareness and perception of the harmful effects of tobacco usage ranges from 89% to 98% depending on the type of tobacco used. In other words, whilst on the one hand, anti-tobacco campaigns do reach the public, on the other hand this does not appear to translate into any substantial decrease in tobacco usage.
Certain aspects of the survey are questionable in the Indian context. It is generally recognised that the use of smokeless tobacco in particular does not respect age. The fifteen years cut off appears to be arbitrary and likely to miss out a sizeable section of users under fifteen who undeniably exist. Restricting the survey to households misses out on the labourers and a large migrant population in Goa who live in temporary shelters particularly connected to the construction industry. The use of smokeless tobacco is rampant to help them get through the day. The section on economics and second hand smoke in the survey does not factor in the seventy lakh odd tourists who visit Goa, both domestic as well as foreign. In short, the “encouraging” findings may be papering over grim ground realities.
India passed the “Control of Tobacco Products Act” one full year before the WHO “Framework on Convention on Tobacco Control” (FCTC) treaty. However, with an estimated 114 tobacco related deaths every hour, the industry with its own champions in government, works overtime to increase the current estimate of 5500 new replacement users every day. Subsequent to the Act being passed in 2003, and coming into force in 2004, no rules were framed, rendering the Act impotent. It took a PIL in the Himachal High Court in December 2004, to direct the government to frame rules immediately. The government obliged, but conveniently forgot to notify the rules so that the end result remained the same; a totally useless law. A further PIL in the Shimla High Court was needed, followed by repeated directives to notify the rules. This was eventually done in July 2006. In short the implementation of any tobacco related legislation has a history of obstruction by the tobacco lobby.
In October 2014 this country ruled (Cigarette and other Tobacco Products – Packaging and Labelling –Amendment Rules) that the pictorial warnings be increased in size to cover 85% of the packing. The Union health ministry set up a medical board to examine the health effects of tobacco on the Indian population before mandating the 85%coverage. The chairman of the committee BJP MP Dillip Gandhi declared that our current stance on tobacco is based on studies done in a foreign setting and that further studies are required in an Indian population in this country before concluding that tobacco actually causes cancer. The proposed increase in the size of the pictorial warnings was put on hold. His committee heard representations from the likes of the All India Beedi Industry Federation, and the Karnataka Virginia Tobacco Growers Association. No health expert, oncologist, or anti-tobacco activist of any description was invited to make a representation; exposing his unashamed bias.
The matter became the subject of a prolonged legal battle. The tobacco industry filed multiple petitions in various high courts in the country challenging the validity of the packaging and labeling rules of 2006; an obvious delaying tactic, to grind the legal system to a halt, paralyze it and neutralize the rules. The Government of India then approached the Supreme Court to transfer the matter before itself and decide once and for all the applicability of the law. The Court accepted; all HC petitions were stayed by the SC as recently as January 2018, and now considered sub-judice, awaiting final judgment. Meanwhile, studies in Australia and elsewhere have now established that “plain packaging” removing all branding with standardised homogenous packaging is also effective. It becomes less macho, therefore less appealing, unfashionable and “not cool”.
Such behind the scenes sabotage by our own legislators across party lines puts a question mark on the final outcome. Tobacco barons hold important positions in government policy making and implementation. It is ironical that on the one hand we have a “National Tobacco Control Program” under the MoHFW and on the other a Tobacco Board under the Ministry of Commerce and Industry to promote tobacco. This Board, with members of both houses of parliament on it, has an obvious priority to protect the export market of Rs 5, 975.08 crore (2016-17) and a domestic market of Rs 20, 000 crores.
The government is a beneficiary shareholder in major tobacco producers either directly or through the PSUs. And patients continue to die whilst we await the outcome of this morbid tug of war.
The final irony. At the function to release the data, delegates were given bottled water manufactured by a company which is a leading producer of smokeless tobacco.
Long live surrogate advertising.
(The author is a founder member of the Voluntary Health Association of Goa).
