India’s Efforts in Curbing Smokeless Tobacco Use Lauded

According to the latest Lancet Global Health Research Review on the Global Impact of Tobacco Control Policies on Smokeless Tobacco Use, India’s efforts to reduce smokeless tobacco consumption have been lauded as “exemplary.” The review highlights India’s comprehensive approach, which aligns with the WHO FCTC and encompasses various measures such as taxation, regulation, labeling, education campaigns, cessation services, and restrictions on sale to minors. The review specifically mentions the ban on smokeless tobacco products like gutkha, along with mandatory depiction of harmful ingredients and pictorial health warnings on packaging. These efforts are commended as exemplary by the review.

The Global Adult Tobacco Survey (GATS) 2 conducted in 2016-17 revealed that the overall prevalence of tobacco users in India was 28.6%, with smokeless tobacco users comprising 21.38% of the population. These numbers indicate a decrease compared to the earlier GATS 1 survey, which reported 34.6% overall tobacco users and 25.9% smokeless tobacco users.

Additionally, India has implemented various policies to discourage tobacco consumption and protect public health. These include bans on advertisements, the prohibition of plastic sachets for packaging, and restrictions on tobacco use in public places. Notably, some states in India, such as Maharashtra, Haryana, Uttar Pradesh, Bihar, Jharkhand, Uttarakhand, Telangana, Nagaland, and Assam, have issued orders to ban smokeless tobacco products and spitting in public places, particularly in response to the COVID-19 pandemic.

However, experts have highlighted the need for more stringent implementation of tobacco-related bans in India, as several states have been lax in enforcing them.

Globally, smokeless tobacco use affects approximately 300 million people, leading to significant contributions to tobacco-related diseases and deaths. Many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control to address smokeless tobacco control, which has been effective in reducing smoking prevalence.

The use of smokeless tobacco products, including pan masala, gutkha, and khaini, is a significant public health concern in India and the Southeast Asian region. Earlier estimates indicated that nearly 80% of smokeless tobacco users reside in Southeast Asia, with around 60% in India.

On World Tobacco Day, Poonam Khetrapal Singh, the WHO regional director for South-East Asia, emphasized the success stories from countries like Bangladesh, India, Indonesia, and Sri Lanka, where tobacco-growing farmers have transitioned to economically viable alternative crops. Singh called upon all partners to support governments in tobacco-growing countries to develop and implement suitable policies and strategies for farmers to shift to growing food crops, leading to improved livelihoods, national economies, and food security.

The Lancet review, which marks the first systematic assessment of the global impact of tobacco control policies on smokeless tobacco use, involved a meticulous examination of 11 electronic databases and literature from January 1, 2005, to September 20, 2021. The findings revealed that 57 countries have implemented policies specifically targeting smokeless tobacco, with 17 of them going beyond the scope of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC).

The review highlights that policy initiatives based on the WHO FCTC have led to reductions in smokeless tobacco prevalence. For instance, taxation measures have resulted in reductions ranging from 4.4% to 30.3%, while multifaceted policies have yielded reductions ranging from 22.2% to 70.9%. The implementation of Article 11 (Pictorial health warnings) and Article 13 (Tobacco advertisement, promotion, and sponsorship ban) of the WHO FCTC has been widespread and impactful.

Experts have emphasized the need to scale up tobacco-related research in light of these findings. Ravi Mehrotra, co-author and member of the ICMR’s India Cancer Research Consortium, stressed the significance of increasing taxation and improving the implementation of existing laws. He stated, “Given that 300 million people use it worldwide, emphasis on increasing taxation and better implementation of the existing laws is of paramount importance. While policies on smokeless tobacco prevention and control exist in various countries, there is a lack of comprehensive research and assessment of their impacts, with limited publication in prominent tobacco reports or scientific literature.”

The review also emphasizes the importance of continuously updating guidelines and frameworks to incorporate new evidence on effective smokeless tobacco control measures. This reflects the need to stay abreast of emerging research and adapt strategies accordingly to enhance smokeless tobacco control efforts.

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