Vision of a Tobacco-Free India – Strengthening Control Measures

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• According to 2017 estimates, the annual economic costs of all tobacco products for the population aged 35 years and above in India were estimated at ₹1,773.4 billion (1.04% of GDP).
• This is in addition to ₹566.7 billion (0.33% of GDP) in annual healthcare costs attributable to second-hand smoking.
• These costs include direct medical and non-medical expenditures, morbidity and mortality losses. 
• As tobacco use in India causes enormous health and economic burden, there is an urgent need to review and strengthen India’s tobacco control framework to realise the vision of a tobacco-free India.

Gaps in Existing Legislation

• COTPA, 2003: 
  • Though the Cigarettes and Other Tobacco Products Act (COTPA), 2003, is a stringent Act, its implementation is poor in several Indian States. 
  • The legislation also has various other shortcomings that require urgent attention.
• Inadequate coverage of Smokeless Tobacco (SLT):
  • Though SLT is cheaper, culturally accepted, and less stigmatized, it is more carcinogenic than smoked tobacco.
  • Although laws like the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations, 2011, contribute to its control, they are relatively weak and poorly enforced. 
• Surrogate and indirect advertising:
  • Surrogate ads (especially for SLT) build brand recognition. Movies, OTT, and social media promote tobacco indirectly.
  • Though direct tobacco advertisements are banned in India, companies use similar packaging for mouth fresheners to build brand recognition and promote tobacco through classical conditioning.
  • Hence, strict bans need to be implemented on both surrogate advertisements and indirect promotion in the media.
• Weak fiscal measures:
  • There are no direct provisions in COTPA for fiscal measures to curb tobacco use. 
  • Raising excise taxes is the most effective way to reduce consumption, yet India’s tobacco taxation remains inadequate and uneven. 
  • For example, the tax burden on bidis (the most consumed smoked product) is just 22%, and about 50% on cigarettes—far below the WHO’s recommended 75%.
  • Since the GST rollout in 2017, minor tax hikes raised overall tobacco taxes by just 4%. 
  • Rising incomes and low taxation made tobacco more affordable in India, also resulting in missed revenue and health opportunities.
• Ineffective warning labels:
  • Although tobacco warning labels are updated every two years, there is limited evidence on their effectiveness in preventing tobacco use.
  • Unlike many European countries that use packaging to educate users about a range of tobacco-related harms, India’s warnings rely mainly on fear-based messaging (oral cancer, early death).
  • COTPA rules (mandates 85% health warnings on tobacco packs) should mandate regular evaluation of tobacco warning labels. 
  • India should also adopt plain packaging to further reduce the appeal and use of tobacco.
• Poor implementation of e-cigarette ban:
  • Though India is one of the few countries to ban e-cigarettes, poor implementation of the Prohibition of Electronic Cigarettes Act (PECA) 2019 has also resulted in an increasing threat of e-cigarettes to public health in India.
  • For example, e-cigarettes are accessible online, making them more accessible to adolescents. 

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Need for a Holistic Approach

• Limitations of current National Tobacco Control Programme (NTCP):
  • The NTCP focuses on awareness and COTPA enforcement.
  • It ignores social determinants like poverty, unemployment, stress, etc.
  • As compared to a large user base, cessation clinics have limited reach.
• Weaknesses in ToFEI (Tobacco Free Education Institute):
  • It currently promotes awareness in schools through posters and biannual activities, but lacks the scientific rigour needed for effective tobacco control. 
  • In contrast, the U.S.’s national public health agency, the Centres for Disease Control and Prevention (CDC) recommends comprehensive school-based strategies in the U.S., including 
    • Enforcing tobacco-free policies, 
    • Integrating prevention education from kindergarten to grade 12, 
    • Training teachers, involving families, supporting cessation for students and staff, and 
    • Regularly evaluating programmes.

Towards Better Regulation and Control

• Challenge faced by public health researchers: The tobacco industry has access to its real-time sales data to adapt sales strategies while public health researchers are unaware of the most recent trends in tobacco consumption.

• Policy recommendations:
  • Adopt ‘Tobacco Endgame’ strategy through multi-ministry (Education, Finance, Health, Law, Social Justice, Commerce, Information & Broadcasting, Consumer Affairs) collaboration.
  • Greater investment in research institutions not only for developing and implementing control measures but also for producing regularly updated, robust data.
  • Independent oversight body to monitor and expose industry interference.
  • Stronger use of demand-side (tax, awareness, cessation) and supply-side (regulation, enforcement) measures.

Conclusion

• India needs a comprehensive, multipronged strategy to reduce tobacco burden.
• Combining stringent laws, higher taxation, effective awareness, social support, school-based interventions, and independent oversight is crucial.
• Sustained collaboration between policymakers, researchers, and implementers is essential to realise the vision of a tobacco-free India.

Source: TH