According to the World Health Organization, tobacco use is responsible for six of eight leading causes of death worldwide and kills more people than HIV/AIDS, legal drugs, illegal drugs, road accidents, murder and suicide put together each year.
It is also the cause of 14.3 per cent of male deaths and 4.7 per cent of female deaths in India and smoking is the third leading risk factor for Disability Adjusted Life Years (DALYs) lost in the country. Yet according to the Global Adult Tobacco Survey (GATS) India Report 2017, 28.6 per cent adults i.e. about 26.7 crore Indians use tobacco in some form.
Inspite of a nationwide ban on smoking in public places and workplaces, about 39 per cent adults are exposed to second hand smoke (SHS) in their own homes, 33 per cent are exposed to SHS at workplaces and 23 per cent are exposed to toxic smoke in public places. Nearly 15 per cent youth use tobacco in some form. Sixth grade students are two to four times more likely to consume tobacco as compared to eighth grade students.
Gender gap is narrowing with more young girls starting to use tobacco. Tobacco use is the leading cause of cancer in India and responsible for the highest rates of oral cancer in the country. It also leads to heart attacks, hypertension, stroke and tuberculosis. Its use or exposure to pregnant women leads to still birth, premature birth and low birth weight of new born.
Exposure of SHS to children causes ear infections, more frequent and severe asthma attacks, respiratory infections (bronchitis and pneumonia) and a greater risk for sudden infant death syndrome (SIDS).
Further, smokeless tobacco use induces spitting at public places, which causes risks of disease like tuberculosis, which kills more than 3 lakh people annually in India.
The effects of tobacco consumption are many-fold: First, according to Government of India, tobacco-related diseases cost over Rs. 1,04,500 crores in 2011, just among adults aged between 35 and 69. The total cost across all age groups would be much higher.
It is estimated that the expenditure on tobacco use by households potentially impoverishes nearly 15 million people in India annually. Second; tobacco crop is water-intensive and use of large quantities of fertilizers and pesticides in growing tobacco eventually degrade the land and pollute water-bodies.
It is also responsible for huge amount of deforestation and creating large quantities of solid waste which is nonbiodegradable and an environmental burden. Thirdly, use of tobacco infringes the right to life as it violates the citizen’s right to clean air, adversely affects health and environment striking away the protection of Article 21 and adversely affecting the lives of citizens.
Tobacco Control Regime
India has always been considered a global leader in tobacco control since the days of negotiations on the World Health Organisation’s Framework Convention on Tobacco Control as it pushed for and endorsed adoption of stronger tobacco control measures under the Treaty.
India was also among the frontline member states of WHO to ratify the Treaty in 2004, enforced a legislation implementing key provisions of the Treaty since 2004 and implemented a National Programme on Tobacco Control from 2007.
The Health Ministry has also implemented nationwide mobile based cessation service along with a quit-line to support users to get rid of the addiction. In 2011, the Food Safety and Standard Authority of India notified ban on use of tobacco and nicotine as an ingredient in any food item, essentially banning sale of gutka in the country.
Starting with the state of Madhya Pradesh in early 2012, almost every state now has a ban on sale of gutka while several of them have implemented ban on sale of all kind of smokeless tobacco products either under food safety laws or through specific legislation to this effect.
Several states have also taken further progressive steps by implementing ban on sale of nicotine, electronic cigarettes or loose sale of tobacco products to reduce the use of this extremely addictive and harmful product. These efforts were substantiated with larger and stronger pictorial health warnings from April 2016 and implementation of effective mass media campaign since 2009 and health spots in movies since 2011.
All these efforts have contributed to increased awareness among the common man and among tobacco users and the recent GATS report of 2017 reveals that there is a decline in the number of tobacco users in the country compared to 2010. Given this momentum of progressive efforts from the Union and the States and when several countries are setting a tobacco free goal for themselves, it is an opportune time for India to take some bold decisions to pave the way for a permanent and comprehensive tobacco control roadmap for the country.
India adopted a very progressive Constitution aimed at ensuring for all its citizens social, economic and political justice, equality, and dignity and prescribed as the duty of the state to raise the level of nutrition and the standard of living. The state is also required to take steps to bring about ‘Prohibition’ of the consumption except for medical purposes of intoxicating drinks and of drugs, excessive doses of which are injurious to health (See Art.47).
However, it failed to mention prohibition of tobacco which is equally injurious to health. Sardar Bhopinder Singh Man, a member of the Constituent Assembly, with foresight during the debates on what we see in the current Article 47, requested the house for addition of the word “tobacco” between “Drinks and drugs”.
Tobacco has today met the test then laid by Shri Mahaveer Tyagi, who proposed to prohibit those intoxicants that are bad and dangerous for health. However, as Sardar Man had observed, “…in moving this amendment, I would be incurring the displeasure of the influential members of this House and I also feel that I am going against the temper of the majority.
His amendment was negatived. This happened when the Father of the Nation had already said, “Ever since I have been grown up, I have never desired to smoke and have always regarded the habit of smoking as barbarous, dirty and harmful. I have never understood why there is such a rage for smoking throughout the world. I cannot bear to travel in a compartment full of people smoking. I become choked.”
Amend Article 47
Seven decades later and after losing more than one million Indians every year to tobacco use, it is pertinent that the Parliament rectifies this historical oversight and adds “tobacco” after “drinks” in Article 47 of the Constitution to pave the way for the union and the state governments to take exemplary measures to reduce tobacco use.
Amending the Constitution and including ‘tobacco’ under the ambit of Article 47 will empower not only the Union Government, but more importantly the state governments to take decisive and comprehensive steps for ensuring tobacco control, including a complete prohibition on manufacture and sale of tobacco within the state.
Both alcohol and drugs have been regulated and controlled in the country through legislative measures reflected under Article 47. Public health is a subject matter for states to legislate. For states to meet their coveted aspirations of improving public health, this amendment is an imperative. In states where prevalence of tobacco use is low or very low, this amendment will clear the road for them to realise the dream of being tobacco free.
Eventually, it will lead to a tobacco-free India. A complete prohibition on tobacco will not only save the present and future generations from premature death and diseases but the expenditures induced by tobacco could alternatively be used in large infrastructure projects like the bullet train corridors that as the PM said, “exemplifies a new India and is an expression of its dreams. Its flight is limitless, its aspirations infinite. Its an India that is flying high.”
This flight certainly needs more wings and putting an end to tobacco use – that costs Rs1,04,500 crores annually – can be the best bet.
(The writers are, respectively, an expert on public health law and an Associate Professor of Law.)