Tobacco control in india

1. Dr. Srabana Misra Bhagabaty , MD
Assistant Professor cum In-Charge,
Department of Preventive Oncology,
Dr. B. Borooah Cancer Institute
Guwahati-16
(Presented as a guest lecture in Department of Preventive and social Medicine,
Guwahati Medical College and Hospital in 2016 under BBCI year of academic
excellence )
Tobacco control program : India
where we are

2. How it came : To India
Tobacco was introduced to India by
Portuguese traders, in 16th century
Was most-commonly consumed by men
and women in the form of the hookah
Not native, and was not inherent but an
introduced addiction that became
unfortunately one component of India’s
socio-cultural behavior
Dr. Srabana M

3. :WHY:
NEED OF ADDRESSING TOBACCO ISSUE
In spite of the fact that “ Tobacco is the
most preventable cause of Death” as
named by WHO
Tobacco killed 100 million people worldwide in the
20th Century
By 2030 tobacco will kill >8 million people each Year
India is the second largest producer and consumer
of tobacco in the world
Dr. Srabana M

4. Type Males Females
Tobacco 47.9 20.3
users
Smokers 24.3 2.9
Smokeless 32.9 18.4
Prevalence of tobacco use (%)
Global Adult Tobacco survey (GATS 2010)
Dr. Srabana M

5. GLOBAL YOUTH TOBACCO SURVEY INDIA 2009-10 (GYTS)
14.6% currently use any tobacco product (Boy = 19.0%, Girl = 8.3%)
4.4% currently smoke cigarettes (Boy = 5.8%, Girl = 2.4%)
12.5% currently use other tobacco products (Boy = 16.2%, Girl = 7.2%)
SHS exposure is moderate – one in five students live in homes where
others smoke, and more than one-third of the students are exposed to
smoke around others outside of the home; one-quarter of the students
have at least one parent who smokes.
Dr. Srabana M

6. Why tobacco control is a real problem
• High consumption rate
• Low quit rate due to its highly addictive nature
Why high consumption
1. Easy Availability
2. Affordability
3. Gaps in stringent law implementation
4. Cultural acceptability
5. Falling into nicotine trap
Dr. Srabana M

7. NICOTINE ADDICTION: the trap
• A psychoactive drug affecting mood and
performance
• Nicotine is:-
- 1000 times more potent than alcohol
- 10 – 100 times more potent than barbiturates
- 5 – 10 times more potent than cocaine or morphine
•Within 10 seconds reaches brain.
Dr. Srabana M

8. Need of the hour : Tobacco control:
addressing Demand and Supply
reduction by
• Planning, Policy and law
• Implementation
• Inter-sectorial co-ordination
• Awareness generation
• Community participation
• Community perception and acceptance
modifications
Dr. Srabana M

9. THE RESPONSE ::::::
Dr. Srabana M

10. Global partnership towards tobacco
Control :Joining hands together : Demand and supply
reduction
WHO Framework Convention on
Tobacco Control (WHO FCTC):
56th World Health Assembly on
21 May 2003
Signed by 168 countries
(including India) and is legally
binding in 180 ratifying countries
(including India)
Dr. Srabana M

11. MPOWER is a policy package: FCTC
(Demand and supply reduction of tobacco)
• Monitor tobacco use and prevention policies
• Protect people from tobacco smoke
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising,
promotion and sponsorship
• Raise taxes on tobacco
• Reduce the size of cigarette
Dr. Srabana M

12. Rules /policies and bans
Dr. Srabana M

13. India has been a forerunner in the Framework
Convention on Tobacco Control (WHO FCTC)
and was the Regional Coordinator for the
South-East Asian Region
The Government of India enacted ‘Cigarettes and Other
Tobacco Products (Prohibition of Advertisement and
Regulation of Trade and Commerce, Production, Supply
and Distribution) Act, 2003 (COTPA)
Year 2003 onwards, India has played a proactive
role on the tobacco control front.
Dr. Srabana M

14. Key Provision of cigarettes and other
tobacco product Act(COTPA), 2003
 Ban on smoking in public places (including indoor workplaces) -Sec 4
 Ban on direct and indirect advertising of tobacco products- Sec 5
 Ban on sales
- Tobacco products cannot be sold to and by children <18 years – sec
6(a)
- Tobacco products cannot be sold within a radius of 100 yards of
educational institutions - sec 6(b)
 Pictorial health warnings – sec 7
 English and one or more Indian languages to be used for health
warnings on tobacco packs – sec 7
 Testing and Regulation: Ingredients to be declared on tobacco product
packages (Tar and Nicotine) – sec
Dr. Srabana M

15. National tobacco control
program(NTCP)
Launched in
2007-08 during 11th Five Year
Plan
Dr. Srabana M

16. With the following two objectives:
> To bring about greater awareness about the
harmful effects of tobacco use and about the
Tobacco Control Laws.
>To facilitate effective implementation of the
Tobacco Control Laws. Dr. Srabana M

17. To fulfill obligations of
• COTPA implementation of provisions
under the law
• FCTC
Dr. Srabana M

18. NTCP INDIA: THE BEGINING
Pilot phase :The Ministry of Health and Family
Welfare launched the of the National Tobacco
Control Programme in 2007-08 in 9 states of the
Country
(Assam, West Bengal, Madhya Pradesh, Tamil
Nadu, Karnataka, Gujarat, Rajasthan, Delhi,
Uttar Pradesh).
Dr. Srabana M

19. Dr. Srabana M
Up scaled : To across 21 states in 2008

20. Structure of the National Tobacco Control
Programme
National
tobacco
control cell
State tobacco control cell
District tobacco control cell
National level
State level
District level
Dr. Srabana M

21. The National Tobacco Control Cell (NTCC) is responsible for
overall policy formulation, planning, monitoring and evaluation
of the different activities envisaged under the programme
Dr. Srabana M

22. State tobacco control cell
Does overall planning, implementation and monitoring
of the different activities,
achievement of physical and financial targets planned
under the programme in the State.
Dr. Srabana M

23. Dr. Srabana M

24. Structure for tobacco control
program(Assam)
Director of Health Services , Assam
State Nodal Officer
Senior consultant(WHO)
District Nodal Officer, Kamrup District Nodal Officer, Jorhat
Psychologist
Social worker
Data entry Operator
Psychologist
Social worker
Data entry Operator
Dr. Srabana M

25. Where we are
Assam became the first state to legally ban consumption of all
forms of smokeless tobacco, including pan masala containing
tobacco and nicotine Dr. Srabana M

26. Rules /policies and bans….

27. Ban on use of plastic pouches
containing tobacco products by a
Supreme Court verdict
April 2011
Dr. Srabana M

28. 8th March 2013
• The Assam government passed an order
banning manufacture and sale of gutkha and
paan-masala containing tobacco and nicotine,
issued under sub-section 2 of Section 30 of
Food Safety and Standards Act, 2006
Dr. Srabana M

29. The Bill was tabled by the State health
minister in order to ‘improve public health
and prevent incidence of cancer and other
health hazards and addiction among the
people of the State.’
Assam : Bill on tobacco
JULY 2013
Dr. Srabana M

30. Registered No.-768/97
THE ASSAM GAZETTE
EXTRAORDINARY
PUBLISHED BY THE AUTHORITY
it 30 , , 11 , 2014, 22 US, 1935 )
No. 30 Dispur, Tuesday, 11th February, 2014, 22nd Magha, 1935 (S.E.)
GOVERNMENT OF ASSAM
ORDERS BY THE GOVERNOR
LEGISLATIVE DEPARTMENT : : : LEGISLATIVE BRANCH
NOTIFICATION
The llthFebruary, 2014
No. LGL.22/2013/49.— The following Act of the Assam Legislative Assembly
which received the assent of the Governor is hereby published for general information.
ASSAM ACT NO. I OF2014
(Received the assent of the Governor on 8th February, 2014)
THE ASSAM HEALTH (PROHIBITION OF MANUFACTURING,
ADVERTISEMENT, TRADE, STORAGE, DISTRIBUTION, SALE AND
CONSUMPTION OF ZARDA, GUTKHA, PANMASALA ETC.
CONTAINING TOBACCO AND/OR NICOTINE) ACT, 2013
Dr.
Srabana

31. Bill becomes act in Assam
On 13th February 2014 as
Assam Health (Prohibition of Manufacturing
Trade, Advertisement, Storage, Distribution,
Sale and Consumption of Zarda, Gutkha, Pan
masala etc. containing Tobacco) Act, 2013.
Dr. Srabana M

32. Violators of the law are liable to be punished
with imprisonment up to seven years and a
fine between Rs 1 lakh and Rs 5 lakh.
Consumption or possession of zarda, gutka
and pan masala containing tobacco is
punishable with a fine of Rs 1,000 for the first
offence and Rs 2,000 for each subsequent
offences.
Dr. Srabana M

33. Decreasing affordability
Dr. Srabana M

34. Hike in Value Added Taxes (VAT) on tobacco products
as announced by the Assam Government,.
The State Government raised VAT on tobacco products
from 13.5 per cent to 20 per cent recently.
2013
To discourage tobacco smoking, VAT on cigarette, bidi,
cheroots, cigar and smoking mixture has been
increased to 25 percent from 20 percent.
2016-17
Hike in service tax by 10-15%
July 2011
Dr. Srabana M

35. 2014
• The first smoke-free district in the state,
Jorhat, is set to be showcased as a model
district in the country for the National Tobacco
Control Programme (NTCP). The Director
General of Health Services (DGHS),
Dr. Srabana M

36. • So far, six villages in the jorhat district have
been declared tobacco-free and an effort is on
to create a tobacco-free district with chief
minister Tarun Gogoi's constituency, Titabor,
being a part of the new project.
Sahpuriya, on the outskirts of Jorhat, became
the first village in the country to be declared
tobacco-free in 2011 and the same year,
Jorhat was the first district in the state to
impose a fine for smoking in public places.
Dr. Srabana M

37. • In 2010, Sikkim was declared the first smoke-
free state in India, and in 2014 Himachal
Pradesh became the second.ter
Dr. Srabana M

38. • Nagaland's capital Kohima was declared as a
'smoke-free city' on April 29.
(In 2007, Chandigarh was declared the first
smoke-free city of India. After this, Kottayam
in Kerala and Shimla followed suit)
Dr. Srabana M

39. • Delhi and Gujarat,10 states and UTs, including
Kerala, MadhyaPradesh, Punjab,Bihar,
Rajasthan, Jharkhand, Chandigarh,
Maharashtra, Haryana and Mizoram banned
gutka by implementing the Food Safety and
Standards (Prohibition and Restrictions on
Sales) Regulations-2011.
Dr. Srabana M

40. Challenges in tobacco control
• Cultural acceptance
• High consumption
• Lack of inter sectoral co-ordination
• Gaps in policy implementation
 Illicit trade
 Open land borders(more than 5000 kilometers
 Free movement of people and goods between countries
 Smuggling reported from India to Bhutan myanmar
pakistan and nepal
 Recent repots of involvement of few organized syndicates
Dr. Srabana M

41. NEED
Realization of health hazards of tobacco by the
Government (govt. initiatives started)
Planning (already there is a policy)
Massive public awareness efforts and stringent implementation
of laws
resulting in
Persistent decline in the
prevalence of tobacco in these countries
Dr. Srabana M

42. • Indicates the need for a more comprehensive
approach to tobacco control within the
country in terms of taxation trade economic
policy and enforcement policy
• Sufficient no of tobacco de-addiction centres
should be set up for those who wish to quit
their habit
Dr. Srabana M

43. Lets prevent it

44. Contact details
• Dr.Srabana Misra Bhagabaty
Email : srabana.misra@gmail.com
Presentation download: www.slideshare.net

45. Thank you
Dr. Srabana M
Bhagabaty