Tobacco a Major Killer

Health warning in the packets is a welcome move to promote tobacco free initiative by reducing the attractiveness of tobacco products, where the graphic picture has to cover 60% of the package, and the text warning will be 25%.
By Dr Suneela Garg / Dr Arvind Garg

Tobacco kills half of its users, with smoking and smokeless tobacco killing nearly 6 million people worldwide. There is one death in every 6 seconds in each year, according to report submitted by the World Health Organization (WHO).Cigarette smoke contains over 4,800 chemicals, out of which 69 are reported as carcinogenic. Apart from cancers, smoking is also a major risk factor of coronary heart disease, chronic bronchitis, stroke; and other conditions like delayed healing of wounds, peptic ulcer disease and infertility.
India is the second largest consumer of tobacco products worldwide with more than 275 million adults consuming a wide variety of tobacco products. It has a comprehensive tobacco control Act, “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA 2003),” in place.
In compliance with this, Union Ministry of Health and Family Welfare has implemented introduction of new graphic health warnings that cover 85% of the principal display area on all tobacco product packages on both sides from 1st April, 2016. Studies indicate that the impact of health warning on an individual’s mindset depend on their size and design i.e. obscure text-only warnings appear to have little impact whereas pictorial health warnings that elicit strong emotional reactions are significantly more effective. According to Canadian Cancer Society Report regarding size of their health warnings, India was ranked 3rd in 2016 after Nepal and Vanuatu, with several countries implementing stronger warnings. Other Asian countries are also at par in this regard, with warnings covering 85% of the package on both sides in Thailand, 80% in Sri Lanka and 90% in Nepal.
On 31st May, 2016, the slogan for World No Tobacco Day was “Get ready for plain packaging”. Plain packaging (also known as standardized packaging or generic packaging) is an important demand reduction measure that reduces the attractiveness of tobacco products, restricts use of tobacco packaging as a form of tobacco advertising and promotion, limits misleading packaging and labelling and increases the effectiveness of health warnings. Australia became the first country to fully implement plain packaging in December 2012. Later on Ireland, the United Kingdom of Great Britain and Northern Ireland and France passed laws to implement plain packaging. Similarly, a number of countries are in advanced stages of considering adoption of plain packaging laws.
In India efforts to curb down tobacco use in India like the decision to increase the size of pack warning labels, along with increasing the legal age of buying and using tobacco, are commendable. The new warning labels with pictures of mouth and throat cancers -were to cover all kinds of tobacco packages, including imported cigarettes and chewing tobacco. Pictorial warnings significantly increase people’s awareness of the harms of tobacco use. It can persuade smokers to protect the health of non-smokers by smoking less inside the home and near children.
Ministry of Health & Family Welfare (MOHFW), in partnership with World Health Organisation (WHO) and the International Telecommunications Union (ITU), has started another innovative initiative by utilising mobile technology for tobacco cessation. WHO-ITU’s ‘Be Healthy Be Mobile’ initiative aims to reach out to tobacco users of all categories who want to quit tobacco use and support them towards successful quitting through constant text messaging on mobile phones. The initiative is fully supported by the Government of India (GOI). GOI had also introduced toll free number (1800 11 2356 / 011-22901701) to help for quitting tobacco and help line 1800110456 for reporting of any COPTA violations.
As per notification issued by MOHFW, GOI dated 24th March, 2017; all tobacco products manufactured on or after 1st April 2017 shall display the second image of specified health warning in the packs. Any person engaged directly or indirectly in the production, supply, import or distribution of cigarettes or any other tobacco products shall ensure that all tobacco product packages shall have specified health warnings as prescribed; and violation of this is a punishable offence with imprisonment or fine as prescribed in Section 20 of cigarettes and other tobacco products act, 2003. Printing the toll free number for quitting in the packages in noticeable size and colour would also have been excellent. Thus 85% graphic health warnings with pictorial depiction of variety of health consequences and devoid of logos, colours, or any other brand images in conjunction with plain packaging, and display of toll free number for quitting are expected to dissuade tobacco consumers to quit and save themselves from the devastating health, social, environmental and economic consequences of tobacco consumption.

(The authors are Director Professor & Head Community Medicine, MAMC Delhi/Consultant Paediatrician Child Care Clinic and Associated with Apollo Hospital, Noida)