Context: ‘World No Tobacco Day’ is observed annually on May 31. India ranks first globally in male cancer incidence and mortality rates. India tops the global list in tobacco-related lip and oral cancers, followed by lung cancer. Along with the health burden, tobacco use imposed an economic cost of ₹1.77 lakh crore (1.04% of India’s GDP) in FY18.
Tobacco prices remain low in India, thus tobacco affordability undermines WHO’s MPOWER framework and fuels the cancer epidemic in India.
Relevance of the Topic:Mains: Tobacco Epidemic in India: Government Initiatives.
About tobacco
- It is the common name of several plants in the genus Nicotiana, and the general term for any product prepared from the cured leaves of these plants.
- Dried tobacco leaves are mainly used for smoking in cigarettes and cigars, as well as pipes and hookahs. They can also be consumed as snuff, chewing tobacco and dipping tobacco.
- It contains the highly addictive stimulant alkaloid nicotine as well as harmala alkaloids.
- It is grown in warm climates with well-drained soil. Major tobacco-growing countries include China, India, Brazil, and the United States.
- It causes a wide range of diseases , including heart disease, stroke, respiratory diseases, and various cancers (especially lung cancer) and affects those consuming it as well as those cultivating it.
Problems with tobacco cultivation:
- It is a highly erosive crop that rapidly depletes soil nutrients. This requires more fertilizers to be used which further worsens soil quality.
- The plant is also a major contributor to deforestation. Up to 5.4 kg of wood is required to process 1 kg of tobacco.
- The production and consumption of tobacco generates nearly 1.7 lakh tonnes of waste every year in India.
- A 2021 study estimated that the country incurred a loss exceeding ₹1.7 lakh crore as a result of tobacco’s effects on the health of its consumers in the fiscal year 2017-2018.
Status of tobacco use in India:
- After China, India has the world’s highest number of tobacco consumers nearly 26 crore, according to an estimate in 2016-2017.
- Also, the health of more than 60 lakh people employed in the tobacco industry is also placed at risk because of the absorption of tobacco through the skin, which can cause various diseases.
- Tobacco use has gone down in the population and tobacco use in women, which went up by 2.1% between 2015-2016 (NFHS).
- Tobacco use is also the cause for nearly 3,500 deaths in India every day, which impacts human capital and GDP growth in a negative way.
Government initiatives to curb tobacco epidemic in India:
- WHO’s Framework Convention on Tobacco Control (FCTC), 2005: India is one of the 168 signatories, to reduce tobacco usage worldwide by helping countries develop demand and supply reduction strategies.
- Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA) 2003: Includes provisions for prohibiting smoking in public places, banning tobacco advertising, and mandating pictorial health warnings on tobacco products.
- National Tobacco Control Program (NTCP) in 2007: To improve the implementation of COTPA and FCTC, improve awareness about the harms of tobacco use, and help people quit it.
- Tobacco taxation: A globally accepted method to effectively control tobacco use is also applied in India. Tobacco, except for tobacco leaves, is placed in the highest tax slab of 28% under GST, and also subject to a heavy burden of cess, given that the commodity is seen as a sin good.
- Promulgation of the Prohibition of Electronic Cigarettes Ordinance, 2019 : Prohibits Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement of e-Cigarettes.
- National Tobacco Quitline Services (NTQLS): To provide telephone-based information, advice, support, and referrals for tobacco cessation.
Challenges in addressing the tobacco epidemic in India:
- High prevalence of tobacco use: Due cultural acceptance and availability of wide variety of products including bidis, cigarettes, and smokeless tobacco, complicate efforts to regulate and control usage.
- Issue with tobacco taxation: The GST system in India relies more on ad valorem taxes than the pre-GST system, which primarily used specific excise taxes. Many countries with a GST or value-added tax (VAT) also apply an excise tax on tobacco products.
- In India, the share of central excise duty in total tobacco taxes decreased substantially from pre-GST to post-GST for cigarettes (54% to 8%), bidis (17% to 1%), and smokeless tobacco (59% to 11%).
- A large part of the compensation cess as well as the National Calamity Contingent Duty, or NCCD currently applied on tobacco products is specific.
- Bidis and smokeless tobacco have low taxes, encouraging consumption.
- Smokeless tobacco products in India are taxed ineffectively due to their small retail pack size (often 1/2 gram or less) which keeps the price low.
- Cigarettes are taxed based on their length, and the presence of filters, creating multiple categories with varying tax implications creates opportunities for cigarette companies to avoid taxes legally.
- Weak enforcement of tobacco control laws:
- Smokeless tobacco products (SLTs) such as gutka, khaini have predominantly been non-compliant with COTPA packaging guidelines.
- The fines for violating COTPA regulations have not been updated since 2003. For instance, a tobacco company is fined a maximum of only ₹5,000 for violating packaging restrictions for the first time.
- COTPA bans direct advertisements of tobacco but is unclear on indirect ads, allowing surrogate advertisements using proxy products like elaichi to promote tobacco brands.
- During the ICC Men’s Cricket World Cup 2023, surrogate ads for at least two tobacco brands, endorsed by famous cricketers, were displayed. These ads indirectly promote tobacco use.
- NTCP is ineffectively implemented due to insufficient staffing, resource allocation, utilization, and lack of effective monitoring mechanisms.
- Economic dependence on the tobacco industry: The industry provides employment and livelihoods to millions of people especially in rural areas, ana also it contributes significantly to government revenues through taxes, creating a conflict of interest in implementing stringent control measures.
- Healthcare burden: The high prevalence of tobacco-related diseases puts a strain on the healthcare system, which is already burdened with other public health issues.
- Access to cessation services: There is limited access to effective cessation programs and support services, particularly in rural and underserved areas.
Way forward:
- Implement the proposed amendments to COTPA in 2015 and 2020:
- Regulations on surrogate advertisements, inclusion of films and video games in the definition of ‘advertisement’, and increasing the fines for violation of advertisement norms by a factor of 10.
- Made licensing necessary for the production, supply, and distribution of tobacco products.
- Inflation adjustment: Mandatory inflation indexing should be applied to specific tax rates on tobacco products to maintain their value and effectiveness in controlling consumption.
- Uniform tax: All products that are exclusively used for tobacco making are brought under the uniform 28% GST slab, will generate the right public health message that all tobacco products are bad and their consumption needs to be discouraged.
- To standardise and increase the retail price, mandatory standardised packing should be implemented for smokeless tobacco pouches (at least 50 g-100 g). This will also make it easier to implement graphic health warnings on the packaging.
- The tiered system should be eliminated or reduced to two tiers, which can then be phased out over time to have a single tier.
- Implement COTPA, PECA, and NTCP more stringently.
- Support for tobacco farmers to switch to alternate crops, avoiding loss of livelihood.
- There is also a need for up-to-date data to understand trends in tobacco use to tackle the tobacco industry, which modifies its sales strategies based on readily available sales trends.