Tobacco was introduced in India 400 years ago by Portuguese. Since then, Indians have consumed tobacco in variety of forms. Studies have shown that 20 types of lethal and disabling diseases are caused by tobacco including cancer, cardiovascular and chronic respiratory diseases.
Oral cancer is the most common form of cancer in India. Incidence rate of oral cancer is the highest in India across the globe. The most important determinant of oral cancer is tobacco which causes about 90% of all cases. Other contributors of oral cancer are alcohol, genetic mutation and human pappiloma virus.
It has been predicted that 13% of all deaths in India will be caused by tobacco, by 2020. Tobacco is the single leading cause of oral cancer globally and in the war against cancer every nation should give highest preference to tobacco control. The government of India have been implemented some nationwide programmes for tobacco control but most of the earlier programmes were primarily limited to health warnings. Recent programmes and legislations are more effective than the earlier programmes but effective implementation of these programmes is the need of the hour. Banning smoking in public places, banning of advertising of tobacco products and restricting sale of tobacco to minors are some welcome decisions made by government. Effective implementation should be done to make realization of tobacco control programs. New strategy should be taken against tobacco addiction in form of emphasized awareness programs predominantly in school, colleges and communities. A strict law against tobacco industry is the 'need of the hour'. By effective implementation of proposed policy, we can achieve the aim of "tobacco free India".
Background-
Consumption of tobacco and its addiction is a global epidemic and the prime human poison of the 21stcentury. It leads to disease, disability and death. Tobacco is the primary preventable reason of death and disease globally today. By 2030, tobacco consumption will cause death of more than 8 million people across the world. It is calculated that 80% of the premature deaths due to tobacco will occur among people living in low and middle income countries. If the trend will not change tobacco use could kill a billion people or more by the end of 21st century worldwide.
According to GATS (Global Adult Tobacco Survey) - India, 2010: the number of people consumes tobacco in India are 275 million adults which are around 35% of the population. India stands at 3rd spot in tobacco production across the world. 80% of tobacco production is consumed in India itself. Tobacco is smoked in the form of cigarettes, bidis and hukkas. In India Smokeless use of tobacco includes gutkha, khaini, betal quid, zarda and snuf. Many of these products are chewed while some are applied to gums and buccal cavity. Smokeless form of tobacco is the most prevalent form of tobacco usage in India followed by smoked tobacco in form of Bidi and cigarettes. As per the Report on Tobacco Control in India (2004), nearly 8-9 lakh people die every year in India due to diseases related to tobacco use. Deaths occur per year due to tobacco use surpassed those due to: Suicides, Homicides, Maternal Mortality, AIDS, Tuberculosis, Motor vehicles accidents, Alcohol and Drugs. Tobacco consumption is increasing at a rate of 2-3% per year and it is predicted that it will account for 13% of all deaths by 2020.
Tobacco consumption and its consequences on health and society-
Tobacco consumption in any form is injurious to general health because it is a common causative factor for addiction, illness, disability and mortality. The consumption of tobacco causes an elevated risk of oral cancer, oro-mucosal lesions and periodontal diseases and other diseased oral conditions. It also affects the result of oral health care involving esthetics. Studies have shown that 20 types of lethal and disabling diseases are caused by tobacco including cancer, cardiovascular and chronic respiratory disease. Tobacco consumption causes high risk to health and develops as a bad habit over a period of time. Anomalies caused by tobacco can take decades to become fully evident, but tobacco use can also show instant harm on consumers and their families and these harms keeps on building little by little each day.
Earlier it was believed that oral cancer is a disease of high income group, but this belief is changing very fast in recent scenario. Tobacco use is very prevalent in low socio-economic group today, and it is also responsible for increased prevalence of oral cancer among rural areas and urban slums. Tobacco addicted individual spent money on tobacco products instead of necessary items like food and health. Resources for these families are already scarce. People who live below poverty line can have a detrimental impact on their health and living due to small diversion of resources. Adolescents and school going children are also getting addicted to smoking and smokeless tobacco too. India global youth tobacco survey (GYTS), 2006 stated the high prevalence of tobacco consumption in school going children especially in age group of 13-15 years. They spent four times of money on cigarettes and Gutkha as compare to their protein diet. Tobacco spit is a pathetic cause for environmental pollution. Roads, streets and pavements are painted by copious spitting and it becomes a culture everywhere in India. The major health hazard associated with smokeless tobacco is predominantly oral cancer. Tobacco consumption is increasing as a habit day by day and consumption levels are elevating in both males and females. The most shocking news is that mortality caused by oral cancer has reached beyond alarming levels. If trends will not change, India will become "capital of oral cancer".
(Source: Operational guidelines; national tobacco control program, 2012)
Existing policy and programs-
In today's world, one of the most common causes of morbidity and mortality is cancer. About 43% of all cancer deaths are due to tobacco consumption, alcohol consumption, infections and inactive lifestyles. Oral cancer is significant constituent of cancer burden across the globe.
The WHO (world health organization) global oral health program is dedicated to function for country capacity building in oro-pharyngeal cancer prevention, inter country exchange of information and experiences from integrated approaches in prevention and health promotion. It has prepared a global surveillance system for oral cancer and its risk factors that helps in making effective policy and programs on national and international level. WHO Framework Convention on Tobacco Control (FCTC) is world's first treaty that works against oral cancer and tobacco consumption globally. Government of India approved the WHO FCTC in 2004 and together they established a framework for an inter-sectoral approach towards tobacco control. WHO FCTC has suggested some measures that help in reducing demand as well as supply of tobacco products. Some of these important measures are-
Tobacco content & product regulation
Ban on tobacco promotion, advertisement & sponsorship
Shielding from exposure to second hand tobacco smoke
Increasing taxes on all tobacco products to decrease the consumption
Non-price measures to hamper the demand for tobacco
Provision of financial assistance for viable alternative activities for tobacco farmers and workers
Norms for Packaging and labelling of tobacco products
Awareness, education, training and communication related to tobacco
encouraging tobacco cessation and providing treatment for tobacco addiction
Ban on sales of tobacco products to and by adolescents(minors)
WHO introduced the MPOWER package to guide the countries in implementation of various programs to decrease tobacco demand as per the mandate of WHO FCTC. The MPOWER package aims towards implementation of proven tobacco control policies.
The union govt. of India have passed the 'Cigarettes and other tobacco products Act (COTPA) in 2003. The primary goal of this Act is reducing tobacco consumption among youth as well as masses and protecting them from the deadly effects of tobacco consumption and second hand smoke (SHS).
National Tobacco Control Program (NTCP) was inaugurated by MOHFW, Govt. of India during 11th five year plan in 2007-08 with the objectives of bringing awareness about the harms of tobacco usage & to promote effective implementation of the tobacco control laws.
Policy Recommendations-
Although various efforts have been put to reduce oral cancer prevalence in India, but still the pace of this dangerous disease is increasing. WHO named it as "Smoking Epidemic". There are various programs which are functioning to reduce the burden of oral cancer and other ill effects of tobacco. But the main problem lies with the effective implementation of these programs. Apart from the programs which are already working towards goal of tobacco control in India, some policy recommendations are:-
First of all we need to have a policy specifically committed to oral cancer prevention and tobacco control. Effective implementation of recent national programs and Acts. Special emphasis on school education and awareness programs. There are approximately 8 lakh elementary schools in India in which around 14 crores children are enrolled. We can cover large chunk of population in very early stage of their life. It will also develop a nature of tobacco resistance among youth and children. Through children we can convey our message to their families and communities that is the world's largest and broadest channel for communicating information to the citizens. We should have an anti-tobacco curriculum to train the children in health implication of tobacco consumption and refusal skills. We should reinforce 'ban of smoking in public places' law and encourage people to quit smoking by community lectures and awareness camps. The role of dentists is also very crucial in diagnosis and prevention of oral cancer. Dentists should check regularly for any signs of tobacco consumptions or any symptoms regarding oral cancer. They should maintain a record book for suspicious cases and convey the data to relevant authority. Conduction of Regular camps and awareness programs in colleges to promote health behavior related to tobacco usage should carried out. They should conduct in such a manner that they can bind youth population with them and convey their message efficiently. Interactive counseling centers should be open at least in every district hospital for tobacco cessation. Government should take strict action against people involved in illegal sale of gutkha pouches. Government should sponsor more tobacco free campaigns and NGOs working against tobacco addiction.
Conclusion-
India is facing a 'smoking epidemic' today. The smokeless form of tobacco is equally responsible for high prevalence rate of oral cancer in India. Tobacco is the prime cause for oral cancer as well as various another non-communicable diseases. It destructs health, wealth and social condition of a person that is addicted to it. To hamper the increased tobacco consumption and reduce the burden of diseases associated with it we have to take some new and improved measures for effective tobacco control. Strong and constant commitment towards tobacco control can fulfill the dream of 'Tobacco Free India'
