Packing a pictorial punch
RAMYA KANNAN
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Would you knowingly inhale rat poison or the 4,000 harmful chemicals in a stick of cigarette? Which is why cigarette packs have been mandated to carry stronger pictorial warnings from today, the World No Tobacco Day…
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Photo: SHARAD HAKSAR
Getting the message across: For a stronger impact...
Is there something different with your pack of cigarettes today? Did you notice anything that might make you want to throw it away? If you did, even if you did not succumb to the thought, history of sorts has been made. If your pack contained a pictorial warning, then the anti-tobacco lobby’s hard work has actually kicked in.
Even if the warnings are in place, the anti-tobacco lobby only considers it a beginning. The pictures they wanted on the packs and the size of display have been diluted. A skull and crossbones image which was originally proposed as part of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003, has also not found a place in the legislation.
The WHO’s Framework Convention on Tobacco Control (FCTC) specifies that the display should be not less than 30 per cent of the pack. Today, the guideline requires manufacturers to print one out of three recommended (Scorpion, X-ray and a diseased lung) to fill 40 per cent of the front of the pack.
This would amount to a total of 20 per cent only, much less than the FCTC requirement, says Anbumani Ramadoss, former Union Health Minister, who, during his term held his ground against tobacco lobbies trying to keep the pictures out. “Tobacco is a known carcinogen and the leading cause of death in the world. Besides, it has a huge impact on morbidity, affecting as it does every single organ of the human body. We have a compelling reason to bring in pictorial warnings. They have been shown to be effective deterrents. It is watered down, yet, a beginning.” he says.
A step backwards
One of the prominent tobacco-related health researchers, P.C. Gupta, of the Healis Sekhsaria Institute of Public Health, Mumbai, says, “It is a big problem that the originally proposed warning has been weakened. When the rest of the world has gone ahead, we have taken a step behind. However, what is good is that there is a provision to review the warnings periodically. This way we will be able to make the images more graphic over a period of time.”
In fact, the WHO, in its communication on the occasion of World No Tobacco Day (May 31), has insisted that tobacco health warnings that appear on packs of cigarettes are among the strongest defences against the global epidemic of tobacco. The WHO particularly approves of warnings that contain both pictures and words because they are the most effective at convincing people to quit.
Amit Yadav, legal officer, HRIDAY, a Delhi-based NGO, says a picture is harder to avoid and works even with non-literates. He says graphic images will certainly interrupt the automatic manner in which a smoker reaches for his cigarette and ultimately lead to quitting too. He says the math works out this way: Anyone who smokes 20 cigarettes a day is exposed to the message 7,300 times a year at the crucial moments – when buying a pack and when taking a cigarette out.
E. Vidhubala of the Tobacco Cessation Centre, Cancer Institute, Chennai, helps smokers kick the habit. She says pictorial warnings convey a clear and immediate message by depicting the actual impact smoking has on health. “The idea is also to reduce the attractiveness of packs, which is a key factor in keeping fresh users, especially the youth, away from them.”
The most convincing argument, however, she says, is that they have been found to work in countries where picture-based warnings were mandated. For example, 58 per cent of smokers conceded that the warnings made them think more about the health effects of smoking. In Singapore, 28 per cent of smokers said they had started smoking fewer cigarettes as a result of the warning. Besides, it is also said to be the most cost-effective way of warning customers about the risks of tobacco consumption, thereby reducing it substantially.
Unacceptable numbers
There is no doubt that cutting down tobacco usage is the need of the hour. In their Report on Tobacco Control in India, Srinath Reddy (Honorary Executive Director, HRIDAY) and P.C. Gupta quote WHO statistics to say the total number of premature deaths caused by tobacco in the 20th century was about 100 million. If current trends of tobacco use continue, it is projected to go up to one billion this century. The WHO, they write, also predicts that India will have the fastest rate of rise in deaths attributable to tobacco in the first two decades of the 21st century. Many of these deaths will occur in the productive years of adult life, as a consequence of an addiction acquired in youth.
No nation can allow its young people to consume the explosive cocktail of 4,000 chemicals that is contained in a stick of cigarette, says Ms. Vidhubala. Apart from the addictive nicotine that most smokers are aware of, there is rat poison (arsenic), insecticide (DDT), preservation fluid (formaldehyde), fuels (butane and methanol), radioactive material (Polonium 210) and toilet cleaning acids. No wonder that tobacco usage causes cancers across a range of organs in the human body. Sustained use can also cause strokes, blindness and cataracts, gum disease, gastric diseases, teeth loss, infertility, birth defects, vascular disease, deep vein thrombosis, psoriasis, hearing loss and osteoporosis. This is by no measure an exhaustive listing of what can go wrong.
Irrespective of this, tobacco use in developing nations like India and China continue to rise, in stark contrast to the fall in tobacco use in the developed nations. Speaking at a recent meeting, V. Shanta, Director, Cancer Institute, said that while the use of tobacco and tobacco products in Western countries is showing a fall after years of intervention and fighting the tobacco lobby, it is alarming that their use is increasing in India. “Unless we start now in India, we will soon have a large youth population affected by disease,” she cautions.
In the Report on Tobacco Control in India, the authors point out that the direct cost of both smoking and non-smoking tobacco products, excluding the cost of accessories such as match sticks, lighters, chillums, ashtrays, etc. to the consumers is quite large, most often between two and three per cent of the total private final consumption expenditure, and between four and six per cent of the amount spent on food. The Tobacco Atlas indicates that the direct costs to the economy attributable to tobacco use in India, where over 1,00,000 hectares is devoted to growing tobacco is US $7,200 million. In addition, there are indirect costs from productivity loss caused by tobacco-related illness or premature death and loss of earnings.
Dr. Ramadoss says, “The total worth of the tobacco industry in India is estimated to be Rs. 35 crore. Guess how much the Indian government spends to treat tobacco-related ailments? Rs. 36 crore!” Responding to an oft-repeated question from the tobacco lobby about the fate of the farmers involved in tobacco cultivation, he said last year, a sum of Rs. 750 crore was approved for the National Medicinal Plant Mission. Tobacco crops could be replaced by medicinal plants as they require the same soil and irrigation requirements and supplemented with alternate cropping of cash crops.
Signs of hope
The big advantage in India is that recent public health interventions to prevent smoking actually seem to be working. For instance, the ban on smoking in public places has had a great impact on reducing smoking, Dr. Gupta says. A study that his institute conducted in Mumbai recently indicated that there is more support for a ban on smoking in public places in India than anywhere else in the world. “Though implementation is not 100 per cent it is pretty admirable in many States. What has also helped is non-smokers coming out to claim their rights to a smoke-free environment.”
Smokers too have a right to that. The difference is they have the ability to do something about it. A start would be to stop smoking.
Alarming numbers
According to the Tobacco Atlas (third edition) released in March, 20-29.9 per cent of men smoke cigarettes in India and under 20 per cent of Indian women smoke. The figures it provides of tobacco users are staggering: India is estimated to have 2,29,392,725 male users of tobacco, just falling short of world-leader China; 11,908,517 women use tobacco products in India, the third highest in the world.
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