Abstract

I am referring to a news item in the June issue of the WHO Bulletin (2004 (82);6:399-478) regarding the recent smoking ban in India. India signed up to WHO's Framework Convention on Tobacco Control (FCTC) on 10 September 2003 (1). The FCTC: Prohibits advertising the promotion of tobacco products and sponsorship by tobacco companies of sporting and other events; Envisages the introduction of price and tax measures to reduce tobacco demand; Introduces measures to provide non-smokers with protection from tobacco smoke; Regulates the contents of tobacco products and Prohibits the sale of tobacco products to children at and below 18 years old (2). However, several anecdotal studies have observed that there has been a very poor response in implementing the legislation for controlling tobacco consumption in India. Whilst it is an achievement that the Indian government has banned smoking, unfortunately the same cannot be said of efforts to implement the ban, in particular in relation to tobacco chewing. In other words, the actual scenario is non-compliance with the FCTC. Probably the hidden agenda is the huge income from ITC (Indian Tobacco Company) and the national revenue from tobacco-related industry. These profits however are offset by the huge annual expenses incurred by tobacco-related diseases which amount to Rs/ 135,170 million (roughly US$2703.4 million) - a much greater sum than that earned by India's tobacco industry (3). The legislation has had a positive impact on smoking in that, at least we can no longer easily find people smoking in public places like railway stations, bus-stations, airports and many vegetarian restaurants (mainly in southern part of India). The penalty for smoking in public places is 100 Rs/ (US$2). However, the situation with chewing tobacco is different. Chewing tobacco is the cause of oral cancer which accounts for over 35% of all cancers in India (4). There are many petty shops and vendors selling chewing tobacco both in factory-produced sachets and betel-quid. Quid is a roll of betel leaf containing areca nut, catechu, lime, either with tobacco or without and sometimes including additives and flavouring agents. It is popularly known as ‘Paan’ in many parts of India and in some other countries in the region. The police do not penalize those chewing tobacco. In India many women have a ‘Paan’-chewing habit - which is traditionally and socially accepted unlike smokingThe number of adult and adolescent males chewing tobacco is rising (in particular, a commercially produced branded sachet-tobacco, which is the cause of a rising rate of oral submuscous fibrosis (OSMF) and a variety of Leukoplakia and pre-cancerous oral lesions which can develop into oral cancer. Historically, 'Paan' was formulated to an individual's wishes but now readymade packets of these products are available as a mixture known as 'Paan masala' or 'Gutkha' and is even available in certain parts of Europe and America. Banning smoking alone does not solve the problem. In our experience, many tobacco smokers are becoming chewers, and a significant proportion of these are developing oral pre-cancerous lesion and oral cancer. They have little information on the ill-effects of chewing tobacco, which can be as injurious for health as smoking. Many people think that chewing tobacco is safer than smoking. However, chewing tobacco is not only highly carcinogenic, it may cause periodontal destruction and other systemic disorders like smoking-induced ailments (5). Controlling tobacco use in India can only work if the campaigns include the ill effects of chewing tobacco as well as smoking. I think it would be an effective measure if India's health care providers, policymakers, and law protecting agencies came forward to implement legislation banning both smoking and chewing tobacco.