Huge tobacco use in India seen killing 1.5 million a year
Tobacco inflicts huge damage on the health of India’s people and could be clocking up a death toll of 1.5 million a year by 2020 if more users are not persuaded to kick the habit, an international report said on Thursday.
Despite having signed up to a global treaty on tobacco control and having numerous anti-tobacco and smoke-free laws, India is failing to implement them effectively, leaving its people vulnerable to addiction and ill health, according to the report by the International Tobacco Control Project (ITCP).
“Compared with many countries around the world, India has been proactive in introducing tobacco control legislation since 2003,” said Geoffrey Fong, a professor of psychology at Canada’s University of Waterloo and a co-author of the report.
“However ... the legislation currently in place is not delivering the desired results - in terms of dissuading tobacco use and encouraging quitting.”
As a result, India, with a population of 1.2 billion, currently has around 275 million tobacco users, the report said.
Harm from tobacco accounts for nearly half of all cancers among males and a quarter of all cancers among females there, as well as being a major cause of heart and lung diseases.
“The tobacco epidemic in India requires urgent attention,” the report said, adding that by 2020, tobacco consumption will account for more than 1.5 million Indian deaths a year.
Worldwide, the number of deaths caused by tobacco is expected to rise from around 6 million a year now to more than 8 million by 2030, according to the World Health Organisation.
The ITCP India Survey conducted face to face interviews with 8,000 tobacco users and 2,400 non-users across four Indian states - Bihar, Madhya Pradesh, Maharashtra and West Bengal.
In India, as in most low income countries, death in middle age is increasing in relative importance due to an increase in smoking related deaths. The disease burden, health care costs as well as other fiscal losses resulting from premature deaths attributable to tobacco consumption will rapidly increase. Earlier WHO estimates suggest that deaths and disability adjusted life years (DALYs) attributable to tobacco use in India will increase from 129 000 deaths and 1719 DALYs in 1990 to over 1.5 million deaths and 24 024 DALYs by 2002. The high levels of tobacco consumption among disadvantaged population groups may lead to a doubling of the disease burden in these social groups from chronic illnesses related to tobacco consumption as well as from communicable and nutrition related diseases, which still account for a large share of total disease burden in the disadvantaged social groups in India. In addition to the differences in prevalence of tobacco consumption between disadvantaged and better off groups, the type and amount of tobacco consumption, which are shown to be directly associated with incidence of tobacco related diseases and mortality, may also vary between the two, further aggravating the differences in disease burden attributable to tobacco between the two groups. Though no data were collected in the NFHS-2 on the type and amount of tobacco consumed, which remains one of the weaknesses of survey, other studies suggest that the poor are 8–10 times more likely to smoke bidis that may lead to greater risk of oropharyngeal and lung cancer in this group than among the better off.
The public policy implications of our study are twofold. Research on tobacco use needs to be considerably systematised with use of more consistent definitions of tobacco consumption and study methodologies. More rigorous comparable prevalence studies over time are needed to establish the trends in prevalence and evaluate the effect of different public policies pursued to control tobacco use. Though studies involving use of household informants are much more economical and easier to administer than those based on individual self reports, the prevalence may be underestimated and need to be adjusted upwards to provide real estimates. In addition, future studies should investigate the prevalence rates of different tobacco products (both smoking and chewing tobacco) separately, as the economic and health effects of different products may vary considerably, and because of the potential differences in prevalence of use of different tobacco products across different sociodemographic groups.
So-called smokeless tobacco - including chewing products such as gutkha, zarda, paan masal and khaini - is the most common form of tobacco use in India, with many poorer people and women preferring these over smoking cigarettes or bindis - small, cheap, locally-made cigarettes.
According to the Global Adult Tobacco Survey, 26 percent of adults in India consume smokeless tobacco - 33 percent of men and 18.4 percent of women. Smokeless tobacco can cause oral and other cancers, as well as other mouth diseases and heart disease.
Among several striking findings in the ITCP report was that, while many smokers and tobacco users said they knew of the health risks, only a small proportion said they would like to quit.
Up to 94 percent of smokers and up to the same proportion of smokeless users in the survey said they had no plans to give up.
Set against this, the report also found that up to 81 percent of smokers and up to 87 percent of smokeless tobacco users expressed regret for taking up the habit, and more than 90 percent of tobacco users and non-users in all four states had negative views on smoking and tobacco.
Tobacco has been used in India for centuries.
Early forms of tobacco were limited to chewing tobacco leaves or smoking tobacco. Today, several products made of, or containing tobacco, are available in the market.
More than 4,000 different chemicals have been found in tobacco and tobacco smoke. More than 60 of these chemicals are known to cause cancer (carcinogens).
Nicotine is a drug found in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine.
Almost 30 percent of the Indian population older than age 15 uses some form of tobacco. Men use more smoked tobacco than smokeless tobacco.
Women are more likely to use smokeless (chewed) tobacco. Beedis are smoked more than cigarettes.
The report said that, while India has been a regional leader in enacting tobacco control legislation over the past 10 years, the laws are poorly enforced, regulations covering smoke-free zones are patchy, and tobacco remains relatively cheap.
Fong said the low percentage of people wanting to quit meant deaths from tobacco use were destined to stay high.
“If there is any single indicator of the urgent need for continued and strengthened efforts for strong, evidence-based tobacco control in India - this is it.”
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By Kate Kelland