The health ministry, along with the NITI Aayog and the Indian Council for Medical Research, could easily commission studies on tobacco alternatives.
What will India look like in another 25 years? This is a question that both citizens and the government are contemplating as India’s celebrates 75 years of Independence. One of the most important items on the agenda is a healthy India at 100. The current health statistics of today are below par and much needs to be achieved.
The government has outlined its key objectives and steps in its health missions for rural and urban people. These have been built based on scientific data and its analysis by experts.
A key ingredient that needs an explicit introduction into the national health missions is the government’s roadmap to curtail the widespread use of tobacco, which is one of the leading causes of a variety of non-communicable illnesses.
The third goal of the UN’s Sustainable Development Goals (SDGs) commits to provide better health and well-being. The purpose of this goal is to reduce early deaths caused by non-communicable diseases through prevention and treatment by a third of the total number of deaths. As a signatory to the convention, India has an obligation to follow through its commitment of achieving these goals.
Perhaps one of the first steps to achieving these goals is for the government to evaluate how many people have been maimed and killed by tobacco use. The government also employed tobacco harm reduction strategies under the National Health Policy, 2017 to reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25% by 2025. With two years to that date, an evaluation will track how far those strategies have worked.
During the pandemic, the government had imposed a ban on smoking and spitting in public. It was enforced with a hefty fine and had curtailed public consumption of tobacco, which had an impact on consumption of tobacco. There are smoke-free cities in India, such as Chandigarh and Kochi, where non-smokers are strict about their rights to be in a smoke-free environment.
Those are still drops in an ocean where cigarettes and beedis are easily and widely available for adult smokers. The WHO Framework Convention on Tobacco Control also proposed providing alternatives to tobacco use. These are not as widely available as tobacco products in India.
Smoking and chewing tobacco products can easily be accessed by consumers almost anywhere in the country but not nicotine alternatives to tobacco. Nicotine gum is available at pharmacies and groceries in urban areas, patches in pharmacies and there is a ban on vapes. It becomes an obligation of the government to provide less harmful alternatives to tobacco to the smokers who want to quit smoking.
There are several studies indicating that there may be benefits to using nicotine. The use of nicotine has to clearly distinguished from the ill-effects of smoking tobacco which produces several harmful by-products including tar and smoke.
There are chemical additives and other harmful substances in tobacco. Inhaling the smoke of these substances and the paper and tendu leaf of cigarettes and beedis are also believed to introduce carcinogenics into the human body and cause a number illnesses.
The Union Health Ministry could conduct a survey of adult smokers to assess if there is a growing need to choose less risky alternatives to cigarettes, beedis and gutka. It is not just smokers but those around them who are affected.
A 2022 study in Japan found that 130,000 people die of smoking every year and 15,000 from secondhand exposure to smoke. Japan has started mapping the use of vape and e-cigarettes and recorded an increase in the number of those switching to these alternatives.
The most recent (2022) study in the UK shows that 13.3% of its population above 18 smokes down from 14% the year before.
They attributed a part of the success to using tobacco cessation devices such as vaping and e-cigarettes. UK has dropped its smoking rate from around 30% in 2000 to less than 15% by 2022.
The UK government’s 2022 study on tobacco alternatives showed that the delivery of nicotine is less and better regulated by vaping.
A 2022 study on tobacco alternatives in Germany noted that harmful additives such as formaldehyde, acetaldehyde, and acrolein were significantly lower in vaping devices.
“However, e-cigarettes can assist smoking cessation and demonstrate similar or better effectiveness compared to nicotine replacement products,” the study on Germany notes.
All of these studies have been independently commissioned by the respective governments of these countries. It is reason enough for the world’s largest democracy to conduct similar studies to scientifically track and assess the efficacy of tobacco alternatives, beginning with the ill-effects of smoking tobacco.
The health ministry, along with the NITI Aayog and the Indian Council for Medical Research, could easily commission such studies on tobacco alternatives in India with help from scientists, users, doctors and independent research organisations.
The national health mission must spell out in explicit terms the dangers of tobacco consumption and offer tobacco alternatives to smokers and gutka-users.