Another blow to enforcement of tobacco control policies in India

Right after the strong and effective guidelines to stop tobacco industry interference in health policies were adopted by the government representatives of 160 countries including India, the pictorial warnings on all tobacco products that were supposed to become mandatory from 30 November 2008 in India, were, again delayed – reportedly due to hectic lobbying by the industry allies and other entities like the beedi growers’ association.

Pictorial warnings on tobacco products have been delayed, at least, seven times. Before going to the 3rd Conference of Parties (COP3) to the global tobacco treaty (Framework Convention on Tobacco Control), the Indian Ministry of Health and Family Welfare had revealed before the Central Information Commission that tobacco industry is putting "pressure" to relax the tobacco control policies (source: The Hindu, 14 November 2008).

The Article 5.3 of the global tobacco treaty, if defined broadly, recognizes “the tobacco industry’s fundamental and irreconcilable conflict with public health.”

The tobacco industry interference has times and again weakened and delayed the enforcement of the public health policies - for example, more than 70 court cases were filed against tobacco control policies in Indian courts in September 2008, and due to aggressive lobbying, the consultative Group of Ministers (GoM) formed to review the pictorial warnings on tobacco products, had diluted the pictorial warnings provision and postponed the implementation of pictorial warnings on tobacco products at least six-times earlier. This is the seventh time the pictorial warnings on tobacco products have been again postponed, as reliable sources revealed, to the end of May 2009.

The industry interference in public health policies certainly needs urgent attention to save lives otherwise it will continue to threaten to reverse the great advancements made in forging public health policies and implementing them. Meantime tobacco continues to kill more than a million people in India, and 5.4 million globally, every year.

Also when these pictorial warnings were finally approved by a GoM, why did the GoM met again in an emergency meeting a week before the pictorial warnings provision was about to become mandatory? GoM including the Union External Affairs Minister - Pranab Mukherjee, the Union Information and Broadcasting Minister - PR Dasmunsi, the Minister of State for Labour and Employment - Oscar Fernandes the Union Minister for Commerce and Industry -Kamal Nath, Union Minister for Culture and Urban Development -Jaipal Reddy and Union Health and Family Welfare Minister Anbumani Ramadoss,

The GOM in an earlier meeting this year headed by India’s External Affairs Minister Mr Pranab Mukherjee had agreed for two mild images of a scorpion signal depicting cancer or an x-ray plate of a man suffering from lung cancer as pictorial warning to deter people from smoking.

These pictorial warnings provide smokers with helpful information on the health effects. Most smokers want this information, and certainly want their children to have this information too. The tobacco industry is continuing its decades-long strategy of trying to minimize the effectiveness of package warnings. The tobacco industry is no friend of smokers - and ironically it’s true that ’the tobacco industry kills its best customers’.

Pictorial warnings on all tobacco products are a good public health strategy because the cost of package warnings is paid for by tobacco companies, not government. Also this should not be looked upon as an isolated initiative rather has to be supported by comprehensive healthcare, legislative and education programmes to attain long-run public health gains. Pictorial warnings may also be appropriate, particularly in countries with low literacy rates or where research shows that smokers are ignoring standard warning labels.

Several nations have implemented strong health warning label requirements. Examples include:

• Canada, whose health minister recently proposed enlarging the labels from 30% of the package face to 60%;
• Thailand, which has added the message "SMOKING CAUSES IMPOTENCE" to its list of required warnings; and
• Australia, which was the first nation to require that "how to quit" information be printed on every pack.
• South Africa, Singapore and Poland also require strong warning labels.

Over past years there were consistent efforts to water down the implementation of the tobacco control policies in India. India’s Union Minister of Labour and Employment, Mr Oscar Fernandes, who is also a member of GoM, had earlier said while replying to a written querry in the Lok Sabha (parliament) on 21 April 2008: "Public health measures such as pictorial health warnings on tobacco products don’t have any immediate economic impact on the industry due to the item’s addictive nature and the time taken for demand reduction, according to various studies." Mr Fernandes also told the Parliament that ’his ministry was receiving representation from various organisations/central trade unions such as CITU, the Tobacco Institute of India, Federation of Farmers Association and others particularly relating to apprehension of loss of employment, arrangement of alternative jobs to the affected ’beedi’ workers and adverse effect on health among others (Source: PTI, 21 April 2008).

On 15 December 2006, GK Sanghi had raised the question in Rajya Sabha about Government’s response to the ’beedi’ workers agitating against the proposed printing of skull and bones on ’beedi’ packs. In May 2007, Gutkha (chewing tobacco) manufacturers in India were attempting to get a court injunction to delay the directive requiring all tobacco products to carry health warnings. Another interesting attempt was made in the same month (May 2007) when External Affairs Minister Pranab Mukherjee suggested in his letter that the sign will likely offend the Muslim community, who are employed in the beedi industry of Murshidabad, as they unlike Hindus bury their dead, and do not burn them.

Another major move to water down the Indian Cigarette and other tobacco products Act also happened in May 2007 when Tamil Nadu Chief Minister M Karunanidhi called on the central government to defer implementation of the legislation, saying that "the move has threatened the livelihood of 1.5 million beedi workers in the State." Karunanidhi said beedi manufacturers in the State have stopped production with some tobacco industry players threatening to go on an indefinite strike from 1 June 2007 if the Act is enforced. Also in May 2007, The Karnataka Beedi Association in India said that the directive to print skull and bones on beedi packs would result in a steep decline in beedi sales adversely affecting the welfare of beedi workers.

The All India Beedi Industry Federation had also written to Prime Minister Manmohan Singh that the 2 October 2008 smoking ban has made things tough for the beedi industry. Meanwhile, "we have told the Prime Minister ... that a forced printing of the pictoral (cancer) warning … will lead to a further decline in sales by 30%," had said Rajnikant Patel, president of the All India Beedi Industry Federation to the media.

As per the World Health Organization (WHO)’s MPOWER Report (2008), despite conclusive evidence, relatively few tobacco users understand the full extent of their health risk. Graphic warnings on tobacco packaging deter tobacco use, yet only 15 countries, representing 6% of the world’s population, mandate pictorial warnings (covering at least 30% of the principal surface area) and just five countries with a little over 4% of the world’s people, meet the highest standards for pack warnings.

“The bidi workers, majority of whom are bidi smokers, are in favour of pictorial health warnings on bidi packets. About 73 percent of the workers agreed that bidis are harmful to health and 79 percent felt that picture based warnings are important on bidi packets, at least to protect the younger generation,’ according to the study conducted by the Voluntary Health Association of India (Source: IANS, 3 November 2008).

The fight to enforce public health policies, and put a check on industry interference, is clearly a long uphill battle indeed.

Bobby Ramakant
(The author is a World Health Organization (WHO)’s WNTD Awardee 2008 and can be contacted at: bobbyramakant yahoo.com)