In conversation with Dr. Nandita Murukutla, Vice President, Global Policy and Research, Policy, Advocacy and Communication, Vital Strategies

Ques 1: Given that the Cigarettes & Other Tobacco Products Act (COTPA) is slated to be amended and government has already put it on a public domain, as a civil society and public health organization, what are your thoughts on the some of the recommendations that you would like to make?

Ans: India is home to approximately 267 million tobacco users. The proposed amendments to the Cigarettes and Other Tobacco Products Act (COTPA) are consistent with the World Health Organization’s recommendations on reducing tobacco use and uptake, and they are good for public health interests. In particular, the strengthening of key policies related to prohibition of advertising and sponsorships by tobacco companies, the removal of designated smoking areas in airports and restaurants, and increasing the minimum age to buy tobacco from 18 to 21 years are essential steps to reducing the burden of tobacco use across the country.

Tobacco use is responsible for one million deaths annually and costs USD 22.4 billion2 yearly. Tobacco control efforts in India have thus far resulted in a decline of tobacco use by 6% between 2009-10 and 2016-17. The strengthening of COTPA, in line with the current amendments, can accelerate India’s vision of reducing tobacco-related ill health.

Ques 2: What is your take on increasing the age to allow consumption of cigarettes and tobacco products to 21 years and the proposed ban on loose cigarettes sales? Is it a good move by the Government?

Ans: Fifteen percent of India’s youth, ages 13 – 15 years, use tobacco according to the 2009 Global Youth Tobacco Survey. Tobacco use among youth is a concern because early initiation is related to lifelong tobacco addiction and increases the risk of lung cancer among other diseases. The move to increase the age to buy tobacco to 21 years will reduce the ease of availability of tobacco to young people and help prevent them from starting tobacco. This could result in a substantial reduction in the prevalence of youth’s tobacco use and dependency.

There are other measures in the amendment that would also protect youth and adults alike from tobacco use. The ban on sale of single cigarettes is necessary. Nearly 75% of all cigarettes sold in India annually are sold as single sticks. These single cigarettes are more affordable than a pack, and they do not contain health warnings. Hence, the ban on the sale of single cigarettes is likely to be effective at reducing the availability, accessibility, and affordability of tobacco, especially among youth. Further, all point-of-sale advertising of tobacco products; sponsorships by tobacco companies, including Corporate Social Responsibility; and advertising ban on new internet based mediums such as social media and online streaming platforms is also proposed to be banned.

Ques 3: In addition to the amendment, what are the steps that should be taken by the Government for tobacco control?

Ans: Regulations like the Cigarettes and Other Tobacco Products Act (COTPA) provide the necessary policy support for reducing tobacco prevalence. However, it is crucial that once these laws are passed, they are also properly implemented and enforced. This must occur at multiple levels, from the national and state, to the city-level. There must be sustained investment in tobacco control programming, including the necessary funding for continued strategic communication on the importance of quitting tobacco for good health. And, in this respect, tobacco control must be integral to public health and prevention at large. Tobacco use is a major risk factor for a variety of illnesses, from communicable to non-communicable, and hence, public health efforts including efforts to expand primary health care under the National Health Mission and specific programs, such as Revised National Tuberculosis Control Program, must prioritize tobacco control as a vital component of such efforts.

Ques 4: What is the role of mass media campaigns as a tool for effective tobacco control?

Ans: Mass media campaigns are an important intervention to reduce tobacco consumption and to increase intention to quit tobacco use. Vital Strategies has long worked to deliver evidence-based population-level campaigns globally and build local capacity to raise awareness about the dangers of tobacco. The campaigns help people understand their personal risk of ill-health as a result of tobacco use, and the burden that their families will endure, and they motivate a desire to quit.

In India, media campaigns have focused on the health consequences of smoking, smokeless tobacco use, and second hand smoke exposure. The campaigns are rigorously pretested to ensure effectiveness. Evaluations of the campaigns have found them to be not only effective, but also highly cost-effective, costing an estimated 4 rupees per quit attempt. Curbing tobacco use is in the governments best interest as it not only saves lives, but also reduces the burden on health care, social and economic systems.

As social media and online video streaming platforms emerge, we recommend leveraging these tools to expand the reach of campaigns. It’s an effort that will protect people’s health and save lives.