New Delhi|HL
There are approximately 110 crore tobacco users in the world and almost a third of them (35.6 crore) use tobacco in the form of smokeless tobacco products.
According to the recent study published in the Lancet Oncology journal just six countries check and regulate the content of smokeless tobacco products while only 41 countries mandate pictorial health warnings on them.
Mentioning the extent of the policy implementation gap in smokeless tobacco (SLT) control, researchers stated that there are only 34 countries have so far reported levying a tax on smokeless tobacco products and only 16 countries have implemented a comprehensive ban on smokeless tobacco advertisement, promotion and sponsorships.
Smokeless tobacco refers to tobacco products that are consumed without smoking usually through mouth and nose. According to the Global Adult Tobacco Survey India Report 2016-17 nearly 20 crore adults (14 crore men and almost 6 crore women) use smokeless tobacco in India. With such high rates of smokeless tobacco use, India accounts for almost 65% of the adult smokeless tobacco users globally while more than 3.5 lakh Indian adults die annually due to various diseases caused by its use. Gutkha, Snuff, Khaini, Pan with tobacco are the most commonly used smokeless tobacco products in India. These products are also popular in other parts of Asia and Africa as well.
Smokeless tobacco products are highly addictive and most are known to cause cancers of the mouth and neck, as well as heart disease and health problems for pregnant women. Smokeless tobacco products contain high levels of nicotine as well as cancer producing toxic chemicals. It contains more than 3000 chemicals of which about 30 are cancer causing. As a result, head and neck cancers are very common in those who consume such smokeless tobacco products. Almost 90% of the oral cancers in India are due to the use of smokeless tobacco. Smokeless tobacco use is also very common among females and is more socially acceptable than the use of cigarettes in the country.
However, the global efforts to control smokeless tobacco use lag behind the progress made in curbing cigarette consumption. A paper discusses its key reasons and makes a recommendation to bridge this gap.
180 countries have already agreed to a common approach to control the demand and supply of tobacco using the WHO Framework Convention on Tobacco Control (FCTC). However, the paper found that:
- Only 138 countries define smokeless tobacco in their statutes.
- Only 34 countries have so far reported levying a tax on smokeless tobacco products.
- Just six countries check and regulate the content of smokeless tobacco products.
- Only 41 countries mandate pictorial health warnings on these products.
- There are only a handful of public awareness campaigns on the harms associated with tobacco so far.
- Only 16 countries have implemented a comprehensive ban on smokeless tobacco advertisement, promotion and sponsorships.
- Globally, fewer smokeless tobacco users are advised to quit vis-à-vis smokers.
The paper concludes that Use of smokeless tobacco is becoming a global cause of concern requiring a greater commitment for full implementation of the evidence-based policy measures.
Talking with Healthlive Professor Ravi Mehrotra, the director of the National Institute of Cancer Prevention and Research (ICMR-NICPR), India and the lead author of the paper said “Smokeless tobacco use as a public health concern beyond the Southeast Asia Region and therefore it requires a comprehensive approach to deal with the challenges identified in the paper. In this regard, the WHO FCTC Global Knowledge Hub on Smokeless Tobacco (https://untobaccocontrol.org/kh/smokeless-tobacco/) at ICMR-NICPR is committed to assisting all countries in implementing the key recommendations from the paper.”
Prof Balram Bhargava, Secretary, Department of Health Research, Government of India and Director General ICMR, New Delhi said, “Given the extent and multiple faces of the SLT use epidemic in India (almost 65% of the world SLT users are in India), the need of the hour is to undertake a national mission to fight against SLT use by bringing together all stakeholders under one umbrella. In this regard, the ICMR envisages a comprehensive and scientific approach to reduce the SLT burden of the country.”
Dr. Dhirendra Sinha from the School of Preventive Oncology (also a co-author) highlighted the global burden of SLT use and said that “smokeless tobacco kills over half a million adults worldwide”.
Dr. Prakash Gupta, Director, Healis Sekhsaria Institute for Public Health, Navi Mumbai and the senior author of the paper, said, “As per the WHO-FCTC, control policies need to be enforced for all types of tobacco including smokeless. Within the area of tobacco control, smokeless tobacco however, gets much less attention from policy makers. For improving public health, strong control policies need to be formulated and enforced for smokeless tobacco.”
Other contributors and collaborators on this paper include experts on the subject from eleven national and international institutions dedicated to work on strengthening tobacco control globally.
