Article from Heath for The Millions :: Volume 35-36 Feb-May 2010

8/9/2019 Article from Heath for The Millions :: Volume 35-36 Feb-May 2010

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okeless ToChallengesThreats for

Heman t G osw ami

Indians alw ays had a penchant for the "im ported"tag on all products. I feel that it would have beenbetter if this fad for the foreign stuff dom inated theIn dian mentality in case of tobacco too. If it w asso , then we wouldn 't have been having the massivechallenge we are now facing on account of our ownhome grow n 'B idi' and "Smok ele ss ' to ba cc o p ro du cts.

W hile the common man didn 't get infatuatedexclusively by the foreign version of tobacco; thepolicy m akers, all these years, looked only towardsthe west for controll ing tobacco. U nfortunately thesection of Indian policy m akers who should not haveimported their understand ing about th e p ro blem -in -hand actually found it easy to import the 'statistics'on tobacco usage and problem . A s a result; all ourtobacco control efforts got concentrated around the'W hite C igarettes ' (which are around 15% of thetotal consumption) and we ignored the challengesposed by the dom estic brown cigarettes, popularlyknown as 'B idi' and also the varied form s of'Smoke le ss' to ba cc o. It is indeed shameful that thegovernm ent does not even have com plete statisticson these products. L ittle is clearly known about

e consum ption patterns, use of tobacco otheran cigarettes, health effects of other form s oftobacco, etc . M ost of the statistics quoted by theov ernment bodies either come from the industryelf , or m ajority of statistical understanding andta comes from foreign papers or funded researchostly focussing on cigarettes) or from sm all sam plerveys about 'self-declared tobacco use' conductedW HO and some other such bodies. A s a result,rganisations and policy m akers grope in dark an daye to work only w ith the best available guessim ates. Not a good scenario for a c ou ntry w hichas to deal w ith over a m illion tobacco related

5 e very y ea r.

acco:ddia

A s one would logica lly conclude, all this has nowproved to be one of the biggest m istakes in Indiantobacco contro l sc enario . Som e realisation has nowdawned -upon about the health effects and deathtoll due to consumption of oth er form s of tobacco;which has been exponentially rising , even though stilllittle at tention is bein g paid to the issue. A m on g allfo rm s, the rise of th e smokeless fo rm of tobacco ispa rti cularly alanning .What is sm eless tobacco?

Fo r m ost parts of the west, sm okeless tobacco is anew thing; atleas t as a commercial product m arketedwith competitive mark eting strategies. However inIn dia, w e have all possib le vari ants of tobacco. A nytoba cco product hich is consumed w ithout it beingburn t and inhaled comes in th e c ate go ry o f smo ke le sstobacco product.. Some of the more popular andco mmercially market ed form s are; Chewing tobacc o

- raw - Chewin gto bacco consists ofsmall pieces of rawfi nely to bacco.M ost of e . es itis un comingfr om s cottagein dustr ies there

U tim e com mercial brands too

comcontai -slakedconldir.kEr.3

!ill 9


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pow dered tobacco. Paan M asala contains alm ostall the ingredients that go into the making of apaan, but are dehydrated so that the final productis not perishable. Paan M asala is more popularin urban areas. The market for Paan M asala hasgrown m any folds over the last 10 years.

Gutka - It is a p reparatio nof crushed betel nut,tobacco, catechu, limeand sw eet or a little savoryflavourings . It is mostlysold across sm all sachetsat a highly econom icalprice of R s. 1 to 8 . It isc hew ing tobac co .

Paan (Betel Qu id ) withTobacco - Paan w ithtobacco consists of;betel leaf, areca nut,slaked lime, catechuand tobacco. Betelleaves contain volatileoils such as eugenoland terpenes, nitratesand small quantities ofsug ar, starch, tann in ands evera l o th er s ub sta nc es .M any C on dim ents an d sw eeten in g ag ents m ay alsobe added as per regional practices and individualpreferences. Each Paan is tailor made andspecific ing redients are ad ded alo ng w ith to baccoaccording to the instructions of the chewer. Onecan find Paan shops in even the sm allest villageso f In dia .

Khaini and ZardaAnother var iant ofchewing tobacco whichconsists of raw to ba ccom ixed w ith fragrancesand spices for achievingdesired flavors. WhileZard a re presen ts to ba ccothat is later m ixed w ithlime by the user, Khaini is a considered a stepahead and provides the final m ixture in a singlepackage. Kh ain i is w idely used for its w ider rangeof fragrances and flavours and is a little costlie rthan Zarda because of its user-frie nd ly n atu re.

Naswar - Naswar is sun and heat-dried tobaccoleaves m ixed with slaked lime and ash from treebark , flav oring and coloring agents. W ater is

Snu s _. Snus is a moistpowder to bacc o productoriginated from a var iantof dry snuff, in the earty19th century in Sweden,consumed by placin g itunder the lip for extendedperiods of tim e. It isavailable in tea bag likepouch es. Snus has itsuniqueness in the fac t that it is st eam -cured rath an fire- cu red. It is sa id to be not fermecontainin g no added sugar, unlike many chewitobacco variants avai lable in In dia.

Snu ff - Snuff is groundor pulv eriz ed to ba cc o,which is generallyinsuff lated or "snuffed"through th e nose . Thereare several types ofsn uff, but traditionallyit mea ns nas al snuff. Itis also often flavouredand typical flavors are floral, mentho late d,and sp ice , either pure or in blends. "Snuff "also refer to dipping tobacc o, which is app .the gums ra ther th an inhaled. Another covariant of this is 'Bajjar' in India. Bajjar issnuff (aka Tapkeer ) applied co mmonly byin Gujarat on th e te eth and gums.

O ther forms - Bes id es the above mentioare numerous oth er variants of liq ui , chE 'l IW irtqan d nasa l tobacco like Tuibur, M ishri, M aGudhaku, P lu g, etc., in use in manypar ts of India.

PromotionStrategy of e 'mll_myTo att ract new users and highligits smokeless tobacco , the ebsite of 0


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co manufacturers spells the advantages of its ducts as repro du ced h ereu nder;

less h arm fuL th an cig arettes .o externaL effects such as those from passive

smoking.Can be used in "N o-Sm oking" areas L ike a irports,air pLanes & o th er pubL ic pLa ce s.UnL ike cigarettes, hands rem ain free since there isno need to hoL d the product during consum ption.As easy to use as chewing gum with a Use & Throwmethod Like that of chew ing gumIt is an ex trem eLy Low -p ric ed p ro du ct

The manufactures promotionaL statement aboveiqhliqhts the exact strategic approach of the

ok eLess tobacco industry. From the above, it isar that the tobacco industry is trying to build upon

res trictions on smoking and take advantage oftobacco control momentum . The industry is alsost rategising to gain from the cessation efforts of a

rge number of peopLe trying to quit smoking. One ofe most dangerous false statements made above areclaims stating, "L ess harm ful than cigarettes." Sim ilar. conception and false notions about safety are alsoing pushed by Swedish 'Snus.

Ith EffectsSmokeLess tobacco is no Less harmfuL than itsok ed varian t L ik e cig arettes. In many cases it isen more harm ful w ith a smaLLer g estation perio dr the onset of health effects and the consequentialfatality. H ow ever m any m yths about the false concept

ut its safety are being spread by the tobacco- ustry to confuse the public and even governments

T o b a c c oc a u s e sm o u t hc a n c e r

around the worLd. In some cases it is also beingwrongLy pushed as a replacement to cigarettes or evend eceitfu lly p ushed as an aLte rnate form of nicotineu se fuL i n quit tin g tobacco. ALLuch claim s are not onLyfalse and inco rrect but rather have the potentiaL toc au se fu rth er m iseries and compLica te an d ag gra va tethe health cond ition of existing smokers. The entry ofb ig pLay ers has res uLted in th ese giants pressurisingthe governm ents and heaLth authorities to declarethat sm okeL ess to bacc o is less harm fu L an d L ik eL ytoo ffer h ealth b enefit s. This is done soLely t o give a falsenotion of safety to peo pLe.

Smokeless tobacco is also a 'class P\ carcinogenand contains over 25 canc er cau sin g ag ents. It isweLL known that oral an d spit tobacco increasesthe risk for leukop lakia. a precursor to oral cancer.C hewin g to ba cco has bee n known to cause cancer,particuLarly of the pancrea tic , oesophagus, m outh andthroat. There is no w clear ev idence that increasingtrend of gutka co nsumption is causing an epidem icof 'oral submucou s fib ros is' and is leading to anincreased incidenc e of oral ca nc er even am ong youngpersons.

Smokeles s tobac co use, which has now becomem ore common among women in India, has been foundto cause adverse reproductive ou tcomes in the form oflow birth weight (lower by an average of 105 g), lowergestation period ( an averag e of 6 days) and higherstilLbirth rates. One of the latest studies by PrakashGupta (in Ahmeda bad) shows that how there is anexponential growth of ca ses in mouth cancer w ithincrease in co nsumpt ion pat terns of chewing tobacco,especi ally Gutk a. The stu dy sh ows that between 1985and 2006 , the incident s of mouth can cer h av e b ecom enea rly 300 perce nt more prevalent am ong youngstersin the age group of 35 to 44 ye ars of age and has seenover four fo ld increase among the 25-34 age group(see Fig . 1). This is in deed alarming.Fig. 1

India, Ahmedabad (Mouth Cancer) Male50.0 46.145.040.035.030.025.020.015.010.05.0oL-~5~~~~__~ _

--1985 32.3-1995--2006

15-24 4554 5564 6574

a11


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The growth of smokeless tobaccoAll evils grow the best in dark, away from anyattention. Sm okeless tobacco is no different. D ue to

lack of focus on sm okeless tobacco by health w orkers,go vern men t an d po licy m ak ers; sm ok eless tobacco h ada very healthy grow th in the last couple of decades.T he evil of sm okeless tobacco found its w ay to schoolsand now the average age of in itiation of smokelesstobacco among the first tim e users has come dow n to8 to 10 years o ld children.

A mere perusal of various snap-shots of somesam ple surveys show how the usage is increasing overthe years. The NSSO data of 1993-94 reported that9.9 % male and 4.3 % females (age>10 yrs) in urbanareas con sum ed sm okeless to bacco. T he N FH S 1 99 8-99 data showed that the consumption of smokelesstobacco was 20.8 % in m ales and 8.8% amongfemales. However NFHS-2 data of 2000 mentionsthat over 35.4% of the males and 18 .2 % femalesconsum ed sm okeless tobacco . The reported figuresshow a possib le trend on the grow ing menace. Latestestim ates put this figure to above 50% w ith alarm ingincreased rates of consum ption am ong fem ales. The2003 survey showed that 10.7% females in Tam ilN ad u, 18% in M aharashtra, 1 4.4 % in M ad hy a P rad eshan d 60 .7 % fem ales in M izo ram are already con sum in gsmokel es s t ob ac co.

The industry has found that chew ing tobacco isa good w ay to get around the trad itional taboo onfema le sm ok in g. C hew ing of tobacco is not perceivedas such a bad thing as smoking am ong females. Sinceit does not sm ell and on the contrary it is scented, sofem ale acceptance of chew ing tobacco is higher. Forthe industry, lack of appropriate leg isla tion dealingw ith the issues posed by the sm okeless tobacco hasalso been very helpful for its grow th. The grow th isso good that the Econom ic Survey for 2 00 8-0 9 re ad sthat, "the beverage and tobacco group recorded theh ig hest g rowth (15.6%) am ong all two d ig it in du str ia lgr ou ps d uring 2008-09; thai too on top of a strongbase . Am ong the in du str ie s su bsum ed u nd er th is p ro du ctgr ou p, cigar ette p rod uction m arg in al ly d ec lin ed d u rin g2008-09." The in crease rep orted most ly indicates thegrow th of sm okele ss to ba cc o.

The grow ing m arket of smokeless tob acco has m ad ethe big players in the mark et take note and enter themarket. M o st b ig tobacco multinat ionals h av e a lr ea dyentered the sm okeless tobacco m arket and are all se tto consolidate the market and grab the lion's shar efrom smal l unorgan is ed units, who till now wereplaying in an open unchallenged m arket. B ig M NC 'sare

12H E A LT H F O R T H E M IL L IO N S February - March and April- May, 2010

also seein g th is as a new life cycle of another tobaccovariant as the replacem ent of the dead cigaretteconsumers (6 million of th eir consum ers die each year)and low induction rates of new cig arette users am onged uca te d and in developed countries.Legal provisions and the taxstructure

Though the addicti ve nature of tobacco in itseLf. is enough; the low entry cost, lax ta x regim e andvirtually no restriction m ark et has further madesm okeless tobacco a very lucra tiv e b us in es s. W hile asing le stick of cigaret te may cost 3 to 15 R upees, asa chet of G utka costs just R s 1/. Even the prem iumbrands of smokeless are priced at h ighly affordableR s. 5/ a pouch. W hile a lo t of atten tion is paid totaxation on cigarettes, smokeless has escaped allatte n tion. It is well known that cigarettes in Indiaare no t su fficien tly tax ed ; h ow ev er sm ok eless to ba ccois vir tually not taxed at all. M ost of the smokelesstobacco is prepared from raw tobacco leaves andreq uires n o re gistration or license. T here is no taxationon tobacco at the entry stage and only two rupees perkilogram as s ervice charge and one paisa per kilogram'tobacco cess' is charged at the tim e of auction saleof tobacco . A ccording to the Tobacco Board R eport,about one m illion rupees were collected by way ofcess by selling tobacco at the auction on an averageprice of around 47 rupees (1 US$) a Kg.

Quite interestingly the taxation on chew ingtobacco is imposed by the governm ent on tobaccopacked through mechanised m achines. In this casetoo the tax is imposed on the basis of number ofm achines used for packaging and not on the fin ishedproduct. A rough estim ate of the assum ed capacity ofm achine and the average suggested sale-price of thefinished product is used as a guideline for collection


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- e -ng obac co and Un--ng ac hin es (Capacity

~Ur-T=:C: _ - - e Government, L ik e M inistryof Hea mance, AgricuLture, etc.This grow i _ ~--== aas 0 be stopped co mpletelyby im --- --- = rohibit io n on aLL form s ofsmokeless -2

.~~~.- .ant '~ activ ist . He is m em ber ofSJ! eTing Committee as well as

~ He also h ea ds th e civil_. - __ - a= - id ia Coalition : among o th er s.


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-May 2010, Vol. 36 No. 1

Yobacco Control:alnlng Momentum\ , % ..~ .

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Article from Heath for The Millions :: Volume 35-36 Feb-May 2010