Effective Strategies for Tobacco Control Advocacy

150 Pages·2012·3.33 MB·English

A Handbook for NGO Personnel
FOR TOBACCO CONTROL ADVOCACY
HEALTH RELATED INFORMATION
DISSEMINATION AMONGST YOUTH
A Handbook for NGO Personnel
A HRIDAY Publication
Introduction
Tobacco as an epidemic remains a serious public health challenge for the country, despite the enactment of a
comprehensive law to reduce tobacco burden, resulting in enormous disability, disease and death.
Non Governmental Organizations (NGOs) are acknowledged as important partners and stakeholders in the
tobacco control movement, not just in India but across the world. The World Health Organization (WHO) has
established a Civil Society Initiative (CSI) to formalize the partnership of working together towards achievement
of the health goals in both developed and developing countries. NGOs can play a significant and multi-
dimensional role in supplementing tobacco control efforts of the government by spearheading awareness and
advocacy campaigns, monitoring the enforcement of tobacco control laws, reporting violations to authorities,
engaging in litigation and building capacity of law enforcement officials to implement the law. They can also
motivate and groom fellow NGOs to get involved in tobacco control.
The purpose of this handbook is to provide NGO personnel with relevant background information about the
magnitude of the tobacco problem, the Indian tobacco control law enacted by the Government of India and the
role NGOs can play in the field of tobacco control including planning, developing and executing effective
advocacy campaigns.
India played a strong leadership role in the global fight against tobacco. In terms of legislation, a beginning was
made in the form of the Cigarettes Act, 1975. The Advocacy Forum for Tobacco Control (AFTC), a national alliance
against tobacco, provided a unique opportunity for all key tobacco control advocates to join in an effective
campaign for tobacco control resulting in a modified and comprehensive tobacco control Bill that was tabled in
the Parliament in late February, 2003. The Bill finally became an Act of Parliament after receiving assent from
the President on May 18, 2003. The Legislation came into force on May 1, 2004.
AFTC is a coalition of 55 pan-India NGOs working in the area of advocacy, awareness promotion and research
related to tobacco control in India. AFTC's main goal is to advocate policies for control of tobacco. AFTC includes
public health experts, health professionals, research scientists and representatives of several Indian NGOs
(www.aftcindia.org).
The handbook is divided into four sections:
Section I: The Burden of Tobacco
Section II: Tobacco Control Legislations and Litigations in India and the Framework Convention on
Tobacco Control
Section III: Role of Civil Society in Tobacco Control
Section IV: Case Studies
Acknowledgements
Advisor: K. Srinath Reddy, Hony. Executive Director, HRIDAY
Scientific Editor: Monika Arora, Director, HRIDAY
Authors:
Amit Yadav, HRIDAY
Anita Peter, Cancer Patients Aid Association
Cecily Ray, Healis Sekhsaria Institute of Public Health
Deepti Singh, HRIDAY
Devika Chadha, Salaam Bombay Foundation
Dhirendra Sinha, School of Preventive Oncology
GC Mathur, Binty
Honney Sawhney, Government of UT of Chandigarh
Jagdish Kaur, Ministry of Health and Family Welfare
KP Narayanan, Swasthya
Mihir Shah, Ahmedabad Dental College and Hospital
Mira B Aghi, Advocacy Forum for Tobacco Control
Monika Arora, HRIDAY
Mukesh Kumar Sinha, Madhya Pradesh Voluntary Health Association
Nayanatara Nayak, Centre For Multidisciplinary Development Research
Karthik Subbaraman, Healis Sekhsaria Institute of Public Health
Prakash C. Gupta, Healis Sekhsaria Institute of Public Health
Priyanka Dahiya, HRIDAY
P.R. Panchamukhi, Centre For Multidisciplinary Development Research
Radhika Shrivastav, HRIDAY
Rakesh Gupta, Rajasthan Cancer Foundation
Shalini Bassi, HRIDAY
Shekhar Salkar, National Organisation For Tobacco Eradication
Peer Reviewers:
Bhavna Mukhopadhyay, Voluntary Health Association of India
Cecily S. Ray, Healis Sekhsaria Institute of Public Health
Manu Mathur, Public Health Foundation of India
Monika Arora, HRIDAY
Prakash C. Gupta, Healis Sekhsaria Institute of Public Health
Sakthivel Selvaraj, Public Health Foundation of India
Vineet Gill Munish, Tobacco Free Initiative, World Health Organization (India Office)
Technical Editors: Byword Editorial Consultants
Printed by: Star Communications, Ph.: 43411023, 9873580222 email: [email protected]
This document has been produced with a grant from the World Lung Foundation. The contents of this manual are
the sole responsibility of the authors and can under no circumstances be regarded as reflecting the positions of
The International Union Against Tuberculosis and Lung Disease (The Union) or the donors.
A HRIDAY Publication
Contents
Page No.
Section I: The Burden of Tobacco
The tobacco epidemic: Global and Indian scenario ................................................................ 02
Effects of tobacco use on health ............................................................................................ 08
Economics of tobacco ........................................................................................................... 18
Section II: Tobacco Control Legislations and Litigations in India and the Framework
Convention on Tobacco Control
Enforcing tobacco control legislation in India ........................................................................ 30
National Tobacco Control Programme .................................................................................. 49
Smoke-free environment in India: Enforcement and compliance ......................................... 53
International best practices in smoke-free laws ................................................................... 58
Ongoing tobacco litigations in India ...................................................................................... 64
Framework Convention on Tobacco Control: Status of implementation in India ................... 77
Section III: Role of Civil Society in Tobacco Control
Advocacy for tobacco control ............................................................................................... 88
Role of coalitions in tobacco control ..................................................................................... 95
The role of civil society in tobacco control ............................................................................. 98
Widening the tobacco control movement: Engaging health professionals ............................ 101
Behaviour change communication and tobacco control ....................................................... 106
Using Right To Information Act for tobacco control ............................................................... 110
Section IV: Case Studies
Cancer Patients Aid Association: Engaging celebrities in tobacco control .............................. 116
Salaam Bombay Foundation: Harnessing youth power for advocacy against
tobacco (Project Super Army) ............................................................................................... 120
HRIDAY: Engaging youth in tobacco control advocacy ............................................................ 124
Rajasthan Cancer Foundation: Tobacco control in Jhunjhunu (2005–2007) ........................... 131
Healis Sekhsaria Institute of Public Health: Mass media interventions for tobacco control .... 135
NOTE-India: Effective utilization of existing legislation .......................................................... 141
Section I:
The Burden of Tobacco
Effective Strategies for Tobacco Control Advocacy
The tobacco epidemic: Global and Indian scenario
The course of the tobacco epidemic globally
Tobacco use began after Europeans, especially British, Spanish and Portuguese explorers, came in contact with
the inhabitants of the American continent. Tobacco was used in many forms. People smoked pipes, cigars and
even a primitive form of cigarettes, inhaled snuff and chewed dry tobacco. These different forms were adopted
by the Europeans and, like fashions, rose and fell with time.1
A few events close in time on both sides of the Atlantic Ocean combined to lead to a tremendous upsurge in
cigarette smoking in the world. Indeed, the tobacco epidemic, as we know it globally, has become a cigarette
epidemic.2 The return of the British soldiers in 1856 from the Crimean war, during which they had learnt to
smoke Turkish cigarettes, shared with them by their Turkish allies, boosted the sale of cigarettes in England.
Cigarettes were already being sold in England by Philip Morris since the opening of a shop in London in 1847. The
development of cheap and mild tasting, flue-cured “bright” tobacco began in North Carolina in 1839, and a good
market had emerged for it in Virginia and North Carolina by 1860.3 During the Civil War (1860–1865), soldiers of
both the North and South received tobacco as rations, and on returning home, they spread the demand for
bright tobacco in the northern region as well. The hand-rolling method used in cigarette factories was replaced
by cigarette-rolling machines, which were developed and adopted in the early 1880s, permitting large-scale
production at a lower cost. In the 1880s, representatives of tobacco companies travelled abroad to market
cigarettes, mainly in areas already opened to trade by the British, such as Australia, Canada, South Africa, China,
Japan and India, and in the early1900s, also in Argentina and Brazil. With the demand soaring, cigarette
manufacturers soon set up factories in most of these areas.4
During the first half of the twentieth century, the increase in cigarette use by young adults was mainly among
men in the developed countries, but in the second half, there was an increase in use by women in the developed
countries and men in the developing countries.5
A follow-up study of 35,000 doctors by Doll and Hill was published in England in 1954, confirming the link
between smoking and cancer. Most doctors gave up smoking as a result. This marked the beginning of a decline
in smoking in Britain.6
The 1964 US Surgeon General's Report held that cigarette smoking was responsible for a 70% increase in the
mortality rate of smokers, when compared to non-smokers. The report estimated that on an average, smokers
had a nine- to ten-fold risk of developing lung cancer compared to non-smokers; heavy smokers had at least a
twenty-fold risk. The risk rose with the duration of smoking and diminished with the cessation of smoking. The
report also identified smoking as the most important cause of chronic bronchitis. Further, it noted a correlation
between smoking and emphysema, as well as smoking and coronary heart disease. It pointed out that smoking
during pregnancy reduced the average weight of the newborn. The release of the report was a major news
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A Handbook for NGO Personnel
event, occupying the front pages of newspapers for many weeks.7 Successive Reports of the Surgeon General
confirmed and extended the grim findings.
Due to rising public awareness of the dangers of tobacco use, especially of the risk of lung cancer, the prevalence
of cigarette smoking began to fall in England in 19506 and in the USA in 1965.7 There followed a decline in
smoking, especially among males, in other developed countries as well, but the epidemic started increasing in
the developing world,.
From the late 1970s, commercial cultivation of tobacco began shifting to low-income countries, due to lower
production costs. The transnational manufacturers currently purchase 85%–90% of tobacco, the raw material,
from the developing world and manage to keep the prices of their manufactured products low. Tobacco growing
countries in the developing world benefit economically from growing the crop, which brings in foreign
exchange, for example. However, they also suffer environmental damage, including that caused by the heavy
use of pesticides, besides deforestation and loss of biodiversity. In addition, the cultivation of the crop is
associated with social and health problems, such as child labour and child malnutrition. An overemphasis on
growing tobacco has become a threat to food security.8
As the prevalence of smoking and cigarette consumption fell in many developed countries due to greater
awareness and tougher tobacco control measures, multinational tobacco manufacturers intensified their
efforts and investments in growing tobacco, manufacturing and selling cigarettes in the developing countries.
Here, awareness was lower, tobacco control legislation was non-existent or weak, and governments possessed
fewer resources for controlling the use of tobacco. Advertising and promotion campaigns in these countries
played a major role in increasing demand.9
Since the adverse effects of tobacco use do not become apparent in a major way until several years after the
onset of use, the consequences in terms of disease and death are far from reaching their peak in the developing
countries, where tobacco use is still on the rise.5 For example, the incidence of lung cancer among males in the
developed countries (56 per 100,000) is currently about twice that in the developing countries (26 per
100,000).10
Global tobacco epidemic facts11,12,13
(cid:108)Tobacco use is the number one killer in the world.
(cid:108)Tobacco causes 1 in 10 deaths (10%) worldwide, nearly 5.4 million a year.
(cid:108)More than 80% of these deaths occur in the developing countries.
(cid:108)Tobacco kills up to half of its regular users.
(cid:108)Of the 1.3 billion smokers alive today, 650 million will eventually be killed by tobacco, 325 million of them
between the ages of 35 and 69 years.
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Effective Strategies for Tobacco Control Advocacy
(cid:108)Tobacco use is a risk factor for at least six of the eight major causes of death in the world.
(cid:108)900 million smokers, or 84% of the world total (1.3 billion), live in developing and transitional economy
countries.
(cid:108)The total global prevalence of smoking is 29%, and 47.5% of men and 10.3% of women smoke.
(cid:108)A hundred million deaths were caused by tobacco in the twentieth century. If the current trends continue,
there will be one billion deaths in the twenty-first century.
(cid:108)By 2030, 70% of the deaths attributable to tobacco will occur in the developing world. The aggressive
marketing practices of multinational companies, which target the youth and women, play a large role in this.
The epidemic in India
Tobacco production has been growing in India since 1950. India is currently the third largest producer of tobacco
after China and Brazil, and exports about one-fourth of its production. Until 1950, tobacco was mainly smoked in
hookahs or chewed. Thereafter, there was a tremendous increase in beedi and cigarette smoking. The first beedi
manufacturing firm was established in 1887 and the first cigarette factory in 1906 by the Imperial Tobacco
Company. A beedi (a type of hand-rolled cigarette wrapped in tendu leaf) is very cheap and is the dominant
product for those who smoke tobacco in India, while Western-style cigarettes constitute a fraction of tobacco
use. Commercially prepared smokeless tobacco products, which were introduced in the 1970s, have grown in
popularity among all social groups, most notably among the youth and women.17
Tobacco toll in India
(cid:108)Each year, 9 lakh Indians die because of tobacco-related diseases. All these deaths are preventable.
(cid:108)More than 2200 Indians die every day due to tobacco use.
(cid:108)Every day, 5500 Indian youth start smoking. They must be protected.
(cid:108)India has the highest number of oral cancer cases in the world and 90% of all oral cancers are tobacco-
related.
(cid:108)Tobacco use is responsible for 40% of all cancers in India.
(cid:108)By 2010, nearly 1 million (10 lakh) people will die every year due to smoking.
(cid:108)Of the smokers who will die, 70% will be between the ages of 30 and 69 years.
Prevalence of tobacco use among adults in India
According to the National Family Health Survey-3 (NFHS-3), conducted in 2005–06:
(cid:108)The prevalence of tobacco use in India is very high, with 57% males and 11% females using tobacco in some
form.
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(cid:108)The vast majority of women who use tobacco chew it, rather than smoke.
(cid:108)Tobacco use among men and women is higher in rural areas than in urban areas (35% of rural men between
the ages of 15 and 49 years smoke cigarettes or beedis, compared to 29% of urban men).
(cid:108)The north-east region has the highest rates of tobacco use, the prevalence exceeding 60% in some states.
Prevalence of tobacco use among youth in India
According to the Global Youth Tobacco Survey (GYTS), 2006, a school-based tobacco-specific survey that focuses
on adolescents of 13–15 years of age:
(cid:108)36.9% of children start smoking before the age of 10. Of these, boys constitute 55.1% and girls 32.1%.
(cid:108)4.2% of students smoked cigarettes, the rate being significantly higher among boys than girls.
(cid:108)11.9% of students used other tobacco products.
(cid:108)The rate of cigarette smoking among the youth is high in the central, southern and north-eastern regions
(12%).
(cid:108)Exposure to second-hand smoke (SHS) in public places is as high as 40.3%.
Diversity of tobacco use in India
Smoked forms of tobacco Smokeless forms of tobacco Nasal/inhaled forms of tobacco
(cid:119)Cigarettes (cid:119)Gutkha (cid:119)Snuff
(cid:119)Beedis (cid:119)Zarda
(cid:119)Cigars (cid:119)Khaini Forms applied to teeth and gums
(cid:119)Cheroots (cid:119)Paan masala
(cid:119)Chuttas (cid:119)Paan with tobacco (cid:119)Gul
(cid:119)Dhumtis (cid:119)Tobacco water (cid:119)Gudhaku 'dant manjan'
(cid:119)Kreteks (cid:119)Meetha mawa (cid:119)Creamy snuff
(cid:119)Pipes (cid:119)Mishri
(cid:119)Chillum
(cid:119)Hooklis
(cid:119)Hookah
The tobacco epidemic may be declining in the industrialized countries but is on the rise in the developing
countries. There is an urgent need to implement effective tobacco control policies in these countries. In India,
the tobacco problem is especially complex because of the large spectrum of tobacco products and the
numerous methods of using tobacco.
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