Food, nay tobacco, for thought

Shobha Shukla *

Campaign espouses tobacco free Manipur on August 19 2014 :: Pix - TSE

The curtain is finally down on the World No Tobacco Day 2017 and we are back to business as usual. There was a flurry of activities in my city, and elsewhere too, during the weeks preceding this day, reaching a crescendo on the 30th and 31st of May. Barring very few exceptions, the script of all the programmes/ discourses seemed to be taken from the same master copy.

Speaker after speaker shouted hoarse the same refrain repeatedly—gory details/pictures of the myriad diseases tobacco consumption brings in its wake; how tobacco is making the poor poorer; the catastrophic cost of medical expenditure on tobacco related diseases is draining the country’s economy; the perils of second hand smoke; why taxes on bidis (hand rolled cigarettes) should be increased etc. Photographs were clicked, press releases duly dispatched, and the media fruitfully occupied. Many took oaths to refrain from tobacco use and to make their city tobacco free (whatever that means).

We had suddenly become super conscious of our duty to contribute our mite for a tobacco free society. And having done our share of the propaganda, most of us can now hibernate smugly till the dawn of the next World No Tobacco Day. We have been doing this repeatedly for the past almost 20 years. Yet the end of tobacco menace does not seem to be anywhere near at site.

As per a research report the number of men smoking any type of tobacco at ages 15-69 years rose by about 29 million, or 36%, from 79 million in 1998 to 108 million in 2015, representing an average annual increase of about 1.7 million male smokers. This makes India home to the second highest number of adult smokers in the world, after China. Add to this the huge number of people consuming chewing or smokeless tobacco.

So the pace of progress on tobacco control is not only slow, but even negative in many regions. If this inaction continues, we will fail on several other fronts as well. The National Health Policy 2017, launched recently by the Indian government, aims to reduce premature mortality due to non communicable diseases (NCDs)-like cardiovascular disease, cancers, diabetes, chronic respiratory diseases, etc— by 25% by 2025.

Tobacco is a major common risk factor for all these diseases. Then again, India is one of the 193 countries who have committed to achieve the 17 sustainable development goals (SDGs), one of which is to reduce pre mature mortality from NCDs by 33% and to end TB by 2030. Effective tobacco control has a direct bearing on achieving all these goals.

All this calls for a serious introspection as to why and where are we failing in our seemingly honest efforts for reducing tobacco consumption. Unless the results are visible in the form of a drastic reduction in the number of tobacco users (which has not happened), there is no point in patting our backs by writing beautiful reports of our year long activities in order to be eligible for another round of philanthropic funding. Bloomberg money has made a positive impact on tobacco control programmes. But the moot question is ‘Are tobacco control activities resulting in a proportionate decline in smoking/tobacco use rates?’

Seasonal efforts will not help. I cannot recall one single programme in my city, where the affected community members sat on the dais with other dignitaries, and shared their personal experiences. Next to the medical fraternity, it is those who have suffered grave economic and health consequences due to their own tobacco chewing/smoking habit, or that of a close family member, who can really motivate others to quit. Their experiential knowledge can also help us change our strategies for better results.

But, surprisingly, they are generally not part of our awareness campaigns/programmes. The powerful role of community participation in the success of any health programme is clearly documented. While the TB control programme (after taking its cue from HIV care and control programmes) is slowly waking up to this reality, tobacco control programmes still thrive on preaching and sermonising and making tobacco control the domain of specialists only.

For example, we always talk of how the poor construction workers and city slum dwellers are frittering away their money and health through smoking bidis and chewing tobacco. In fact bidi smoking is 5.5 times more popular than cigarettes in India. But how often do we actually involve them in our efforts? Tobacco control programmes need to be held in their midst and not in air conditioned halls with a plethora of speakers.

We have to listen to them too as to why they eat this poison and tell them, by way of live examples (people who have come out of their addiction and/or those who have suffered) why this addiction is fraught with dangers. This advocacy exercise will have to be done repeatedly, and not just seasonally around World No Tobacco Day, in order to help/encourage people to make an informed choice of quitting. Simply giving them sermons will not do.

Well, sermons of religious and faith leaders can help, so do I believe. We Indians can do a lot many things in the name of religion (even be at each other’s throats). So why not take the help of our preachers in temples, mosques, churches, public places to exhort their followers to quit tobacco? For once, a blind following of their gurus’ extortions (to quit tobacco) will do the people good.

The again, timing of full fledged tobacco cessation clinics (even though their number is woefully insufficient) should be made more user friendly. You cannot expect a daily wage earner to be able to make it to these clinics during their working hours.

It is indeed important for the government to establish tobacco control units in all districts. But it is equally important for these units to function effectively, and show quantitative results- by way of a decrease in sale of tobacco products and a decrease in actual number of tobacco users. And for this they might have to change their current strategies for tobacco control.

The benefits of taking tobacco companies to task for their nefarious activities; enforcing strict compliance of tobacco control policies; raising taxation on tobacco products; having an adequate number of well equipped tobacco cessation clinics; and running advocacy/awareness campaigns cannot be disputed. But unless we bring the affected community centre stage, alongside specialists and experts, we can happily (or rather sadly) keep on observing World No Tobacco Day forever.