India Third-Largest Market of the Deadliest Killer in the World - Tobacco

By Tarit Mukherjee
PIB Features

New Delhi, May 27, 2011 (Washington Bangla Radio) Tobacco products are made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed or snuffed. All contains the highly addictive psychoactive ingredient, nicotine.

Tobacco was introduced into India by Portuguese traders during AD 1600. Its use and production proliferated to such a great extent that today India is the second largest producer of tobacco in the world. Soon after its introduction, it became a valuable commodity of barter trade in India. Trade expanded and tobacco spread rapidly along the Portuguese trade routes in the East, via Africa to India, Malaysia, Japan and China. During this period, the habit of smoking spread across several South Asian countries. Virtually every household in the Portuguese colonies took up the newly introduced habits of smoking and chewing tobacco.

India is one of the biggest tobacco markets in the world, ranking third in total tobacco consumption. However, the per capita consumption in the country is 0.9 kg compared to the world average of 1.8 kg. Tobacco usages in India is contrary to world trends since chewing tobacco and beedi are the dominant forms of tobacco consumption, whereas internationally, cigarette is the dominant form of tobacco use.

In the late nineteenth century, the beedi industry began to grow in India.  The price differential from cigarettes favoured the use of beedis and this domestic product soon supplanted cigarettes as the major form of tobacco consumption. While tobacco chewing was practiced for many centuries, commercial production and marketing have been scaled recently, with the introduction of the gutka. The rate of growth of consumption of gutka has overtaken that of smoking forms of tobacco. As a result, oral tobacco consumption has opened a new and broader front in the battle between commercial tobacco and public health in India.

The Global Adult Tobacco Survey India report notes that Khaini is the most commonly used smokeless tobacco product. Gutkha is the second most common form. The consumption of smokeless tobacco in India is also prevalent in various other forms e.g. paan with tobacco, paan masala with tobacco, Gul, Mawa, Mishri, Bajjar, Gudakhu etc, which are used as dentifrice i.e. for application on teeth or gums. Evidence shows that smokeless tobacco contains more than 3000 chemical compounds of which 29 are proven carcinogens i.e. cancer causing substances.

One of the main risk factors for tobacco use is number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases. It is the single most  cause of disease, disability and death. Each year people die prematurely from smoking or exposure to secondhand smoking. Despite these risks people smoke cigarettes.

The harmful effects of smoking do not end with the smoker. Adults and children aged 3–11 years are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons as smokers. Secondhand smoke exposure causes diseases  including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. Each year primarily because of exposure to secondhand smoke nonsmoking people die of lung cancer, heart disease, and children younger than 18 months have lower respiratory tract infections. As per the recent Global Adult Tobacco Survey (GATS) India Report, 2010, the use of smokeless tobacco among adult males in India is as high as 32.9% and for females it is 18.4%. Overall, 26% of the adult population consumes smokeless tobacco. The Global Youth Tobacco Survey (GYTS)-India, 2009 similarly revealed that 12.5% (Boys = 16.2%, Girls = 7.2%) youth use tobacco products other than cigarettes.

According to ICMR, 50% of cancers among men and 25% among women in India are related to tobacco use. Nearly 90% of oral cancers are related to use of chewing tobacco. States with high prevalence of smokeless tobacco also face the challenge of high burden of oral cancer. Besides oral cancer, smokeless tobacco use is also associated with cancers of food pipe, pancreas, kidney, throat and stomach. There is also increased risk of death from cardiovascular diseases among smokeless tobacco users.

Recently an initiative has been taken and serious concern raised over growing Gutka/Pan Masala menace in India. India has the highest number of oral cancer in the world with 75,000 to 80,000 new cases of oral cancers being reported every year and chewing tobacco and gutka contribute to 90 percent of oral cancer cases in the country.

Cancer of oral cavity is frequent and common finding among the cancer patients show addiction to gutka and other tobacco products. It is observed that magnitude of tobacco related cancer in average is on an upward trend in Eastern and North Eastern India. This is largely due to high prevalence of tobacco consumption.

According to the Global Adult Tobacco Survey (GATS 2010) nearly one third of Indian population is addicted to smokeless tobacco. A large number of children and youth in India are addicted to smokeless tobacco. These preparations essentially have tobacco with or without supari and are well proven to be harmful for health.

Smokeless tobacco contains nicotine and direct consumption of which is highly addictive. Scientific evidence has established that tobacco chewing causes cancer of mouth, ocesophagus (food pipe), larynx and pharynx (throat), pancreas, stomach, kidney and lung. It can also cause high blood pressure and other life threatening cardiovascular conditions like myocardial ischemia, stroke etc.

Consumption of tobacco may be reduced by raising the price of tobacco. It has proven to be one of the most effective strategies for preventing and controlling tobacco use. Specifically the increasing cigarette prices would decrease the prevalence of tobacco use, particularly among youth and young adults, and that increases in cigarette excise taxes would lead to substantial long-term improvements in the nation’s health. A 10% increase in the price of cigarettes is estimated to reduce consumption by nearly 4% among adults, and the potential reduction among young people and low-income populations is even higher.

Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have shown to reduce smoking rates, tobacco-related deaths, and diseases caused by smoking. A comprehensive program is a coordinated effort to establish tobacco free policies, reduce the social acceptability of tobacco use, promote cessation, help tobacco users quit, and prevent initiation of tobacco use. This approach combines educational, clinical, regulatory, economic, and social strategies.  The World Health Organization (WHO) has chosen “The WHO Framework Convention on Tobacco Control” as the theme of the next World No Tobacco Day, which is on  31 May 2011. (PIB Features)

Disclaimer: The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of PIB or WBRi.