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Tobacco ad ban: The issues and health aspects

Preeti Mehra

THE proposed Bill seeking a ban on tobacco advertising and sponsorship, expected to be introduced in the Budget session of Parliament, has had different reactions from every quarter. The tobacco companies, its chief target, are indignant and want self-re gulation. Advertising agencies, anticipating substantial revenue loss, are keeping their fingers crossed. Health professionals and anti-tobacco groups are jubilant.

To gauge its impact on the actual health status of the country and the experiences of other countries in their efforts to reduce tobacco consumption, Business Line spoke to two officials of the World Health Organisation. Dr Robert J. Kim-Farley, WHO's re presentative in India, focusses on the issues before the country. Ms Martha R. Osei, Regional Advisor, Health Promotion and Education -- the focal point for a tobacco-free initiative in South-East Asia -- speaks about the health aspects and the experienc e of other countries. Together they provide another point of view.

`Good start, but enforcement...' -- Dr Robert J Kim-Farley

Do you feel that the proposed Bill to ban tobacco advertising and sponsorship will bring about a reduction in the consumption of tobacco in the country?

The proposed legislation is a very good start in that direction. It is a first step, in the sense that if there is no legislation, there can be no change. If you have legislation, at least there is a basis on which change can start. Now that is as far as the law. Its enforcement is another issue. But this will be the first step -- you first get the law and then see how it can be enforced. I think the legislation will help to set societal norms, a standard and give out a message to the people.

Though advertising is banned in the case of alcohol, we continue to have surrogate advertising and brand extensions. It has not made much difference to consumption. Will this not happen in the case of tobacco as well?

Again, I feel it is a step in the right direction. Without the ban you will have billboards, ads on TV and radio targeting especially the youth to try to make it seem that this is a very attractive lifestyle. If you smoke, you will have a fast car, is th e kind of message that is put out. So, maybe surrogate advertising comes in, but it is better than blatant advertising. In the future who knows, there will be issues raised about surrogate advertising as well.

Almost 80 per cent of Indian smokers are in rural India, and there are others who chew tobacco, gutka -- subjects on the State List. How will a ban on advertising and sponsorship help this population?

No doubt the ban on advertising is going to impact more urban dwellers. But to what extent rural dwellers get influenced by the habit patterns of urban dwellers that will have an effect. I think when the rural folk go to urban centres and do not see such advertising, they will be less attracted.

Also, there is a question of the taxation structure. If a product is made by the poor and designed for use by the poor, then the taxes are much less. If that product is beneficial, it makes a lot of sense and is a very progressive stand of the government . But when you have a situation like that of bidis rolled by the poor and meant for the poor and the tax is only Rs 8 per 1000, I think, then you are subsidising a harmful product for the poor. I think that is something that needs to be addressed. The ta x structure is equally important as the advertising issue.

About tobacco-related issues being on the State List, in India several States are taking very progressive measures. Being on the State List may prove to be beneficial, for only a few States have tobacco interests.

When you talk about reducing tobacco consumption, you automatically talk about its adverse impact on the tobacco farmers and the bidi rollers. Their jobs are at stake. Besides, critics point out that tobacco is a very hardy crop which is difficult to sub stitute and that it rejuvenates the soil, etc. What is your stand on this?

There are a few things to be understood. The ban is not on the sale of cigarettes, it is on advertising. Most people who are already smoking or addicted, are going to continue. We should offer an opportunity for smoking cessation, but the real emphasis, I think, needs to be on the youth. If you can stop someone from starting to smoke, the chances are they will not take it up later in life.

What I am saying is that even if all the youth stop smoking today, you still have a long way to go and lots of cigarettes still to sell in the future here. We hope there will be a gradual tapering off, but there is not certainly going to be a complete st oppage on smoking with a ban on advertising. It would be nice if it happened, but that is not the reality. So I think we are certainly not going to see anyone out of business here for a long time and there will be plenty of time to talk about crop substi tution and other ways of employment. All these things will happen over time. There is not going to be a sudden economic crisis here which is what the tobacco growers would like the people to believe.

In fact, where the employment issue is concerned, we have seen worldwide it has not been because of reduction in tobacco use that people have lost jobs, it is because of mechanisation. Tobacco companies in order to make higher profits bring in machines t o replace humans -- they are more expensive than machines to run. That is what caused the reduction in jobs in the tobacco industry.

But India has the unique bidi industry where the product is made totally by hand.

It is a very dangerous product. Much higher in tar and nicotine than other cigarettes and harmful to the local people. Certainly the issue of taxes should be considered here. They should bring them into the taxable category, instead of subsidising a harm ful product.

If India is really serious about reducing tobacco consumption, in your opinion, what are the other measures they should take?

We need to have a two-fold approach. One is to try to stop the onslaught of tobacco companies efforts to reach our youth and to make them smokers. The other is to outreach, both in the rural and the urban, and spread the message of the harm of smoking, s o that it stops making smoking so attractive.

I would also encourage increasing taxes on cigarettes, a higher price will discourage people to start smoking. And do not let that tax revenue go to the general treasury, but let it be used for sports sponsorships, etc., and also for anti-tobacco message s. Let radio and television have anti-tobacco messages paid for by taxes raised from smoking.

Since considerable business interests are involved and the tobacco lobby is strong, how can India resist pressures from this quarter? Have other countries succeeded?

If you go into the history of tobacco, big tobacco companies have tried to influence governments, even the WHO. My thinking is that this can be achieved by openness, transparency and putting light on the matter by journalists and others working in this a rea. For example, the exposure in the US of the internal memorandum where tobacco companies have been trying to say that well, we did not know the harmful effects of cigarettes, that we do not try to adjust the nicotine levels for addiction, that type of thing has a lot of effect. And looking at campaign contributions, looking at how much is going into politicians' election campaigns -- it is then that people will recognise the coalition that is going on. When people start seeing these relations and the visibility of such things increase, it will make a difference.

`There is no safe tobacco' -- Ms Martha R. Osei

Are there any WHO campaigns against tobacco that have been very successful and can be replicated to reduce tobacco consumption in the country?We advocate to countries, we support them technically in terms of materials, facts, figures, studies that they n eed to do in terms of getting the necessary data base based on which they can have campaigns and policies and strategies developed. Whatever action is taken at the country level are national actions. The ownership belongs to the country and not WHO. In t he context of your question what I can say is that Thailand and Sri Lanka are two countries in the region which have mounted effective tobacco control campaigns. They have succeeded in terms of reducing the consumption rates.

Can you give me details about the campaigns? Is there anything very innovative about these campaigns?

Thailand, for example. If you go back 15 years there was a controversy between the Thai ministry office and GATT. Initially it was not GATT as such, it was the multinational tobacco companies who wanted to bring in their tobacco products and Thailand was telling them that we will not allow you to bring in your products as we have enough tobacco here. We would like to make sure that we protect our people.

But, according to the trade laws, they cannot do that. So the case went to GATT and it ruled that Thailand cannot prevent the MNCs from bringing in their tobacco products. But what they can do in the interest of public health is to protect their people b y putting in place strategies and activities in the interest of the people. One of them was a ban on tobacco advertisements because they realised that most people, particularly children, start using tobacco under the influence of advertising. Thailand wa s the first country in the region that put in very strict ban on tobacco advertising and it has worked.

Is it sufficient to ban tobacco advertising to bring down use of tobacco?

It is one of the five key strategies that countries can use. If you ban tobacco advertisement and promotion but do not educate the public about it, if you do not raise taxes to make it inaccessible to vulnerable groups like young people, poor and women, and if you also do not look at smuggling issues which influence tax effects in the country, you will not be able to reduce consumption. These strategies have to come together comprehensively.

But you also have to realise that countries cannot do everything at the same time. So they take it one at a time, like it is happening in India. Like it has happened in other countries. And they deliver. But the important thing is for countries to learn that these are the strategies that need to be put in place to reduce consumption keeping in mind the country's own peculiar situation.

What is worse smoking tobacco or chewing tobacco?

There is no safe tobacco. Whether you chew it or you smoke it, the impact of tobacco on health is there. In India we have read a lot about even young people suffering from tobacco-related oral cancer affecting the jaw, tongue, throat, the palate...We als o know cases of people who have suffered from lung, heart and respiratory diseases due to smoking. There is no good out of tobacco, you can see that.

Apart from a physical dependence, is there a psychological dependence on tobacco as well? What does your research show?

We know that when people smoke, within seconds they are effected by the nicotine, the tobacco. It leads to a dependency, an addiction as it effects the brain. You need to have a certain level of nicotine in the blood stream all the time, you get addicted to tobacco and because of that you do not like to quit. What I see is a physiological as well as psychological dependence. There are all kinds of chemicals in tobacco which are addictive, whether you chew it or smoke it.

What does your research show, does displaying warning signs on cigarette packets really help? The proposed Bill has increased the size of the warning sign, will that make a difference?

It does very well. We have got documentation from other countries where there has been reduction in tobacco use, specifically smoking, where they had large warning labels on cigarettes. The examples are Turkey, South Africa, Canada and Thailand. These co untries have insisted on the use of huge warning labels on cigarette packets and it has resulted in reduction of tobacco use.

Research conducted in these countries indicate that those who quit using tobacco were motivated by the warning labels. The important thing is for the labels to be large and predominant and read in the language that people understand. In Canada they have suggested that the warning label should not only be large, but they have asked tobacco companies to graphically show what tobacco use causes. So they have photographs on the packets that show what happens with tobacco use.

It is also important that the message does not just say that tobacco is harmful to your health, but that tobacco causes cancer. Thailand in the last two years has come out with ten rotatory messages, one of them is `tobacco causes impotence'.

Why is it that there has been a slump in smoking in the developed world, but the Asian figures are going up?

This is due to a lot of reasons. First, the tobacco industry has increased its promotion of products, especially on the vulnerable groups such as the youth, the poor and women. They have made it seem, particularly for the youth, that this is the way you should go if you want to be who you are. They've linked tobacco use to good life and being macho. They have also targeted women and used the slug of liberalisation that women have come of their own -- if you smoke you are the unique woman that you want t o be. They are also targeting families, see the slogan Made for Each Other, what does that slogan mean?

The other thing, the developed countries started controlling tobacco 10-15 years ago and now we are seeing the impact. It's not just one strategy they adopted, but a comprehensive strategy looking at taxes, public education, laws and regulations. The dev eloping countries also started documenting the impact of tobacco on the health of their citizens way back and the cost that they have to incur to treat tobacco related diseases. They have used the info to put in place effective strategies to reduce tobac co consumption.

There has also been extensive litigation against tobacco companies, they are not able to survive in developed countries so they are shifting to developing countries. Yes, to some extent dumping is also going on, but there is also manipulation of countrie s. When they want to take policy decisions, the tobacco industry comes in manipulates and lobbies and makes sure that those effective policies do not come in.