The strategy adopted when it comes to addressing the tobacco menace is either quit or die. There are more than 100 million people in India who use tobacco regularly. India has the world’s most diverse range of tobacco options, which vary from dangerous to very dangerous and two in three smokers die of tobacco related illness.
With such a large number of people using tobacco, it is high time to move from “quit or die policy” alone to “harm reduction” policy as well. All tobacco products have been viewed throughout the past 50 years as ‘Deadly in Any Form or Disguise’, as a 2006 WHO campaign phrased it. The WHO’s Framework Convention on Tobacco Control urges its 150+ Parties, including India, to adopt measures to reduce the demand for tobacco products (e.g., warning labels, public health campaigns, tax increases) and reduce the supply of tobacco products, including encouraging tobacco growers to shift to alternative crops.
Although touted as a success, smoking rates have only modestly declined over the Treaty’s first 10 years – around 2% in total, according to a 2017 study published in The Lancet. The WHO Framework Convention on Tobacco Control (FCTC) is the first international public health treaty focusing on global public health issue of tobacco control. Its objective is to devise means of tobacco control based on current, relevant, scientific, technical and economic considerations. India ratified the WHO FCTC in 2004. The Treaty also includes the concept of tobacco harm reduction – encouraging tobacco users to switch to less harmful alternatives. The FCTC defines tobacco control as “a range of supply, demand and harm reduction strategies to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke” but little focus has been given to the harm reduction strategies.
Tobacco harm reduction is based on the principle of reducing harm from cigarettes through devices that reduce the harms associated with smoking by providing nicotine (cleaner form of nicotine intake) to people who cannot or do not want to quit (by themselves or with currently-approved methods).
Over the last 15 years, technological and scientific innovations have led to the development of a wide variety of tobacco and nicotine products that are significantly safer than cigarettes; over a relatively short period of time, millions of smokers worldwide have switched to these products. Products like snus, e-cigarettes, and heated tobacco products have gained popularity as tobacco harm reduction products in many countries including Sweden, UK, USA, Japan, New Zealand. These products are classified under the broad category of novel tobacco and nicotine products.
Novel tobacco and nicotine products are alternative nicotine delivery systems with significantly less harmful emissions than smoke from the combustion of tobacco leaves and could be an option for those who are unable to achieve smoking abstinence using other available means.
Taking a cue from the tobacco “epidemic”, the Indian government imposed a blanket ban on electronic cigarettes with the passing of the Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Act, 2019.
The ban was imposed without exploring the possibilities and scientific evidence of e-cigarette as a product that can aid in tobacco cessation. Imposing a ban on e-cigarette or less harmful alternatives takes away the right of smokers from shifting to a better alternative.
The direct health expenditure on treating tobacco-related diseases alone accounts for 5.3 per cent of total health spending in India in a year (WHO). It has been found that treatment of tobacco-related diseases and the loss of productivity caused therein cost the country almost Rs 13,500 crore annually. The Government should identify better alternatives and encourage innovation that can eventually lead to the betterment of public health. It is essential for the government to take on a multidimensional and unprejudiced stance in adopting harm reduction alternatives for the betterment of its citizens.
The prohibition should be relooked in a way that this wide range of innovative products has the potential to dramatically reduce premature deaths and diseases. While tobacco control strategies driven by regulation, taxation, counselling and therapeutic nicotine replacement techniques for smokers are the need of the hour, these strategies can be complemented by allowing well-regulated, scientifically substantiated, less harmful alternatives made available for smokers who are unable to quit by any means. Reduced harm products, regulated by law, can help create an impact on the current smoking population.
Views expressed by the author are personal and need not reflect or represent the views of the Centre for Public Policy Research.
Anu Anna Jo is a Senior Associate, Research at CPPR. Anu, by qualification holds an M.sc. in Economics (specialised in Environmental Economics) from Madras School of Economics and B.A. Honors Economics from Jesus and Mary College, Delhi University. She has been associated with Madras School of Economics as a Research Assistant since 2018 on various projects. She has also interned with Dept. of Economic Affairs, Ministry of Finance, Government of India in 2014.