Madhya Pradesh stands out as the best model of implementing gutka
ban. This is the result of administrative will coupled with political
and public action
The implementation of the Food Safety and Standards
Authority of India (FSSAI) notification 2011 that effectively prohibits
the production, sale, and consumption of gutka products containing
tobacco and nicotine is one of the landmark public health interventions
in Madhya Pradesh in recent years. In a country where 90% oral cancers
are directly related to use of smokeless tobacco, the State-level
intervention that Madhya Pradesh has initiated is of high importance for
two apparent reasons. First, this has undone the previous history (also
the myth, of an impractical ban!) of 2001 that failed to sustain the
ban due to various pressures including that of judiciary and industrial
lobbies. Secondly, the current move has provided momentum to the action
against gutka and pan masala all over the country. , After Madhya
Pradesh imposed gutka ban, Kerala, Bihar, Maharashtra, Rajasthan,
Jharkhand, Chhattisgarh, and Haryana followed suit.
The
health challenges of the gutka products have long been a concern for
public health activists and people. In India, the consumption of gutka
is widespread and this outnumbers any other form of tobacco use. As per
the Global Adult Tobacco Survey India 2010, 75% of the current 275
million tobacco users consume gutka. Because of easy availability, low
prices and the attractive marketing, gutka products have gained
popularity among schoolgoing children and adolescents over the years. As
per the Global Youth Tobacco Survey India Report, 2006 the use of gutka
is 10% among the boys and 5.5% among girls of schoolgoing age. The
National Institute of Health & Family Welfare in its fact-finding
report mentions of 3,028 chemical ingredients in gutka products. Of
these, 28 chemical ingredients are proven carcinogens! As per the study
of Indian Council of Medical Research, 70,261 people were detected with
cancer of the mouth, tongue and hypo pharynx in 2010 because of
“smokeless tobacco products.” The numbers of those affected have been
steadily rising from 2008.
Madhya Pradesh stands out
as the best model of implementing gutka ban and this is importantly, the
result of administrative will coupled with political and public action.
The need for enforcement primarily originated from the high levels of
gutka consumption in the State. The State developed an initial plan of
action under the leadership of the then Food Commissioner, and
implemented the plan rigorously by ensuring the support of district
administrations, the general public and the media. As of July 2012,
approximately 50 raids were conducted and four million pouches
confiscated.
The implementation has evidently
succeeded to curtail both the supply and the demand for gutka in the
State. The enforcement of ban is widely discussed and appreciated en
masse. Now, rampant use is reduced. Access is considerably reduced for
casual users, children and women. Retailers had a loss of 50% turnover
in the last four months after the ban and most importantly all the 16
registered factories were sealed to close. Certainly, blackmarketing
exists through cross-border smuggling but the wide reach of the supply
chain is shattered by the ban and subsequent administrative actions.
However,
one of the major drawbacks is the lack of adequate cessation facilities
in the State. In the absence of such facilities, gutka users may switch
to other products that are cheap but equally harmful.
However,
what is important now is to sustain the fight through continuous
monitoring of implementation systems with coordinated
inter-State/district activities. Further to this, the experience of
Madhya Pradesh and other States should inform the National Tobacco
Control Programme of India in order to extend the best practices across
the country. This would surely provide a great leap forward to the
tobacco control initiatives.
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