Reducing the harm

In a country where one in 20 young men could die of cancer by the age of 70, it is essential that the ban on the sale of gutka and pan masala containing tobacco be effectively enforced in every State and Union Territory. A total of 24 States and UTs — Tamil Nadu is the latest to join the list — have introduced a ban based on the August 2011 regulation issued by the Food Safety and Standards Authority of India. The campaign to stop the manufacture, storage and sale of this injurious product has been greatly aided by the Supreme Court, which has been asking for compliance reports from State governments. The control of tobacco is an integral part of global public health strategies to reduce the incidence of cancer and the growing burden of non-communicable disease. This objective is vital to India and China, which together represent the biggest markets for growth, and need to be at the forefront of the struggle to curb consumption. For India, the significance of a countrywide ban lies in the potential impact it can have: about 52 per cent of oral cancers are attributable to the consumption of smokeless tobacco products. A significant reduction in newly initiated users as well as weaning away of existing consumers will therefore prove immensely rewarding.

State governments must take extraordinary measures to make up for the delay in implementation of a ban on gutka and pan masala caused by legal hurdles. Given that food safety has not enjoyed high priority, there has not been much capacity-building or recruitment of personnel in this area. It is essential that the State food safety authorities and Tobacco Control Cell enter into a partnership with civil society to identify the weak links in the enforcement chain and take remedial action. The approach to any violation must be one of zero tolerance. There is something to be learnt here from the aggressive international efforts to curb the sale of tobacco products, with the help of NGOs. These agencies, such as the Asia Pacific Association for the Control of Tobacco, have forged alliances that cover entire countries and regions, and they meet regularly to discuss experiences and strategies. Evidently, the ban on gutka and pan masala containing tobacco could be enforced because there is a law against the addition of harmful substances to food. The bigger and unmet challenge, though, is to bring smoked tobacco, including bidis, under similar control. Industry has been exaggerating the impact of eliminating tobacco from an economic viewpoint, while good smoking cessation programmes for consumers are absent. Until all forms of consumption are choked off through regulation, the leaves of Nicotiana tabacum will continue to take a heavy toll.