India Steps up Tobacco Warnings to Combat Nearly 1m Deaths

Source from:  FT.com 10/23/2014

India has stepped up efforts to curb nearly 1m tobacco-related deaths a year by issuing new rules to embolden the health warnings on tobacco packets and make the country one of the world's strictest in terms of tobacco labelling.

But while regulators try to crack down on branded cigarettes and similar products, there is still a vast unregulated market for tobacco in India. And it's far from clear that slapping warnings on cigarette packs will have much impact on health.

For one thing, many more Indians smoke traditional bidis than branded cigarettes. In addition, a lot of people get their nicotine fix from chewing tobacco and other products often produced in the informal sector.

India currently requires 40 per cent of the packaging on tobacco products to be covered by warnings, a figure that will rise to 85 per cent in a few months, including images and written warnings connecting smoking with throat cancer.

The new rules will put India alongside Thailand as the world's strictest country by this measure, and form part of a global trend to use vivid health warnings as a deterrent to smokers.

Action is undoubtedly required. Some 35 per cent of adults use tobacco in some form and between 800,000 and 900,000 people die from tobacco related diseases every year.

However, the tobacco industry is resisting, forwarding complaints that the move robs them of branding space and invades their intellectual property rights. Even some in the anti-smoking lobby don't think such labelling works.

"Just displaying stuff, I think throughout the world it has not made an impact," says Sajeela Maini, president of the Tobacco Control Foundation of India and author of The Last Puff. "People will get immune to those pictures after a while."

Maini believes the answer is to hold classes on health in schools and, ideally, to ban tobacco products altogether.

Vast informal market make regulations porous
In fact, the large informal market for tobacco products in India may mean that regulations on labelling reach a very limited portion of the country's tobacco consumers.

Firstly, many Indians smoke bidis – crushed and dried tobacco wrapped in tendu leaves – switching between bidis and more expensive cigarettes, depending on their disposable cash. Many of these products are largely produced as a cottage industry and remain difficult to regulate.

"It's everyone – men, women," says Mussa, aged 52, who has a small stall selling cigarettes in Colaba, Mumbai. "If you don't have money, then you smoke bidis." He sells a packet of 20 cigarettes for Rs190 ($3.10) or a single cigarette for Rs10.

And then there is smokeless tobacco, which has a bigger following among adults than smoking. Just 14 per cent of adults smoke tobacco but 26 per cent use smokeless tobacco, according to a 2009-2010 survey.

Amongst the most popular products is khaini, a chewing tobacco and gutkha, a mouth freshener made of betel nut and tobacco that is used by some 70 per cent of college students, according to estimates from the Tobacco Intervention Initiative.

While smokers may migrate to smokeless products, people rarely make the change in the opposite direction as smokeless tobacco tends to be more addictive. A 2009-2010 survey found 12.6 per cent of India's population had quit smoking, having been daily smokers, though only 4.8 per cent of smokeless tobacco users have managed to leave the habit behind.

"Chewing tobacco has also been reported as "starters" for adolescents as it is cheap and easily accessible, who at a later age initiate dual (smoking and smokeless forms) use," one report by the Public Health Foundation of India. "Awareness of the hazards from use of SLT [smokeless tobacco] is very low amongst the rural populations."

Consumption of these smokeless products is rising too. Where 28 per cent of men and 12 per cent of women were found to use smokeless tobacco in a 1998-1999 survey, the figures had increased to 33 per cent and 18 per cent respectively in a 2009-2010 survey.

The Indian government has tried to crack down on the sector, with many states banning gutkha in particular. But regulation has been difficult to enforce in this vast informal industry and there is further controversy, given the large economy related to chewing tobacco: the gutkha and paan masala business is valued at some Rs100bn.

Despite the large and complicated tobacco market in India, the government insists the new labelling rules have bite. "[This] will tell each and every one, including potential users of cigarettes, that tobacco means nothing else except death," said Harsh Vardhan, health minister.

But the industry seemed to shrug them off. Shares in ITC, one of India's largest tobacco groups, gained 1.2 per cent and 0.6 per cent to Rs353.95 in the two sessions since the decision was announced. Enditem