Prevent tobacco lobby interference

Tobacco use remains a major public health challenge in India accounting for over 13 lakh premature adult deaths a year. Many more suffer from myriad diseases. The annual cost of tobacco attributable diseases among adults in India for the year 2011 was estimated to be a whopping 1,04,500 crores. That accounted for 1.16% of India’s GDP and far exceeded the governments’ expenditure on health as well as the total excise collected from tobacco that year.

Governments, especially in the last two decades, have taken several measures to curb tobacco use. India enacted the Cigarette and Other Tobacco Products Act in 2003 that mandated pictorial health warnings on tobacco products and prohibited smoking in public places, the advertisements of tobacco as well as tobacco sales to minors. The National Tobacco Control Program is in place since 2007 to raise awareness on tobacco harms, promote the implementation of laws, and offer cessation support.

These measures did make a difference. Nationwide surveys show that the proportion of people using tobacco came down from 34.6% in 2010 to 28.6% in 2017. This meant 81 lakh fewer tobacco users during this period saving a significant number of lives. We, however, are yet to plug a crucial policy gap: protecting these public health policies from tobacco industry interference.

In 2003, the World Health Assembly adopted the first global health treaty, the WHO Framework Convention on Tobacco Control to address the tobacco pandemic using evidence-based demand- and supply-side measures. India played an active role in negotiating the Convention signing and fully ratifying it in 2004. As India remains among the world’s largest consumer, producer, and exporter countries of tobacco, it is indeed crucial to protect public health policies from commercial interests in the tobacco sector.

A decade and a half passed since India signed the Convention but is yet to have a national policy to prevent tobacco industry interference. In 2011, as part of the public interest litigation, the Government of India had submitted to the Karnataka High Court to develop a code of conduct for public officials preventing tobacco industry interference in the development and implementation of tobacco control policies/programs. While such a policy did not materialize at the national level, at least 14 states in India, starting with Punjab in 2015, adopted a protocol for public officials. These protocols limit the interactions of public officials with the tobacco industry making them transparent, and prevent the exchange of favors as well as any partnership between a public agency and the tobacco industry.

These subnational measures despite their suboptimal enforcement seem to be yielding some results. Last month, a collaborative of 26 tobacco control researchers and practitioners across the country developed the India Tobacco Industry Interference Index 2020. The Index uses a standardized tool and systematic gathering of information from public sources to assess various aspects of interference such as the level of industry participation in policy development; benefits to the tobacco industry; measures for transparency; and preventing conflicts of interest. The overall Index score indicates the degree of tobacco industry interference: lower the score, lesser the interference. The Index 2020 has an overall score of 61 out of 100 indicating an improvement in governments’ efforts in protecting public health policies from industry interference compared to the previous years.

To protect the public health gains and to do better in the future, it is high time that India adopts a national policy cutting across ministries and departments. To do this well, we would need to do more than just the codes of conduct for public officials, and check the so-called corporate social responsibility activities by the tobacco industry; divest and prevent public investments in tobacco companies; provide alternative and safer livelihoods for tobacco growers and workers; and align policies of commerce, finance, agriculture and other non-health departments with the public health goals over time.

(The writer is Director, Institute of Public Health, Bengaluru)