Regulating tobacco would go a long way in managing cardiovascular diseases

November 19, 2020 2:17 PM

In the past few years, the government has been very vocal and innovative in communicating its health priorities through its several programs like the Fit India Movement, Ayushman Bharat for free access to healthcare for millions of Indians among other things.

The next step for this law would be to eventually ensure that our country becomes smoke-free.

By Dr Sundeep Mishra

The most prominent take away from the ongoing COVID-19 pandemic at an individual level is the importance of keeping our bodies free from ailments and illness. Co-morbidities have contributed to the lion’s share of fatalities among those who were fighting the Coronavirus. At a public policy level, it is important that we adopt a strong multi-pronged approach to tackle the pressing health issues in India, which would involve decisive law-making, focus on behavioral change and making the health infrastructure robust and accessible.

One such pressing health issue in India has been the burden of cardiovascular diseases. Cardiovascular diseases (CVDs) often rank as one of the leading causes of mortality in India. According to a Lancet study, in 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million. Nearly 25% of all mortalities in India can now be traced back to CVDs with ischemic heart diseases as well as strokes responsible for more than 80% of this burden overall. Tackling CVDs is a complex task. There exist a number of risk factors which are interrelated and which influence cardiovascular health. These involve economic and societal aspects extending far beyond our public health/health systems in general.

In our fight to reduce the CVD burden, one of the most important things that the government needs to do urgently is to control tobacco usage. As per the World Health Organization (WHO), nearly 1.9 million people die each year from tobacco-induced heart diseases globally. This again equates to around 25% of all deaths attributed to heart diseases. Not only that, tobacco use also results in substantial morbidity as well as tremendous health care costs related to CVD. Although the consumption of tobacco adversely affects all countries regardless of the levels of their economic or health system development, undoubtedly the impact is most profound in the low- as well as middle-income countries (LMICs) including the likes of India. These countries also shoulder the largest share of total/premature deaths arising out of CVD globally.

Hence, it is imperative that we move towards being Smoke-Free India. In India, Cigarettes and Other Tobacco Products Act in 2003 (COTPA) is the principal tobacco control act in force. Over the years, this Act has had some positive impact on tobacco control, however, with changing times and circumstances, it is important that it undergoes amendments so as to make tobacco products harder and more expensive to access. According to a Lancet report on the changing patterns in cardiovascular diseases and the associated risk factors in Indian states study – “Smoking was the only major cardiovascular disease risk factor that decreased in prevalence from 1990, suggesting that implementation of the Cigarettes and Other Tobacco Products Act (COTPA) in 2003 to discourage use of tobacco products, and the National Tobacco Control Program (NTCP) launched in 2007, may be facilitating a reduction in tobacco use, but sustained efforts are needed for further progress.”

The next step for this law would be to eventually ensure that our country becomes smoke-free. One-third of India’s youth are subjected to secondhand smoke in public places, and such exposure also causes death, disease and disability among smokers and nonsmokers, including children. More importantly, this also needs to be sustainably addressed through a comprehensive ban on smoking-areas in our public spaces like restaurants, airports, hotels and offices. Hence through the amendment to COTPA Bill, all designated smoking areas (DSAs) in airports, hotels and restaurants must be abolished. Moreover, comprehensive smoke-free regulations which include restaurants, workplaces and bars reportedly reduce the risks of heart attacks by as much as 85%, improve the respiratory health of workers, and may also reduce the risk of stroke. Only a comprehensive smoke-free statute which prohibits DSAs will save lives as well as improve the public health of all Indians. Coincidently, the 2nd of October also marks 12 years since the government passed the smoke-free rules in 2008.

It is no coincidence that atleast 61 countries have introduced bans on smoking in indoor public spaces, and atleast 42 have completely banned smoking in airports.

The other important aspect is tobacco advertisement at the point of sale. A study which assessed data from around 130 countries showed how point of sale advertising bans are associated with significantly reduced smoking experimentation among the youth. A study which reviewed data from as many as 77 countries estimated that putting a ban on point of sale displays reduced daily smoking prevalence by about 7%. At least 42 countries comprehensively ban tobacco advertising, promotion, and sponsorship (TAPS) including point of sale advertising, and 21 of these countries also ban tobacco product display.

In the past few years, the government has been very vocal and innovative in communicating its health priorities through its several programs like the Fit India Movement, Ayushman Bharat for free access to healthcare for millions of Indians among other things. It is now time that the government also takes formidable action against known killers like tobacco and help destress the health system in the country.

(The columnist is Professor of Cardiology, AIIMS, New Delhi. Views expressed are the author’s own.)

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