The fact that the Supreme Court has upheld the implementation of 85% graphic warnings on tobacco packs—and that the tobacco industry is finally starting to comply with the law—is a great step forward for health in India. The government, as well as the higher courts of the country, have successfully resisted the tobacco industry’s opposition to implementing this progressive health policy. There is no doubt that this step will help save lives.
These warnings will reach every current and potential tobacco user in India—including children—and deliver essential knowledge (and warning) about the harm caused by tobacco, irrespective of whether the user is literate or not. In combination with other policies such as effective levels of tobacco taxation, this step can help reduce the burden of India’s tobacco epidemic, which is, after China, the worst in the world. Another good news is that this step will help propel the government of India towards its pledge under the 2030 Agenda for Sustainable Development, which aims at improving the health and wealth of all its citizens.
Tobacco-related diseases cost India $22.4 billion annually, and non-communicable diseases (NCDs) will lead to $4.58 trillion in economic losses by 2030. The World Health Organisation (WHO) has estimated that India could halve the rate of NCDs by investing just $0.3 per person to fund programmes to reduce the four big behavioural risk factors—one of which is tobacco use. In addition, a recent study found that most Indians still don’t have health insurance, so the cost of treating tobacco-related diseases typically falls on families—often those who are least able to afford it. This can have a negative impact on educational, nutritional and life opportunities available to other family members. So, there is a moral and economic argument to invest in strategies for reducing tobacco usage.
India has long needed to raise awareness of the fact that tobacco is proven to play a pivotal role in causing or worsening many different preventable and communicable diseases. Tobacco is the main cause of diabetes, cardiovascular diseases, chronic lung diseases and various types of cancer—the four major NCDs. Exposure to second-hand smoke can also increase a person’s susceptibility to tuberculosis—which is one of the country’s most challenging health problems. Tobacco users living with HIV—there are about 3 million people living with HIV/AIDS in the country—have a shorter life expectancy than people living with HIV who don’t use tobacco. In short, using graphic warnings to reduce tobacco use could deliver a much bigger health dividend than expected.
In addition to this progress on health warnings on tobacco packs, India has been a world leader in changing the narrative about tobacco. Hard-hitting television advertisements are running frequently, there are rules which force warnings to be run when films in theatres show tobacco usage, and even railway trains carry these strong messages as they move through urban and rural parts of the country.
This commitment towards increasing public alarm about the diseases that can be caused by tobacco could smooth the path for other policy interventions that improve public health—such as discouraging the consumption of unhealthy foods and beverages, and preventing air pollution. As with tobacco, it will be essential to stay resolute in the face of industry interference, but the dividend that comes from reducing preventable diseases will be worth it.
By José Luis Castro
The author is president & chief executive officer, Vital Strategies, and chair, Non-Communicable Disease Alliance