India entering the third phase of the tobacco epidemic
The world’s largest tobacco control event – the14th World Conference on Tobacco and Health – is being held in Mumbai from March 8th to 12th at the NCPA (National Centre of Performing Arts).
India being in the midst of a rising tobacco epidemic a conference such as this here in Mumbai couldn’t have happened at a more opportune time. I was there yesterday to meet a blog friend from Chile who was attending the conference and attended a few sessions with her. This is what I got from it.
There are four stages (socio-economic) of the tobacco epidemic:
Stage 1: Smoking is not widely prevalent in the countries in this stage (example, Sub-Saharan Africa) and it is often the well-to-do who mainly smoke.
Stage 2 (China, Japan, South-East Asia and North Africa): Smoking becomes common across different strata of society, mainly amongst the men. About 50% to 80% of men tend to smoke and about 10-15% of the women.
India is in this stage too, and it is common for women from the lower socio-economic groups to consume tobacco (chewing tobacco and smoking beedis), unlike some other countries where women smokers are mostly from the upper classes. For example in China most women smokers are “businesswomen, actresses, singers and young students who think it’s cool to light up a cigarette”. Their numbers are fast rising. I do not have data on India although there is no doubt that upper class women in India are fast taking to smoking, just like the men.
In Japan 43 percent of adult men smoke as against 13 percent of women.
Stage 3 (Latin America, and countries in Central and Eastern Europe): As awareness of tobacco’s harmful effects increases, smoking decreases. In fact the percentage of the smoking population decreases to about 40% as many men stop smoking. This trend is more common in men with a higher educational level. However, women smokers continue to increase (marketers often target women in countries in this stage) and about 35%-45% of women have now started to smoke. However this is the peak rate for women and by the end of this stage the percentage of women smokers starts to fall.
Stage 4 (Western Europe, the United Kingdom, the United States, Canada and Australia): Smoking starts to decline slowly and steadily, for both men and women, as awareness levels about the harmful effects of tobacco consumption become known amongst the population. It is people from the lower socio-economic groups who tend to smoke more.
India is different
Although India is in the second stage of the tobacco epidemic and it is mostly men who smoke, tobacco consumption is common amongst the poor. Perhaps it is the hard life coupled with insufficient food that makes men and women from the poorer strata to turn to chewing tobacco and smoking beedis (cigarettes rolled in leaf) 57% of Indian men are tobacco consumers in India (data from the National Health Survey), as against 11% of women.
They are not mainly from the higher economic strata, at least not yet. The data below is revealing:
Tobacco consumption in India:
- Bidi smokers: 50%
- Tobacco chewers: 38%
- Cigarette smokers: 14%
Clearly, the well to do are not the main tobacco consumers in India unlike other countries in Stage 2. Beedis, which are cheaper and are stronger than cigarettes are mostly smoked by those from the lower socio-economic classes and chewing tobacco is also more common in this class.
One wonders what will happen when India reaches the third stage of the tobacco epidemic, a stage which is marked by the increase in women smokers, mainly from the higher socio-economic class. This trend is already evident in the cities. We have a huge problem…illiteracy and poverty which makes it difficult to get through to the poor on one hand, and on the other hand, the notion amongst some people that smoking is cool. If this continues India’s tobacco epidemic just might get out of control. We will get it from both ends.
I am not sure why educated and westernized people in India haven’t understood the dangers of smoking as well as their counterparts in western developed countries. When the western world lit up they were not as aware of the harm that tobacco caused. Evidence has started mounting over the years and there is a strong movement against second-hand smoke as well.
The reasons why countries tend to get mired in the second and third stages is because of a lack of education about the harmful effects of tobacco as well as weak legislation.
But as Mr. Braj Kishore Prasad (Joint Secretary from the Indian Ministry of Health and Welfare) said at the Tobacco Conference, India has excellent legislation:
- The 2003 Tobacco Control Act
- Ban on Public Smoking (2008)
- Pictorial warnings to appear on packs in May 2009, subject to the government winning the court cases against this
- Tobacco Advertising is banned
- And a five year plan in place for massive awareness campaigns
The only problem (as Mr. Prasad saw it) was that implementation can become a problem in India. To counter this he said sensitisation programmes need to be conducted at the state level so that officers are strict about implementation. This too is planned.
Well, I am not sure whether it’s lack of sensitisation or a lack of will or lack of officers to do the job which is the real problem.
Benefits of the public smoking ban:
- Air pollution decreases due to decrease in cigarette smoke.
- Helps in controlling tobacco consumption amongst people (proven by research in various countries)
Will public smoking bans lead to family members being exposed to second hand smoke (SHS)?
Fears that public smoking bans lead to increased smoking at home (and thus higher exposure of family members to SHS) are thought to be unfounded. In fact there is some evidence to the contrary as in a California study, that the “increase in the proportion of workplaces going smoke free was associated with an increase in the prevalence of smoke free homes.” However, the effect of a public smoking ban tends to vary amongst households and will certainly vary by country. Studies have also shown that if the family has more than one adult smoker the chances of a home becoming smoke-free decrease. However studies have also shown that homes with children often go (or remain) smoke-free even after a public smoking ban.
One is unsure of the effect of a public smoking ban on SHS in Indian homes. Those who smoke without elders/spouse knowing will be forced to cut down on smoking, while those who smoke openly might just hunt around for another place to smoke or do it at home.
(The picture at the conference as well as the one of the pictorial warnings on tobacco packs are by me. The last picture is a poster on the harmful effects of second-hand smoking and is from cdc.gov)
Related Reading: Asia is smoking and so are the women!
The public smoking ban should not go up in smoke
Eleven reasons why Indians are not as healthy as they should be
India has one of the highest cancer rates in the world