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Editorial
TOBACCO RESEARCH IN INDIA
Tobacco use is the single most preventable cause of adult death and disease in the world today. This fact has been accepted and is being emphasized by the World Health Organization and all other agencies concerned with human health in the world. The scientific evidence on which this statement is based is overwhelming. There is more scientific evidence on health effects of tobacco use then perhaps any other substance. In addition, nicotine, the main pharmacologic agent in tobacco, is one of the most addictive substances known to mankind. It has been established that the primary reason for using any tobacco product by a habitual user is to satisfy physiologic requirement of nicotine. The tobacco plant has existed for thousands of years in South America. When Columbus landed in the New World on 11 October 1492, he was offered golden tobacco leaves as a courtesy, but he threw them away. Some of his followers, it is said, picked up the leaves and brought them back to the Old World. Tobacco use spread with remarkable rapidity and today tobacco is cultivated and tobacco products are manufactured in almost all parts of the world. A large area in India is used for tobacco cultivation (406000 hectares) although it forms a small percentage (0.2%) of the overall (181 million hectares) cultivated area (0.2%). India is the second largest producer of tobacco in the world producing about 576200 metric tons of tobacco. Globally, cigarette smoking is the dominant form of tobacco use. In Indian context, the tobacco use implies the use of tobacco in any form of chewing or smoking. Smoking and chewing habits however, differ a great deal in different parts of India. Different types of smoking habits such as bidi and cigarette and chewing habits such as khaini, mawa, and betel quid differ even more in different parts of the country. In general, men smoke as well
as chew tobacco whereas women generally only chew tobacco with exception of few areas where prevalence of smoking among women is high. In coastal areas of Andhra Pradesh and Orissa, women smoke cheroot (called chutta) in a reverse manner (i.e. with glowing end inside the mouth) and in some northern parts of India, women often smoke hukkah or hubble-bubble. Among men, cigarette smoking is largely confined to urban areas whereas in rural areas men mostly smoke bidi. A total of about 100 billion cigarettes are manufactured in India. The production of bidi is much higher, about 850 billion pieces. A considerable amount of tobacco is used for other forms of smoking such as in hookah or as chutta in specific geographic areas. Tobacco is used in a wide variety of smokeless (chewing, applying, dipping etc.) forms, some of which are manufactured. The smokeless tobacco industry in the form of gutka and pan masala, has grown in recent years to several hundred million US dollars in last two to three decades. The cigarette industry is dominated by the subsidiaries of the multinational British American Tobacco. The India Tobacco Company controls nearly two thirds of the cigarette market and another subsidiary Vazir Sultan Tobacco, grabs additional 15% market share. Godfrey Philips which is a subsidiary of another multinational, Philip Morris, controls about 11% of the market share. The only other large cigarette company is Golden Tobacco. Tobacco employs a large number of people numbering into several millions. Major employers are tobacco products like bidi and chutta that are hand made and they are quite often made at home. The manufacturer supplies necessary ingredients, collects, manufactured bidis and pays on the basis of number of bidis made. At times the whole household including women and children, chip in.
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Indian Journal of Public Health
Most of the global research on tobacco is concerned with smoking. Smoking causes a vast spectrum of diseases, many of which could result in death. There are over 50 diseases that are caused, increased or exacerbated by smoking. In addition to well known four major categories: cancer; respiratory diseases; circulatory diseases; and, digestive diseases; the list encompasses diseases of reproductive system, digestive system, endocrine – digestive Systems, sensory & nervous system, skeletal system, muscular system, and skin. These disease lists are dynamic, as research expands they increase. For example – there have been many recent results on delayed wound healing among smokers after surgery. The conventional wisdom is that schizophrenics smoke because it reduces their symptoms. Recent evidence however suggests that smoking may be a factor in causing schizophrenia. During June, 2002 the International Agency for Research on Cancer, 2002 gave announced a much larger list of cancers caused by smoking after a comprehensive evaluation of evidence in the literature. The use of tobacco imposes major health consequences. Globally, an estimated 4 million deaths are caused by tobacco every year—3 million in the industrialized countries and 1 million in the developing world. There is a lag period of several decades between the initiation of tobacco use and the appearance of health effects. Therefore, the current mortality is the result of the use of tobacco several decades earlier. On the basis of the current use of tobacco, it is projected that by 2030, some 10
Vol.XXXXVIII No.3
July - Sept, 2004
104
million deaths every year will be caused by tobacco, about 4 million in the industrialized and 6 million in developing countries. While most industrialized countries have made major strides in their tobacco control efforts, in many developing countries the use of tobacco is still increasing. These statistics emphasize the need to place tobacco control high on the public health agendas of developing countries India has taken major strides in recent years in the area of tobacco control. The first international treaty on public health proposed by the World Health Organisation, the Framework Convention on Tobacco Control was vigorously discussed by countries during 2000-03. India was a vocal proponent of a strong treaty and took an active role in developing it. Also, it was one of the first few countries to sign as well as ratify the treaty. Indian Government passed a comprehensive tobacco control act in 2003. Parts of the Act have been enforced from May 1, 2004. These parts deal with a complete ban on advertisement of all tobacco products in all media, ban on smoking in public places and ban on sell of tobacco products to minors. Research conducted in India has played a crucial role in formulation of tobacco control policies and would play important role in successful implementation and further enhancement of these policies. It is also clear that while ascertaining health parameters of any country or the region, the extent of the use of tobacco would form an extremely important component. With these thoughts this special issue on tobacco research in India is presented.
PC Gupta DN Sinha
