Srabana zonal

Dr. Srabana Misra Bhagabaty , MD Assistant Professor cum In-Charge, Department of Preventive Oncology,

Dr. B. Borooah Cancer InstituteGuwahati-16

(Presented as a guest lecture in Department of Preventive and social Medicine, Guwahati Medical College and Hospital in 2016 under BBCI year

of academic excellence )

Tobacco control program : India where we are

How it came : To India

Tobacco was introduced to India by Portuguese traders, in 16th century

Was most-commonly consumed by men and women in the form of the hookah

Not native, and was not inherent but an introduced addiction that became unfortunately one component of India’s socio-cultural behavior Dr. Srabana M

Bhagabaty

:WHY:NEED OF ADDRESSING TOBACCO ISSUE

In spite of the fact that “ Tobacco is the most preventable cause of Death” as

named by WHO

Tobacco killed 100 million people worldwide in the 20th Century

By 2030 tobacco will kill >8 million people each Year

India is the second largest producer and consumer of tobacco in the world

Dr. Srabana M Bhagabaty

Type Males Females

Tobacco 47.9 20.3

users

Smokers 24.3 2.9Smokeless 32.9 18.4

Prevalence of tobacco use (%)Global Adult Tobacco survey (GATS 2010)


GLOBAL YOUTH TOBACCO SURVEY INDIA 2009-10 (GYTS)

14.6% currently use any tobacco product (Boy = 19.0%, Girl = 8.3%) 4.4% currently smoke cigarettes (Boy = 5.8%, Girl = 2.4%)

12.5% currently use other tobacco products (Boy = 16.2%, Girl = 7.2%)

SHS exposure is moderate – one in five students live in homes where others smoke, and more than one-third of the students are exposed to smoke around others outside of the home; one-quarter of the students have at least one parent who smokes.


Why tobacco control is a real problem

• High consumption rate• Low quit rate due to its highly addictive nature Why high consumption

1. Easy Availability2. Affordability3. Gaps in stringent law implementation 4. Cultural acceptability5. Falling into nicotine trap


NICOTINE ADDICTION: the trap• A psychoactive drug affecting mood and

performance • Nicotine is:- - 1000 times more potent than alcohol - 10 – 100 times more potent than barbiturates - 5 – 10 times more potent than cocaine or

morphine•Within 10 seconds reaches brain.


Need of the hour : Tobacco control: addressing Demand and Supply reduction by

• Planning, Policy and law • Implementation• Inter-sectorial co-ordination• Awareness generation• Community participation• Community perception and acceptance

modifications


THE RESPONSE ::::::


Global partnership towards tobacco Control :Joining hands together : Demand and supply

reduction

WHO Framework Convention on Tobacco Control (WHO FCTC): 56th World Health Assembly on 21 May 2003

Signed by 168 countries (including India) and is legally binding in 180 ratifying countries(including India)


MPOWER is a policy package: FCTC(Demand and supply reduction of tobacco)

• Monitor tobacco use and prevention policies• Protect people from tobacco smoke• Offer help to quit tobacco use• Warn about the dangers of tobacco• Enforce bans on tobacco advertising,

promotion and sponsorship• Raise taxes on tobacco• Reduce the size of cigarette


Rules /policies and bans


India has been a forerunner in the Framework Convention on Tobacco Control (WHO FCTC) and was the Regional Coordinator for the South-East Asian Region

The Government of India enacted ‘Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA)

Year 2003 onwards, India has played a proactive role on the tobacco control front.


Key Provision of cigarettes and other tobacco product Act(COTPA), 2003

Ban on smoking in public places (including indoor workplaces) -Sec 4 Ban on direct and indirect advertising of tobacco products- Sec 5 Ban on sales

- Tobacco products cannot be sold to and by children <18 years – sec 6(a) - Tobacco products cannot be sold within a radius of 100 yards of

educational institutions - sec 6(b) Pictorial health warnings – sec 7 English and one or more Indian languages to be used for health

warnings on tobacco packs – sec 7 Testing and Regulation: Ingredients to be declared on tobacco product

packages (Tar and Nicotine) – sec


National tobacco control program(NTCP)Launched in

2007-08 during 11th Five Year Plan


With the following two objectives: > To bring about greater awareness about the

harmful effects of tobacco use and about the Tobacco Control Laws.

>To facilitate effective implementation of the Tobacco Control Laws. Dr. Srabana M

Bhagabaty

To fulfill obligations of

• COTPA implementation of provisions under the law• FCTC


NTCP INDIA: THE BEGINING

Pilot phase :The Ministry of Health and Family Welfare launched the of the National TobaccoControl Programme in 2007-08 in 9 states of theCountry (Assam, West Bengal, Madhya Pradesh, TamilNadu, Karnataka, Gujarat, Rajasthan, Delhi, Uttar Pradesh).



Up scaled : To across 21 states in 2008

Structure of the National Tobacco Control Programme

National tobacco

control cell

State tobacco control cell

District tobacco control cell

National level

State level

District level


The National Tobacco Control Cell (NTCC) is responsible for overall policy formulation, planning, monitoring and evaluation

of the different activities envisaged under the programme


State tobacco control cell

Does overall planning, implementation and monitoring of the different activities,

achievement of physical and financial targets planned under the programme in the State.



Structure for tobacco control program(Assam)

Director of Health Services , Assam

State Nodal Officer

Senior consultant(WHO)

District Nodal Officer, Kamrup District Nodal Officer, Jorhat

Psychologist

Social worker

Data entry Operator

PsychologistSocial worker

Data entry Operator


Where we are

Assam became the first state to legally ban consumption of all forms of smokeless tobacco, including pan masala containing tobacco and nicotine


Rules /policies and bans….

Ban on use of plastic pouches containing tobacco products by a Supreme Court verdict

April 2011


8th March 2013

• The Assam government passed an order banning manufacture and sale of gutkha and paan-masala containing tobacco and nicotine, issued under sub-section 2 of Section 30 of Food Safety and Standards Act, 2006


The Bill was tabled by the State health minister in order to ‘improve public health and prevent incidence of cancer and other health hazards and addiction among the people of the State.’

Assam : Bill on tobacco JULY 2013


R e g is te re d N o .-7 6 8 /9 7

TH E AS S AM G AZE TTE

EXTRAORDINARY

PUBLISHED BY THE AUTHORITY

i t 30 , , 11 , 2014, 22 US, 1935 ) N o . 3 0 D i sp u r , T u e s d a y , 1 1 th F e b r u a ry , 2 0 1 4 , 2 2 n d M a g h a , 1 9 3 5 (S .E .)

G O V E R N M E N T O F A S S A M O R D E R S B Y T H E G O V E R N O R

L E G IS L A T IV E D E P A R T M E N T : : : L E G IS L A T IV E B R A N C H

NOTIFICATION

T h e llth F ebru ary, 2014

N o . L G L .2 2 /2 0 1 3 /4 9 .— T h e f o l l o w i n g A c t o f t h e A s s a m L e g i s l a t iv e A s s e m b l y which received the assent of the Governor is hereby published for general information.

ASSAM ACT NO. I OF 2014

(Received the assent of the Governor on 8th February, 2014)

THE ASSAM HEALTH (PROHIBITION OF MANUFACTURING, A D V E R T I S E M E N T , T R A D E , S T O R A G E , D I S T R I B U T I O N , S A L E A N D

CONSUMPTION OF ZARDA, GUTKHA, PANMASALA ETC. C O N T A IN IN G T O B A C C O A N D / O R N IC O T I N E ) A C T , 2 0 1 3


Bill becomes act in Assam

On 13th February 2014 as

Assam Health (Prohibition of Manufacturing Trade, Advertisement, Storage, Distribution, Sale and Consumption of Zarda, Gutkha, Pan masala etc. containing Tobacco) Act, 2013.


Violators of the law are liable to be punished with imprisonment up to seven years and a fine between Rs 1 lakh and Rs 5 lakh. Consumption or possession of zarda, gutka and pan masala containing tobacco is punishable with a fine of Rs 1,000 for the first offence and Rs 2,000 for each subsequent offences.


Decreasing affordability


Hike in Value Added Taxes (VAT) on tobacco products as announced by the Assam Government,.

The State Government raised VAT on tobacco products from 13.5 per cent to 20 per cent recently.

2013To discourage tobacco smoking, VAT on cigarette, bidi, cheroots, cigar and smoking mixture has been increased to 25 percent from 20 percent.

2016-17

Hike in service tax by 10-15%

July 2011


2014

• The first smoke-free district in the state, Jorhat, is set to be showcased as a model district in the country for the National Tobacco Control Programme (NTCP). The Director General of Health Services (DGHS),


• So far, six villages in the jorhat district have been declared tobacco-free and an effort is on to create a tobacco-free district with chief minister Tarun Gogoi's constituency, Titabor, being a part of the new project.

Sahpuriya, on the outskirts of Jorhat, became the first village in the country to be declared tobacco-free in 2011 and the same year, Jorhat was the first district in the state to impose a fine for smoking in public places.


• In 2010, Sikkim was declared the first smoke-free state in India, and in 2014 Himachal Pradesh became the second.ter


• Nagaland's capital Kohima was declared as a 'smoke-free city' on April 29.

(In 2007, Chandigarh was declared the first smoke-free city of India. After this, Kottayam in Kerala and Shimla followed suit)


• Delhi and Gujarat,10 states and UTs, including Kerala, MadhyaPradesh, Punjab,Bihar, Rajasthan, Jharkhand, Chandigarh, Maharashtra, Haryana and Mizoram banned gutka by implementing the Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations-2011.


Challenges in tobacco control• Cultural acceptance• High consumption• Lack of inter sectoral co-ordination• Gaps in policy implementation Illicit trade Open land borders(more than 5000 kilometers Free movement of people and goods between countries Smuggling reported from India to Bhutan myanmar pakistan

and nepal Recent repots of involvement of few organized syndicates


NEEDRealization of health hazards of tobacco by the

Government (govt. initiatives started)

Planning (already there is a policy)

Massive public awareness efforts and stringent implementation of laws

resulting in

Persistent decline in the prevalence of tobacco in these countries


• Indicates the need for a more comprehensive approach to tobacco control within the country in terms of taxation trade economic policy and enforcement policy

• Sufficient no of tobacco de-addiction centres should be set up for those who wish to quit their habit


Lets prevent it

Contact details

• Dr.Srabana Misra Bhagabaty Email : [email protected]

Presentation download: www.slideshare.net

mailto:[email protected]

Thank you


Healthcare

Srabana zonal