Clamping down on second-hand smoke

There has been a lot of hype around the Indian government's ban on smoking in public places. The various health and social benefits of the ban have been over-represented in virtually every kind of media. Nearly everyone has confused the possibility of achieving these benefits with the actual reality on the ground. The simple fact is, many smokers behave as if they have never heard of the ban. They continue to smoke blatantly, even arguing that the Health Minister Anbumani Ramadoss has no right to tell them how to live their life.

This is possible mainly because enforcement of the ban is very poor. On the very first day, there was some sketchy reports of people being fined by the police, but those quickly died down. The Centre, in its usual style, has imposed the ban, but left it to the states to enforce it. Most states have not bothered to do anything of this sort. Even the Delhi government does not seem to care much for enforcing the ban; it is more worried about the impending assembly elections.

An important impetus behind the ban on smoking is the need to protect non-smokers from harmful effects. It is not widely known that smoke that is exhaled by smokers is dangerous to those around them. Cigarette smoke floating around smokers, better known as 'second hand smoke', has the potential to afflict other with chronic disease, and even the risk of death under prolonged exposure. Tobacco smoke is a complex mixture of more than 4000 chemical compounds, including 69 known carcinogens that are released into the air.

Those who live with smokers face particularly high risks, as they are constantly exposed to this passive smoke. Asthma patients too face a higher risk of attacks in smoky atmospheres. And children have no choice but to silently suffer as adults smoke around them. A 2008 study of children in Singapore found that children with family members who smoked were at more risk of developing asthma and allergies than others. The Global Youth Tobacco Survey showed that approximately 40 per cent of Indian youth between t he ages of 13 and 15 were exposed to tobacco smoke outside their homes.

Superficially separating the smokers from non-smokers in a restaurant or office is not enough, as second hand smoke floats around to do the damage. Exposure to second hand smoke in the workplace is estimated by the International Labor Organisation to cause approximately 200,000 deaths per year worldwide.

Such numbers have certainly led to a principled blanket ban on smoking, coupled with fairly strict norms for any exceptions that are permitted. Currently, hotels with 30 or more rooms, or restaurants with 30 or more tables can have a smoking area. The latest rules differ in the sense that smoking areas in these places now have to be physically separated with full height walls, automatically closing doors, and separate negative air pressure to not allow smoke to drift outwards. This space is also to be established solely for the purposes of smoking, and no other services will be allowed in such areas.

The scientific evidence on health risks of second-hand smoke indicates that it is a cause of lung cancer, heart disease, low birth weight and chronic lung ailments such as bronchitis and asthma. A 2004 study published in the British Medical Journal found that exposure to second-hand smoke increases the risk of heart disease among non-smokers by as much as 60 per cent. A report of the World Health Organization's International Agency for Research on cancer bears this out. Says Dr. Margaret Chan, Director General, World Health Organisation: "The evidence is clear. There is no safe level of exposure to second hand tobacco smoke." Chan urged all countries to take action to protect the health of all by passing laws requiring all indoor workplaces and public places to be 100 per cent smoke free."

Published studies of the immediate effects of smoking bans on hospital admissions for acute myocardial infarctions have found that admission rates dropped significantly in cities in the United States, Italy and Ireland. After a smoking ban was legislated in Scotland, there was a 17 per cent reduction in hospital admissions for acute coronary illnesses.

With the newly enacted ban on smoking, India is now in-line with health policies in developed countries, where such bans have been in place for some years now. Most of those countries had chosen to enact their bans, despite significant revenues that were accruing to their treasuries from taxes on the tobacco industry. The health benefits, they decided, far outweighed the revenues from such taxes. Unfortunately, the government's position in India is not sufficiently progressive; most states still are largely more interested in tax revenues from cigarette sales in toeing the health agenda of the Centre.

This is regrettable, because in sheer economic terms too, a ban on smoking could be justified. Apart from the human costs of smoking, the economic costs of smoking in India are also staggering. The annual health costs for treating tobacco related cancers, coronary artery disease and chronic obstructive lung disease is conservatively estimated at Rs.27,700 crores.

Another important weapon in the battle against smoking is the Control of Tobacco Products Act, commonly known as COTPA, which came into effect in 2004. The Act covers prohibition of advertisement and regulation of trade and commerce, production supply and distribution of tobacco products. This has been fairly effective in curbing the direct marketing efforts of tobacco companies, but has not stopped them from marketing surrogate goods (clothing, for example) carrying the same brand names as the cigarettes whose advertising is prohibited. Alcohol companies too have taken to this track, and 'bottled water' of various brands is now freely advertised by many whose core business interests are in alcohol itself.

The Advertising Standards Council of India has been lax to clamp down on such breaches, although these are clearly evident even to lay observers. Critics have pointed to some of ASCI's failures as evidence that self-regulation does not work (the council is largely composed of advertising professionals themselves, and its efforts are mainly in the form of voluntarily agreed restraints on advertising, rather than true external accountability).