According to the Global Adult Tobacco Survey, covering 22 countries, 248 million people use smokeless tobacco in the form of gutka, iqmik or snus. A whopping 82% of them are in South-East Asian countries, majorly in India and Bangladesh. In India, 21.4% of all adults consume tobacco in smokeless form, which is a leading cause of gum disease, tooth decay, and cancer, as these products contain more than 30 carcinogens. Since smokeless tobacco products are consumed in a variety of formulations, including those with flavouring agents and alkaloids, it is challenging to regulate the use of these products.
In 2005, the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC) came into force. Legally binding in 181 countries, the treaty includes provisions for lobbying, demand reduction, regulations, packing and labeling, awareness, research and other areas for tobacco control. Although the agreement aims to address the growing tobacco epidemic, how well are its regulations implemented? A recent study has highlighted some drawbacks in the implementation of FCTC in signatory countries.
With the global efforts concentrated on curbing cigarette consumption, concerns regarding smokeless tobacco usage have been neglected.
“Due to the aggressive campaign against smoking, smokeless tobacco emerged as a cheap replacement,” says Prof. Ravi Mehrotra. He is the Chief Executive Officer of the India Cancer Research Consortium of the Indian Council for Medical Research (ICMR). “The global implementation of the WHO-FCTC measures for smokeless tobacco prevention and control has remained inadequate and varied, even in countries with a high smokeless tobacco burden,” he laments.
In the current study, published in the journal The Lancet Oncology, the researchers collected and analyzed data from various published reports such as the Global WHO FCTC Implementation Progress Reports of 2012, 2014, 2016, 2018, WHO reports on global tobacco epidemic 2013, 2015 and 2017, Global Tobacco Surveillance System Data and the WHO-NCI Monograph. They examined the prevalence, trends and policy progress in smokeless tobacco control on the lines of the WHO FCTC guidelines.
Where are countries erring?
The findings paint a sorry picture of smokeless tobacco regulation. Of the 181 countries where the treaty is followed, 138 have a well-defined usage of what constitutes smokeless tobacco, 34 report taxing smokeless tobacco products, 41 mandate pictorial warnings on these products and only 6 of them mandate that the data on pH and free nicotine in such products should be displayed.
According to Article 13 of FTCC, the signatories have to enforce a comprehensive ban of all tobacco advertising, promotion and sponsorship. However, the study found that the implementation of this article has remained slack, as shown in the graph below.
The number of countries that have taken different steps to ban smokeless tobacco advertising, promotion and sponsorship at various levels. [Data Source]
An essential aspect of kicking the habit of using smokeless tobacco is spreading education and awareness among the masses about its ill-effects. This provision is enforced by Article 12 of the FCTC, which states parties to ‘promote and strengthen public awareness of tobacco control issues’. The study found that only 65 countries had an anti-tobacco mass media campaign, and 30 of them included tobacco use prevention in the school curriculum. The study also found that not all countries have adequate support for people who intended to quit the habit.
The number of countries where different types of support are available for cessation of smokeless tobacco usage [Data Source]
“Several parties to the FCTC consider smokeless tobacco use as a regional concern limited to the South-East Asia Region alone,” explains Prof Mehrotra, talking about the gap in implementing these measures. “This issue is compounded by a scarcity of data, research, and a lack of a robust evidence base, slowing down policy progress on smokeless tobacco prevention and control,” he adds.
A 2018 study by researchers at the Tata Medical Center, Kolkata, has reported that India's progress in complying with the FCTC has been inconsistent. It found that there are significant gaps in the surveillance and noncompliance of tobacco control laws in many parts of the country. The control laws that are in place are also highly sophisticated and act as a deterrent to its successful implementation. The pro-tobacco lobbies argue against the legislation by claiming that banning tobacco production would lead to massive loss of employment and negatively impact the economy. Other ethical issues related to child labour further complicate taking actions.
The researchers of the current strongly recommend all stakeholders, both at global and regional levels, take active steps towards implementing the FCTC guidelines. Educational campaigns that dispel myths related to smokeless tobacco use are necessary too.
“The myriad ways in which smokeless tobacco can be used presents a robust concern. We need the ability to test and measure the contents of smokeless tobacco products in all regions,” concludes Prof Mehrotra.
Data presentation and visualization - Spoorthy Raman
This article has been run past the researchers, whose work is covered, to ensure accuracy.