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“So we have written to the government”: Doctors fight back against Big Tobacco

One of India’s leading cancer specialists has called for an investigation into the country’s tobacco lobby; its influence over the government; and efforts to derail the country’s tobacco control efforts.

A full-scale inquiry

Kailash Sharma – academic director of the Tata Memorial Hospital in Mumbai (and a member of an NGO anti-tobacco coalition) – wrote to a number of high-level government officials at the beginning of September.

The letter asks that a full-scale inquiry be launched in the country’s tobacco lobby and the extent to which it has influenced government action against public health NGOs involved in tobacco control activities. The letter’s addressees include Prime Minister Narendra Modi; Union Health Minister J. P. Nadda; Minister of Home Affairs Rajnath Singh; and National Security Advisor Ajit Doval.

“While the tobacco industry lobbies to enhance business, public health activities are lobbying to save (people) from death, disease and deprivation,” Sharma wrote.  He accuses tobacco companies of seeking to “derail the efforts of the Government of India and tarnish our image internationally.”

By Nyttend - Own work, Public Domain,
The Philip Morris Blended Leaf Complex in Richmond, Virginia, U.S.

“A sinister plan to demolish…tobacco control”

Sharma cites documents leaked earlier this year, revealing what Sharma calls “a sinister plan to demolish India’s tobacco control efforts by targeting activists and NGO.”

The leaked documents Sharma alludes to are ones published by Reuters in July. The documents reveal global tobacco giant Philip Morris International (PMI) has deliberately subverted and, in some cases, flagrantly violated India’s tobacco control regulations in recent years.

Such efforts are targeted at “winning the hearts and minds” of the 18-24 age demographic, the documents reveal. One common tactic is dispensing free cigarettes at venues frequented by young people. Another method is colourful advertising at tobacco shops and kiosks, with proprietors often being bribed to put the ads up. This is despite such promotion being prohibited under the Cigarettes and Other Tobacco Products Act (COPTA).

61177676 - indianapolis - circa august 2016: packs of marlboro cigarettes. marlboro is a product of the altria group ii Copyright: <a href=''>jetcityimage / 123RF Stock Photo</a>
Packs of Marlboro cigarettes, as sold by Philip Morris International

The Reuters exposé reports that other tobacco producers such as ITC Ltd., use similar illicit tactics. The tobacco companies in question, predictably, deny wrongdoing. Philip Morris, for one, maintains its methods are fully compliant with Indian law. Nonetheless, the revelations caused significant controversy within the Indian government. The Union  health ministry sent letters to both ITC and PMI threatening “punitive action.”

This outrage notwithstanding, there have been allegations that the tobacco industry has more influence on government than the latter is willing to admit to. Indeed, the Reuters documents include sections on how the tobacco company wishes to “influence the influencers”, “build allies across several ministries” and “engage the Prime Minister.”

Important strides – but still work to be done

A no-smoking sign in Mumbai. Tobacco control efforts have been gaining pace in India in recent years.

It is undeniable that, under the government of Narendra Modi, important strides have been made in enacting tobacco control measures. Perhaps the most notable example is pictorial warnings on tobacco product packaging. From April 1 last year, warnings had to cover 85 percent of the packaging’s principal display area. This placed India third among countries with the largest pictorial warnings on tobacco products. As a result of these measures, smoking rates are declining in the country – especially among the youth.

However, on the reverse, there still much to be done. The lack of progress in certain areas, such as taxation, has been interpreted as reluctance on the part of Modi’s government to upset the tobacco lobby too much. When Harsh Vardhan was replaced as Union Health Minister by J. P. Nadda, some viewed the former’s hardline anti-tobacco stance as one reason why he was ousted. The fact Modi’s home state is Gujarat – a major tobacco producer – only heightened such insinuations.

Arguably India’s greatest tobacco-related controversy in recent months – and the one which prompted Sharma to write his letter – is the crackdown on NGOs engaged in anti-tobacco activities. The most notable example is perhaps that of the Public Health Foundation of India (PHFI).

Crackdown on NGOs

PHFI logo, which shows its motto, knowledge to action forming the bridge between a bud and a flower ( Licensed into public domain by author/copyright holder.
Logo of the Public Health Foundation of India (PHFI), which faced scrutiny over its anti-tobacco efforts earlier this year.

As Health Issues India reported in April, the PHFI had its Foreign Contribution Regulations Act (FCRA) registration revoked. This prevents the PHFI from accessing foreign funds. This was due to alleged misuse of funds from the Bill and Melinda Gates Foundation for anti-tobacco lobbying, when they were intended for HIV control measures.

The cancellation of the PHFI’s FCRA license was described by the Financial Express as a “victory for Big Tobacco.” More recently, Bloomberg Philanthropies came under scrutiny from the Indian government for “aggressively….lobbying against an established economic activity.” Such lobbying has been described as an “unhealthy activity”. It is this designation which has drawn the ire of public health advocates.

India’s tobacco industry is a heavyweight economic player in the country. India’s is the world’s third-largest tobacco sector. It generates more than US$3 billion in revenue for the Indian exchequer each year in excise duty and foreign exchange. According to the Tobacco Institute of India (TII), it provides the livelihood of 45.7 million people.

“10 jumbo jets crashing every day”

India loses a million lives to smoking each year – “equivalent to 10 jumbo jets crashing every day”

The financial and human cost of tobacco consumption in India is significant. The Wire reports that the India loses Rs 1.04 trillion (US$15.59 billion) to smoking every year. It also loses one million lives. This represents a sixth of global tobacco deaths.

It is this enormous human impact that Dr Sharma emphasises in his letter. To illustrate the enormity of the death toll, Sharma writes “every day 3500 people die due to tobacco. That is equivalent to 10 jumbo jets crashing every day. This is the only consumer product, with no good use whatsoever, that kills every third consumer prematurely.” He further adds, “The income from tobacco is only 17% of the healthcare cost incurred for treatment of tobacco-related illnesses.”

On the stigma surrounding anti-tobacco lobbying, Sharma opines, “[the] media has reported that pro-tobacco lobbies want to impress upon the government that tobacco control is an international conspiracy. These lobbies don’t want tobacco to be banned in India. We, doctors, have a strong counter opinion. So we have written to the government.”

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