Dr Nandita Murukutla: Large graphic warnings will benefit every Indian

A report tabled today by a parliamentary panel suggests reducing anti-tobacco pictorial warnings from proposed 85% to 50%. Gory photos don’t elicit awareness, it argues. A behavioural scientist on why that’s plain claptrap

The debate about graphic health warnings (GHWs) on tobacco packs should be of urgent interest to every person who wants to see India achieve its economic potential. India currently loses 6 per cent of its annual GDP to preventable illnesses and premature deaths. Chronic diseases caused by tobacco use — heart disease, cancers, chronic respiratory illness and diabetes — are responsible for 60 per cent of deaths, 40 per cent of hospital stays and 35 per cent of outpatient visits.

The World Health Organization (WHO) says that ill health pushes 2.2 per cent of Indians into poverty each year. The Harvard School of Public Health found that chronic diseases would cost India $4.58 trillion in economic losses by 2030. And yet, the latest National Family Health Survey shows that there are still millions of tobacco users in India.

Graphic health warnings work in both, developed countries and emerging economies. Canada was the first country to implement graphic warnings and found a significant reduction in tobacco use. South Asia, Singapore and Thailand use large GHWs to increase awareness of the harms of second-hand smoke exposure and prompt quitting. Nepal implemented warnings covering 90 per cent of the pack, even as the country was rebuilding after a devastating earthquake. This month, Myanmar, despite all its challenges, announced it would implement large GHWs on all tobacco products. Yet, India waits.

Countries must fight tobacco industry interference. It is worrying that Deloitte’s report, commissioned and funded by British American Tobacco (one of the world’s richest multinational tobacco businesses), is being used [by the parliamentary panel] to argue the case against graphic warnings. This report scientifically rebutted on its publication in May 2011, is out of date, and contradicts evidence in favour of GHWs amassed from the now 78 countries that implement such warnings.

There is also a contradiction in the tobacco industry’s argument that GHWs have no impact, while also claiming that millions of livelihoods will be impacted. Dire warnings around illicit trade are also a smokescreen to take the focus off health; a number of tobacco companies have been prosecuted for fuelling illicit trade. Remember, this is the same industry that knew for decades that its products harmed health, but claimed the exact opposite in courts of law, in discussions with governments and in the media – all to protect its profits.

The interests of the industry and health are entirely incompatible. There is no risk-free exposure to tobacco. Even handling tobacco can lead to nicotine absorption and a type of nicotine poisoning known as green tobacco sickness. The tobacco industry therefore puts not just those who consume tobacco at harm, but also the poor and exploited people who try to make a livelihood out of tobacco farming and work.

The only beneficiaries from the delay in implementing GHWs is the tobacco lobby that wants to profit from India’s growing wealth, and doesn’t care that its products cause harm. That’s why WHO recommends keeping tobacco away from discussions about health policy, including graphic warnings.

Large graphic warnings are easily understood by the young, the poor and people with low levels of literacy. They serve as a reminder, every time a person reaches for that tobacco pack, of the grave illness that can lie ahead. The industry doesn’t want people to be reminded of that. It’s bad for business.

India made a commitment internationally to implement WHO’s Framework Convention on Tobacco Control (FCTC), a global health treaty whose central recommendations include graphic health warnings.

At the last Conference of the Parties to the FCTC in Moscow, India announced its intention to implement 85 per cent graphic health warnings, among the largest in the world. On the eve of this year’s meeting of the parties to the FCTC (being held in India), it’s time for India to deliver on that previous commitment, to protect its citizens from harm and ensure its economic potential is not sacrificed in the tobacco industry’s pursuit of profit.

The writer is country director, India, and Director for global research, Policy Advocacy and Communication Division of Vital Strategies

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