Tobacco-Related Deaths on the Rise in India

By Dr Debanjan Banerjee, Geriatric Psychiatrist, NIMHANS

Edited by Didhiti Ghosh, Bureau Chief (Kolkata), IOP

Kolkata / Bangalore, June 2, 2019: Of the more than 6 million tobacco-related deaths every year across the world, one-sixth occurs in India alone. Experts see the total tobacco-related deaths rising to 8 million by 2030. This year, the focus of World No Tobacco Day, an initiative on the part of the World Health Organization is on "tobacco and lung health," celebrated on 31st May. The campaign wishes to raise awareness on the negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease and the fundamental role that lungs play for the health and well-being of all people.

Introduced in India first in the 17th century, the practice of smoking tobacco merged with the age-old habit of smoking cannabis. Tobacco in the form of cigars, cigarettes, bidis, grounded betel nut (chewable), khaini and snuff form the bulk of its usage in India.

In India alone, every third adult consumes some form of tobacco. Bidis are the most commonly consumed tobacco product and are primarily consumed by the poor. Bidis alone contributed to 5.8 lakh deaths in the country in 2011.

The World Health Organization (WHO) estimates around 125 million smokers in India and around 72% of all males have used tobacco in any form at least once in their lifetime. The National Mental Health Survey (NMHS) conducted in 2015-16 showed 21% of the entire Indian population using tobacco with the male: female ratio being 4:1. The concerning fact is that second-hand tobacco smoke affects even more people and the young economically-productive population are amongst the most affected. The Indian Heart Association (IHA) in its 2015 report states that India contributes to 75% of the world’s cardiac deaths even though it consists of only 20% of the world population.

Talking to Didhiti Ghosh, Prof Anand Kumar, President of the Indian Academy of Health Psychology remarked, “One of the cardinal reasons for tobacco abuse is stress, which acts as a gateway to gain peer approval. Primarily a habit, the act then becomes an addiction, and ends up causing physical cravings or dependency.”

The sad part of parents and family emotionally abusing the dependent individual to stop the act without taking a deeper indulgence to their mental state results in further defence on the latter’s part.

The damaging effects of tobacco include chronic obstructive lung disease, bronchitis, lung cancer, ischemic heart disease, angina (conditions arising from decreased blood supply to the heart and consequently infarction or heart attack), hypertension, and brain stroke, apart from increases the risk of dementia.

The physical and cognitive functions affected by tobacco use include decreased thinking and processing speed, general physical ability and muscle strength. As these effects are usually sub-threshold and do not manifest as frank illness till late, they are often undetected and eventually the body gets easily vulnerable to the effect of other diseases.

Nicotine, the chemical constituent of tobacco, acts on the “reward centre” of the brain (responsible for feeling good experiences) to release a chemical called dopamine (the “feel happy” substance in the body) to give a “kick” which ultimately leads to the addictive habit.

Tobacco doesn't harm the individual alone, but also affects national economies through increased healthcare costs and decreased productivity. It worsens health inequalities and exacerbates poverty, says a report published in the Times of India.

The Indian Council of Medical Research (ICMR) says that tobacco accounts for about 30 per cent of all cancers in men and women in India. Mouth cancer is most common among men followed by lung cancer. Tobacco-related cancer accounts for 42 per cent of all male deaths due to cancer and 18.3 per cent of all female deaths.

Of the 4,800 chemicals used in tobacco, 69 are known to cause cancer. Smoking tobacco releases carbon monoxide which blends haemoglobin in the blood more easily than oxygen does, thus reducing the amount of oxygen circulating in the body.

Unfortunately, “smoking” is considered to be equivalent of “smartness” in many societies, millions of young people succumb to its first use only on experimentation or peer pressure and subsequently get trapped in the vicious cycle of addiction. In fact, tobacco is known to be a gateway substance, i.e. an addictive product that can slowly lead to other addictions, which is quite correct. Cannabis and alcohol are the two commonest addictions that easily develop after the person has early and heavy tobacco use.

The optimistic part, however, is that after the complete cessation of its use even in heavy users, in 60-70% of cases these effects are almost completely reversible in 5-10 years.

The Indian Government with the introduction of the Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975 was the first legislation to come which led to the mandatory statutory warnings on the cigarette packs. It eventually gave way to the Cigarettes and Other Tobacco Products Act (COTPA), 2003 which was extended to all forms of tobacco-containing products.

The National Tobacco Control Program (NTCP) of the Central Government is the cornerstone of surveillance, policy making and also awareness and training related to tobacco use. There are established treatments for quitting tobacco which include counselling, nicotine-replacement strategies (gums, lozenges, patches, spray, etc) and medicines. Psychiatrists and psychologists mainly deal with the de-addiction process, however, the onus lies on all physicians and social workers to help in this regard. There are training programs run by the Centre for the general practitioners and dentists to detect tobacco-related problems at the earliest and refer for the required help.

Despite the ban on advertising and sale of tobacco products to minors and smoking in public places, India has however remained one of the world's weakest regime for warning people against the use of tobacco. The country slid from a ranking of 123 to 136 among 198 countries in 2012 based on the extent of their system to warn about health hazards, as per a report by the Canadian Cancer Society.

The cleaner way forward seems to lie more in the motivation to conquer the ill effects of this silent and legal killer, with lesser hopes from tough mandates alone. 

Image Courtesy: Medical News Today, PBS, The Nation

(Dr Debanjan Banerjee is a practising psychiatrist at the Geriatric Unit of NIMHANS and specializes in ageing and old-age related mental health. E-mail: dr.djan88@gmail.com)

(DIDHITI GHOSH is an India Columnist at La Agencia Mundial de Prensa, USA, and is the Bureau Chief of Indian Observer Post based in Kolkata. E-mail: didhiti.24@gmail.com | LinkedIn: https://bit.ly/2H6gNAv).