In recent decades, India's healthcare policy can scarcely be described as pro-poor. Caught between the proliferation of expensive private hospitals and a crumbling public healthcare system, poor Indians have increasingly been elbowed out of a basic right to health. That is why the Indian government's proposal to ban the sale of loose cigarettes should deserve praise. It represents a simple and progressive means of delivering healthcare to the population without incurring vast costs. Roughly 70 per cent of cigarette sales are in loose form and the biggest buyers of single sticks are low-income people (rich people usually buy singles in a vain attempt at cutting back or gradually kicking the habit). They remain not only at the highest risk of contracting lung disease from smoking but lack the wherewithal to finance adequate treatment, given that cancer treatment can easily run into lakhs of rupees. A humongous 90,000 to 100,000 people in India die every year because of health complications caused by tobacco consumption, according to International Tobacco Control Project. That's about 1.5 per cent of the six million people who die such deaths worldwide, according to World Health Organization (WHO) statistics. Worse, not all of these deaths are the direct result of using tobacco products but of passive smoking. In this, women from low-income families, already suffering the effects of inhaling noxious fumes from chulhas are major victims, followed by children.
The proposed ban on loose cigarette sales, which is expected to be followed by more stringent prohibitions on smoking in public places and punitive fines, are part of India's commitments to the WHO's global anti-smoking campaign. They mark a continuation of policies introduced by Anbumani Ramadoss, health minister in the United Progressive Alliance's first stint in power, imposing stringent norms on tobacco and alcohol sales and advertising in India (including the graphic pictorial warnings on cigarette packets). Nor have they been entirely fruitless. The WHO estimates suggest that such bans and warnings can reduce tobacco consumption by up to 16 per cent.
As always, however, success lies in its enforcement. Like gutka and other forms of chewing tobacco, single cigarette sticks are sold in over eight million outlets, the bulk of them makeshift roadside shacks. Will the government really be able to monitor these? The way the ban on gutka has panned out suggests there are challenges. The fact that beedis seem to have somehow escaped all strictures is something the government also needs to consider. Such measures would be even more effective if they became part of a comprehensive public health policy that included addressing issues arising out of alcoholism, air pollution and lack of public cleanliness. For example, more stringent enforcement of laws against spitting - a huge and largely ignored cause of the spread of infectious diseases - is one and the prime minister's Swachh Bharat campaign provides a ready-made platform for it. Then there's air pollution, for which the solution of scrapping fuel subsidies has been glaringly obvious for at least two decades. But that remains in the grip of so many vested interests that Indians are destined to be struggling for air for many years to come, even if they all stop smoking.
