INDIA’S BATTLE TO BAN CHEWING TOBACCO CLASS 9TH ENGLISH
In September 2010, Mahadev Prasad Sharma, a potato and onion vendor from the eastern Indian state of Bihar, was diagnosed with stage four mouth cancer. In Mumbai, where he went for surgery, the central portion of his lower jaw was removed.
Less than three years later, the cancer returned, this time as two marble sized, yellowish lumps on the inside of his left cheek. When his surgeon, Pankaj Chaturvedi, told him that the only treatment was another surgery, the 57 year old man started to sob.
He asked for the operation to be put back a month as his daughter was studying for her computer course exams and he didn’t want to give her the bad news. Mr. Sharma’s cancer is caused by chewing khaini,’ a mixture of tobacco and lime that is popular in Bihar, said his surgeon Mr. Chaturvedi, Associate Professor and head and neck surgeon at Tata Memorial Hospital in Mumbai.
Around 14% of Indian adults smoke cigarettes and beedis’ (hand-rolled cigarettes), but nearly 26% use smokeless tobacco, including chewing tobacco, according to the Government of India and World Health Organization Global Adult Tobacco Survey of 2009-2010.
Approximately 85% of the oral cancer patients I treat are either smokers or tobacco chewers, Mr. Chaturvedi said, After years of treating thousands of patients, I decided to take action to stop people from using a substance that is proven to cause cancer, the surgeon added.
He launched a campaign called Voices of Tobacco Victims in 2008 to advocate for more stringent tobacco control in India. The campaign empowers cancer survivors to tell their stories to influence policy makers and raise awareness among other tobacco users about the damaging effects of tobacco on health.
The campaign’s greatest success has been to ban the manufacture, storage, distribution and sale of gutka,’ a form of chewing tobacco commonly consumed in India.
The opportunity to advocate for the gutka ban arose with the Food Safety and Standards Act of 2011, under which the central government prohibited the use of tobacco and nicotine as ingredients in any food product.
Gutka is a crushed preparation of tobacco and paan masala,’ a mixture of areca or betel nut, sugar, spices and perfume.
Under the FSSA, gutka can be categorized as a food product, and therefore should not contain substances injurious to health, like tobacco.
The implementation of the FSSA lies with the health ministry of each state. Voices of Tobacco Victims directed its efforts to have the gutka ban implemented at state legislatures and in April 2012, Madhya Pradesh became the first Indian state to ban gutka, said Mr. Chaturvedi.
With the support of other doctors and cancer survivors, he launched similar campaigns and filed public interest litigations in other states and union territories. This month, Karnataka became the last Indian state to make the manufacture and sale of gutka illegal.
The ban’s effect on stopping Indians from chewing tobacco is limited. Pure chewing tobacco and paan masala continue to be sold as two separate packets that users can mix for themselves before consumption, according to Mr. Chaturvedi.
But (the ban) has drawn widespread attention to the public health epidemic tobacco has caused. Until it was banned, gutka was marketed as a mouth freshener to target youth, he added.
In the western Indian state of Maharashtra, the ban on gutka has been more effective than in other states because the manufacture and sale of paan masala has also been prohibited since July 2012.
In Maharashtra, manufacturing units of gutka and paan masala have been closed and the state government has seized 16 crore rupees ($ 2.9 million) worth of tobacco products, more than all other states combined, said Mahesh Zagade, Commissioner of the Food and Drug Administration in Maharashtra.
There are no figures for the decrease in consumption yet… but the general perception is that consumption of gutka and paan masala has significantly decreased, he said. However, boundaries between Indian states are porous, and paan masala that is manufactured in other states can illegally be brought into Maharashtra, Mr. Zagade added.
The Maharashtra FDA must also submit a report to the state government each year to renew the ban on paan masala. This is because it is banned under a different section of the FSSA than the one that bans gutka. Paan masala has addictive and carcinogenic properties itself, but it is prohibited because its magnesium carbonate content is above the permissible level. The Food Commissioner needs to demonstrate annually if the amount of magnesium carbonate is above the permissible level. The state ban on paan masala is up for renewal on July 19.
Many children are as young as 12 when first exposed to gutka and paan masala… they don’t even know what cancer is, and by the time they realize it is bad for their health, they can’t stop, said Mr. Chaturvedi.
Once diagnosed with cancer, even if a patient stops chewing tobacco, the genetic damage is irreversible, he added.
Patients stream into his clinic, their faces disfigured and stitches running from their lips to necks. Many have had part or all of the tongue removed and can barely speak. Pradeep Kumar Sharma, a 52 year old coalfield worker from Madhya Pradesh, has been consuming liquids through a tube in his nose since March. A patch of flesh the size of a golf ball was removed from his thigh to replace cancerous cells in his cheek.
He’s in a lot of pain. But his children and I are in even more pain… they used to beg him not to chew gutka but he never listened, said his wife, Durga Sharma.