I watch the Indian Premier League (IPL) every few days — especially to follow the fortunes of the Delhi Capitals. What strikes me, however, is what happens between overs.
The IPL has a huge viewership — the largest among contemporary offerings and perhaps the highest among all sporting events. The advertisements between overs can obviously be afforded only by firms and products with a pan-India reach and high commercial sales. They are majorly dominated by either gambling apps or “elaichi” and “masala” products. What does that say about our consumption patterns — and the businesses that can afford these commercials?
Gambling apps are at least followed by a rapidly-spoken, half-understood disclaimer. The entertainment and sporting icons who glamourise the use of elaichi/masala pouches do not need a similar disclaimer because they are supposedly advertising a non-harmful and non-addictive substance. But is it not obvious that this is a form of surrogate advertisement for oral tobacco? It may be legal, but is it ethical?
Much of the conversation on tobacco has focused on smoking and, recently, on “vapes”. But tobacco consumption in India is mainly through smokeless tobacco (oral tobacco). The Global Adult Tobacco Survey (GATS 2017) revealed that 29 per cent of people over 15 in India consume tobacco. There are twice as many oral tobacco consumers (21 per cent of the adult population) as those who smoke tobacco (10.7 per cent).
We are global leaders in oral tobacco consumption, and the only region with prevalence rates exceeding 20 per cent. Is it any surprise then that we are also the region with the highest prevalence of mouth cancer? Not only do we have the highest incidence of mouth cancer and head-neck cancer, but the rates of these cancers are estimated to be increasing at a compound annual growth rate of 23 per cent. This increase has paralleled the rising use of pouched tobacco.
The Indian state has proactively moved against tobacco. The ban on smoking in public spaces and regular increases in the price of cigarettes did decrease smoking — but led to the shift of the consumer towards oral tobacco. Since 2011, a ban on the production and sale of gutka (masala mixed with tobacco) has been legislated by most Indian states. These bans are, however, not easily enforced and have also been challenged in court — with occasional success.
Tobacco cannot be eradicated by bans. Nicotine, one of the active alkaloids in it, is among the most addictive products consumed. Once addicted, people need to feed their craving. The GATS survey informs us that 92 per cent of consumers of tobacco are well informed of its harmful effects. Many wish to discontinue — but cannot. Once consumed regularly for a few months, dependence on nicotine necessitates further consumption.
At the level of the street corner retailer, it is usual for the masala/flavoured mouth freshener to be sold with a small quantity of low-priced or free oral tobacco (colloquially called “chotu”). The consumer merely has to mix the two.
Victims of tobacco continue to invite heart disease, strokes, lung disease, oral cancer, lung cancer, bladder cancer, esophageal and gastric cancer. Their chemical dependence on nicotine makes it difficult for them to quit tobacco even if they wish to.
The real hope for reducing tobacco use lies in education and prevention of nicotine addiction. There has been a modest decrease in tobacco consumption in India between the two GATS surveys of 2010 and 2017. The percentage of the adult population consuming tobacco has decreased from 34.6 per cent to 28.6 per cent. This decrease is very marked in the younger ages (15-17 years), but minimal in older age groups. This further confirms that moving people already dependent on nicotine away from it is difficult. It is easier to dissuade the young from adopting tobacco. Education is key. The endorsement of masala by our icons flies in the face of these efforts.
Tobacco devastates families, it devastates consumers. Fifty per cent of users die of a tobacco-related illness. Tobacco use can decrease life spans by one decade. In India, tobacco-related cancers represent 42 per cent of male and 18 per cent of female cancer deaths at ages 30-69 years. It is the largest contributor to premature death. These deaths are preventable.
We cannot let the next generation follow the previous ones. Our idols need to join us to spread the very opposite message — that tobacco is addictive and the greatest long-term threat to young people’s health.
The writer is Professor of Head-Neck Oncology & Head of the National Cancer Institute at AIIMS, New Delhi
