(Tiré de Info-tabac no 78, mai 2009)
Conference in Mumbai
Tobacco continues to ravage the developing world, but a counter-attack is being organized
By Pierre Croteau
The Indian hosts of the 14th World Conference on Tobacco OR Health were relieved to welcome over 2,000 men and women who came to take part in the event in Mumbai, on March 8, 2009.
Like Dr. Prakash C. Gupta and the conference’s organization committee, everyone was still thinking about the shootings, explosions and hostage takings that occurred between November 26 and 29 in 2008 at Mumbai Central Station, in two luxury hotels, and in other places around the city. During those four days, Pakistani terrorists killed 136 Indians, 28 tourists from ten foreign countries, and wounded 293 other people. A war between India and Pakistan could well have resulted of this tragedy, but in the spirit of Mahatma Gandhi, a round was won. We can breathe again, even if it is the polluted air of Bombay; the city was officially renamed Mumbai in 1995.
Between the 8th and the 12th of March 2009, conference participants from over 90 countries and every continent gathered in India’s populous and feverish financial, commercial and film metropolis (Note: Mumbai and its suburbs totalled close to 20 million inhabitants in 2008, making it the most populous city in India. According to forecasts, it will be the largest urban agglomeration in the world by the year 2020.) to speak seriously and even studiously, of another great reaper of the human kind – one more discrete and insidious than war: the smoking epidemic.
According to a clever summary of national estimations carried out by the World Health Organization (WHO), this epidemic has already claimed 100 million lives during the 20th century. The death toll by far exceeds that of the two world wars combined. In addition, according to the WHO, if this trend continues in developing countries, where most of the world’s population lives, smoking could cause over a billion deaths in the 21st century.
India Is Eternal, Indians Are Not
With its 1.1 billion inhabitants and life expectancies of 61.8 years for men and 63.8 for women, life expectancies well exceeded in Quebec and Canada in the early 1940’s, and with India’s average national income per person 41 times lower than in Canada, India did not wait to become rich before debating and waging war against smoke and tobacco.
Already, in developing countries such as China, India, Indonesia, Bangladesh, Brazil or Mexico, six countries with over 100 million residents each, between 15% and 20% of all adult male deaths are due to smoking, and tobacco causes illness to even more people than it kills. Even if public awareness has not reached the same level as in North America and Western Europe, more and more ordinary people, including smokers, know that tobacco consumption causes health problems. When Indian Health Minister, Dr. Anbumani Ramadoss talked about smoking without looking at his notes or using a teleprompter, with knowledge worthy of a specialist, many participants at the Mumbai conference listening to the opening ceremony, may well have hoped to find this eloquence in more elected representatives in their own countries.
Protecting and Discouraging
Since October 2, 2008, a smoking ban has been in force in all Indian public areas including restaurants, inns, entertainment facilities, stadiums, stations, educational institutions, hospitals, and workplaces in general. A survey has shown that 94% of the adult population of India’s four largest cities supports this measure. Unfortunately, a previous ban voted for by the Union Parliament of India in 2003, remained ineffective throughout the country mainly due to the lack of precise directives that were to be sent to the 28 states and local authorities. This time, directives aimed at applying the law seem to be well set and delinquents have already been fined. As in the past in New York, or more recently in Quebec and Italy, café, bar and discotheque operators in Delhi, Mumbai and Kolkata today are shouting economic assassination, while others already see the long term interests in non-smoking businesses.
According to the 2009 Tobacco Atlas, taxes represent about 69% of the price of a package of cigarettes in India, proportionately comparable to the Canadian average. As the British epidemiologist Richard Peto and the American economist Hana Ross explained during the conference – according to historical data from the United Kingdom, France and the United States – a high taxation level on tobacco products has been, until now, the safest and most powerful means to cure tons of smokers of their drug addiction. However, in India as elsewhere, we know that prevention is better than a cure.
Denormalizing and Warning
In a country that annually produces more hours of film than the United States, the Indian Republic government passed a ban on showing smoking scenes in 2003. India is, however, a liberal democracy and after long disputes before the courts, the Delhi High Court judged, in January 2009, that this violated moviemakers’ rights to freedom of expression. Supporters of tobacco control now hope that the Indian film production and television industry, nicknamed “Bollywood,” will be responsible and follow a code of conduct, since there are many smokers on the country’s screens, even more so than in the actual population.
In India, 33% of adult men smoke either cigarettes, as we know them in America, beedis (a type of Indian cigarette less standardized but considered more toxic by experts), or other tobacco products. Among adult women, the proportion of smokers doesn’t even reach 4%. Such a difference between the prevalence of smoking among men and women is very common in Asia and Africa. For example, 59.5% of adult Chinese men smoke compared to only 3.7% of adult Chinese women. In addition, plug tobacco is very popular among women as well as men in several rural areas of India. India is the world’s third largest producer of tobacco.
In the Tobacco Kills magazine, which is published by the India Action Council against Tobacco (ACT), one of the host organizations of the Mumbai conference, it is reported that Indian health groups have denounced the postponement of the obligation to affix illustrated warning labels on packages of tobacco products. This postponement is attributable to the fact that some Indian ministers found the images proposed by the Department of Health to be too strong. Partisans of public health also wonder what language to use for warning labels written on packages, because in spite of school programs, most Indians do not understand English, as pointed out by Editor in Chief of Tobacco Kills, Sushil Silvano.
In the end, British American Tobacco, Philip Morris, Imperial, and other cigarette multinationals are not the only propagators of false economic arguments aimed at slowing down the tobacco control process. Furthermore, in this year of congressional elections, which surveys have predicted to be tight, it is certainly not easy for the Union government to tell the Indian beedi and cigarette manufacturers: “Quit India!” as M. K. Gandhi (1869-1948) told the British before the country’s independence.
Not easy to say, although not impossible to achieve with some determination and a strategic mind, in the country where the game of chess was invented. The Indian experience will continue to be observed with strong interest by developing countries and wealthy countries alike.
A Colourful Conference
In addition to speeches, the opening and closing ceremonies of the 14th World Conference on Tobacco OR Health gave way to music and dance. Musicians of India’s navy demonstrated that they could attract an audience with the sound of a clarinet and a saxophone when they were not on duty. Children from the most unprivileged classes in Mumbai, who are supported and trained in their artistic projects by the Salaam Bombay Foundation, put on a show of song and dance. The Salaam Bombay Foundation, which hosted the Mumbai conference along with the Healis Sekhsaria Institute for Public Health and the previously mentioned ACT, is devoted to the civic education of children and has been leading a campaign for the prevention of smoking since 2002, particularly in Maharastra, the Indian state of which Mumbai is the capital city.
Along with eight hemi-plenaries, nine panels and 33 smaller symposiums, the Mumbai conference also welcomed kiosks from international, foreign and Indian organizations. It also allowed for the display of posters from dozens of countries from around the world and encouraged informal contacts between those that are concerned with public health.
The many subjects that were covered during expert communications included some of the different diseases caused by smoking; mortality, morbidity and loss of productivity among the population; and measures taken by various states to offset or ban the publicity of tobacco products, event sponsorship by the industry and the indirect promotion of smoking.
Speeches also covered topics such as the protection of non-smokers in different places, the environmental costs of tobacco farming, the taxation of tobacco products and their illicit trade, services and products to be offered to candidates who want to stop smoking, as well as health warning labels to be printed on cigarette packets.
During the four and a half days spent in the National Center for the Performing Arts of Mumbai, or in nearby locales, participants of the 14th World Conference on Tobacco OR Health were able to familiarize themselves with the above subjects so long as they were fluent enough in English, since no interpretation services were available and the printed material was largely in English only.
It was no surprise that the Mumbai conference ended on March 12th with an appeal to the WHO to maintain the fight against tobacco as a priority, as well as with a series of recommendations to governments concerning the ratification and enforcement of the World Health Organization Framework Convention on Tobacco Control (FCTC).
A 15th World Conference on Tobacco OR Health is to take place in 2012 in the city-state of Singapore.
India`s Minister of Health, Dr Anbumani Ramadoss, at right,
opened the 14th World Conference on Tobacco OR
Health.
Every morning, two hemi-plenaries took place simultaneously,
such as this one on smoke-free tobacco.
Then, some 2,000 delegates were divided into a multitude of workshops.
Displaying a poster for several hours is a way to inform
everyone of your activities.
However, the display room, which is located off in a tent, was little busy.
Young delegates participated in an anti-smoking demonstration
in the streets of the Indian metropolis.
Three months after terrorist attacks in Mumbai, safety measures were
designed to protect conference places.
The studious delegates were spoilt for the choice of presentation subjects.
Our coverage of the 14th World Conference on Tobacco OR Health was partly provided thanks to funding from Health Canada. The opinions expressed do not necessarily represent those of Health Canada.