1. Tobacco Control in India
Dr. Vinayak M. Prasad Director (Public Health) Ministry of Health & Family Welfare
Tobacco Free Initiative

2. TOBACCO USE IN INDIA Prevalence of tobacco use Males (%) Females
NFHS-3
Tobacco users
57.0
10.8
Smokers
32.7
1.4
Chewers
36.5
8.4
Source: NFHS – 3,

3. BURDEN OF TOBACCO USE
Nearly 1 million persons die due to tobacco use every year in India.
50% of cancer deaths, majority of cardio-vascular and lung disorders; other related diseases are attributed to tobacco consumption.
Total economic cost of the 3 major diseases due to tobacco use in India was Rs. 30,833 crores (USD 7.2 billion) in

4. TYPES OF TOBACCO USE IN INDIA
Smoking
Chewing
Cigarettes
Gutkha
Bidi
Khaini
Hookah
Zarda
Dhumti
Gudhaku
Chutta
Paan (with tobacco)
Chillum
Gul
Cigars
Mawa ,Mishri

5. TOBACCO CONTROL ACT, Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003

6. SCOPE OF THE ACT
The Act is applicable to all products containing tobacco in any form i.e.cigarettes, cigars, cheroots, bidis, gutka, pan masala (containing tobacco) khaini, mawa, mishri,snuff etc. as detailed in the schedule to the Act.
The Act extends to whole of India.

7. Provisions under the Tobacco Control Act, 2003

8. Prohibition on smoking in public places
Section 4 of Tobacco Control Act, 2003 provides;
Smoking in all “public places” is prohibited.
A “public place” means any place to which the public have access, whether as of right or not, and includes auditorium, hospital buildings, railway waiting room, amusement centers, restaurants, public offices, court buildings, educational institutions, libraries, public conveyances and like which are visited by general public but does not include any open space.
Creation of smoking areas – In restaurants, hotels and airports smoking areas are to be physically segregated in such a manner that the air from these areas does not circulate to the non- smoking areas.
Display of prominent non smoking signs e.g. “Smoking here is strictly prohibited” is mandatory at all public places.

9. Prohibition of advertisement, promotion and sponsorship of all tobacco products.
Section 5 of Tobacco Control Act, 2003 provides;
Both direct & indirect advertisement of tobacco products prohibited in all forms of audio, visual and print media
Total ban on sponsoring of any sport and cultural events by cigarette and other tobacco product companies
No trade mark or brand name of cigarettes or any tobacco product to be promoted in exchange for sponsorship, gift, prize or scholarship
No person, under contract or otherwise, to promote or agree to promote any tobacco product.

10. Prohibition on Sale to Minors
Section 6 (a) of Tobacco Control Act, 2003 provides;
Sale of tobacco products to persons under the age of 18 is prohibited.
The seller should ensure that the person who is buying the tobacco product is not a minor.
A display board to be put up at the point of sale declaring that “sale of tobacco products to minors is prohibited”.
Sale of cigarettes & other tobacco products to minors is prohibited

11. Prohibition on sale of tobacco products near educational institutions
Section 6 (b) of Tobacco Control Act, 2003 provides;
In order to restrict access of youth for tobacco products, the sale of the same is prohibited in an area within radius of 100 yards of any educational institution.
A display board to be put up outside the educational institutions declaring the same.

12. Health warnings on tobacco products packs
Section 7 of Tobacco Control Act, 2003 provides;
All tobacco product packages to carry prominent and legible health warnings.
These warning shall also be pictorial in nature.
The warnings will given in the same language as given on the pack.
All imported tobacco products should also carry the specified warnings.

13. Regulation of contents of Tobacco Products
Section 11 of Tobacco Control Act, 2003 provides;
Nicotine and Tar contents of all tobacco product must be clearly displayed on the packs
Producers of tobacco products must ensure that these harmful contents are within maximum permissible limits as prescribed by the rules
The testing of tobacco products to measure nicotine and tar contents to be done only at Govt. recognized laboratories

14. Enforcement agencies and mechanisms
Any police officer, not below the rank of Sub- Inspector
Any officer of State Food or Drug Administration
Any other officer, holding the equivalent rank being not below the rank of Sub-Inspector of Police
As authorized by the Central/State Governments.

15. PROVISIONS BROUGHT INTO FORCE w.e.f 1ST MAY 2004.
Prohibition of smoking in public places.
Prohibition of advertisements, sponsorship
and promotion of tobacco products.
Prohibition of sale of tobacco products to minors.

16. PROVISIONS BROUGHT INTO FORCE w.e.f 1st DECEMBER 2004.
Prohibition of sale of tobacco products near Educational Institutions was brought into force from 1st December 2004.

17. Action taken for effective enforcement of the provisions
The rules relating to prohibition of advertisement, sponsorship and promotion of tobacco products were amended and notified on 31st May 2005, further amended in October 2006.

18. Amendment rules notified in 2005
Ban on sale of tobacco products through vending machines
Ban on sale of tobacco products by minors
Restrictions on the content, size and number of point of sale of advertisements
Ban on visible stacking of tobacco products at the point of sale to prevent easy access to minors
To prevent brand sharing and surrogate advertising of tobacco products; ‘indirect advertising’ has been comprehensively defined.

19. Amendment rules………contd.
Ban on display of tobacco products or their use in movies or television
Health warning to be placed as a prominent bottom scroll in cinema and television programmes, which have been produced prior to this notification
Ban on display of names / logos of tobacco brands in any manner during media coverage of international events sponsored by tobacco manufacturers.

20. Process of implementation of specified health warnings on tobacco packs

21. RULES FOR SPECIFIED HEALTH WARNINGS FOR TOBACCO PRODUCT PACKS NOTIFIED
The rules for specified health warnings were notified on 5th July 2006 and are as follows:
The specified health warnings shall occupy at least fifty percent of the principal display area/s of the pack
- shall be positioned parallel to the top edge of the package and
- in the same direction as the information on the principal display area/s.
None of the elements of the specified warning are severed, covered or hidden in any manner when the package is sealed or opened.
No messages that directly or indirectly promote a specific tobacco brand or tobacco usage in general are inscribed on the tobacco product package.

22. No product shall be sold unless the package contains the specified health warning.
The specified warnings shall be inscribed in the language/s used on the pack.
No tobacco product package or label shall contain any information that is false, misleading, or deceptive, or that is likely or intended to create an erroneous impression about the characteristics, health effects, or health or other hazards of the tobacco product or its emissions.
The minimum size of the specified health warning on each panel of the tobacco pack shall be 3.5 cm x 4 cm to ensure that the warning is legible and prominent.
The specified health warning on tobacco packs shall be rotated every 12 months or as may be decided by the Central Government from time to time.

23. SPECIFIED HEALTH WARNINGS TO BE DISPLAYED ON TOBACCO PRODUCT PACKS as notified on 5th July 2006
For smoking forms of tobacco packs
For chewing/smokeless forms of tobacco packs

24. Process of implementation of specified health warnings on tobacco packs……..contd
Skull & bone sign and picture of the dead body was found to be objectionable
Group of Ministers (GoM) constituted.
Parliament amended the Tobacco Control Act, 2003.
Revised provisions were to come into effect from 1st Dec 2007.

25. Revised Specified Health Warnings after amendment, notified on 29th September, 2007
(1) For Smoking Forms of tobacco packs:-
(a) Smoking causes cancer
(b) Your smoking kills babies

26. For chewing/smokeless forms of tobacco packages:-
(c) Tobacco causes painful death
(d) Tobacco causes Mouth Cancer

27. Process of implementation of specified health warnings on tobacco packs……..contd
2nd GOM Meeting held in 12th November The GOM decided to revisit the pictorial warnings and approach Himachal High Court for extension of time.
GOI filed application in the High Court of Shimla for extension of time of 4 months for implementation of revised provisions.
Implementation of specified health warnings on tobacco packs w.e.f. 17th March 2008 as per order of the Shimla High Court.

28. Challenges in implementation of the law
Number of court cases challenging the provisions of the Tobacco Control Act/Rules which is hindering its effective implementation.
Resistance and representations from the tobacco industry

29. Counter campaigns by civil society

30. India’s journey in
Tobacco Control

31. India has been a forerunner in the WHO FCTC and was the Regional Coordinator for the South-East Asian Region.
India was one of the first few countries to ratify the Framework Convention on Tobacco Control (FCTC) in 2004.
The GOI has enacted a comprehensive national tobacco-control legislation in 2003.

32. MILESTONES
ACHIEVED

33. ACHIEVEMENTS
The Govt. of India (GOI) has allocated approx. USD 8 million (Rs 40 crores) for for tobacco control
Pilot Plan for National Tobacco Control Program launched.

34. - Plan for Pilot Phase (2007-08)
NATIONAL TOBACCO CONTROL PROGRAM
- AN OVERVIEW
- Plan for Pilot Phase ( )

35. District Tobacco Control Programme- Proposed Model (Pilot Basis)
MoH&FW
States/UT’s are proposed to be covered during the Pilot Phase.
State Tobacco Coordination Committee
(Chair - Health Secretary)
State Tobacco Control Cell
A total of 2 distts. proposed to be covered in Pilot TCU’s will be set up in each distt in Govt. Medical Colleges / RCC’s/ Distt. Hospitals
District Tobacco Control Units
Training
IEC
School Programs
Tobacco Cessation
Monitoring tobacco control laws & reporting

36. Components of proposed District Tobacco Control Programme (Pilot Phase)
Training : Training of School teachers, health workers, health professionals, law enforcers, NGO’s, women SHG’s on tobacco control
IEC : IEC using Cable TV channels, Nukkad/Street Corner Shows, Exhibitions, Melas, etc in the regional language at grassroot level. Anti tobacco awareness programs by the trained Women SHG/ NGO’s.
School Programs : School Programme for Govt. Schools with the help of NGOs. In the pilot plan, it is proposed to take up at least 50 Schools per district.
Monitoring Enforcement of Tobacco Control Laws
Tobacco Cessation Centres : Setting up of TCC’s in Districts.

37. National Programme for Tobacco Control during 11th Five Year Plan - proposed
Main components of the NTCP are:
Setting up of National Regulatory Authority (NRA)
State Tobacco Control Programme
District Tobacco Control Programme
Anti tobacco Public Awareness Campaigns
Establishment of tobacco testing labs

38. ACHIEVEMENTS
A public awareness anti-tobacco campaign launched through various media channels like radio and television covering the entire country.
Taxes (Excise Duty) increased by 5% on cigarettes. Taxes on bidis also increased substantially for the year
Specific rates of duty on cigarettes to be increased by about 5%; duty (excluding cess) on biris to be raised from Rs. 7 to Rs. 11 per thousand for non-machine made biris and from Rs. 17 to Rs. 24 per thousand for machine made biris; duty on pan masala not containing tobacco to be reduced from 66% to 45%; withdrawal of exemption for pan masala containing tobacco and other tobacco products given to units in the North Eastern States.

39. ACHIEVEMENTS contd
Health Minister’s Award (Tambakoo Virodh Puruskar) launched in recognition of outstanding achievement in the field of tobacco control.
The award will be conferred in four categories viz. individual/institutions/civil society organizations/state governments on World No Tobacco Day every year.

40. Effective collaboration with WHO has resulted in the following :
ACHIEVEMENTS
Effective collaboration with WHO has resulted in the following :
National Tobacco Control Cell set up to provide technical support to plan, coordinate and monitor all activities relating to tobacco control.
Tobacco control community and school based interventions implemented
Support provided for pilot community, school, rural and slum based interventions targeting different populations at state level

41. ACHIEVEMENTS
A network of 18 tobacco cessation centers and services set up across the country and standardized manuals and systems developed for the same.
The network of tobacco cessation centers has been expanded to cover five new states – Mizoram, West Bengal, Andhra Pradesh, Kerala and Assam.
The 18 Tobacco Cessation Centers established across the country have treated over 30,000 clients to quit tobacco and have covered several lakh of population through outreach programmes for tobacco control.

42. Outreach of the Tobacco Free Initiative in India

43. ACHIEVEMENTS
A wide range of anti tobacco IEC materials covering various forms of tobacco use and targeting diverse population groups developed and disseminated.
Widespread media coverage and advocacy with role models promoting young smokers to quit smoking.

44. ACHIEVEMENTS
Repeat Global Youth Tobacco Survey (GYTS), Global School Personnel Survey (GSPS) and Global Health Professional Survey (GHPS) 2006 was conducted as a part of Global Tobacco Surveillance System in India.
As per GYTS, prevalence of current tobacco use among year age group school going children is 14.1%.
As per GHPS, Current cigarette smoking and use of other tobacco products among third-year medical students was reported 11.6% and 5.4% respectively.
Capacity of National Tobacco Control Cell strengthened by hiring technical and legal staff.

45. Let us all work together to fulfill the dream of a healthy, tobacco free world