India’s unique opportunity to reduce harm from tobacco and ensure food security, ET HealthWorld

by Dr Sudhanshu Patwardhan

Every year, the World Health Organisation (WHO) comes up with a theme for May 31stWorld No Tobacco Day, to rally public health troops in the fight against the use of risky forms of tobacco products. This year’s theme is “We need food, not tobacco“.

Hunger and a lack of nutritious food kill millions of people worldwide every year. Feeding the ever-growing world population without denuding forest land remains a big challenge, for reasons ranging from the environment, climate change, and biodiversity. Therefore, in a world with finite arable land, repurposing tobacco farms for growing food is an obvious target for policymakers, environmentalists, and economists. There is indeed a causal relationship between higher use of arable land for growing tobacco and food shortages, as this year’s theme highlights. Global demand for tobacco continues relatively unabated, thus keeping suppliers invested in a profitable crop. Also, one cannot simply switch tobacco farms and farmers to grow alternative food crops with a snap of a finger.

There may be hardly any adult in the world who does not know the harms of tobacco. Every year, over eight million (80 lakh) people die from tobacco-related diseases globally. Millions more suffer due to the loss of friends and family to the harms of consumption and exposure to smoked and smokeless tobacco products. Quitting tobacco can give users years of health and wealth, but users still continue because it is not easy to quit! There is clear evidence that attempting to quit without pharmacological and behavioural support is more likely to fail. The obvious question then is: how do we ensure that current users of tobacco get all the help they can from their healthcare advisers and governments to make quitting tools accessible, affordable, appealing, and available? If done at a global level, quitting success will breed further confidence among consumers, healthcare practitioners, and policymakers, accelerating the decline of the demand for tobacco.Tobacco farming has lifted millions out of poverty. With regards to freeing up tobacco farmland for growing food crops, it is important to remember that tobacco is an unusually hardy plant. Not all food crops can withstand the conditions that the tobacco plant cang up tobacco farmland for growing food crops, it is important to remember that tobacco is an unusually hardy plant. Not all food crops can withstand the conditions that the tobacco plant can. Unlike edible vegetables and fruits, the produce from tobacco plantations is a leaf that is included as a raw material for further processing into a product, thus not subjecting the farmers to the whims and shameful wastage due to the strict size and shape requirements of western supermarket buyers. The tobacco leaf markets are utility-focused and well supported through long-standing relationships across stakeholders in a sophisticated global supply chain. Any slogan that simply calls for more food instead of tobacco oversimplifies the economics of tobacco.India is one of the largest producers and exporters of tobacco. India is also the source of a large proportion of the world’s extracted and purified nicotine used in medicinal nicotine replacement therapy products (NRT) and for the e-liquid used in the growing global e-cigarette market that is replacing cigarettes in many countries. As one of the largest producers of nicotine and tobacco and with the world’s second-largest market of tobacco users, India is well poised to bring two orthogonal fields from this year’s World No Tobacco Day theme into reality. This is how.

Evidence from the UK shows that appropriately regulating safer forms of nicotine may hold the key to achieving a tobacco-free population in the coming decades. The wide range of product formats available in the UK, from nicotine gums and patches to heated tobacco products and nicotine pouches, provides adult consumers with much-needed choice for quitting their smoking habit. In Sweden, men have already become smoke-free, i.e., less than 5% of Swedish men smoke. Despite the high prevalence of oral tobacco use in the form of Swedish-style ‘snus’, Swedish men have the lowest oral cancer rates in Europe, further confirming nicotine’s safety profile. These real-world examples of tobacco harm reduction through innovation into safer tobacco and nicotine products can be adapted for India’s adult tobacco users’ needs. For current users in India, wouldn’t a nicotine pouch or a tobacco snus, without the added toxic substances that are found in the Gutkha and Zarda products, bring down the incidence of oral cancer dramatically? There is no pride in being the world’s oral cancer capital! Similarly, for the millions of Indians who smoke bidis and cigarettes, making available a wider range of safer nicotine products, behavioural support from healthcare practitioners, and AI-based cessation apps will enhance success rates in their quit attempts. The key to not getting lung diseases from tobacco consumption is to not inhale nicotine with any smoke. The Royal College of Physicians of England published their groundbreaking report in 2016 on e-cigarettes titled “Nicotine Without Smoke”, highlighting this core principle of tobacco harm reduction.

With regards to the agricultural transformation much needed to free up arable land, a global reduction in demand for tobacco will be a key economic driver over time for farmers to seek other viable alternatives. In that process, it would be crucial to provide government support and subsidies for a planned reduction in tobacco farming. The WHO’s Framework Convention on Tobacco Control (FCTC) dedicates two entire articles in the original treaty text to alternative livelihoods for those in the supply chain and environmental impact: Articles 17 and 18. Particularly on those two articles, little progress has been made in the past 20 years since the treaty came into force. That is because even less success has been achieved in the ground-level implementation of Article 14, which calls for tobacco dependence treatment provision at a national level. The FCTC is often elegantly simplified as a treaty for demand reduction, supply reduction, and harm reduction strategies. The largest demand arises from the billion-plus cohort of current users of risky tobacco products, and that’s where affordable cessation support and safer nicotine alternatives offer the highest likelihood of practical harm reduction. A supply reduction will naturally follow!

This year’s WNTD theme creates a false dichotomy, unnecessarily pitting tobacco farmers against a hungry world. Nevertheless, the spirit of the theme may well be fit for a show of leadership by India. If India can invest in nicotine literacy, cessation services with trained healthcare professionals, and widely accessible and affordable nicotine replacement products using a fraction of the homegrown tobacco for nicotine extraction, 300 million Indian tobacco users may well find a sustainable way to quit their risky habit for good. The health and wealth gains for individuals as well as the nation’s economy are invaluable. Agricultural transformation will naturally follow this, purely on economic principles. Food for thought indeed.

dr. Sudhanshu Patwardhan is a medical doctor and nicotine expert in the UK.

Disclaimer: The views expressed are solely those of the author, and ETHealthworld does not necessarily subscribe to them. shall not be responsible for any damage caused to any person or organisation, directly or indirectly.

  • Published On May 31, 2023 at 05:17 AM IST

Join the community of 2M+ industry professionals

Subscribe to our newsletter to get latest insights & analysis.

Download ETHealthworld App

  • Get Realtime updates
  • Save your favourite articles

Scan to download App

#Indias #unique #opportunity #reduce #harm #tobacco #ensure #food #security #HealthWorld

What’s your Reaction?