On one pretext or the other the Government has so far shied away from putting larger pictorial warnings on cigarette packets and other tobacco-based products despite the grave risk these pose to public health. Policy Pulse tries to find the hitches and glitches that dog the issue
“We are committed to 85 percent pictorial warnings on both sides of cigarette packs. We have said that before but the final decision will be announced after going through the Parliamentary Committee’s report,” says the Union Health Minister JP Nadda, just days before the committee on subordinate legislation (COSL) presented its report in the Lok Sabha or Lower House of the Parliament.
Soon after this the Government has given an undertaking to the Rajasthan High Court that they will impose 85 percent pictorial warnings on all tobacco products. The ministry had also used a public notice for the industry on how larger pictorial warnings were to be implemented. Yet, a visit to cigarette vendors prove that most brands are yet to follow what the Government has said in its affidavit before ther High Court.
Contrary to the Health Minister's claims the committee has recommended smaller pictorial warnings saying that the 85 percent pictorial warnings would be “too harsh” and would result in “flooding of illicit cigarettes”. The committee has recommended limiting pictorial warnings to 50 percent on both sides of cigarette packs and in case of Biddis and chewing tobacco it should be limited to 50 percent on just the display side.
One of the reasons given by the Parliamentary Committee to recommend smaller pictorial warnings was how the livelihood of millions of people would get affected if the government was to go ahead with larger pictorial warnings. In fact, the report also quotes the Ministry of Labour and Employment’s view that “if the Government goes ahead with the decision to implement 85 percent pictorial warnings, it would have adverse effects on livelihood of millions of people who are dependent on this vocation.” The Ministry of Labour had, therefore, recommended that the matter requires further deliberation. Though the report by the committee mentions the recommendations of the Labour Ministry it has conveniently not included the recommendations of the Health Ministry. Internal Ministry documents accessed by Policy Pulse show how the committee had asked for the opinion of the Health Ministry in the matter as well, in a written reply to the parliamentary committee's question on possible effects on the livelihood of people the Health Ministry had opined that increasing pictorial warnings will have no affect on the livelihood of people. And the adverse health effects of smoking bypass the other concerns. But their committee deliberately kept it out of its report.
The committee in its report also cites the claim made by the Central Tobacco Research Institute which says that tobacco cultivation, processing and manufacturing are a source of employment to around 3.2 crore people in our country. The report also cites an earlier report by the Health Ministry (published in 2008) which says over 88 lakh people are involved in rolling of Biddis. Activists also disagree with this opinion. “There is no evidence that implementing larger graphic warning labels will hurt tobacco industry or Biddi workers. Experiences from other countries shows that small scale industries, such as Biddi manufacturing, will not disappear overnight and moreover there is no credible evidence to support the claim that larger graphic warnings will cause an increase in illicit trade – it’s a myth perpetuated by the industry.” says Monica Arora, an anti-tobacco expert from PHFI or Public Health Foundation of India.
Another argument by the committee that larger pictorial warning would lead to increase in illicit trade doesn't have much weight. As evidence from countries that have successfully implemented larger graphic warnings, like Australia and Uruguay, shows that that there is little change in illicit trade following implementation. And all imported packs are also required to have the Indian health warning and those that are smuggled will be easily identifiable by Government officials and in any case it would be an enforcement issue. Also, according to a cross country survey in Australia which was published in the journal tobacco control after plain packaging was introduced there was no increase in the use of illicit tobacco. So, if plain packaging does not affect illicit sale of tobacco why would pictorial warning? Even logically, illicit sale of any product would depend on its cost more than packaging.
While the committee talks about how larger pictorial warnings could affect livelihoods of people, they seem to have ignored the adverse health effects and cost of smoking. According to a health survey undertaken by the Ministry in 2009, nearly one million tobacco related deaths have taken place in the country. Just in 2011 the total health expenditure from tobacco-related diseases was more than one lakh crore rupees. This is over 80 percent more than the revenue earned through tobacco excise duty through the same year. According to global youth tobacco survey nearly 15 percent children in the country use some form of tobacco and about 35 percent adults consume tobacco in various forms from cigarettes to Biddis to chewing tobacco. Yet, the Parliamentary Committee seems adamant to reduce the pictorial warnings. “The cost can't just be considered from a one sided perspective of employment. What about the cost of hospitalisation? What about human life?”, asks Dr PK Julka, oncologist at AIIMS.
Another big question is how many of these tobacco consumers are educated? Large graphic warning labels would be better at informing about the dangers of tobacco use and prevent youth from starting to use tobacco. Further, they are easily recognisable by low-literacy audiences and children—two vulnerable population groups. Not only for the less educated audience pictorial warnings have a great impact and are very powerful way of reaching at masses to make them aware about the ill effects of smoking. A recent survey of smokers in Uruguay found that the larger pictorials covering 80 percent of packaging were more effective than the smaller pictorials, which covered 50 percent. The larger labels were more noticeable, caused smokers to think more about the health harms related to smoke, increased thoughts about quitting and caused smokers to forgo smoking a cigarette more than the smaller labels. In the last five years, a growing number of countries including many tobacco growing countries like Brazil have implemented larger graphic warning labels as part of comprehensive tobacco control strategies. To date, Nepal, Thailand, Australia, Uruguay, Sri Lanka, Brunei, Canada, Chad, Brazil, EU, Mauritius, Mexico, Moldova, Turkey, Turkmenistan, and Venezuela have legislation calling for 65 percent or larger warnings labels. In fact India is currently ranked 136 amongst 198 countries in terms of prominence of pictorial warnings on tobacco packs.
Another absurd argument by the committee is that there's hardly any evidence to prove how larger pictorial warning could reduce consumption of glancing. To justify this, the report cites Global Consulting Firm Deloitte’s assessment of the tobacco regulations in 27 countries which have shown ‘no impact’ of large and cumbersome health warnings. In that case it is unclear why the COSL is concerned that if the Government goes ahead with the implementation of the 85 percent health warning, it would have adverse effect on the livelihood of millions of people. It just can't be both ways. Furthermore, the Commerce Ministry has also said that there was no decrease in tobacco production as a result of the implementation of the warnings in India in 2008-09.
Ideally larger pictorial warnings should have come in place from April 1, 2015 when the Ministry notified that all tobacco products should have 85 percent pictorial warnings but after concerns were raised by the industry the Ministry postponed the notification and have the responsibility to deliberate upon its decision to the committee on subordinate legislation. But the Rajasthan High Court directed the Health Ministry in September 2015 to take steps immediately for the implementation of 85 percent pictorial warnings from April 1, 2016. In fact the Health Ministry also gave an affidavit to the court saying that it would implement the pictorial warnings. Aishwarya Bhati, Supreme Court Lawyer says, “the recommendations of the this COSL are regressive and go against the Rajasthan High Court that had ordered the Ministry of Health and Family Welfare to implement the 85 percent pack warnings from 1st April 2016.” Also the constitution of the committee comprising of the likes of Dilip Gandhi who question the link between tobacco usage and cancer and Biddi baron Shyam Charan Gupta has made many question the authenticity of the report.
The report also relies heavily on the findings of a British American tobacco company sponsored study while overlooking the recommendations of the Health Ministry. There are many other independent studies that show how larger pictorial warning can motivate people to quit smoking but those haven't been included by the parliamentary committee. “The recommendations are a direct response to industry interests and have no basis in science or protecting the public. It is ironic that a Biddi baron is getting to decide the fate of health warnings on tobacco products in India – even thought his conflict of interest in serving on this committee has been pointed out to the Government time and again,” says Monica Arora.
Tobacco expert from PHFI. While repeated attempts to reach the head of the committee Dilip Gandhi went futile, the World Health Organisation had issued a statement saying that “any reduction in size of warnings would be a huge setback to public health in South East Asia region.” Not only that as many as 67 tobacco control organisations have written to the Health Ministry to express their disappointment with the government's decision.
The committee also says it will not be practical to implement pictorial warnings on packs especially Biddis because of the round shape. But internal communication between the Health Ministry and the Parliamentary Committee available with Policy Pulse show that the Ministry had made dummy packs and floated them in the market last year to check the efficacy. The Ministry then stated in a written reply to the Parliamentary Committee that there would be no problem in increasing pictorial warnings on cigarette packs but that has also been left out in the report. The committee also recommends that the Government should invest in information campaigns instead of increasing pictorial warnings. Though there is a need to increase awareness campaigns but that should not be a reason to dilute pictorial warnings.
Recommendations of the COSL are not binding on the concerned department. In this case the Ministry of Health and Family Welfare is at liberty not to accept the recommendations of the Committee as per the Chapter 11 of the Manual of Parliamentary Procedures. So the Health Ministry can well go ahead with its earlier notification and increase the pictorial warnings size at least for the health of the nation.