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India pushes ban on smoking in public places
Newsdesk
Special Report: National India pushes ban on smoking in public places
AP Photo/Ajit Solanki
India’s health ministry has decided to enforce a national ban on smoking in public places with effect from Oct 2, 2008. A set of comprehensive rules has been notified, under which smoking will not be permitted in public places, including railway stations and work places. Hotels with more than 30 rooms, restaurants with seating capacity for more than 30 people, and airports might have physically segregated smoking areas. All other public places—including smaller hotels and eateries—will have to be completely smoke free. India actively participated in the Framework Convention on Tobacco Control (FCTC) negotiations and was one of the first countries to have ratified it. Although the national antitobacco law—the Cigarettes and Other Tobacco Products Act 2003—came into effect long before the FCTC ratification, the country “has drawn continuous strength from FCTC to implement the law”, as pointed out by Health Minister Anbumani Ramadoss. In addition to the ban on smoking in public places, the 2003 Act contains provisions relating to tobacco advertising and promotion, pictorial warnings, labelling of tobacco packs, and youth access to tobacco. These provisions are being implemented in a phased manner. The first ban on smoking in public places in an Indian state was imposed
Smoking of bidis in public places is also prohibited under the new rules
922
in July, 1999, in Kerala, and was a result of a court directive. Since then, judicial activism has helped shape antitobacco policies, both by directing the government to take suitable measures and by triggering public debate on the issue. In July, 2001, the Supreme Court of India directed the central government to enforce a national ban on smoking at public places. After the passage of the 2003 Act, the health ministry notified rules in 2004 banning smoking in public places. But this could not be enforced, because the definition of a “public place“ was ambiguous and a mechanism for enforcement was absent. The new rules address both these concerns. Anybody found smoking in a public place can be fined 200 rupees. The manager or owner of the premises can be fined an amount equal to the total fine for individual offences on their premises. The health ministry plans to increase the penalty to 1000 rupees for individual offences and 5000 rupees for managers and owners for every offence committed on their premises. The rules identify designated people who will be authorised to impose and collect fines. In private offices and workplaces, the onus of enforcement would be with the head of administration or the human resources manager. Despite such elaborate rules, enforcement remains a key issue. Ramadoss is aware of this and cites the example of the health-ministry building, where just three people have been fined for smoking offences since smoking was banned in the building. “We can’t accomplish this task without the involvement of the public and active participation of civil society”, he comments. For this, voluntary organisations might be legally empowered to fine offenders. Similarly toll-free telephone lines will be set up to encourage community reporting of offences.
Chandigarh—the first Indian city to be declared smoke-free in 2007—is a good example of enforcing the ban with active participation of civilians. “It has been a roller-coaster ride”, says Hemant Goswami (Burning Brain Society, Chandigarh, India). “The compliance goes up whenever we check. In May and June, we filed nearly 1000 complaints and got favourable orders in 400 of them, while notices were issued to the [remaining] 600. When the police do not act, civil society has to stand up and flood them with complaints.” For the ban to affect the incidence of cancer due to smoking and secondhand smoke inhaled by non-smokers, legal measures alone are not sufficient, asserts Yogendra Kumar Sapru (Cancer Patients Aid Association, Mumbai, India). “[The ban] must be accompanied by a massive public education campaign on the ill effects of both smoking and second-hand smoke.” Cessation clinics could help those wanting to quit. 18 clinics, set up with help from WHO, have helped 40 000 people quit tobacco in the past 5 years. 15–20% of these people have quit without the use of nicotine replacement therapy, according to Vineet Gill Munshi (WHO India office, New Delhi). Now the health ministry has plans to set up 100 cessation clinics over the next 2 years. Unfortunately, there are undesirable effects of the smoking ban. In Kerala, tobacco chewing is increasing in men, children, and adolescents, possibly due to the ban and tobacco-industry strategies to shift their focus to smokeless tobacco products. This could be dangerous, considering that chewing tobacco products is a major cause of cancers of the oral cavity in India. The ban on tobacco advertising in the media has led to a surge in “point of purchase” advertising, which was left out of the ban.
Dinesh C Sharma www.thelancet.com/oncology Vol 9 October 2008
Special Report: National India pushes ban on smoking in public places
AP Photo/Ajit Solanki
India’s health ministry has decided to enforce a national ban on smoking in public places with effect from Oct 2, 2008. A set of comprehensive rules has been notified, under which smoking will not be permitted in public places, including railway stations and work places. Hotels with more than 30 rooms, restaurants with seating capacity for more than 30 people, and airports might have physically segregated smoking areas. All other public places—including smaller hotels and eateries—will have to be completely smoke free. India actively participated in the Framework Convention on Tobacco Control (FCTC) negotiations and was one of the first countries to have ratified it. Although the national antitobacco law—the Cigarettes and Other Tobacco Products Act 2003—came into effect long before the FCTC ratification, the country “has drawn continuous strength from FCTC to implement the law”, as pointed out by Health Minister Anbumani Ramadoss. In addition to the ban on smoking in public places, the 2003 Act contains provisions relating to tobacco advertising and promotion, pictorial warnings, labelling of tobacco packs, and youth access to tobacco. These provisions are being implemented in a phased manner. The first ban on smoking in public places in an Indian state was imposed
Smoking of bidis in public places is also prohibited under the new rules
922
in July, 1999, in Kerala, and was a result of a court directive. Since then, judicial activism has helped shape antitobacco policies, both by directing the government to take suitable measures and by triggering public debate on the issue. In July, 2001, the Supreme Court of India directed the central government to enforce a national ban on smoking at public places. After the passage of the 2003 Act, the health ministry notified rules in 2004 banning smoking in public places. But this could not be enforced, because the definition of a “public place“ was ambiguous and a mechanism for enforcement was absent. The new rules address both these concerns. Anybody found smoking in a public place can be fined 200 rupees. The manager or owner of the premises can be fined an amount equal to the total fine for individual offences on their premises. The health ministry plans to increase the penalty to 1000 rupees for individual offences and 5000 rupees for managers and owners for every offence committed on their premises. The rules identify designated people who will be authorised to impose and collect fines. In private offices and workplaces, the onus of enforcement would be with the head of administration or the human resources manager. Despite such elaborate rules, enforcement remains a key issue. Ramadoss is aware of this and cites the example of the health-ministry building, where just three people have been fined for smoking offences since smoking was banned in the building. “We can’t accomplish this task without the involvement of the public and active participation of civil society”, he comments. For this, voluntary organisations might be legally empowered to fine offenders. Similarly toll-free telephone lines will be set up to encourage community reporting of offences.
Chandigarh—the first Indian city to be declared smoke-free in 2007—is a good example of enforcing the ban with active participation of civilians. “It has been a roller-coaster ride”, says Hemant Goswami (Burning Brain Society, Chandigarh, India). “The compliance goes up whenever we check. In May and June, we filed nearly 1000 complaints and got favourable orders in 400 of them, while notices were issued to the [remaining] 600. When the police do not act, civil society has to stand up and flood them with complaints.” For the ban to affect the incidence of cancer due to smoking and secondhand smoke inhaled by non-smokers, legal measures alone are not sufficient, asserts Yogendra Kumar Sapru (Cancer Patients Aid Association, Mumbai, India). “[The ban] must be accompanied by a massive public education campaign on the ill effects of both smoking and second-hand smoke.” Cessation clinics could help those wanting to quit. 18 clinics, set up with help from WHO, have helped 40 000 people quit tobacco in the past 5 years. 15–20% of these people have quit without the use of nicotine replacement therapy, according to Vineet Gill Munshi (WHO India office, New Delhi). Now the health ministry has plans to set up 100 cessation clinics over the next 2 years. Unfortunately, there are undesirable effects of the smoking ban. In Kerala, tobacco chewing is increasing in men, children, and adolescents, possibly due to the ban and tobacco-industry strategies to shift their focus to smokeless tobacco products. This could be dangerous, considering that chewing tobacco products is a major cause of cancers of the oral cavity in India. The ban on tobacco advertising in the media has led to a surge in “point of purchase” advertising, which was left out of the ban.
Dinesh C Sharma www.thelancet.com/oncology Vol 9 October 2008