India could prevent 9 million deaths over the next 10 years, if it bans smoking and resort to heavy tax on tobacco products. A study by a team of scientists led by Sanjay Basu at Stanford University, USA finds a combination of tobacco control policies and pharmacological interventions alone could avert upto a third of these deaths.
The study on the ‘Effect of Tobacco Control Measures during a period of rising Cardiovascular Disease Risk in India,” by researchers found cardiovascular diseases (CVD) accounts for over three quarters of all global deaths from heart diseases and stroke in low and middle-income countries, with India topping the list. More than one in three CVD deaths in India occur among young and working-age people, leading to substantial economic and societal costs.
“Smoking has been estimated to be responsible for about one in 20 deaths among women and one in five deaths among men between the age of 30 to 69 in India, many due to CVD,” notes the study. “Over the next decade, CVD deaths in India are expected to increase by 12%”.
Though India enacted a national legislation to control smoking in public places in 2003, its provisions remain poorly implemented or enforced. As a result one in every three adults are exposed to smoking at work in 2009 and 2010 varying from 15.4% in Chandigarh to 67.9 per cent in Jammu and Kashmir. Tobacco cessation programmes have received limited government financial support and cessation advice by healthcare professionals is provided infrequently.
Tobacco taxation remains very low in India, at around 38% on cigarette and 9% on bidi, far below the minimum of 70% recommended by World Health Organisation (WHO). Taxation has direct impact on consumption – a 10% increase in cigarette prices reduced consumption by 3.4% in rural areas and 1.0% in urban areas and the corresponding consumption rate for bidi was 9.2% and 8.5%.
A ban on smoking is expected to avert approximately 0.7 million myocardial infarction deaths or deaths due to heart attacks and 0.4 million stroke deaths over a decade. By comparison, a 300% increase in taxes on cigarette is anticipated to avert one million heart attack deaths and 0.6 million stroke deaths over a decade. A similar tax hike on bidis would save 0.8 million deaths due to heart attacks and 0.5 million due to strokes. A 300% tax hike on both the products is anticipated to avert approximately 2.1 million heart attack deaths and 1.0 million stroke deaths over a decade in India.
The authors suggest besides ban on smoking and higher taxes, a provision for brief cessation advice by healthcare providers, mass media campaigns and increased access to aspirin, antihypertensive drugs and statins could reduce deaths due to heart attacks and strokes. However, ban on smoking and higher taxes are likely to be the most effective strategies for reducing heart attack and stroke deaths over the next decade, according to the researchers.
The authors say, full implementation of the UN Framework Convention on Tobacco Control (FCTC) in India would yield substantial reduction in mortality from heart attacks and stroke. Despite evidence of links tobacco use to CVD, its consumption in India and several other countries is on the rise. Vigorous implementation of tobacco control policies is expected to avert 25% of all predicted CVD deaths – equivalent to over 9 million averted deaths over the decade beginning 2013.