India has comprehensive tobacco control policies in place to address the growing problem of tobacco use, but their effectiveness differs among states due to diverse socio-economic, demographic, cultural, political, commercial, and geographical factors. Using a realist lens to understand what works, for whom and why in tobacco control, the Anushthana team at the Institute of Public Health Bengaluru (IPH) in association with the International Union Against Tuberculosis and Lung Disease (The Union) organized a two-day national consultation on tobacco control policies at The Chancery Pavilion, Bangalore from 6-7 July, 2023.
The consultation brought together state-level government officials, public health experts, researchers, academicians, civil society organizations, and tobacco control advocates to design strategies to curb tobacco use and promote public health. On the first day, Shri Dinesh Gundu Rao, Minister for Health & Family Welfare, Govt of Karnataka, graced the occasion by unveiling a short documentary and a policy brief developed by the research team at IPH Bengaluru. The consultation had three panel discussions: 1) Sustainability and scale up of current good practices related to tobacco control policy implementation, 2) Policy recommendations, newer initiatives & State level COTPA amendments, and 3) Strategies to counter persisting challenges in implementing COTPA, NTCP and newer legislations, including a session on the political economy of tobacco by Dr. Upendra Bhojani and a group activity on recommendations for the updation of the COTPA Law enforcers manual.
Keeping in line with a focus on policy guided by implementers’ wisdom, one of the key strengths of the consultation was the panel discussions consisting of state nodal officers working in tobacco control, civil society members, academia, and the medical community of various Indian states who shared the context-specific facilitators and barriers they faced. The event provided a platform for participants to voice their opinions, concerns, and recommendations. The knowledge and insights gained from this consultation will be instrumental in shaping evidence-based policies and programs to reduce tobacco consumption and its associated health risks. It is now imperative to translate the ideas and recommendations generated at the consultation into tangible actions, forging a path towards a tobacco-free future.
Next steps
In order to sustain the consultation’s momentum and progress, the upcoming activities include sharing the recommendations from the consultation with the Ministry of Health, Government of Karnataka to operationalize them in the state, sharing the recommendations on updating law enforcement manual at the national level, sharing the documentary for training purposes, and submitting the Prohibition of Electronic Cigarettes (PECA) guidelines to the Union Ministry for further action.
The burden of tobacco-related illnesses is high in India, with about 1.35 million people dying each year. Despite comprehensive tobacco control laws and policies, implementation is varied among Indian states. The Anushthana project organized two regional consultations—held online and in-person in Raipur, Chhattisgarh—in association with the International Union Against Tuberculosis and Lung Disease (The Union). The consultations brought together government officials from health, food safety, police and relevant departments, independent researchers, and members from civil society organizations from 18 states and union territories who are working in the field of tobacco control and public health.
The purpose of the regional consultations were to
Discuss state-specific tobacco control implementation strategies
Cross-pollinate ideas and facilitate research and practice collaborations in tobacco control
Promote leadership and highlight a set of best practices in tobacco control.
Tobacco kills over one million adults in a high-burden country like India each year. Despite a comprehensive tobacco control law – the Cigarettes and Other Tobacco Products Act (COTPA), 2003, implementation remains varied across Indian states due to several contextual factors. The Anushthana team members (Dr. Pragati Hebbar, Vivek Dsouza, Praveen Rao S, and Kumaran P) of the Chronic Conditions and Public Policies cluster at IPH visited three Indian states i.e. West Bengal, Arunachal Pradesh, and Kerala during the months of November and December 2021. The objective of the field visit was to understand local contexts and on-ground implementation successes and challenges in the field of tobacco control. The team undertook field observations in three districts of each state focussing on the implementation of COTPA sections 4, 5, 6, and 7. Simultaneously, the team met relevant stakeholders to understand their views on tobacco control policy implementation.
To aid the data collection, the team worked with Julee Jerang (IPH field consultant in Arunachal Pradesh) and MANT (a non-profit public health organisation in West Bengal). The field visit is part of a five-year research fellowship awarded to Dr. Pragati Hebbar and is funded by the DBT/Wellcome Trust India Alliance.
Thirteen members of the Chronic Conditions and Public Policies cluster at IPH actively participated in the three day conference of the 5th National Conference on Tobacco or Health (NCTOH). This three-day scientific programme focused on diverse public health issues and challenges in tobacco control at the national and sub-national level along with context-specific solutions for their replication towards achieving tobacco free environments. There were plenary sessions, panel discussions, symposia, oral presentation, poster discussion, and workshops on many aspects of tobacco control which will pave the way towards building effective policy and program.
Dr Upendra Bhojani, Riddhi Dsouza, Anand Kumar, Kanika Chaudhary, Ketki Shah, Dr Pragati Hebbar, Vivek Dsouza, Dr Chandrashekar Kottagi, Kranthi Vysyaraju, Aishwarya Ashok, Praveen Rao, Achyutha Nagara Gadde and Kumaran P from the Institute of Public Health (IPH), Bengaluru actively participated in this 3-day national conference held between September 25 and 27, 2021. Dr Upendra Bhojani, Director, IPH Bengaluru on Day 1 (September 25, 2021) was in a panel discussion and presented on “How should we approach commercial determinant of health?”, he was part of the plenary session on September 26, 2021 on “Emerging Issues in Tobacco Control: Contextualising Global Interventions” and he presented on “Tobacco Industry Interference”.
Dr Pragati Hebbar made two oral presentations- “Implementation’ of tobacco control policies in LMICs – a realist synthesis to explain the process and its facilitators and barriers” and the second, “LifeFirst: Impact of a school-based tobacco- and supari-cessation intervention among adolescents in Mumbai, India.”
This national conference was a boost to tobacco control efforts by the amalgamation of tobacco control professionals, health programme managers, public health experts, civil society advocates, academicians and researchers of various clinical and non-clinical disciplines from different states across the country under one roof who shared their contextual experiences and best practices in tobacco control which was aimed to ultimately lead to advancing tobacco control in the country.
