Dr. Upendra Bhojani, co-authored a paper in the BMJ Global Health, along with Amiti Varma & Latha Chilgod of the Institute of Public Health, Bengaluru. This is the first peer-reviewed paper from the DEEP project titled “Diverse and competing interests around tobacco: qualitative analysis of two decades of parliamentary questions in India”. The paper analysed 1315 tobacco-related questions asked by 729 MPs over the two decades (1999-2019).

MPs had concerns about health (consumption patterns; harms; cessation; regulations); trade (production & export; Tobacco Board of India; market growth); agriculture (support for farmers); labour (working conditions; alternative livelihoods; impacts of regulations). The nature of concerns changed over time with health becoming a dominant concern. Other issues like trade took somewhat of a back seat, possibly due to a growing awareness on health harms and incremental tobacco control regulations.

Livelihood and economy-related concerns persisted throughout. The number of MPs asking tobacco-related questions varied widely across states. States, from where maximum MPs asked questions (Andhra Pradesh; Maharashtra; Uttar Pradesh; Karnataka; Tamil Nadu in that order) are the states with a greater presence of tobacco industry.

Key takeaways: (1) parliamentary questions, that remain underutilized in health policy research, could be a useful resource; (2) tobacco evokes diverse & competing interests implying a need for careful mediation and consultative approach to policy making for public health gains; (3) In India, state-level (economic, political, historical, cultural) contexts are crucial in understanding the political economy of tobacco and formulating tobacco control regulations; (4) identifying key concerns help public health folks engage with diverse political voices when tobacco control reforms are planned/executed enhancing political support across sectors and constituencies for tobacco control.

We would like to thank DBT/ WT India Alliance for their support. The paper can be accessed here.

Led by Dr. Upendra Bhojani and Adhip Amin from IPH, the India Tobacco Industry Interference Index 2020 report has been produced through a collaborative work of several institutions and individuals active in tobacco control research and practice in India. The report was released in September 2020 at the 5th National Conference on Tobacco or Health (NCTOH)-Virtual. Dr. Upendra Bhojani participated in the conference and was a panelist in a session that focused on Stopping Tobacco Industry Interference. The NCTOH panel talk and release is available here at NCTOH youtube page.

This report is a systematic and collaborative effort at assessing the implementation of the WHO FCTC Article 5.3 in India. The Tobacco Industry Interference Index helps to assess the implementation of the FCTC Article 5.3 through standardized tools using a systematic inquiry and materials in the public domain. Index report and summary are available for download at the India country page on the Global Tobacco Index webportal.

Tobacco industry interference in public policies remains a major concern in India. The overall score for the India 2020 Tobacco Industry Interference Index is 61 out of 100. This suggests a small but definite improvement in implementation of the FCTC Article 5.3 in 2019 compared to the year 2018 (score 69/100) and 2017 (score 72/100). Higher score indicates greater interference.

Ketki Shah received a doctoral fellowship under the DBT/Wellcome Trust India Alliance project led by Dr. Upendra Bhojani. She has registered her PhD in December 2020 at The University of Trans-Disciplinary Health Sciences and Technology (TDU). At TDU, her PhD is co-supervised by Dr. Prakash BN. Her PhD focuses on understanding from a worker’s perspectives the issues, and experiences with shifting to alternative and safer non-tobacco livelihoods.

Ketki’s PhD is divided into three phases. In the first phase, she plans to do an integrative review to explore and review the initiatives that have been tried out in South and South East Asia. The findings will be used to understand factors that influence transitioning to non-tobacco livelihoods. In the second stage, she aims to map the supply chain of bidi in Gujarat to identify the processes, geographies and workers involved. And finally in the third phase, she plans to conduct a primary qualitative inquiry with former and current bidi workers. This is to understand from their perspectives the dynamics and drivers for transitioning to alternative non-tobacco livelihoods.

She hopes that the evidence generated would inform processes that protect workers (from occupational-hazards and livelihood losses) as the demand and supply for tobacco hopefully reduces with tobacco control measures.

Amiti Varma from the DEEP project presented a paper on “Situating tobacco in health policy: Using parliament as an instrument of accountability” at the 6th Global Symposium on Health Systems Research (8 – 12 November, 2020). She presented findings from an analysis of two decades of tobacco-related questions in Indian parliament. This is part of a broader project (DEEP) that is also looking at parliamentary questions as one of the ways of understanding public policy towards tobacco.