Pursuit of HappynessSmoke-Free Challenges—An

Indian Perspective

Karthik Subbaraman, Dr. Prakash C GuptaHealis Sekhsaria Institute for Public Health

UICC World Cancer Congress, 2008Geneva, Switzerland

The Global Smoke-free Status

l Thirty-one countries (18%) have established comprehensive smoke-free policies

l Twenty-five countries (15%) are planning to implement smoke-free policies by 2008 or 2009

l Fifty-one countries (30%) are making significant progress with smoke-free policies

l Sixty-five countries (38%) have limited or no smoke-free policies

The Smoke-free Status in India

The Ministry of Family Health and Welfare of India passed a smoke-free notification on May 30, 2008.

The smoke-free legislation is scheduled to come into effect from October 2, 2008.

General overview of the situation..

The Bad Guy

Public

Policy advocatePolicy influencer

Enforcer

Policy makers

The General Public

Challenge 1 = Illiteracy

“Does smoke-free Mumbai mean that one can

smoke freely in Mumbai”?

Political pressure thwarts India anti-smoking move (Friday 20th July 2007) By Kamil Zaheer

NEW DELHI, July 20 (Reuters) - Political pressure has blocked a plan to put graphic pictorial warnings on cigarette packets, India's health minister said on Friday, seen as key in reducing the nearly 1 million deaths a year due to tobacco use.

"There has been a lot of pressure from all parties," Health Minister Anbumani Ramadoss told reporters. "The chief ministers have written, lot of ministers have come, MPs have given representations," Ramadoss said, after receiving an award from the World Health Organization for his efforts to fight the widespread use of tobacco products in India.

But opposition from politicians, including federal and state ministers, and some ruling Congress party MPs led a group of ministers dealing with the plan to delay and dilute its implementation.

Ramadoss said the government planned to strictly enforce existing laws banning smoking in public places such as restaurants, bus stops and railway stations, and ensure no one smoked in any workplace including factories.

But political leaders from Andhra Pradesh, where thousands of people are employed in the tobacco industry, said the move for pictorial warnings would hurt the poor.

"We know smoking is injurious to health but putting such health symbols will hamper the job opportunities of hundreds of thousands of rural workers," said Andhra Pradesh labour minister G. Vinod.

The Policy makers

Challenge 2 = Neglect of Public Health

Challenge 3 = Implementation gap

Challenge 4 = Growing apathy in the system

Policy influencer—Media in India

Too many cooks spoil the broth..

Challenge 5 = Media Volume—growing threat?

63,229 registered newspapers published in more than 22 languages in India

Favor private news organizations over public news organizations (64% and 57%, respectively)

Media type Rural reach(in %)

Urban reach(in %)

Television 38 75

Radio 18 20

Print 15 35

Cinema 5 12

Paid media efforts, then and nowJuly 19, 2008

Eighteenth century smoking advertisement in India

Advertisement industry in India

Indian tobacco manufacturing companies diversifying intonon-tobacco products like¡ Fast Moving Consumer Goods (FMCG)¡ Real estate ¡ Hospitality

A closer look at the advertising trends in newspaper and television provides a possible insight into their reasons for doing so.

Trends in the Indian Advertisement Industry

l According to a media analysis conducted in 2007, real estate andFMCGs ranks first in the advertisements posted on newspapers andtelevision, respectively

l Interestingly, there was no specific allocation for health-related information dissemination in both newspapers and television; further, the Central government or State-government related promotions ranked least in the newspaper advertisements

l Challenge 6 = Negligible media priority for health-policy related information coupled with increased growth and diversification of the tobacco industry

Entertainment industry—Bollywood

There is a very close association between the largest entertainment industry in India and the increasing disregard for health concerns due to smoking amongst Indian youth

The Bollywood is growing at an average growth rate of 25% per year; this amplifies the potential reach of the entertainment industry within India and globally

Challenge 7 = Role models for smoking behavior and acceptability

India’s bronze medal winner at the 2008 Olympics, and India’s biggest superstar

Policy Advocates

The “I” factor

Challenge 8 = Lack of synergy

Summary of smoke-free challengesl Challenge 1 = Illiteracy

l Challenge 2 = Neglect of Public Health

l Challenge 3 = Implementation gap

l Challenge 4 = Growing apathy in the system

l Challenge 5 = Media Volume—growing threat?

l Challenge 6 = Negligible media priority for health-policy related information coupled with increased growth and diversification of the tobacco industry

l Challenge 7 = Role models for smoking behavior and acceptability

l Challenge 8 = Lack of synergy amongst policy advocates

The problem, the victim, and the solution

the Elephant(PROBLEM)

the Tiger(EMPOWERED)

and the Cell phone(SOLUTION)

“I THINK WHAT IT REALLY SHOWS IS THAT NO MATTER WHAT YOU SET YOUR IMAGINATION TO, YOU CAN DO IT”

Merci beaucoup!