A few years ago, many Indians woke up to the sight of a respected Hollywood star on the front pages of newspapers and on huge billboards across their cities, promoting a brand that most of us know stands for a variety of smokeless tobacco products like gutka and pan masala.
No doubt cultural nuances were missed since the actor later clarified that he was unaware of the implications of his act and that as an advocate of cancer awareness, after losing two family members to the disease, he would never promote anything tobacco related. More recently (and culturally closer), some stars from Bollywood and Tollywood were in the news for dissociating themselves from tobacco products’ promotions. Increased knowledge about the deadly effects of tobacco aside, we can also attribute these acts to an increased awareness about surrogate advertising. One may wonder why these public announcements by members of our entertainment industry are so deserving of our attention. Let us consider a few well-known facts available in the public domain.
India has 266.8 million tobacco users, the second largest consumer base in the world, which includes both smoking and smokeless tobacco users. According to WHO, 12 per cent of the world’s smokers are found in India. These statistics throw light on the magnitude of health-related challenges that tobacco usage is causing directly and indirectly. In fact, about 1.2 million deaths per year are attributed to second-hand smoke. Non-smokers exposed to this are at an increased risk of developing heart disease by 25-30 per cent and stroke by 20-30 per cent. The costs continue to pile up. Treatments for cancer, heart diseases and stroke are quite expensive, adding to the distress for the economically weaker sections of society. At the national level, the economic cost attributed to tobacco use from all recorded deaths between 2017-2018 for persons over 35 was a staggering Rs 1,773.4 billion.
The Indian government has instituted various laws to curb tobacco usage, including requiring larger graphic warnings on packs, prohibiting their sale near educational institutions or to minors, mandating Designated Smoking Areas (DSA) for certain places, banning smoking in public spaces, fining those who spit out chewed tobacco and banning the direct or indirect advertisements of tobacco or tobacco-related products. While they address key challenges, a lot more ground needs to be covered. One area in need of immediate increased attention is surrogate advertising and the role of celebrity endorsements.
Manufacturers use brand extensions to build associations and to advertise, as we have seen with the “mouth fresheners” advertisements. These are usually sold under the same brand name and with very little differentiation. Consumers, especially young people, are subliminally lured and convinced to make a positive association between the two. Meanwhile, well-known personalities are misled into believing that their endorsement is for a tobacco-free sister product so their conscience can rest as there is no law being broken.
Even though strict ban has been laid down by the government on direct or indirect means of tobacco advertising, brand extension promotions are a loophole-exploiting practice that circumvents the law. However, despite the ambiguity, most of us can agree that the practice is decidedly unethical. Overlooking this aspect would be an unfortunate negation of one’s social responsibilities, especially by public role models with massive influence and reach, who therefore, need to be more accountable.
A simple endorsement can undo years of efforts and investments by governments in trying to control tobacco use prevalence intended to saving lives and families from the burden of deadly diseases. One may reasonably ask how a few actors can make millions of Indians overcome their habits? Popular culture and those at the top of it continue to have a strong sway over individual behaviours and choices, especially when you consider that more than 50 per cent of smokers start using tobacco before the age of ten and that the one-third of the youth experiment with tobacco as a result of Tobacco Advertising, Promotion and Sponsorship (TAPS).
We need to continue fighting against tobacco as it is still entrenched in our lives especially through popular culture. Tobacco is the only consumer product in the world to kill every second user according to WHO.
As a cancer surgeon, I have seen first-hand the impact it has not just on patients but also their families. The immense pain of avoidable deaths is compounded by the financial burdens and other challenges that come with it. Tobacco products are still being sold near educational institutions even as DSA norms are flouted elsewhere. While surrogate advertisements continue to thrive and prevail, our movies and online streaming channels blatantly show the usage of tobacco products. Creative expression and freedom of speech should also be seen in conjunction with the right to life and good health. If we don’t address the tobacco use, we could be staring at death tolls more than that of Covid-19 each year.
During Covid-19 peak, we rose to the occasion displaying strong social, collective and individual responsibilities that prioritised community health. Public role models from all sectors and walks used their platforms and influence to help further these goals. The pandemic is not entirely out of our lives and yet we see a sustained momentum for prevention and addressing the pandemic. Meanwhile, the much older tobacco epidemic, which worsens Covid-19 and other illnesses, continues unabated. In light of this, it is essential that we keep the spirit of collective action alive.
Our country has a significant youth population. With global flashpoints like climate change, our young people already worry about the world they are to inherit. The costs of tobacco are an avoidable drain on resources that should be instead engaged in improving this world. Role models should not underestimate their contributions here. I hope to see them leading from the front and using their voice to leave behind a richer legacy — one of a tobacco-free and smoke-free India as the future of our country.
(The writer is professor and surgeon, Department of Head Neck Surgery, Tata Memorial Centre, Mumbai)