The two most important causes of disease and death among adults in the world today are tobacco and alcohol. It is ironical that they persist in causing largest number of diseases and deaths despite their being preventable and public health scientists having highest level of research evidence on these two exposures causing disease and deaths among humans.
Notwithstanding the recent statements by some members of Indian Parliament, there is no doubt or difference of opinion on tobacco causing cancer and other serious diseases leading to deaths. Even the tobacco industry does not dispute the evidence. It still opposes and fights every tobacco control measure in every country but mostly on legal and procedural issues, rather than by questioning the evidence.
Considering the global nature of the tobacco problem and the transnational tobacco industry that is the cause of the problem, the World Health Organization, for the first time, initiated an International treaty, WHO Framework Convention on Tobacco Control (WHO FCTC). The treaty came into force on February 27, 2005 and has proved to be a highly successful, having been ratified by 180 countries so far.
The FCTC lays down basic principles and legal framework for advancing tobacco control but the progress has not been easy. Every policy measure faces a great deal of hurdles from the vested interests - a case in point being pictorial health warnings (PHWs) on tobacco products in India.
Since 2007, every notification on PHWs has been delayed for implementation and diluted in the process - the most recent one being the delay in implementation of notification requiring 85% of principal display area of tobacco products to be devoted to PHWs that should have come into effect on April 1, 2015, but has been put in abeyance.
The issues with alcohol control are even more complex than tobacco control. Tobacco, although grown in huge quantity has no beneficial use for humankind unless one terms satisfying an unnecessary and harmful addiction as a benefit.
Alcohol, on the other hand, is indispensible in medical procedures, pharmaceutical preparations, industrial processes, even household applications. So for alcohol control policies, one can only focus on controlling human use of alcohol.
Any use of the phrase ‘alcohol control’ however, immediately gets connected to the failed experiment of prohibition in the USA during 1930s that had its roots in the temperance movement. Therefore the issue of alcohol control often gets connected to mortality and moral values. In India so far, partial prohibition of alcohol has been based on its harmful social influences rather than public health impact.
There is an urgent need to start thinking of alcohol control based on hard scientific public health evidence. In addition to traffic accidents, the research evidence that alcohol causes cancer at many different sites: mouth, larynx, pharynx oesophagus, liver etc. is unequivocal.
Yet other than tobacco, there is no cancer causing consumer product that is so freely and widely available. Compared to tobacco, awareness of alcohol causing cancer is extremely low and there are no warning labels on alcohol bottles or restrictions on their surrogate advertisements and promotions.
Another issue complicating alcohol control is a slight reduction in the risk of cardiovascular diseases when alcohol is consumed in small, in fact very small, quantity. Rather than negating alcohol control, this points out towards informing consumers on safe level of alcohol consumption for cardiovascular diseases - information that is completely absent from bottles and advertisement of alcohol.
To improve public health, it is high time that we start thinking about tobacco and alcohol control policies based on strict scientific evidence without being derailed by the vested interests.
The writer is a Director with the Healis - Sekhsaria Institute for Public Health
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