Tobacco is the only legally available consumer product that has no good use except causing disease, disability and death. In India, there are 27.5 crore tobacco users, that is, every third Indian adult uses some form of tobacco.

But that said, a blanket ban on tobacco is unlikely. It is an important exportable commodity that brings revenue and foreign exchange. And there are millions of people who earn their livelihood from tobacco. In fact, a key argument from the industry against increasing the size of the pictorial health warnings on tobacco products is that it would ultimately rob tobacco farmers off their livelihood.

But there is a constant and willful suppression of an important fact: tobacco doesn’t spare even those earning from it, especially the farmers.

A very characteristic illness in tobacco growers is Green Tobacco Sickness. It occurs when tobacco workers hand-harvest, cut or load tobacco plants, usually early in the morning or after a rainfall when tobacco plants are covered with moisture. It occurs through exposure of skin to dissolved nicotine from tobacco leaves. Nicotine is a very harmful chemical that not only causes dependence but can directly lead to several systemic illnesses.

Symptoms of GTS include weakness, headache, nausea, vomiting, dizziness, abdominal cramps, breathing difficulty, abnormal temperature, pallor, diarrhoea, chills, fluctuations in blood pressure or heart rate, and increased perspiration and salivation. Severe cases may require immediate admission and intervention. Even the storage of tobacco in houses was found to lead to higher incidence of nausea, headache and dizziness.

Most field workers are part of unorganised small-scale set-ups without access to protective clothing, health insurance or even made aware about the risks. Many of these workers also develop respiratory diseases similar to emphysema and end up having altered pulmonary (lung-related) function. They have also been found to have higher incidence of musculoskeletal problems.

Tobacco crops require application of pesticides and may result in serious health effects to those handling it. Another associated problem more relevant, mainly in children and family members, is that of third hand exposure ie tobacco dust around them.

Tobacco crop leads to loss of nutrient content of soil that necessitates higher quantity of fertilizers and manure. In addition, curing of tobacco requires large quantities of firewood and results in deforestation as well as environmental pollution. In many areas, farmers have given up paddy and pulses for tobacco. This is impacting the regional food security. Most of the biomass is being diverted for tobacco curing depriving cattle stock of their feed.

Due to higher requirements of fertilizers, pesticides and fuelwood for growing tobacco crops, farmers require strong financial support. These are generally provided by loan sharks and also at time through bigger tobacco companies. This traps them into a vicious cycle!

Anti-tobacco campaigns need to also address farmers and educate them about the ill-effects of handling the crop and encourage them to switch to alternative crops. This is especially important because the domestic and international demand for tobacco is shrinking rapidly. A thought reinforced by a recent report of a Parliamentary committee on Environment and Forests that recommended the promotion of an alternative livelihood in the interest of farmers, environment and the larger society.

(The writer is Professor and Head & Neck Surgeon with Tata Memorial Hospital. Views expressed are personal.)