Family is exposed to second-hand smoke that adds to their indoor pollution, a risk factor for NCDs says Suneel

Suneel Vatsyayan says "In our society, tobacco is comparatively more acceptable, affordable, and available" 

Vinnie, Nada Health Advocate 

Vinnie Choudhry is a student of management, pursuing her MBA from IIM Bangalore. She graduated in Economics from the University of Delhi. She has been associated with Nada India Foundation since her school days where she participated in a Pehchaan Radio club Show which waconducted to raise drug awareness amongst young people. The following interview was conducted on phone with  Mr. Suneel Vatsyayan, founder of Nada India Foundation, which has been working for prevention of tobacco, alcohol and other drugs and non-communicable diseases for 20 years now.The organisation has been instrumental in rehabilitating the lives of several families whose members were caught in the web of addiction.

Vinnie - Sir, Thanks for getting on call with us. Can you tell us about how you decided about setting up Nada India Foundation? What is its mission? What activities has it initiated to achieve the same?

Suneel - Nada India was set up by me, Suneel Vatsyayan and O. Michael Smith. The purpose of starting this trust was to organize barrier free services for treatment and prevention of alcoholism and drug addiction. We calculated the risk factors, and observed that the people who are suffering from these addictions get affected by non-communicable diseases mainly due to unhealthy diet, and physical inactivity, dependence on alcohol, tobacco and other substances . Our ultimate goal is to bring about holistic well-being. Later during the course of time, our activities became more comprehensive. Now, the mission of Nada India is to facilitate ‘Good Health for All’. We are moving towards ‘well-being as a state of being’. 

Vinnie- Sir, what has been your first-hand experience with Tobacco in India?

Suneel- Tobacco is just the chemical. It is nicotine that is addictive. Smoking can be one way of consuming it, chewing can be another form. Then, we have e-cigarettes, gutkha, nicotine patches, etc. We have been working with alcohol and drug addicts primarily, we found that even after they left drugs and alcohol, they continued with tobacco. Years later if we see the patients, who had left alcohol and drugs, we find that they died of diseases caused by consumption of tobacco. That’s because people and society as a whole see tobacco as less of a harm, which isn’t true. On the contrary, it is more lethal. This is amplified by the fact that it isn’t illegal to smoke, which makes its consumption more socially acceptable. In our society, tobacco is comparatively more acceptable, affordable, and available. 

Vinnie - Right, sir. Moving to our next question. We see that there can be stringent steps that can be taken by the government like a blanket ban on tobacco. In reality, the government is taking relatively smaller steps like banning vaping. What do you think is holding them back from taking radical measures to cure tobacco addiction from the ground level?

Suneel- That’s because there are commercial determinants of health. It means there is  a stake of people who are investing in this industry. That leads to direct conflict of interest. Since tobacco is very addictive, there is profit for corporations as well as revenues for the government attached to tobacco consumption. Tax Revenue has been promoted as a best practice for deterrence by WHO. Increasing revenue means increase in revenue of the government. Naturally, if the government bans tobacco, they also lose out on revenue. That’s why, it goes hand in hand for both the agencies. 

Unknowingly, they become part of the problem, rather than becoming part of the solution. That is why, there is a differentiation between cigarettes and tobacco and other tobacco products. Stringent laws exist but their implementation is poor. It is illegal to sell cigarettes to anyone under 18 years of age, but you can see the reality. Nowadays, civil society has come up with their own activities and things have changed like, prevention at the workplace, stricter norms against public smoking exist, but the public is ignorant, their involvement is zero. This problem has to be dealt with at the local level.

Vinnie- Right, sir. There are government mandated pictorial warnings that have to be put on cigarette packets. How far do such initiatives impact the consumer’s mindset? 

Suneel- It has its own effects. Cigarette packets have a picture of a person suffering from oral cancer, which looks very ugly. The point I am driving at is that there isn’t glamour attached to cigarette smoking anymore. Earlier, expensive packets of cigarettes would be visible from young boy’s pockets so that girls could see, which was an attempt to impress her. It is no more like that because of the mandatory warning. Also, there are countries who are vouching for plain packaging for cigarettes. I myself did market research for package testing for cigarettes. Our next step can be towards plain packaging of the cigarettes. 

Vinnie- Sir, you must have come across patients who are addicted to tobacco. Based on your experience, what are the implications of smoking on their families? 

Suneel - First, the family is exposed to second-hand smoke that adds to their indoor pollution. Second, would be the cost of cigarettes itself. Third, there is a cost involved with tobacco i.e. the health burden as well as the cost of the treatment.The family members have to bear things like the unpleasant smell of smoke. Fourth, it can lead to in house fires..

Among the nonsmoking youth in India, about one in two were at risk of exposure to SHS at home and public place and about one in four at indoor workplace. Being female, living in rural area, lower education and socioeconomic status and use of smokeless tobacco were found to be significantly associated with SHS exposure among nonsmoking youth in India. Read 

Vinnie- Do you think tobacco smoking follows a certain gender-based trend?

Suneel- It is no more male’s business , there are less men consuming it. There are more children and females smoking nowadays. That’s because the tobacco industry is targeting these new segments i.e. women and children.

Source:  bidi.jpg https://www.theindianwire.com/wp-content/uploads/2019/12/bidi.jpg 

Vinnie- There are various forms of tobacco, say on  beedi and cigarettes. Upon our analysis, we found that cigarette smoking is confined to the upper strata of the society and beedi for the people who can’t afford cigarettes. Do you agree with this finding?

Suneel- There is nothing like inferior or superior. One shouldn’t differentiate between the both. It is to do with the carcinogenic nature of tobacco, the paper and the leaf. It is a question of choice and availability of these products. In cigarettes, there is a double harm that is done to society. You need to cut trees to get the paper for cigarettes. But in beedi, you just use the tendu leaves without cutting the tree itself. You can definitely say that there exists a rural and urban divide in terms of type of tobacco consumed.

Even for the lower economic strata, the cigarette companies come up with cheaper variants: a strong tobacco with less filters. They always target young people who want to start smoking by supplying them with a stronger form such that they get addicted. It has been observed that as the tobacco content goes down, the cost of the product falls, and the number of cigarettes consumed per day rise. 

Vinnie- There are a few corporates who drive a lot of revenue from cigarette sales. Do you think corporations like these should do something to give back to society? 

Suneel- I agree with this point of view. But we shouldn’t encourage this practise. It's like ‘I kill somebody but I pay for it’. Most civil societies don’t accept corporate donations because of this conflict of interest. Even the government shouldn’t accept this money. Otherwise it won’t have a deterrence effect. What about surrogate advertising? Just check with your younger siblings, they are reaching out to those people. You know how they are doing that? 

Vinnie- How is that?

Suneel Just check back at your school to see what companies’ notebooks they are using. They are all produced by a particular Tobacco company. The child is exposed to this brand at such an early age. Then the brand gets a recall value. This benefits their business later on when the child comes of age to smoke. Similarly, they have hotels, etc. that add to the recall value of their brand.

The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people. Read 

Vinnie- Sir, we would like to understand the process of rehabilitation of a smoker?

Suneel- Treatment rate is very low. Either people leave it just for the sake of it, but  then they get back at it. Or they continue to smoke. 

It is a multi-step process. First is raising self-awareness by making the patient list consequences of continuing to smoke. Amplifying his voice – ‘today is my last day’. We ensure his own manageability by conducting physical medical tests upon admission. Throughout the process, we use some substitute that helps him maintain the taste of his saliva. This saves him from relapsing.

Vinnie- At the society level, what factors do you think push an individual towards tobacco? 

Suneel- First is availability of tobacco, second is acceptability in terms of it being available next to a chocolate. It means right from day one, you have been given a message that you can smoke cigarettes whenever you get of age. 

Vinnie- One last question, do you think the price of tobacco plays a role in its demand?

Suneel- Certainly, yes. It is because there is no other way to deter consumers other than increasing the prices of tobacco. 

We need to tackle the issue from the demand side. There are no preventive measures. If you visit the deaddiction centers, you would see that they continue to use tobacco. We had conducted a workshop around the same issue. They say that the patients are working to leave drugs, whereas cigarettes are a smaller menace so they won’t harm them much. Rather, it affects their immunity to diseases. Hence, tobacco should be banned and this ban be implemented at such hospitals. This is all that I have to say.

Vinnie- Thank you for your time, sir.