Need to prioritize supply-side intervention for curbing tobacco epidemic in India

The theme of the World No Tobacco Day (WNTD) 2023 ‘Grow food, not tobacco’1 rightly emphasizes the importance of supply-side interventions for the first time, which is in accordance with Articles 17 and 18 of the Framework Convention on Tobacco Control, the first public health treaty negotiated under the auspices of the World Health Organization (WHO) in 2005. This provides for viable alternative to tobacco growers and also focuses on protection of the environment. WNTD, celebrated annually on the 31^st of May since its establishment by the WHO in 19872, aims to raise awareness about harmful effects of tobacco, featuring different themes each year to address societal needs and attract attention to the current situation. In India, 266.8 million adults use tobacco in various forms3, which contributes to 1.35 million deaths annually4 and loss of 24.48 million disability-adjusted life years5. Tobacco use has also been attributed to seven out of 10 leading causes of deaths6. While the main goal of tobacco control programmes is to bring down the demand for tobacco, the strategies for reducing the supply of tobacco need to be balanced with the efforts to reduce the demand7. The WNTD 2023 campaign encourages governments to discontinue providing subsidies for production of tobacco and instead use the funds that are retained to support farmers to shift towards more nutritious and long-lasting crops1.

Tobacco is grown in more than 124 countries8, taking up 4 million hectares of land8 that could be used for crops, which would feed over 11 million people in countries such as China, India, Indonesia, Malawi, Mozambique, Tanzania and Zimbabwe and reduce food insecurity29. In India, tobacco is produced on an area of 431,146 hectares, accounting for 0.27 net area under cultivation10, leading to an annual loss of 45 kg of topsoil per acre. It is estimated that if we redirect the land area under tobacco cultivation towards other crops, we could produce 5.53 million tonnes of fruits, 7.78 million tonnes of vegetables, 1.2 million tonnes of rice, 36.2 million tonnes of sugarcane, 7.58 million tonnes of groundnut, 14.43 tonnes of maize, 10.3 million tonnes of potato or 1.5 million tonnes of wheat, which could provide highly nutritious food to millions of families and improve their standard of living11. Thus, agricultural diversification can be used as a supply-side intervention, diverting farmers to grow useful food crops instead of tobacco cultivation. These measures underscore the benefits, which could result from directing these resources towards vital food crops in terms of food production, food security and general well-being.

Besides food insecurity, growing tobacco is endangering the health of the producers. More than 17 million people worldwide are employed in tobacco farming industry9. The average amount of nicotine that a tobacco farmer who plants, grows and harvests tobacco, inhale each day is equivalent to that in 50 cigarettes, which leads to nicotine poisoning known as ‘green tobacco sickness’ among one in four farmers12. In addition, tobacco farmers generally have higher blood levels of aluminium and arsenic due to their exposure to pesticides, leading to a number of health issues, such as endocrine disruption, genetic changes, benign and malignant tumours, birth defects and blood and neurological disorders12. Each year, between one and five million cases of pesticide poisoning are reported, and 11,000 agricultural workers around the globe lose their lives as a result13. As per WHO data, among 12 of the primary countries that produce tobacco, seven out of 10 farm workers are women, besides 1.3 million children under the age of 14 who are forced into labour. These vulnerable populations are at higher risk because of higher absorption of nicotine leading to reproductive and infertility disorders12. Therefore, phasing out tobacco cultivation will benefit the health of farmers and their family who grow tobacco crops and in turn will not only increase their productivity years but also contribute to overall national growth and development.

Tobacco poses a significant threat to the environment. The effects of tobacco on environment occur at different stages, including production, distribution, use and disposal14. Tobacco crops, as compared to other crops, absorb key elements from the soil, including nitrogen, phosphorus and potassium, which, when coupled with the specific agricultural techniques meant to achieve high nicotine levels and high leaf yields, namely ‘topping’ and ‘desuckering’, contributes to the depletion of soil nutrients1516. The cultivation of tobacco also results in the permanent loss of priceless natural resources such as water sources, forests, plants and animal species12. According to the WHO, tobacco poisons our planet by consuming 22 billion tonnes of portable water, producing 2 million tonnes of packaging waste (the equivalent of 9433 goods trains) and causing deforestation of 5 per cent of forests worldwide17. Since the 1970s, an estimated 1.5 billion hectares of forests have vanished from the planet, accounting for up to 20 per cent of the annual increases in greenhouse gases18. The tobacco crop prevents the optimal outputs of at least six major food crops. Tobacco farming, combined use of fertilizers and irrigation are responsible for more than 70 per cent of the environmental harm in most impact categories14.

The total value of the global tobacco market was estimated at US$ 849.9 billion in 2021, and it is anticipated to grow at a compounded annual growth rate (CAGR) of 2.4 per cent from 2022 to 2030. The demand for tobacco has been maintained by the rising smoking rates in various countries such as Asia and Africa12. When farmers switch from tobacco cash crops to food crops, the short-term financial gains are surpassed by the long-term benefits of increased food security, besides having less frequent farmer debt, a decrease in illness and poverty among farm workers, and a widespread environmental protection in low- and middle-income countries13. A record number of 349 million people from 79 countries, many of whom reside in low- and middle-income nations, experience severe food insecurity due to tobacco cultivation12.

Future Direction

In line with the recommendations of Indian Council of Agricultural Research (ICAR), the viable substitutes of tobacco crop, depending upon contextual geographical factors like soil, climate, and water supply should be promoted19. The following crops are suitable for irrigated areas: potato, ginger-wheat, tomato, lady’s finger, cabbage, cauliflower, garlic, tomato, brinjal (aubergine), pulses, turmeric, Caster-groundnut, cotton-groundnut, black gram, green gram, mustard, ragi and sugarcane, groundnut, oil palm, cotton, chilli, maize, onion and cucumber19. Mustard, sorghum, green gram, coriander, Bengal gram, soybean, red gram, safflower, groundnut, maize, bajra and caster are suitable for non-irrigated areas19. Crop diversification is crucial to guaranteeing long-term sustainability of agricultural practices and financial viability. In addition to acting as tobacco substitutes, the suggested substitutes improve soil quality and lessen the dangers connected with tobacco cultivation.

In order to encourage the transition towards more sustainable alternatives than tobacco, governments must establish the necessary conditions and regulatory frameworks that will create a win–win situation for farmers. Further, civil societies should create a cadre of ambassadors to mitigate the industry interference in tobacco production and provide alternative livelihood models for farmers, including vocational training to them. The farmers should be encouraged by the government to get involved with crop substitution by cultivating more environment friendly crops that will enhance community well-being. Besides, more productive crops should be developed through research in order to reduce the production of tobacco and mitigate the problem of food insecurity.

Around the world, a number of supply-side initiatives have been proposed or put into practice to decrease the cultivation of tobacco20. A few of these interventions can be applicable in the Indian setting along with crop substitution. Financial incentives such as price supports or quotas should be provided to encourage farmers to switch from growing tobacco, which may be gradually diminished over time. Further, crop diversification should be placed within broader rural development agenda rather than as an isolated intervention to reduce the supply of tobacco. Investment in alternative economic opportunities for farmers and removal of subsidies for businesses centred on the tobacco industry are other measures which have been successfully adopted by various countries20.

A concern mostly spread by the tobacco industry is that higher pricing on tobacco products shall lead to a substantial increase in smuggling, thus increasing the supply of illicit tobacco products. However, ample studies have allayed this concern. The existing literature has pointed out that an increase in tobacco taxes shall not only reduce demand (best measure in MPOWER; monitoring tobacco consumption and the effectiveness of preventive measures, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, and raise taxes on tobacco) but also lead to an increase in government revenue. The government should seriously think about substantially increasing taxation on all tobacco products, in line with WHO recommendations21. Contrary to the belief of myths spread by the tobacco industry, most countries have seen no net job losses and few have seen net gains, if there is a reduction in the supply of tobacco. These myths should be dispelled with dissemination of accurate information to all the stakeholders.

WNTD 2023 campaign seeks to reduce tobacco use across the globe. It strives to educate the general public about the negative health effects of tobacco use, including lung cancer, heart disease, respiratory conditions and many more. The campaign exhorts governments to take action and put into effect strict regulations to forbid farmers from cultivating tobacco. Further, it should also support imposing high taxes on tobacco products.