There has been an overall global decline in tobacco use over the last two decades with about one in five adults worldwide consuming it in 2022 compared to one in three in 2000, according to the estimates in the latest WHO (World Health Organisation) tobacco trends report released on Monday.

The report shows that 150 countries have been successful in reducing tobacco use, with India among the countries that have taken the most effective measures over the years to curb the practice.

There has been an overall global decline in tobacco use over the last two decades with about one in five adults worldwide consuming it in 2022 compared to one in three in 2000, according to the estimates in the latest WHO (World Health Organisation) tobacco trends report released on Monday.

The report shows that 150 countries have been successful in reducing tobacco use, with India among the countries that have taken the most effective measures over the years to curb the practice.

The 2021 Global Youth Tobacco Survey’s India data showed there was a 42% reduction in tobacco use among 13-15-year-old school-going children in the past decade. The Global Adult Tobacco Survey India data released for the period 2016-17 showed the prevalence of tobacco use in Indian adults dropped to 28.6% from the earlier prevalence of 34.6%. It is expected to show a similar trend when fresh data is released likely later this year.

What really has worked in India’s case is bringing in stringent laws from time to time to regulate the sale and distribution of tobacco products, and banning the sale and distribution of newer tobacco products— electronic nicotine delivery devices (ENDS)— such as e-cigarettes across the country.

“The Indian government has been taking consistent measures to bring down the prevalence of tobacco use in the country. For India, use of smokeless/chewing tobacco such as khaini, and zarda has been a bigger concern, and also the major focus while drafting interventions,” said a senior government official who is a part of the tobacco control division, government of India, on condition of anonymity.

India implemented 85% pictorial warnings in 2018 on cigarette packets meant to make people aware of the harmful effects of tobacco use. It is also mandatory to mention quit line number, 1800-11-2356, on all packs containing tobacco products as part of the health warnings. To dissuade tobacco use among adolescents, the government banned the sale and distribution of tobacco products within 100 metres of the premises of an educational institution, and most states have banned smoking in public spaces.

Experts also said that India has addressed the challenge of curbing tobacco use quite well.

“India has demonstrated a steely resolve to contain the menace of tobacco through a comprehensive control strategy that combines several demand and supply reduction measures. India, as a signatory to FCTC (WHO Framework Convention on Tobacco Control), is actively involved in combating the menace of tobacco with renewed fervour. From imposing a complete ban on e-cigarettes in September 2019, under the guise of preventing potential health risks to India’s youth, to bringing the new age OTT Platforms under the realms of ‘Films and TV Rules’ with the same intent, implementation of 85 percent pictorial health warnings, a ban on gutka and other tobacco control policy measures, Government of India has exhibited complete will in protecting the youth of our nation,” said Bhavna Mukhopadhyay, chief executive, Voluntary Health Association of India.

“But it is, needless to say, more efforts are needed to change the landscape of tobacco control in India. As envisioned a relative 30 per cent reduction in the prevalence of current tobacco use is possible through concerted efforts in the right direction, the significance of those could be increasing taxes on tobacco products, strengthening tobacco control laws and ensuring its enforcement,” she added.

One of the major challenges will be strict enforcement, especially of laws against the use of ENDS.

“It was found that vaping devices were being sold illegally in some parts of the country, which is why the health ministry wrote to states to ensure stricter compliance and harsh punishment for those found defaulting. India has the right laws and the improvement in numbers is proof of that; what is needed now is more targeted intervention and effective enforcement of measures,” said a senior central government official, requesting anonymity.

Another important step that the government is working on is towards moving tobacco farmers away from growing tobacco.

“The government is looking at alternative crop arrangements for tobacco farmers such as cotton, pulses, cereals etc. to ensure their livelihood does not suffer,” added the official cited above.

In the longer scheme of things, curbing tobacco use is also likely to help in cutting down tobacco-related cancers as tobacco use is one of the key risk factors for non-communicable diseases including certain types of cancers, according to experts.

“Tobacco use tops the list of cancer-causing risk factors; it is one of the preventable causes of oral cancer,” said Dr PK Julka, former head, radiation oncology, All India Institute of Medical Sciences, Delhi.