-by Upendra Bhojani

⁽Director and DBT/Wellcome Trust India Alliance fellow, Institute of Public Health, Bengaluru – India)

 

Photo by Suthir (CC BY-SA 4.0) via Wikimedia Commons

India is among the largest consumer, producer and exporter countries in the world as far as tobacco is concerned. In India, every year, tobacco use accounts for over 1.3 million adult deaths and costs 22.4 billion USD. India has been continually strengthening tobacco control regulations to reduce tobacco use and the associated harms. While tobacco use prevalence has reduced over time, the degree of decline varies widely across Indian states. What is clear is that tobacco is a highly addictive substance and widespread use of tobacco in a given population cannot be entirely explained through individual choice or lifestyle. Several factors beyond the control of individuals shape tobacco use in society: two of such important factors include public policy around tobacco and the tobacco industry/trade. There is a relative lack of research explaining the political economy of tobacco in India. We are currently pursuing such work through the DEEP project (Deciphering Epidemic of Epic Proportion) funded by the India Alliance to better understand whether and how these factors explain the differential decline in tobacco use prevalence in Indian states from 1990-2017.

 

As part of this broader research inquiry, we studied what concerns Indian parliamentarians had on tobacco by analysing 1315 tobacco-related questions asked by 729 MPs (Member of Parliament) over the two decades (1999-2019). We find that MPs had major concerns about (1) health [consumption patterns and trend; health harms of tobacco; provision of cessation services; tobacco control regulations and their implementation); (2) trade (trends in tobacco production and export; functioning of the Tobacco Board of India; tobacco taxation); (3) agriculture (livelihoods and welfare of tobacco growers); and (4) labour (working conditions; livelihood alternatives to tobacco; and negative impacts of tobacco control regulations). The nature of concerns changed over time: health became a dominant concern with trade issues taking a somewhat back seat, possibly due to growing awareness on health harms and incremental tobacco control regulations. The concerns related to tobacco-linked livelihoods and economy persisted throughout. The number of MPs asking tobacco-related questions varied widely across Indian states. The states from where maximum MPs asked questions (Andhra Pradesh; Maharashtra; Uttar Pradesh; Karnataka; Tamil Nadu in that order) are the states with a greater presence of the tobacco industry.

 

I, along with my co-authors (Amiti Varma and Latha Chilgod) published the findings including the characteristics of these questions and the parliamentarians asking these questions as well as thematic narratives of the nature of concerns expressed through these questions in the BMJ Global Health. The paper is available as open access for reading/download here.

 

The four key takeaways are: (1) parliamentary questions, that remain underutilized in health policy and systems research, could be a useful resource; (2) tobacco evokes diverse and competing interests implying a need for careful mediation and consultative approach to policymaking for public health gains; (3) In India, sub-national, state-level (economic, political, historical, cultural) contexts are crucial in understanding the political economy of tobacco and formulating tobacco control regulations; (4) identifying key concerns by parliamentarians help public health folks engage with diverse political voices when tobacco control reforms are being planned or executed, enhancing the political support across sectors and constituencies for tobacco control.

 

20th April 2021