India scores high in graphic health warnings, cessation bans: WHO report on global tobacco use

Tobacco use remains one of the most significant public health challenges worldwide, contributing to millions of deaths annually due to related illnesses such as cancer, cardiovascular diseases, and respiratory disorders. Recognizing the urgency of combating tobacco consumption, countries around the globe have adopted various measures to reduce usage and protect public health. Among these, India has emerged as a global frontrunner in tobacco control, particularly noted in the latest World Health Organization (WHO) report on global tobacco use for its effective implementation of graphic health warnings and cessation policies.

Graphic Health Warnings: Making Tobacco’s Harm Visible

One of the standout achievements highlighted by the WHO is India’s stringent regulation on tobacco product packaging. India mandates that cigarette and bidi packs display graphic health warnings covering 85% of the packaging surface—one of the largest warning areas globally. The warnings combine graphic images depicting the harmful effects of tobacco with clear, concise textual messages written in multiple Indian languages to ensure wide comprehension.

These visual warnings are designed to evoke an emotional response and convey the harsh realities of tobacco use, including images of diseased lungs, oral cancer, and heart ailments. Studies have shown that such pictorial warnings are more effective than plain text in discouraging tobacco use, especially among young people and less literate populations. India’s commitment to prominently featuring these warnings on nearly the entire packaging has set a benchmark that many countries aspire to emulate.

Comprehensive Cessation Support: Beyond Warnings

Graphic warnings alone are not enough to curb tobacco use; equally important are accessible and effective cessation support systems. India has invested in developing a robust framework to help tobacco users quit, offering a variety of support options that include a national quitline, counseling services, and integration of cessation treatments into primary healthcare settings.

The quitline provides free telephonic counseling, guidance, and motivational support to those who want to stop using tobacco. Meanwhile, healthcare providers across the country have been trained to identify tobacco dependence and provide cessation advice, including pharmacological treatments when necessary. These efforts have been lauded by the WHO as exemplary, contributing significantly to tobacco control outcomes.

Innovative Regulatory Measures: Tackling Tobacco Promotion in New Media

India’s tobacco control initiatives extend beyond conventional means. Recognizing the influence of digital media and entertainment, India became the first country to introduce regulations requiring anti-tobacco warnings on over-the-top (OTT) streaming platforms. These platforms, including popular services like Netflix, Amazon Prime, and Disney+ Hotstar, have become major sources of content consumption, especially among younger demographics.

The regulations mandate that any depiction of tobacco use in OTT content must be accompanied by health warnings at the beginning and midpoint of the program, alongside a continuous static message during scenes showing tobacco consumption. This pioneering approach aims to counter glamorization of tobacco use in popular media, reducing its appeal to impressionable viewers.

Progress and Impact: What the Numbers Say

India’s efforts have begun to yield measurable results. According to recent surveys and data collated by WHO, tobacco use prevalence in India has seen a gradual decline in recent years. The visibility of graphic warnings has increased awareness of tobacco’s dangers, motivating many users to attempt quitting. Furthermore, cessation programs have facilitated successful quitting attempts among thousands of tobacco users.

However, India remains home to one of the largest numbers of tobacco consumers worldwide, with more than 250 million users, many of whom consume smokeless tobacco products like gutka, khaini, and betel quid. The smokeless tobacco sector poses unique challenges due to its cultural acceptance, diverse forms, and widespread availability. Hence, continuous vigilance and targeted interventions are essential.

Challenges Ahead: Bridging the Gaps

While India’s tobacco control framework is strong, several challenges remain. Enforcement of tobacco control laws, especially in rural and semi-urban areas, is often inconsistent. The informal tobacco market thrives, offering products that escape regulatory scrutiny, and affordable tobacco products remain easily accessible to vulnerable populations, including youth and economically disadvantaged groups.

Moreover, cessation services are not uniformly available across the vast country. Many primary healthcare centers lack trained personnel and resources to deliver effective tobacco cessation support. There is also a need for greater public education campaigns tailored to various languages and cultural contexts to reach diverse communities.

The socio-economic factors tied to tobacco use also complicate control efforts. For many low-income households, tobacco use is both a habit and a source of livelihood, given the extensive employment in tobacco farming, production, and sales. Thus, any tobacco control strategy must balance public health priorities with economic realities, offering alternative livelihoods and support for affected communities.

Government and Civil Society Collaboration

India’s success is also attributed to the collaboration between government agencies, non-governmental organizations (NGOs), and international bodies like WHO. The government’s tobacco control legislation, including the Cigarettes and Other Tobacco Products Act (COTPA), sets the legal framework for tobacco regulation. NGOs play a crucial role in grassroots awareness, advocacy, and helping implement cessation programs.

Public campaigns, such as the ‘Quit Tobacco Movement’ and ‘Tobacco-Free India’ initiatives, have helped shift public perception, positioning tobacco use as a serious health hazard rather than a socially acceptable norm. Educational institutions and workplaces are increasingly adopting tobacco-free policies, reinforcing behavioral change.

Future Directions: Sustaining Momentum

To build on its achievements, India is focusing on several key areas:

• Strengthening Enforcement: Improving monitoring and enforcement of tobacco control laws, especially in remote areas, to prevent sales to minors and restrict tobacco advertising and promotion.
• Expanding Cessation Services: Scaling up cessation programs by training more healthcare workers and integrating tobacco dependence treatment into all levels of healthcare.
• Targeting Smokeless Tobacco: Developing specific policies to address smokeless tobacco use, including packaging warnings, taxation, and public education.
• Research and Surveillance: Enhancing data collection and research to better understand tobacco use patterns and the effectiveness of interventions.
• Economic Alternatives: Promoting crop diversification and alternative livelihoods for those dependent on tobacco production.

Conclusion

India’s prominent position in the WHO’s global tobacco report underscores its commitment to reducing tobacco-related harm through innovative, evidence-based policies. Graphic health warnings and cessation support have proven effective pillars of its tobacco control strategy, complemented by groundbreaking regulations for new media platforms. While challenges persist, India’s comprehensive and evolving approach offers a model for other nations grappling with tobacco use.

By maintaining political will, fostering collaboration, and continuously adapting to emerging trends, India is on a promising path to achieving its vision of a tobacco-free future — safeguarding the health of millions and setting a powerful example for global tobacco control.