Beedi fix: Time to target rural population

The government should turn its attention to the beedi that is far more toxic and harmful than cigarettes

While the recent banning of e-cigarettes by the Indian government, and by Tamil Nadu earlier, has been welcomed, there is concern that the real issue, that of rampant beedi smoking and tobacco chewing, may have been ignored.

The carcinogenicity of tobacco smoking was established in the 1950s and available evidence suggests that active tobacco smoking causes cancers of the lung, the lower urinary tract, including the renal pelvis and bladder, the upper aerodigestive tract, including the oral cavity, pharynx, larynx, oesophagus, and the pancreas. Evidence also points to cancers of the nasal cavity, paranasal sinuses, nasopharynx, stomach, liver, kidney, cervix uteri, adenocarcinoma of the oesophagus and myeloid leukemia, as per a study on ‘Bidi Smoking and Public Health’ published by the Ministry of Health and Family Welfare.

Beedi smoke contains higher amounts of tar, nicotine, carbon monoxide, ammonia, hydrogen cyanide, other volatile phenols and carcinogenic hydrocarbons, benzanthracene, benzopyrene and radioactive uranium.

The beedi has to be frequently lit. Because of the low-porosity of the leaf wrapper and the absence of significant filtration, beedi smoke deliveries of toxic chemicals are higher than those from cigarettes. A beedi has to be puffed two to three times more frequently than a cigarette, leading to greater inhalation of nicotine, tar and carbon monoxide. The tar intake of beedi smokers has been reported to be three times that of cigarette smokers.

Beedis also have the potential to lead to chronic bronchitis and cardiovascular disease.

“We are requesting the State government to ban all kinds of tobacco, not just e-cigarettes. Usage of beedi is very high in rural areas, especially in the low-income groups. Beedi smoking population is higher than the cigarette smoking population and hence beedis should be banned. According to the GATS 2 (Global Adult Tobacco Survey 2016-17), current beedi smokers in Tamil Nadu constitute 5.4 per cent, which is higher than the 5.3 per cent in GATS 1 (2009-10),” said S Cyril Alexander, State convener, Tamil Nadu People’s Forum for Tobacco Control (TNPFTC).

The GATS is a global standard for systematically monitoring adult tobacco use (smoking and smokeless) and tracking key tobacco control indicators, conducted by the Tata Institute of Social Sciences (TISS), the Ministry of Health and Family Welfare, Government of India, and the World Health Organization (WHO).

Currently in Tamil Nadu, about 10.8 per cent of men smoke the beedi, and hardly any women are into the habit. Of this, 6.9 per cent are from rural areas and 3.9 per cent from urban areas.

India is the third largest tobacco producer and the second largest consumer world-wide. Mortality due to tobacco usage in India is estimated to be over 13 lakh annually. Of these, 10 lakh are attributed to tobacco smoking and the rest to smokeless tobacco use. The incidence of oral cancer is high, exceeding even that of lung cancer and accounting for almost half of all oral cancers in the world.

Possible solutions

The probable solutions include harsher laws and prohibitive penalties for violators, educating people and creating awareness, especially in the rural and lower economic segments of the society, and insisting on regular cancer screening on a sustained basis, and adopting a healthier lifestyle, better food habits, oral and sexual hygiene.

“In the US, smoking has come down from 40-45 per cent to 10-15 per cent now, reflecting a big reduction in occurrence of lung cancer. In India and Tamil Nadu, while smoking has gone down from 30-35 per cent to 28-30 per cent, the consumption of tobacco in non-smoking form has increased, thus resulting in increased cases of cancer. About 40 per cent of cancer cases are related to tobacco. If we reduce that, lung cancer cases can come down drastically. The harmful effect of beedi smoking has to be seen in the context of total tobacco consumption, including non-smoking tobacco products,” said Dr V Shanta, chairman of the Cancer Institute, Adyar, Chennai, an authority on the subject and an iconic figure in fighting cancer in the State. She has also been awarded the Padma Bhushan and the Padma Vibhushan for her pioneering work in this field.

The cancer institute regularly holds awareness camps in preventive oncology through their centres across Tamil Nadu, and does a cancer screening of more than 5-6 lakh people annually. Those detected with cancer are given free treatment.

Dr Shanta said that any unusual behaviour of a body organ, manifesting over a longer period of time and which does not heal by normal medication, needs to be scanned immediately to rule out any cancerous possibilities, especially among those who consume tobacco in any form. For example, non-healing ulcers in the mouth, cheek or tongue, change in one’s voice, any persistent problem in swallowing, and any cough that lasts longer than a few days should be a strong case for a medical consultation, to rule out any possibility of cancer.

Beedi production scenario in Tamil Nadu

Tamil Nadu is one of the largest beedi producers and employs the largest number of workers in production and sale of beedis, a study by the Centre for Health and Social Justice stated. There are around 75 largescale manufacturers producing 50 lakh or more beedis a day, and about 500 small manufacturers producing between 5-50 lakh beedis a day. The industry employs between five and seven lakh people also, sources said.

Even passive smokers should be careful. Lung cancer [cases] is going up in women who do not consume tobacco. We do not have enough data yet to prove it, but the impact of passive smoking cannot be ruled out. And the impact of passive smoking on children and infants would be known once they grow up. They may be prone to cancer when they grow older —Dr V Shanta, chairman, Cancer Institute, Chennai