I have been meaning to write about this matter for a few days now, just never managed to make time for it. There has been a huge hue and cry over the banning of gutkha in certain states of India. While the public health professionals have more or less welcomed the move, the smokeless tobacco industry has hit back. In a series of prominent advertisements put out in the leading dailies, they have tried to highlight the plight of their industry and garner public support and sympathy for their cause.
I am presenting some of these adverts that have caught my eyes:
The above advert, a quarter page plea, was published on 1st October, 2011. The following one came up on the 10th of the same month:
The third one followed a mere 5 days later, on the 15th of October:
Ranging from the emotional to the economic, they have run through the gamut of reasons and arguments to augment their case. A slight hint at the nexus between the policy makers and big tobacco, represented by the cigarette industry, has also been made. This harkens back to the early days of the war against smoked tobacco, when the causal relationship between cigarette smoking and lung cancer was not strongly established.
However, I shall stray from the ban-all policy. I mean increasing prices, implementing legislations against public smoking, levying taxes and spreading awareness about the ills of smoking has helped to curb the rampant smoking levels but still, smoking remains a social illness that refuses to go away. A blanket ban is now being tried with the smokeless cousin – the gutkha. It remains to be seen how this works out.
Now, there is always the debate whether one should assume a pro-active, sometimes paternalistic role, while implementing public health measures like banning of gutkha or restrictions on smoking or one should provide everyone with the required information and evidence and then let the people make the decision for themselves. Now I am a big supporter of individual freedom and shared decision making, no matter what the issue. In a paternalistic move to ban gutkha, a number of stakeholders (the producers and the consumers of the product, primarily) were left out of the decision making matrix. This is, in my opinion, not the way to go.
The truth remains that until and unless people are made aware of the extent of damage caused by a particular substance, simply banning it will not solve the problem. It might make it worse as unregulated, fly-by-night scamsters may come up with poorer quality and adulterated products that impose a greater risk on the individual. A similar problem was envisioned with the illegal status of commercial sex workers who were rendered vulnerable to sexually transmitted infections and homosexual people, especially men having sex with men (MSMs) who refused to come out of hiding for fear of legal persecution and hence were left in the shadows.
However, the ground reality remains that in a nation like India, sometimes, it is very difficult to establish such great shared decision making platforms. In a largely agricultural, rural-based population with poor levels of education, behavior change is a difficult task. The thing is, entrenched behaviors, like use of intoxicants is difficult to weed out merely by passive processes like behavior change communication, which, I believe, is, on the best of days, a weak and anemic tool to counter the menace of smoking or drinking or substance abuse in general. Hence, the easier and better (or so perceived) method is cracking the legislatory whip. Banning gutkha.
So while it does not gel with my ideals of perfect public health policy-making, it does seem to be the only one which has the highest probability of working out well. Some may say this was a choice where the least poor alternative got selected.
What is your opinion? Paternalism or power to the people?