Smoking corner in office to go up in smoke soon

Health Minister Anbumani Ramadoss has said that by the end of May 2008, a smoke-free workplace law would be implemented across India. Speaking exclusively to CNN-IBN on Devil’s Advocate he said that any office or workplace whose employees are caught flouting this law would be fined heavily. He also asked Shah Rukh Khan and Amitabh Bachchan to follow Rajnikanth's example and quit smoking on screen.

Karan Thapar: Hello and welcome to Devil’s Advocate. Does the government have a duty to discourage smoking? If so, how effectively is the government doing it? That’s the key issue I shall raise today with the Health Minister Anbumani Ramadoss.

Dr Ramadoss, given the present confusion of the government’s position on smoking, let me start by attaining your position as Health Minister. First of all, do you believe the Government has a duty to discourage smoking?

Anbumani Ramadoss: Absolutely — given the fact that India is one-sixth of humanity living on just 2.4 per cent of the world’s land, forty per cent of its health problem is tobacco related.

Karan Thapar: Alright, given that you say that the government has a duty to discourage smoking, do you also accept that all the research shows that graphic pictorial warnings are considerably more effective than textual cautions on cigarette packets?

Anbumani Ramadoss: Yes, it is very effective given India’s illiteracy rate and multi-language problem. Earlier we had textual statutory warnings but that didn’t prove to very helpful.

Karan Thapar: So you are saying that given that India has thirty six per cent illiteracy and on top of that it is a multi-lingual society, pictorial warning are perhaps the only way of making the poor and the uneducated aware of the harmful effects of smoking?

Anbumani Ramadoss: It is not the only way, but it is certainly a very effective way. We have seen examples of its effectiveness in other countries.

Karan Thapar: So is it the most effective way?

Anbumani Ramadoss: I can’t say it is the most effective way. It is one of the effective ways. To take as an example, 55 per cent of tobacco in India is beedi, and beedi is generally smoked by illiterate people.

Karan Thapar: Let me point out an international research that shows 68 per cent of Brazilian smokers and 57 per cent of Canadian smokers—two countries where pictorial warnings are compulsory—say that pictorial warnings have made them think twice, maybe even three times, about smoking. Is there any reason to believe that if pictorial warnings were made compulsory in India, Indians would behave differently?

Anbumani Ramadoss: I don’t think so. I am sure it will be very effective. All these times we have been saying things to people, but now I believe it is time to scare them and say: Look at these pictures. This is how you’ll end up if you smoke and continue the intake of tobacco products.

Karan Thapar: I want to repeat what you said: The time to scare people has come?

PAGE_BREAK

Anbumani Ramadoss: Yes, absolutely because contrary to the western world where the tobacco usage is coming down, in India it is frighteningly going up.

Karan Thapar: Okay given that it is going up frighteningly, let me put something else to you. It is well known, as you said a moment ago, 40 per cent of all illnesses in India are tobacco-related leading to a million deaths a year. The World Health Organisation estimates that by 2020, almost 15 per cent of all deaths in India will be tobacco related. Given those facts and given that tobacco smoking is increasing, what would happen if India does not make pictorial warnings compulsory?

Anbumani Ramadoss: Pictorial warning is a part of the activity that also includes no smoking in public places, no advertisements of any tobacco products, no selling of tobacco to minors, etcetera. Pictorial warning is only a part of this activity.

Karan Thapar: If all of that was done effectively, what would happen to India?

Anbumani Ramadoss: Pictorial warning is going to play a major part of warning and scaring young and adult people who don’t know the ill-effects of tobacco.

Karan Thapar: So pictorial warnings could actually save lives? People who would otherwise smoke and die could be saved?

Anbumani Ramadoss: Absolutely. You have been seeing it in the western world, but I believe it is going to be the same in India.

Karan Thapar: So you’re saying that pictorial warnings are a matter of life and death? They can save lives?

Anbumani Ramadoss: I am sure they can. I am saying again that pictorial warning is one more step towards putting people off smoking.

Karan Thapar: How do you justify the fact that on four separate occasions your government has failed to implement its own decision to make pictorial warnings compulsory on cigarette packets, leave alone beedi packets and other tobacco-related products? How do you explain that?

Anbumani Ramadoss: It is related to both political activity and the judiciary.

Karan Thapar: The judiciary is pushing for it. The Shimla High Court is setting deadlines.

Anbumani Ramadoss: Yes but they extended the deadline till March this year.

Karan Thapar: Because you asked for it.

Anbumani Ramadoss: But if you see, the intention of the government is to implement pictorial warnings. There are no two views on that.

Karan Thapar: You say it is the intention of the government but four times the cabinet has failed to implement its own decision.

Anbumani Ramadoss: It is not the cabinet. It has nothing to do with the cabinet or the Group of Ministers. Time and again, due to political intensity, the problem of the labourers, the employees, and the beedi workers, a lot of pressure has been mounted on the government by the Members of Parliament and by members of various political parties.

Karan Thapar: Pause for a moment and listen to what you’re saying — The pressure on the government due to beedi workers and cigarette workers. There are today 30 lakh beedi, cigarette and tobacco workers in the country. Against that there are 250 million people who smoke and another 750 million who can be tempted to smoke. How can the concerns of 30 lakh cigarette and tobacco industry workers in the country overweigh the interest of a billion Indians?

Anbumani Ramadoss: See we are not saying that we are going to do away with pictorial warnings. Pictorial warning is going to get implemented without a doubt. The intention of the government is to bring it but it is just the time factor. Now we have till March end and we’re going to bring it before that. Definitely we are at that, and the Group of Ministers are at that.

PAGE_BREAK

Karan Thapar: You keep talking about the intention of the government. You were meant to do this in July 2006. Four times after that the deadline has been avoided. It is quite possible that you may miss it the fifth time as well. You are losing lives in the meantime. Here is a government that admits that people could die, are dying, and the number of people likely to die is growing, and yet it is failing to implement its own decision.

Anbumani Ramadoss: Again I’ll say that the government is faced with some practical problems. We are overcoming that. If you see any scheme in the country, there will be practical problems. We have to overcome that, we have to go there in consonance and in consultation. I say again, the ultimate aim is to bring out pictorial warnings. There are no two views on that.

Karan Thapar: You are going to bring out pictorial warnings?

Anbumani Ramadoss: Yes.

Karan Thapar: Let me tell you why many people doubt you. They don’t doubt you personally because they know you are totally committed to this, but they doubt your government and its intentions. That’s because Pranab Mukherjee, the minister in charge of the Group of Ministers handling this decision, told The Indian Express last week that pictorial warnings which are repulsive can’t be accepted. Let me quote his words to you: “If cancers and tumours are repulsive, pictures of them can’t be anything else.” So what is he talking about?

Anbumani Ramadoss: See I don’t like to comment on the view of the Group of Ministers because it is an internal consultation.

Karan Thapar: And it is embarrassing?

Anbumani Ramadoss: No, that’s a different issue. But I would like to reiterate, we could start somewhere, move positively and go forward...

Karan Thapar: So what will you start with — images of a smiling child?

Anbumani Ramadoss: No it is not images of a smiling child. In the next couple of months you are going to see what kind of pictures we bring out and how we create awareness.

Karan Thapar: The organisation Hriday is carrying out the campaign in newspapers in full scope. Advertisements appeared in The Hindustan Times and The Times of India demanding from the government the severest, most graphic pictorial warnings. You know that all the research done suggests that severe graphic pictorial warnings work. I want to quote to you the Association of European Cancer League. This is what they say: “The two warnings identified as the most effective at discouraging smoking were the warnings depicting a diseased mouth and the warnings depicting a lung tumour.” Now, do you think that such pictures should be there? Give me your opinion.

Anbumani Ramadoss: Personally I believe that pictures should scare the people. But then again it is the decision of the government and the Group of Ministers. We also have to take into the consideration the interests of various sections of people including industry workers. And let me put it this way — we are going to do it progressively, if at all.

Karan Thapar: So you are going to begin ineffectively and you are going to hope and pray that one day you get the courage to do it?

PAGE_BREAK

Anbumani Ramadoss: You can’t just say that before it happens.

Karan Thapar: But tell me something. Will you have pictures of a diseased mouth and a lung tumour? I know you as a minister want them. You said so. Will Pranab Mukherjee, Kamal Nath and the rest of the ministers accept that?

Anbumani Ramadoss: It has nothing to do with Mr Pranab Mukherjee. He is a very senior politician.

Karan Thapar: He’s gone public with his view.

Anbumani Ramadoss: No, no...we have all confidence in him. It has nothing to do with him. The Information and Broadcast Ministry...

Karan Thapar: If it the matter of saving lives, how does the I&B Ministry come in?

Anbumani Ramadoss: Both the I&B Ministry and the Health Ministry, in consultation with each other, are going to decide what sort of pictures should go on the warnings. It has nothing to do with Mr Pranab Mukherjee or any other ministers in this case.

Karan Thapar: Minister, what you’re overlooking is that pictures of the sort I am talking about—diseased mouth and lung tumour—were agreed to by the government. The GoM accepted that. Pictorial warnings were supposed to start from December 1. Then the government rivalled its own decision. The GoM changed its mind and went back on its own agreed policy. I am asking you. Can you get them to accept those pictures? You want them but will they accept them?

Anbumani Ramadoss: The GoM, the Health and I&B Ministry are going to bring out pictures. We will bring out whatever is acceptable in consultation with the GoM.

Karan Thapar: In the same interview to The Indian Express, Pranab Mukherjee said that skull and cross bone symbol is offensive to minority communities. So what? If it is offensive it is more likely to put them off smoking, which is what it is intended to do.

Anbumani Ramadoss: I would not like to comment on that.

Karan Thapar: Because it is embarrassing?

Anbumani Ramadoss: Not actually but that is the intention of bringing the pictures.

Karan Thapar: It is to put people off?

Anbumani Ramadoss: No...I mean yes. It is to create awareness, to scare people off...

Karan Thapar: When people look at tumours on cigarette packets, when they see skull and cross bones on cigarette packets, they are scared, they are repulsed. As a result they don’t smoke. If you put a picture of a smiling baby, they’ll probably smoke two cigarettes.

Anbumani Ramadoss: We are not going put smiling babies on the packets. We are going to put pictures that will scare people.

Karan Thapar: Is it fitting that such communal considerations should influence ministers in a matter where tens of million, maybe hundreds of millions, could be saved, otherwise they lose their lives?

Anbumani Ramadoss: Like I said earlier, we have to take into consideration the various sections of people, and the problems they are facing at that level. Considering all these factors, we are now bringing in clauses and these things like pictures. And we are going to do it progressively.

Karan Thapar: Can I interrupt? You keep talking about what you’re going to do. The reason I am interrupting is that you’ve got a problem doing it. I know you want to do it, but you’ve got a Group of Ministers who is stymieing you. You’re a young MP. You’re a first time minister. Do you find that on an issue where you passionately believe that the government has to act, but morally the government is committed to act, elder politicians with perhaps vested interests...

PAGE_BREAK

Anbumani Ramadoss: I strongly deny what you’re trying to say. Intention of the government is very clear. It is against tobacco and tobacco-related activities.

Karan Thapar: Speaking to the The Indian Express, Pranab Mukherjee said that he has six lakh beedi workers in his constituency in Jangipur, West Bengal. To many people that sounds like he is more worried about the impact on his personal career than the health of the Indian people.

Anbumani Ramadoss: Mr Pranab Mukherjee is one of the senior most politicians of our country. We stand by him and he always does what is right for the country. There are no two views on that.

Karan Thapar: Is he doing what’s right for cigarette smokers? Is he doing enough to discourage them?

Anbumani Ramadoss: Again I am saying, we have to take into consideration all the sections — the poor section, the workers, etc.

Karan Thapar: I know I am embarrassing you but I am persisting because at the end of the day you believe in what you’re saying, but you are stymied by some people who won’t help you. In December you revealed that four Chief Ministers and 150 MPs had met you, and a further seven Chief Ministers had written to you, pleading pictorial warnings should not happen. Who are these Chief Ministers?

Anbumani Ramadoss: It is not like four Chief Ministers and 150 MPs had met me...

Karan Thapar: You had said so.

Anbumani Ramadoss: I was misquoted. One Chief Minister met me and three...

Karan Thapar: Who?

Anbumani Ramadoss: Dr Rajashekhar Reddy.

Karan Thapar: Who were the three who wrote to you?

Anbumani Ramadoss: Chief Minister of Tamil Nadu and West Bengal.

Karan Thapar: And who was the third?

Anbumani Ramadoss: The Chief Minister of Andhra.

Karan Thapar: Why do these three Chief Ministers not want pictorial warning?

Anbumani Ramadoss: It is not like they didn’t want it. They had some views on that because the beedi industry employs...

Karan Thapar: Have they been lobbied by the tobacco industry?

Anbumani Ramadoss: The issue here is that the cigarette industry is pushing the beedi industry, and the beedi industry is pushing its employees to go to the streets and to protest.

Karan Thapar: As a result is the government being pushed?

Anbumani Ramadoss: When you have hundreds and thousands of people on the street, it is the duty of the government to listen to them.

Karan Thapar: But 30 lakh beedi and cigarette workers versus a billion Indians, and you side with the 30 lakh and endanger a billion?

Anbumani Ramadoss: It is not like I am siding with them.

Karan Thapar: But your colleagues are

Anbumani Ramadoss: As state governments, they have to take the views of their people and their grievances into consideration. None of these Chief Ministers said they don’t want pictorial warnings.

Karan Thapar: ‘Take it slowly, take it easily, don’t endanger people and don’t endanger our victory and our politics?’

Anbumani Ramadoss: They are asking us to take care of the apprehensions of the people — the poor people, the illiterate people. These people have their families to support. But again I would reiterate that the intention of the government is very very clear. The intention of the government is against tobacco, and we are going to save millions of people when we have more measures coming like workplace smoke-free policies etc.

PAGE_BREAK

Karan Thapar: So far we have talked about the government’s attitude to smoking. Let’s now talk about civil society’s responsibility. Should celebrities who are role models and who influence people’s behaviour, smoke in public?

Anbumani Ramadoss: When you say celebrities, what I have been advocating, even when I initially took over as Health Minister, is that the movies are most responsible. There shouldn’t be any smoking scenes in movies because we have statistics showing that 52 per cent of children have their first puff of cigarette due to movie celebrities.

Karan Thapar: So movies have a huge impact?

Anbumani Ramadoss: Absolutely. When I had said that, there were so many people who were against me. You yourself had written an article against me questioning how I got my MBBS degree. This was the intensity of the opposition I had at that time.

Karan Thapar: Do you think Shah Rukh Khan should have smoked at the cricket match?

Anbumani Ramadoss: Absolutely not. What was the necessity? See these are celebrities and millions of youngsters are looking towards them. In fact, it is not only movie personalities but other personalities as well.

Karan Thapar: So you agree with me — celebrities ought not to smoke in public because they set the wrong example, they encourage young people?

Anbumani Ramadoss: Absolutely. Even my four-year-old daughter could say this.

Karan Thapar: So you are today a Health Minister appealing to celebrities here saying: In the bigger, wider interest of the Indian people do not smoke in public?

Anbumani Ramadoss: I have been appealing for the last three and a half years, and again I request celebrities, in whatever fields they are, movies or sports or anything else, not to smoke in public.

Karan Thapar: If Rajnikant can agree not to smoke in his movies, do you think Shah Rukh Khan and Amitabh Bachchan should make a similar commitment? If Rajnikant can do it, should Shah Rukh Khan and Amitabh Bachchan follow?

PAGE_BREAK

Anbumani Ramadoss: Easily. They could do that easily.

Karan Thapar: Rajnikant said that he did it because you made a personal appeal to him. Would you make a similar personal appeal to others?

Anbumani Ramadoss: I have already made an appeal to Shah Rukh Khan and I’ll be happy to do that again through you and CNN-IBN. Please don’t smoke in any of your movies Mr Shah Rukh Khan.

Karan Thapar: You said you made an appeal to Shah Rukh Khan previously. Did he ignore it?

Anbumani Ramadoss: I don’t know that. But again I would like to make an appeal, not only to Mr Shah Rukh Khan, but also to Amitabh Bachchan and to all the other personalities. Children are being affected. 14-year-olds are taking to smoking tobacco. India is very concerned about alarming rise of incidences of young people getting addicted to tobacco.

Karan Thapar: You have made an appeal to Shah Rukh Khan. You are making an appeal to Amitabh Bachchan. In the bigger interest of people, don’t smoke in public.

Anbumani Ramadoss: Not only in public but also in the movies.

Karan Thapar: Because 51 per cent people who start smoking do it because they see it in movies. In 2003, India made it an offence to smoke in public. However the fine is only Rs 200. On the other hand, the fine for jumping is 600, speeding 900, and using mobile while driving is 1500. Why can’t you increase the fine for smoking in public places?

Anbumani Ramadoss: We are going to change it because it is in the Act, not in the rule. We are going to change it now. From May end, there is going to be a smoke-free workplace policy.

Karan Thapar: What will be the fine for transgression?

Anbumani Ramadoss: We are looking into that. Today the act says two hundred rupees, but we are going to penalise the institute, hotel, restaurant, office or wherever. From June nobody, not even the employees, can smoke in a public place such as offices, restaurants, pubs, basically anywhere in the country except the roads or your houses.

Karan Thapar: So you are saying from June onwards, not just workplaces, but as happens in England and Ireland, you’re going to ban smoking in pubs and restaurants as well?

Anbumani Ramadoss: Yes. Anywhere there’s an employee, because an employee should have access to smoke-free atmosphere.

Karan Thapar: And this happens this June? And is there any guarantee this will happen?

Anbumani Ramadoss: Yes.

Karan Thapar: And your colleagues and cabinet will let it happen?

Anbumani Ramadoss: It is in the rules and it has to because we are moving forward towards Framework Convention on Tobacco Control (FCTC).

Karan Thapar: We will have to wait and see if it actually happens but in the meantime it was a pleasure talking to you Dr Ramadoss.

Anbumani Ramadoss: Thank you.