Carcinogenic threat lurking in public places across India

We invariably celebrate the birth anniversary of Father of Nation Mahatma Gandhi every year with great gusto. Yet, in year 2008, the celebration was made even more special when a landmark decision was taken on 2nd October to prohibit 'smoking' in all public places in India under the Prohibition of Smoking in Public Places, 2008 and Cigarette and Other Tobacco Products Act (COTPA). Accordingly, smoking has been prohibited in parks, playgrounds, auditoriums, cinema halls, hospitals, offices, markets, shopping malls, hotels, restaurants, eateries, libraries, courts, bus stands, railway stations, educational institutions and all places of public access.

Majority of people believe that smoking affects only the smoker, and exposure to second-hand smoke causes no harm. However, contrary to popular perception, there isn't any risk-free level of exposure to second-hand smoke. Second-hand smoke contains more than 7,000 chemicals, of which at least 70 are carcinogens (cancer-causing agents). There are two types of second-hand smoke - mainstream smoke that the smoker inhales, and sidestream smoke that emanates from burning tobacco. Of the two, sidestream smoke has the highest concentration of carcinogens.

In public places, second-hand smoke hence becomes as worse as smoking. No wonder, it has become one of the most serious health problems in India. One in four adults is exposed to second-hand smoke in public places. More than 30 percent of adults in India are exposed to second-hand smoke at their offices.

If you are exposed to sustained second-hand smoke every day, you are smoking 2 cigarettes per day without your knowledge. This fact answers the question 'why non-smokers get cancer?'. Second-hand smoke affects the heart and the blood vessels and increases the chances of asthma, lung disorders, stroke, and heart attack. Also, when pregnant women are exposed to harmful second-hand smoke, it can affect the fetus to make newborns under-weight and at increased risk of other health complications.

The hazards caused by second-hand smoke are in violation of the fundamental right guaranteed by the Indian constitution under Article 21. Every individual has the right to health and the right to smoke-free public places. So, when smokers 'smoke' in public places, they not only harm their health but also threaten the lives of others in the vicinity of the public place.

India's principal tobacco control law "Cigarette and Other Tobacco Products Act" was introduced in 2003. For any law to be effective, it has to be amended from time to time. More than two decades have passed since the introduction of COTPA. A meager fine of up to Rs 200 is slapped for violation of COTPA and smoking in public places. Note that the upper limit is Rs 200, and the enforcing authority (police, municipal body) can slap a fine of as little as Rs. 30 for the violation. It is high time COTPA is amended to match the current developments and the fine amount hiked to Rs 2,000 to make it a strong deterrent for the violation.

I began this write-up by talking about the birth anniversary of Mahatma Gandhi and I wish to end it with his golden words: "The earth, the air, the land, and the water are not an inheritance from our forefathers but on loan from our children. So, we have to hand it over to them at least as it was handed over to us."

The onus is on us to protect Indians from harmful second-hand smoke and guarantee them 'smoke-free' air.

The Union Health Ministry has proposed the COTPA amendment bill 2020. Let us all urge our public representatives to get the bill passed at the earliest and save precious lives from the second-hand smoke hazard in public places.

(The writer is an oncologist and member of Karnataka Govt's High-Power Committee on Tobacco Control)