After 10 years, a policy targets tobacco industry interference in India’s health ministry

The Global Tobacco Networking Forum, a high-profile tobacco industry event, was scheduled to be held in Bengaluru in October 2010. The government of India’s Tobacco Board had partnered with the forum that was to be hosted at a hotel owned by the Indian Tobacco Company Limited.

Some public health experts, including Upendra Bhojani, who got wind of this, felt that a government agency partnering with a tobacco trade body event would go against an Indian legislation that prohibits advertising and promoting tobacco and its products.

Bhojani’s workplace, the Institute of Public Health, filed a petition in the Karnataka High Court against the event. The petition wanted the Tobacco Board to withdraw its sponsorship and pull out of the event. They also wanted the government to come up with a policy that would bar all government officials, across ministries, from all unnecessary interactions with the tobacco industry.

Shortly after, the Tobacco Board withdrew itself and its funding from the event. The central government gave the court an undertaking that it would follow through on the Tobacco Control Act and would formulate a policy to prevent the interference and influence of the tobacco industry in government policies, following which the petition was dismissed.

It has taken the government a full decade to come up with a five-page code of conduct for government officials to prevent tobacco industry interference in public health policies. But the code comes with a built-in limitation: it is only applicable to health ministry officials despite the fact that the influence of the tobacco industry in public policy is far more widespread.

Limiting tobacco industry’s interference

“At the time, in 2010, I really believed that the court order would quickly trigger the government to come up with a policy on the issue,” said Bhojani, who had offered to work with the government on the policy.

For the last 10 years, Bhojani has filed multiple right-to-information requests to check on the policy’s progress and contacted every new health secretary since 2010 to remind them of the pending matter. “After a few years, I realised this was not going to happen so easily… especially given the divergence between the health ministry and commerce ministry’s interests on tobacco,” said Bhojani, now a director at the Institute of Public Health.

While many experts in India and overseas told IndiaSpend they are, by and large, happy with the new code of conduct, they drew attention to its inherent limitation. For example, it would not apply to events, such as the Global Tobacco Networking Forum that the Karnataka High Court stopped in 2010 because the code does not forbid officials of the Tobacco Board or the commerce or finance ministries from interacting with tobacco industry officials.

However, these entities regulate many issues related to tobacco cultivation and sale such as the quantum of tobacco grown in India, exports, customs, duties and taxes on tobacco and tobacco products such as cigarettes and gutkha. The Tobacco Board’s remit is to promote the cultivation, marketing and export of tobacco.

The code does have limitations, critics said. For example, it does not directly address issues like government investment in tobacco companies (such as the shares held by the Life Insurance Corporation and other public sector undertakings in ITC) and corporate social responsibility funding by tobacco companies that basically works “to improve their public image while also marketing their tobacco products”, said Bhojani.

India’s score on tobacco industry interference

India made some progress in the Global Tobacco Industry Interference Index 2020 released in November. India scored 61/100 this year compared to 69 in 2019 and 72 in 2017. A higher score indicates greater interference from the tobacco industry in a country’s governance.

The Tobacco Industry Interference Index ranks countries based on their score on 20 parameters, such as whether the government accepts/supports/endorses assistance from the tobacco industry on tobacco control, whether the government participates in corporate social responsibility programmes of tobacco companies, if the tobacco industry is given special monetary benefits and whether government officials meet with tobacco industry executives.

A “good start” was how Mary Assunta, the lead author of the index, described India’s new code of conduct for its health ministry officials. It would be “more effective” when it covers all government officials “as the tobacco industry is notorious for lobbying non-health departments such as trade, finance and agriculture to champion its interests”, added Assunta, the head of global research and advocacy at the Global Center for Good Governance in Tobacco Control.

Many countries, including Australia, Brunei, Darussalam, the United Kingdom and the Philippines, already have a national code of conduct or guidance that applies to their whole government, she noted.

The report lauded the Indian government for keeping the tobacco industry at bay in some instances. The government, “to its credit, rejected all attempts made by the industry to influence and stall the legislation enacted in 2019 banning e-cigarettes in India”, it said.

“India’s new code of conduct to prevent industry interference will probably reflect in an improved score in the next index too,” said Monika Arora, executive director of HRIDAY, a non-profit specialising in public health. “But some components within the index do not show improvement, such as the role and influence of corporate social responsibility programmes by tobacco companies.”

The index listed a number of examples where tobacco industry officials and Indian government officials have interacted. For example, it noted, many government entities including the Life Insurance Corporation have financial stakes in ITC Limited and other tobacco companies.

Government officials have also been on boards of tobacco companies after their retirement, such as former foreign secretary Nirupama Rao, ex-diplomat Meera Shankar and former secretary at tourism ministry Shilabhadra Banerjee. It also flagged the financial benefits that the tobacco industry enjoys in India, such as exemptions on cess and goods sales tax on bidis.

The index also documented other examples of interactions between the head of a foundation funded by tobacco company Philip Morris International, and a junior minister in the commerce ministry and senior officials in the NITI Aayog. Instances such as chief ministers of Punjab and West Bengal inaugurating ITC hotels, the presence of a Union minister as a chief guest at the Times LitFest sponsored by pan masala brand Rajnigandha, and ITC’s partnership with NITI Aayog to train farmers were also highlighted.

In 2004, a health ministry report had chronicled many examples of the tobacco industry’s interference in the country’s public health efforts and government. The Institute of Public Health recorded more instances in a 2016 study while a multi-part Reuters investigation in 2017 documented how tobacco company executives were meeting officials from different countries on the sidelines of the WHO’s 2016 Global Conference on Tobacco Control held in India.

Several Indian politicians have also had business interests in tobacco companies such as former civil aviation minister Praful Patel (Nationalist Congress Party), SC Gupta (Bharatiya Janata Party), Harvansh Rathore (BJP), Shailendra Jain (BJP) and Shravan Patel (Indian National Congress).

Barrier between the industry and government

India’s new code of conduct for staving off tobacco industry interference is applicable to all officials of the Union health ministry, all its departments, autonomous institutions under its jurisdiction and any person acting on its behalf.

Any existing partnerships, agreements or collaborations with the tobacco industry must be discontinued, the new code requires. It stipulates how public officials can or cannot interact with the tobacco industry, whether they can form partnerships or take contributions from tobacco companies, how to prevent conflict of interest and how to report any violations of this code of conduct.

The code has been formulated in compliance with a global treaty – the World Health Organization’s Framework Convention on Tobacco Control. India ratified this treaty in 2004 along with 181 other nations.

Countries “need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts”, states the preamble of the Framework Convention on Tobacco Control. Article 5.3 of the treaty asks that countries ensure their public health policies are protected from commercial and vested interests of the tobacco industry. It recommends that countries should limit interactions with the tobacco industry and only interact “when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products”.

In India, tobacco is regulated by the Cigarettes and Other Tobacco Products Act, 2003. This Act looks into the prohibition of advertisement and the regulation of trade, commerce, production, supply and distribution of tobacco and its products. The Cigarettes and Other Tobacco Products Act has many provisions to limit access to tobacco products and reduce their impact on people.

For example, it mandates that all tobacco packaging in India must bear pictorial warnings about smoking, and prohibits smoking scenes in films, the sale of tobacco to children or near schools, and smoking in public places.

Although it has taken 10 years for the central government to come up with this code of conduct, several state governments have already put in place their own versions of the same policy over the last few years. Maharashtra, Karnataka, Tamil Nadu, Kerala, Uttar Pradesh, Bihar, Punjab, West Bengal, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Mizoram and Meghalaya have all done so.

Government departments at odds

Tobacco kills about 800,000-900,000 Indians annually, according to government data, but it also rakes in big money for the country’s coffers.

The total value of India’s tobacco exports was Rs 6,211.5 in 2016-17 and Rs 6,513.9 crore in 2015-16. India exports tobacco to about 100 countries.

On the other hand, tobacco is the “single largest source of preventable deaths” globally, accounting for over 7 million deaths per annum. “Tobacco users who die prematurely deprive their families of income, raise the cost of healthcare and hinder economic development,” said the new code of conduct.

Thus the profitability of tobacco on the one hand, and its adverse impacts on the other, keep various wings of the government at odds with each other. The tension in India’s tobacco policy is clear – there are many government departments involved and they have different objectives.

For example, the Union health ministry is concerned with the ill-effects of tobacco on healthcare and the disease and death potential of cigarettes, bidis and tobacco products. This ministry works towards reducing the consumption of tobacco and creating public health awareness. This ministry administers the Cigarettes and Other Tobacco Products Act.

The Union agriculture ministry has a programme to help tobacco farmers switch to alternative livelihoods and diversify into growing other crops. The Department of Revenue in the Ministry of Finance looks into the illicit trade of tobacco.

But other wings of the government, such as the Tobacco Board under the Ministry of Commerce, are at odds with the efforts of the health, finance and agriculture ministries.

The Tobacco Board is concerned with the “overall development of tobacco growers and the Indian tobacco industry”. It works to ensure fair prices to tobacco growers, organises tobacco auctions and works to increase demand for Indian tobacco in foreign markets. In 2017, it coordinated with ITC to buy tobacco after farmers complained that they were not getting good prices for their crop.

The board maintains that it follows the Framework Convention on Tobacco Control guidelines on tobacco control and restricts and regulates the volume and type of tobacco that can be grown in different districts each year. The board also has a provision to punish tobacco farmers who flout its guidelines.

The fine for violating the board’s restrictions on how much tobacco can be grown, is Rs 5,000, a minuscule sum for cultivators of this cash crop, or two years in jail or both.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.