India’s recently introduced Goods and Services Tax (GST) reform strategy has raised eyebrows, and started debates. It has also improved India’s standing as a country endeavoring to keep its people healthy.
While the reforms failed to place all tobacco products into a dedicated “sin goods” bracket, advantages include raising the tax on smokeless tobacco products to 40%. This move increases the price of an addictive, harmful product so that it should be used less frequently, if at all, while generating tax revenue. It also aligns with a World Health Organization (WHO) recommendation, which counts “sin taxes” as an important strategy to address the harmful use of tobacco. India, a signatory of the WHO Framework Convention on Tobacco Control, committed to raising tobacco taxes as outlined in that agreement.
In addition to higher taxes, India also has one of the strongest requirements for health warning labels placed on smokeless tobacco products, requiring 85% coverage of the pack surface area, among the largest in the world. These labels are designed to be graphic, prominent, and comprised of colors that stand out from the product branding.
Evidence shows that warning labels are effective. According to the most recent Global Adult Tobacco Survey, nearly half of people who currently use smokeless tobacco in India reported they considered quitting because of a warning label. In Rajasthan, Uttarakhand, and quite a few other states, more than 60% of respondents considered quitting because of a health warning label.
Despite this, an estimated 200 million people in India use smokeless tobacco, that’s more than one in five adults, and double the number who smoke tobacco. Moreover, an analysis of global data shows the massive burden of smokeless tobacco-caused disease on India, comprising almost three-quarters of all smokeless tobacco-related disease globally, including a wide variety of cancers, cardiovascular disease, and pregnancy complications.
So why the disconnect?
Look to current smokeless tobacco packaging for a clue.
Due to the wide variety and often small size of smokeless tobacco packaging and depending on where they are placed on the product–the health warnings can be illegible and/or barely visible. Standardisation of the shape, size, and material of this packaging removes one of the key barriers to warning label visibility and impact. This provides an evidence-based opportunity for India to further extend its health policy leadership.
A recent study led by the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health invited Indian consumers to discuss and compare current smokeless tobacco packs against standardised alternatives. Overall, focus group participants found warning labels on a standard rectangular sachet smokeless tobacco pack the easiest to see and understand. They also viewed the warnings as effective deterrents, describing them as “very dangerous and painful,” “very horrible,” and prompting reactions like, “no one will eat this.”
Simply put, the standardisation of pack shape and size in this study leveled the playing field for health warning labels to do their job.
Currently, few countries set standards for smokeless tobacco product packaging. India can lead the world by proposing that all smokeless tobacco be sold in a standard rectangular sachet pack with large warning labels, shown to be effective in this study. To accentuate the warning labels, India can also have tobacco companies put their product in a package with a standard colour, commonly known as “plain packaging”, usually drab and olive-hued, without any additional imagery or marketing copy beyond text to describe the brand and product.
By implementing all these standards in tandem with existing large health warnings and 40% GST tax, India would make real headway on improving compliance with warning label placement, reducing product appeal, and ultimately reducing use.
Comparatively, Norway combats its own high rate of smokeless tobacco use as one of the 16 countries that currently require plain packaging for smokeless tobacco products. While this helps because it negates a significant marketing strategy for tobacco companies, Norway, unlike India, does not have strong requirements for large, graphic warning labels on smokeless tobacco. This gives India a tremendous opportunity now to both surpass Norway and further demonstrate its global leadership by becoming the first country to standardise the size and shape of smokeless tobacco packaging.
India has already exceeded many countries by requiring health warning labels on smokeless tobacco products, and many can learn from India’s approach to having some of the largest health warning labels in the world. The horrible imagery on these labels reflects reality—smokeless tobacco is terribly damaging to people who use it. Standardising the shape and size of smokeless tobacco packs alongside the strong health warning labels and recent tax hike would serve as an important, yet realistic, next step in helping Indians become healthier and tobacco-free.
