While high rate of stomach and esophageal cancers in the Valley has been a major cause of concern for the medicos, the region has off late been witnessing a rise in lung cancer among men. In 2017, at least 507 new cases of lung cancer were registered at Sher-e-Kashmir Institute of Medical Sciences (SKIMS), the highest among all cancers. Expert term this rise in cancers as a trend "similar to that in other metropolitan cities".
The biggest risk factor for lung cancer and many other types of cancers, world over is tobacco. International researches have attributed smoking as the cause of cancer in around 90 percent of cases. Moreover, according to a report by Indian Council of Medical Research titled "Health of the Nation's States", tobacco use was the third leading cause of death and disability in J&K. What is worrying is that Kashmir for long has been standing at top among all states in terms of tobacco use. As per latest National Family Health Survey (NFHS 4), as many as 38.2 percent men in J&K use some or the other kind of tobacco.
The Global Adult Tobacco Survey (GATS) 2016-2017 puts J&K at number six among all states in terms of tobacco smoking. The only states that have a higher prevalence of smoking than that of J&K are five north-eastern states of Mizoram, Meghalaya, Arunachal Pradesh, Tripura and Manipur. A survey by Government Medical College (GMC) Srinagar, "Tobacco Use in School Going Adolescents of District Srinagar of Kashmir", published in International Journal of Science and Research had another shocker. It found that 23 percent of adolescents were currently smokers and 18 percent of studied population had started smoking when they were just 14-15 years old. Given the magnitude of the problem, the entire healthcare machinery of the state should have geared up to reduce the consumption of tobacco here. However, doctors working with the cancer patients rue the apathy of authorities towards the growing risk. Fifteen years ago, a law was enacted in India to curb the incidence of smoking.
This law, the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 or COTPA was eventually brought into J&K in 2009. However, the law has remained confined to papers, thus having little or no impact on smoking pattern in the state. According to the COTPA, smoking in public places is an offence. Meant to decrease the number of cigarettes smoked, by penalizing smoking outside a private space such as home, this clause of the law sees open violations day-in and day-out as smokers puff their health out in offices, restaurants, markets and even in hospitals.
Moreover, the violation of this clause also exposes non-smokers not just to agony but to health hazards of second hand smoke. While the law prohibits sale of cigarettes to individuals below 18 years of age, the gross disregard to this clause came to fore through a survey by GMC which found that a majority of smokers, in the age group of 15-18 purchased cigarettes from local shops, "just like any other commodity". The Act also prohibits sale of cigarettes in places within 100 meters radius from outer boundary of an institution of education. However, at many places vendors are stationed in areas adjoining schools in Kashmir, thus defeating the purpose and spirit of all anti-tobacco measures put in place by governments. Recently, union ministry of health and family welfare pushed for bigger and more horrifying warnings on tobacco products.
These new specified health warnings that came in vogue from 01 September are gory images of a person with mouth cancer and another one with a throat cancer. Instead of the existing "injurious to health" message, the new packets of tobacco products mince no words and state "tobacco causes cancer". However, experts feel that putting the warning on packets of cigarettes has no impact on Kashmir's young due to lax rules.
A healthcare professional working in GMC Srinagar said that since most young people, when they start smoking, purchase cigarettes loose, and not in packets, they are not exposed to the warning messages. "Nor are they aware of the helpline number that is there on the packets in case they decide to seek help for quitting," he said. The COTPA categorically bans the sale of loose cigarettes. Moreover, the sale of cigarettes brought in from other countries, without any specified warnings, although banned, has been thriving in Kashmir.
Although in the previous year, the food control authorities carried out token drives to seize stock of such cigarettes, the steps taken were little given the magnitude of the market. Officials in the department have often lamented lack of support – monetary and logistic, to carry out such drives. The implementation of COTPA is responsibility of state's health departments as well as Food Control Organisation. As per documents, Rs 96 lakh have been allocated to the state under National Tobacco Control Program (NTCP), meant to carry out various activities in a bid to address abuse of tobacco. However, despite funding, neither is there any manpower in place to work for this program nor has any activity been carried out in this regard. Awareness generation about the impact of smoking and how to get rid of tobacco addiction is one of the major components of the program.
A senior official in health department said that both the departments, health and food control, have been passing the buck and roles of the two in implementation of tobacco control laws were yet to be defined. While national health mission (NHM) claims that funds for implementation of NTCP have been transferred to health department, the department has been finding the task "difficult" given lack of human resource. In such a scenario, where rules are clear but implementation continues to be the challenge, tobacco continues to claim lives through lung and other cancers.