Prohibition vs. Regulation – What’s the Right Path for Tobacco Control in India?

~ Balancing Health and Policy in Tobacco Control~

Mumbai, November :  The Global Sustainability Alliance Health Council convened a pivotal roundtable discussion on tobacco control, bringing together experts from healthcare, public policy, and addiction research to examine the challenges of prohibition versus regulation in addressing tobacco consumption. The dialogue explored the limitations of current tobacco control policies, the socio-economic impacts of tobacco use, and the critical need for compassionate, evidence-based strategies moving forward.

The roundtable emphasized the necessity of shifting the perspective on tobacco use, recognizing addiction as a disease rather than a habit. Experts argued for the implementation of more effective and inclusive regulations that can both protect public health and ensure fair treatment for those affected by tobacco addiction.

Dr. Lancelot Mark Pinto, Consultant Pulmonologist and Epidemiologist at PD Hinduja Hospital, strongly criticized the societal stigmatization of smokers. “We use the word ‘smoker,’ which ideally, we shouldn’t. It’s a person who smokes, not a smoker,” he explained. “It is an addiction, not a habit.” Dr. Pinto called for a societal rethink of addiction, urging that it be treated as a medical issue rather than a moral failing.

Dr. Sabita Jiwnani, Professor of Thoracic Surgery at Tata Memorial Hospital. raised concerns about India’s ban on e-cigarettes, calling it ineffective. “India banning e-cigarettes has actually been a joke on us. They are so easily available. This ban is just an eye wash,” she asserted. She advocated for regulation instead of prohibition to enable the government to better control accessibility and prevent access of harmful products.

Pingal Khan, Partner at Ashlar Law, offered a critical observation on India’s policymaking approach: “Indian policymaking often takes a feudal stance: 'We are right, you are wrong.' This mindset has turned smokers into societal outcasts—a glaring policy failure. When you make your fellow citizens feel like lepers, you fail as a society, as citizens, and as a government.” Khan noted that while the Supreme Court recognizes addiction as a disease, the government continues to treat it as a choice, fueling stigma rather than offering support.

Dr. Rohan N. Bartake, Tobacco Treatment Specialist and Founder of "Quit Buddy," emphasized the importance of tailoring tobacco control strategies to each country’s unique context. “The WHO's MPOWER framework emphasizes strengthening laws, raising awareness, and promoting cessation, among other aspects. While we must ensure strict adherence to this framework across all areas, it's important to remember that one approach won't work for every country, as each has its unique dynamics. Therefore, we must tailor solutions to account for socio-economic factors and other local considerations,” he said.

Dr. Upendra Bhalerao, Consultant Cardiothoracic and Transplant Surgeon at Jaslok Hospital, discussed the broader policy context, drawing attention to the failed history of prohibition. “Consider the availability of sugary drinks and the prominence of alcohol shops everywhere. Prohibition has never worked. When smoking or consuming tobacco products is outlawed, it doesn’t eliminate the problem—it just drives it underground.” he said, emphasizing the need for regulation instead of prohibition.

Dr. Anil Heroor, Cancer Surgeon and Robotic Surgery Specialist, emphasized the need to reframe tobacco use as a disease rather than just an addiction. “As a clinician and cancer surgeon, I have witnessed firsthand the devastating effects of tobacco, particularly when it leads to tobacco-related cancers. The impact is not limited to the individual; it ripples through their family and the larger community. The consequences of tobacco use are not just a health crisis—they represent a deep socio-economic challenge, affecting not only the patient's well-being but also their loved ones and the broader society,” he said.

Kshitij Jadhav, MD, PhD, Assistant Professor at the Koita Centre for Digital Health at IIT Bombay and Chief Project Coordinator of AI Centres of Excellence, Ministry of Education, Government of India, concluded the discussion by calling for a shift in mindset. “Smoking addiction isn’t just a matter of willpower; it’s a disease. Like any other disease, it requires a comprehensive, end-to-end strategy—from effective laws and treatment frameworks to empathetic, technology-driven interventions,” he said.

This roundtable marked an important step in reshaping the conversation around tobacco use, with experts calling for stronger regulation, better access to cessation treatments, and a comprehensive, inclusive approach to addressing tobacco consumption. The experts agree that a unified, evidence-based strategy is essential for addressing tobacco cessation in India and improving public health outcomes across the nation.

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