tobacco control legislations in india
TABLE OF CONTENTS
1. Introduction ………………………………………………………………………………. 2
2. Research Objectives ………………………………………………………………….… 2
3. Review of Literature …………………………………………………………….……... 3
4. Method of Study ………………………………………………………………….………. 3
5. Research Tools ………………………………………………………………….………… 3
6. Chapter One
Tobacco Control Legislations- Past and Present …………..………...4
7. Chapter Two
Other Acts relating to Tobacco Control & Recent case laws…... 11
8. Chapter Three
Challenges in Implementation & Suggestions ……………………… 19
9. Chapter Four
Conclusion ………………………………………………………………………….. 23 10.Bibliography …………………………………………………………………………………. 24 TABLE OF CASES
1. Doctors For You v. State of Bihar,
Civil Writ Jurisdiction Case No.14729 of 2013 ……………………………. 15
2. S. Cyril Alexander v. Union of India,
Writ Petition No. 9955 of 2014 …………………………………………………... 15
3. Love Care Foundation v. Union of India and Others,
Writ Petition No.1078 (M/B) OF 2013 ………………………………………… 16
4. Dharmendra Kansal v. Union of India & others,
Writ Petition (PIL) No. 37 of 2014 (2014) ………………………………….... 16
5. Anurag Kashyap v. Union of India,
Writ Petition No. 119 of 2014 ………………………………………………………. 16
6. Dinar Yashwant Sohoni v. State of Maharashtra,
PIL No. 98 of 2013 ……………………………………………………………………..... 17
7. Ravishankar v. Union of India,
W.P. No. 2497/2013 …………………………………………………………………….. 17
8. Doctors for You v. State of Bihar,
Civil Writ Case No. 14729 of 2013 …………………………………………………. 17
9. Health for Millions v. Union of India & Ors.,
Nos. 5912-5913/2013, SLP(C) Nos. 413 …………………………………………. 18
10. Rajat Industries v. Union of India,
Case No. 6024 of 2013 …………………………………………………………………… 18
INTRODUCTION
Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. Government of India has taken various initiatives for tobacco control in the country. Besides enacting comprehensive tobacco control legislation (COTPA, 2003), India was among the first few countries to ratify WHO the Framework Convention on Tobacco Control (WHO FCTC) in 2004. The National Tobacco Control Programme was piloted during the 11 th Five Year Plan which is under implementation in 42 districts of 21 states in the country. The advocacy for tobacco control by the civil society and community led initiatives has acted in synergy with tobacco control policies of the Government. Although different levels of success have been achieved by the states, non prioritization of tobacco control at the sub national level still exists and effective implementation of tobacco control policies remains largely a challenge.
The past decade has seen a significant paradigm shift in tobacco-related policies that has led to a significant curtailing of the use of tobacco in many countries. However, nearly all of these advances have occurred in industrialized countries. Unfortunately developing countries’ policies have lagged far behind, and tobacco consumption in these countries continues to rise. The Indian Parliament recently introduced a multifaceted tobacco control bill (the Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill of 2001).
RESEARCH OBJECTIVES
To synthesize the available scientific knowledge on tobacco use in India with a view to assessing the magnitude of the problem, identifying the gaps in knowledge, recognizing health hazards, reviewing the user practices and attempts to reduce the burden of tobacco as well as evolving future tobacco control policies.
To summarize tobacco use and its consequences in India and examine the major legislative control measures and recent case laws.
To discuss additional measures required to successfully implement these control legislations and curb tobacco use in India.
REVIEW OF LITERATURE
S.F. Gambescia, Beginner’s guide to Tobacco Control Legislation- The guide assumes the users—health officials, advocates, lawyers, leaders within non-governmental organisations—have little legislative and policymaking experience. Generally, the book takes a macro level approach in coaching users to introduce and implement meaningful tobacco control policies at the national or sub-national levels. It does not attempt to answer all questions related to the formidable task of passing tobacco control laws, but identifies the sundry of questions that need to be asked to facilitate success in effecting change in these areas. For example, the guide reinforces the need to create a broad based coalition to support a legislative effort, but does not attempt to answer how to form or manage a coalition.
Robert L. Rabin & Stephen D. Sugarman, Regulating Tobacco- This book analyzes specific strategies that have been used to influence tobacco use--including taxation, regulation of advertising and promotion, regulation of indoor smoking, control of youth access to cigarettes and other tobacco products, litigation, and subsidies of smoking cessation--and set them against the latest scientific findings about tobacco use and the changing cultural and political setting against which policy decisions are being made.
METHOD OF STUDY
The research method of collecting information related to this project is the doctrinal method.
RESEARCH TOOLS
Books, Journals, Websites, Articles, Case laws
CHAPTER ONE Tobacco Control Legislations- Past and Present
Effective tobacco control in other parts of the world has been achieved via multipronged strategies focusing on reducing the demand for tobacco products. These strategies include the following: raising taxes; publishing and disseminating information about the adverse health effects of tobacco, including adding prominent health warning labels to products; imposing comprehensive bans on advertising and promotion; restricting smoking in workplaces and public places; and extending access to nicotine replacement alternatives and other cessation therapies.
These demand reduction strategies are typically accomplished through national legislation. In India, health legislation has been historically enacted at state levels. National legislation has been reserved for major issues requiring country-wide uniformity.
India has a short history of tobacco-related legislation. The first national level bills were introduced not to curtail but to build a foundation for the tobacco industry and enable it to be competitive on the international market. Early attempts to enact tobacco control legislation were insufficient and only recently has there been significant impetus to come up with a multifaceted national control measure.
History of Tobacco use in India
The Portuguese introduced tobacco to India 400 years ago and established the tradition of tobacco trade in their colony of Goa. Two hundred years later the British introduced commercially produced cigarettes to India and established tobacco production in the country. Today, of the 1.1 billion people who smoke worldwide, 182 million (16.6%) live in
India. Tobacco consumption continues to grow in India at 2– 3% per annum, and by 2020 it is predicted that it will account for 13% of all deaths in India1. Tobacco use in India is more varied than in most countries. Only 20% of total tobacco consumption is in the form of cigarettes. A common alternative to traditional cigarettes is the bidi, a hand-rolled, filterless tobacco cigarette. Tobacco is also used in the hookah (a traditional water pipe), as pan masala or guthka (a chewing tobacco containing areca nut), as chutta (a clump of tobacco smoked with the lighted end inside the mouth), and mishri (a powdered tobacco rubbed on the gums as toothpaste). Bidis account for the largest proportion of tobacco consumption in India, at about 40%.
In India an estimated 65% of all men and 33% of all women use some form of tobacco. While the prevalence of smoking among men and women differs substantially — 35% of men and 3% of women — both use smokeless tobacco products to approximately the same extent2.
Nationally representative and reliable prevalence data on tobacco consumption are scarce in India. The 52nd National Sample Survey conducted by the National Sample Survey Organization in 1995-96 was the first nationally representative household survey to collect data on tobacco consumption in population, 10 years and older, using surrogate household informants. The prevalence rates of consumption of tobacco in any form were found to be 51.3% for men and 10.35% for women, 15 years and older.3 The study provided an insight into the socioeconomic, cultural and demographic correlates of tobacco consumption. It concluded that the prevalence of both chewing and smoking forms of tobacco was significantly higher in rural, poor and uneducated population. Sporadic studies have been undertaken to show that education and occupation have an important simultaneous and independent relationship with tobacco use and this requires attention from policymakers and researchers.4
India is now demonstrating a steely resolve to contain the menace of tobacco through a comprehensive control strategy that combines several demand and supply reduction measures. Many factors in the Indian tobacco control initiatives have collectively contributed to this national consensus. These include: increasing awareness of the health, environmental and developmental damages caused by tobacco; growing global support for tobacco control; developing policies and programs for effective action and decisive interventions by the activists, non-governmental organizations and the Indian Government.
Anti-Tobacco Policies and Practices in the Past
Pro-tobacco legislation dates back to 1975 with the Tobacco Board Act, introduced to develop the tobacco industry. It facilitated the regulation of production and curing of tobacco, fixed minimum prices, and provided subsidies to tobacco growers; the objective was to develop the Indian tobacco market and make the industry export competitive. Similarly, the Tobacco Cess Act of 1975 was enacted to collect duty on tobacco for the development of the tobacco industry. Anti-tobacco advocates have criticized these Acts because they nurtured the tobacco industry through subsidies and loose export policies.
India’s first national level anti-tobacco legislation was the single-faceted Cigarettes Act of 1975, which mandated health warnings on cigarette packets and on cigarette advertisements. This Act prescribed all packages to carry the warning ‘‘Cigarette smoking is injurious to health’’ in the same language used in the branding on the package. The text was to be a minimum of 3 mm in height, irrespective of the dimensions of the surface on which it appeared or of the dimensions of the brand name. While this Act was a major step in tobacco control, it did not apply to non-cigarette tobacco products. In the years following the Cigarettes Act of 1975, there were a number of other single-faceted national attempts at controlling tobacco use. For instance, in statutes dealing with the preservation of the environment, the Prevention and Control of Pollution Act of 1981 included smoking in the definition of air pollution. The Motor Vehicles Act of 1988 made it illegal to smoke or spit in a public vehicle. Finally, the Cable Television Networks Amendment Act of 2000 prohibited the transmission of tobacco, liquor, and baby food commercials on cable television across the country.
Many state-level governments in India have imposed different types of tobacco control legislation. The Delhi government was the first to impose a ban on smoking in public places, with the Delhi Prohibition of Smoking and Non- smokers Health Protection Act of 1996. In addition to prohibiting the sale of cigarettes to minors and prohibiting sale 100 m from a school building, this law allowed for enforcement in public places and public transport by the police and medical professionals. A first time offender is fined 100 rupees (US$ 2.40) and briefed by the police or medical officer about the law and the negative health consequences of tobacco use.
As expected, it has been difficult to enforce this ambitious programme, and it has probably had little real impact — the key problem being lack of manpower to enforce the law.
Other states too have enacted bans on public smoking. For example, in 1999 the Kerala High Court came out with a judgement prohibiting smoking in public places, including parks and highways. Similarly, the state of Goa introduced anti-tobacco legislation in 1999. Following intense lobby from pro-tobacco groups the final legislation was a diluted version of the original bill, but did maintain an important provision that banned smoking in public places. Spitting of residues from chewing tobacco in public places was also prohibited by the legislation. In the past 12 months, the states of Tamil Nadu and Andhra Pradesh have banned the marketing and sales of guthka.
In February 2001, Indian Prime Minister Vajpayee’s Union Cabinet introduced the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill, a multifaceted anti-tobacco legislation to replace the Cigarettes Act of 1975. Smoking in public places would be outlawed, the sale of tobacco to persons below 18 years of age would be prohibited, and tobacco packages would be required to have warnings the same size as that of the largest text in English or the local language. The proposed national Bill would prohibit tobacco companies from advertising and sponsoring sports and cultural events. Significantly, this Bill covers most tobacco products including not only cigarettes, but also cigars, bidis, cheroots, cigarette tobacco, pipe tobacco, hookah tobacco, chewing tobacco, pan masala, and guthka.
Recent Legislative gestures
The Cigarettes and Other Tobacco Products Act
The Indian Parliament passed the ‘Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill, 2003’ in April 2003. This Bill became an Act on 18 May 2003. Rules were formulated and enforced from 1 May 2004. This Bill became an Act on 18 May 2003. Rules were formulated and enforced from 1 May 2004. This law was intended to protect and promote public health, encompass evidence based strategies based strategies to reduce tobacco consumption and impose penalties to the violators.
Provisions of COTPA
The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels, restaurants and airports and open spaces. 5 Places where smoking is restricted include auditoriums, movie theatres, hospitals, public transport (aircraft, buses, trains, metros, monorails, taxis,) and their related facilities (airports, bus stands/stations, railway stations), restaurants, hotels, bars, pubs, amusement centres, offices (government and private), libraries, courts, post offices, markets, shopping malls, canteens, refreshment rooms, banquet halls, discothèques, coffee houses, educational institutions and parks. Smoking is allowed on roads, inside one's home or vehicle.6 The meaning of open space has been extended to mean such spaces which is visited by public, and includes open auditorium, stadium, bus stand.7
Advertisement of tobacco products including cigarettes is prohibited. No person shall participate in advertisement of tobacco product, or allow a medium of publication to be used for advertisement of tobacco products. No person shall sell video-film of such advertisement, distribute leaflets, documents, or give space for erection of advertisement of tobacco products. However, restricted advertisement is allowed on packages of tobacco products, entrances of places where tobacco products are sold.8 Surrogate advertisement is prohibited as well under the Act.
Tobacco products cannot be sold to person below the age of 18 years, and in places within 100 metres radius from the outer boundary of an institution of education, which includes school colleges and institutions of higher learning established or recognized by an appropriate authority.9
Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate pictorial warning, its nicotine and tar contents.10 Cigarette packets are required to carry pictorial warnings of a skull or scorpion or certain prescribed pictorial warnings along with the text SMOKING KILLS and TOBACCO CAUSES MOUTH CANCER in both Hindi and English.
The Act also gives power to any police officer, not below the rank of a sub-inspector or any officer of State Food or Drug Administration or any other officer, holding the equivalent rank being not below the rank of Sub-Inspector of Police for search and seizure of premises where tobacco products are produced, stored or sold, if he suspects that the provision of the Act has been violated.11
A person who manufactures tobacco products fails to adhere to the norm related to warnings on packages on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 5000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 10000.12
A fine up to Rs. 200 can be imposed for smoking in public place, selling tobacco products to minors, or selling tobacco products within a radius of 100 metres from any educational institution.13
A person who advertises tobacco products shall on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 1000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 5000.14
The Act repealed The Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975.15
The owner/manager/in-charge of a public place must display a board containing the warning “No Smoking Area - Smoking here is an offence “ in appropriate manner at the entrance and inside the premises.16 In place where tobacco products are sold must display appropriate messages like “Tobacco Causes Cancer” and "Sales of tobacco products to a person under the age of eighteen years is a punishable offence”.
The WHO Framework Convention on Tobacco Control (FCTC) and its Implications for India
The World Health Assembly of the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC) at its 56th Session in May 2003. India ratified the convention on 5 February 2004 and commenced enforcement of the national tobacco control law in May 2004. It was the eighth and the largest country to ratify the treaty. India advocated strong provisions in the FCTC and was unanimously elected as the coordinator of the countries belonging to the WHO South-East Asian Region. The FCTC does not clearly lay down a law which shall be universally applicable, but sets out guidelines for various national and international measures to encourage smokers to quitand restrain non-smokers from taking tobacco as a habit. As a signatory to the treaty, the Indian Government has been pursuing a proactive and bold strategy for tobacco control.
CHAPTER TWO Other Acts relating to Tobacco control and Recent Case laws
The laws other than the COTPA and the WHO framework convention on Tobacco Control (FCTC) are listed below (in chronological order)-
The Railways Act, 1989 (Act No. 24 of 1989, w.e.f July 1, 1990)- The Railways Act among other things regulates smoking on trains. It prohibits smoking if objected to by another passenger and confers authority on the railway administration to prohibit smoking in any train or a part of a train. It imposes a maximum penalty of 100 rupees for those who contravene the Act’s no smoking provisions.
Ministry of Information and Broadcasting Notification S.O. 836 (E), Section 5B(2), Cinematograph Guidelines, December 5, 1991 (w.e.f December 6, 1991)- Issued pursuant to Section 5B(2) of the Cinematograph Act of 1952, the Guidelines require the Central Board of Film Certification to ensure that “scenes tending to encourage or glamorize consumption of tobacco or smoking” do not appear in movies.
Cable Television Networks (Regulation) Act, 1995 (w.e.f September 29, 1994)- The Cable Television Networks (Regulation) Act, 1995 (Act No. 7 of 1995) (CTNA) requires that all advertisements comply with a prescribed advertisement code. The most recent version of this code is contained in the 2009 CTNA Rules and prohibits direct advertising of cigarettes or tobacco products. The code, however, permits the indirect advertising of such products under certain circumstances. (Note that a July 2010 Ministry of Information and Broadcasting Directive, appears to prohibit indirect advertising on cable networks until guidelines called for by the CTNA Rules are issued.) CTNA does not regulate international cable television networks. The version uploaded here is as amended only through August 31, 2007.
Ministry of Health and Family Welfare Notification G.S.R. 561(E), September 1, 2004 (w.e.f December 1, 2004)- The Prohibition on Sale of Cigarettes and Other Tobacco Products around Education Institutions Rules, 2004, defines “educational institutions” which may assist with the interpretation of this term in the public place definition of COTPA.
Ministry of Health and Family Welfare Notification G.S.R. 345(E), May 31, 2005 (w.e.f November1, 2006)- G.S.R. 345(E) announces the Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Rules, 2005. G.S.R. 345(E) amends the first rules enacted to implement COTPA (the 2004 Rules) by substituting new provisions on point of sale advertising and adding a definition of “indirect advertising.”
Ministry of Health and Family Welfare Notification G.S.R. 417 (E), May 30, 2008 (w.e.f October 2, 2008)- G.S.R. 417(E) supersedes the first rules enacted to implement COTPA (the 2004 Rules) and announces the Prohibition of Smoking in Public Places Rules, 2008. These new rules (1) impose duties upon certain parties such as owners, managers to ensure that smoke free policies are followed; (2) specify the requirements of "smoking areas" in hotels, restaurants, and airports; and (3) authorize officers to collect fines for the violation of specified smoke free rules.
Ministry of Health and Family Welfare Notification S.O 2814(E), November 28, 2008 (w.e.f November 30, 2008)- S.O. 2814(E) amends a rule announced in G.S.R. 693(E) regarding the languages in which the health warnings are written.
Ministry of Health and Family Welfare Notification G.S.R. 693 (E), September 29, 2008 (w.e.f November 30, 2008)- G.S.R. 693(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling (Amendment) Rules), 2008. Issued after G.S.R. 182(E) (the Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008), G.S.R. 693(E) contains substitute language regarding health warnings on retail packaging, requiring warnings to be printed on external packaging such as cartons.
Cable Television Networks (Amendment) Rules, G.S.R 138(E), February 27, 2009 (w.e.f February 27, 2009)- G.S.R. 138(E) announces the Cable Television Networks (Amendment) Rules, 2009. These Rules amend the Cable Television Networks Rules, 1994 with regard to indirect advertisement and brand stretching, permitting such surrogate advertising under certain circumstances. (Note that a July 2010 Ministry of Information and Broadcasting Directive, however, appears to prohibit indirect advertising on cable networks until guidelines called for by the CTNA Rules are issued.)
Ministry of Health and Family Welfare Notification G.S.R 182(E), March 25, 2009 (w.e.f May 31, 2009) - G.S.R. 182(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling) Rules, 2008. Issued under COTPA, the Rules specify components of the health warnings (i.e., content, size, rotation, etc.), but various provisions in subsequent rules replace certain language in the 2008 regulations. Provisions prohibiting misleading descriptors and obscuring the health warnings on the package remain in G.S.R. 182(E) unaltered.
Ministry of Health and Family Welfare Notification G.S.R 305(E), May 3, 2009 (w.e.f May 31, 2009)- G.S.R. 305(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2009. Issued after G.S.R. 182(E) (the Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008, G.S.R. 305(E) contains substitute language for the definition of “package” and for the location of the health warning. G.S.R. 305(E) deletes the requirement that the warning be located on both sides of box and pouch type packs.
Ministry of Health and Family Welfare Notification G.S.R 1866(E) (w.e.f July 30, 2009)- G.S.R. 1866(E) authorizes certain officers, in addition to those already designated in COTPA, to carry out the entry, search, and seizure provisions in COTPA Section 12 (with respect to any violation of the Act) and Section 13 (with respect to violations of tobacco product packaging and advertising).
Ministry of Health and Family Welfare Notification G.S.R 680(E), September 15, 2009 (w.e.f September 15, 2009)- G.S.R. 680(E) announces the Prohibition of Smoking in Public Places (Amendment) Rules, 2009. The Rules add to those issued in G.S.R. 417(E) by listing additional persons authorized to collect fines for the violation of specified smoke free rules.
Ministry of Health and Family Welfare Notification G.S.R 985(E), December 20, 2010 (w.e.f December 20, 2010)- Issued after G.S.R. 182(E) (Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008), G.S.R. 985(E) contains substitute language on the issue of rotation, requiring that health warnings be rotated every 24 months instead of one year. The rule also re-establishes the May 2009 health warnings, ensuring that pictures of a lung x-ray and diseased lungs continue to be displayed on smoked tobacco product packages and a picture of a scorpion continues to be displayed on smokeless tobacco product packages.
Food Safety and Standards (Prohibition and Restriction on Sales) Rules, 2011 (w.e.f August 5, 2011)- The Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations, 2011 prohibit, among other things, tobacco and nicotine from being used in any food products. Courts in several states have relied on this provision to impose bans on the manufacture, distribution, and sale of "gutka" or "pan masala."
Ministry of Health and Family Welfare Notification G.S.R 619(E), August 11, 2011 (w.e.f August 11, 2011)- G.S.R. 619(E), entitled the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Amendment Rules, 2011, amends regulations related to the prohibition on the sale of tobacco products to and by minors.
Ministry of Health and Family Welfare Notification G.S.R 786(E), October 27, 2011 (w.e.f November 14, 2011)- G.S.R. 786(E), entitled Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) (Second Amendment) Rules, establishes rules for television and film including a prohibition on tobacco product placement and a requirement for health warnings when tobacco products or their use are displayed. For print and outdoor media, G.S.R. 786(E) requires cropping or masking brand names and logos of tobacco products.
Ministry of Health and Family Welfare Notification G.S.R 570(E), July 26, 2011 (w.e.f December 1, 2011)- G.S.R. 570(E), the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2011, amends a rule announced in G.S.R. 182(E) regarding the languages in which the health warnings are written and updates the components of the health warning.
Ministry of Health and Family Welfare Notification G.S.R 417 (E), May 27, 2011 (w.e.f December 1, 2011)- G.S.R. 417(E) announces the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2011. The rules establish new graphic health warnings for packages of smoked and smokeless forms of tobacco. The rules also increase the number of warnings for smoked tobacco products from two to four, and increases the number of warnings for smokeless tobacco products from one to four. The new warnings became effective December 1, 2011, but were subsequently replaced by the health warnings contained in G.S.R. 724(E).
Ministry of Health and Family Welfare Notification G.S.R 708(E), September 21, 2012 (w.e.f October 2, 2012)- G.S.R. 708(E) announces the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Amendment Rules, 2012. These rules amend provisions governing the display of tobacco products or their consumption in film and television.
Ministry of Health and Family Welfare Notification G.S.R 728(E), September 27, 2012 (w.e.f April1, 2013)- G.S.R. 724(E) announces the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2012. The Rules establish new health warnings for tobacco product packaging, effective April 1, 2013.
RECENT CASE LAWS
Doctors For You v. State of Bihar, Civil Writ Jurisdiction Case No.14729 of 2013, High Court of Judicature at Patna (2014)- Doctors for You, a non-governmental organization, sued the State of Bihar seeking implementation of various provisions of the Cigarette and Other Tobacco Products Act (COTPA). In response to the petition, the court ordered that signs informing the public about the negative effects of tobacco be posted at all government primary, secondary, and post-secondary schools as soon as possible. Additionally, the court ordered the local police to create a monthly report about enforcement of the Act and submit the report to various government agencies.
S. Cyril Alexander v. Union of India, Writ Petition No. 9955 of 2014, High Court of Judicature at Madras (2014)- A public interest lawsuit requested that the government exclude tobacco companies from the Corporate Social Responsibility requirements under Indian law in order to prevent the companies from earning goodwill through direct and indirect advertising. The petitioner asked for the money that tobacco companies would have spent on a corporate social responsibility campaign instead be paid to the government for medical expenses for people with tobacco-related diseases and other tobacco control programs. The court directed the government to determine how tobacco companies can best meet their corporate social responsibility obligations. The court asked for appropriate action to be taken within four months of the decision and disposed the petition.
Love Care Foundation v. Union of India and Others, Writ Petition No.1078 (M/B) OF 2013- A non-governmental organization seeking to reduce smoking among Indian youths petitioned the Indian government to adopt plain packaging of tobacco products. The organization argued that attractive packaging is a form of advertisement and sought a rule prohibiting the use of logos, colors, or brand names on tobacco product packaging. After reviewing evidence supporting the impact of a tobacco plain packaging law in Australia and a study of plain packaging in Brazil, the court concluded that plain packaging and health warnings reduce the ability of attractive packaging to mislead consumers about the harms of smoking. The court urged the Indian government to consider the feasibility of implementing the plain packaging of cigarettes and other tobacco products as early as possible.
Dharmendra Kansal v. Union of India & others, Writ Petition (PIL) No. 37 of 2014 (2014)- A public interest lawsuit requested that cigarette manufacturers and the Indian government comply with the provisions of the Cigarette and Other Tobacco Products Act (COTPA) regarding tar and nicotine levels. Specifically, the law requires manufacturers to provide the tar and nicotine content of cigarettes on the label. The law also requires the government to set maximum permissible limits for tar and nicotine, which are also to be displayed on cigarette packs. The court said that it did not have the power to compel the government to implement this provision of the law, even though the government had failed to set maximum tar and nicotine levels for cigarettes in the 11 years since the law was adopted. Instead, the court banned the sale of cigarettes in the State of Uttarakhand, effective one year after the date of the decision. The court said that the ban will not take effect if the government prescribes maximum nicotine and tar limits and manufacturers provide this information on their labels. Additionally, the court ordered that all loose cigarettes must be sold with the specified warning label on the cigarette or the packaging, effective six months from the date of the decision.
Anurag Kashyap v. Union of India, Writ Petition No. 119 of 2014, Bombay High Court (2014)- The makers of an Indian film challenged the rules issued under the Cigarettes and Other Tobacco Products Act (COTPA) requiring a static anti-tobacco health warning at the bottom of the screen during the time that tobacco products are displayed in the film. The filmmakers argued that the health warning would unnecessarily disturb the viewers’ attention and destroy the enjoyment of the movie. The court denied the filmmakers’ request, noting that granting a stay of the advertising rules would interfere with the government’s implementation of the rules. In particular, the court referred to another court decision ordering the government to rigorously implement the law and the rules promulgated under the law. However, the court noted that the filmmakers could ask the government to modify or delete the rules related to anti-tobacco health warnings in films.
Dinar Yashwant Sohoni v. State of Maharashtra, PIL No. 98 of 2013, High Court of Bombay (2014)- A public interest lawsuit requested implementation of the rule requiring educational institutions to post a sign stating that cigarettes and other tobacco products may not be sold within a 100 yard radius of a school. The court found this requirement mandatory and ordered the state government’s Education Department to instruct all schools to implement the rule before the start of the 2014-2015 academic year.
Ravishankar v. Union of India, W.P. No. 2497/2013, High Court of Karnataka at Bangalore (2013)- A tobacco control advocate filed a lawsuit against various government agencies seeking full enforcement of India's omnibus tobacco control law and the rules promulgated to implement the law. The advocate did not allege any specific violations of the law. After receiving information from government agencies that they plan to take appropriate action to enforce the law against violators, the court disposed of the petition. The court noted that it is not appropriate to go directly to the court for enforcement of a law if law enforcement agencies are designated.
Doctors for You v. State of Bihar, Civil Writ Case No. 14729 of 2013, High Court of Judicature at Patna (2013)- Doctors for You, a humanitarian organization, sued the State of Bihar seeking enforcement of various provisions of India's omnibus tobacco control law. The court ordered the government to undertake an educational campaign (including newspaper, electronic media, and radio communications as well as through displays at public places) on the harmful effects of smoking and chewing tobacco prior to taking any enforcement action.
Health for Millions v. Union of India & Ors., Nos. 5912-5913/2013, SLP(C) Nos. 413-414/2013, Supreme Court of India (2013)- The tobacco industry challenged rules implementing the advertising provisions of India's tobacco control law, particularly the restrictions on advertising at the point-of-sale and the definition of indirect advertising. In 2005 and 2006, the Bombay High Court ordered that implementation of the rules be stayed. Health for Millions, an NGO, challenged this decision, and, in July 2013, the Supreme Court of India found that there was not a sufficient reason for the earlier decisions staying the rules. The Court ordered the government to rigorously implement India's Tobacco Control Law and its rules. The legality of the rules, however, still is at issue in the Bombay High Court.
Rajat Industries v. Union of India, Case No. 6024 of 2013, High Court of Judicature at Patna (2013)- A company that manufactures gutkha sued the government of India objecting to letters sent by the Ministry of Health and Family Welfare to various state governments requesting that they consider banning smokeless/chewing tobacco in the form of gutkha, pan masala, zarda and other chewable products with nicotine. The court dismissed the claim as premature because it does not challenge any bans on gutkha and pan masala, merely the informational letters sent by the government.
CHAPTER THREE Challenges in implementation and suggestions
THE TOBACCO EPIDEMIC- THREATS AHEAD
The gloomy and mournful predictions about the growing magnitude of tobacco’s threat to India relate to a rise both in the proportion of deaths attributable to tobacco and in the absolute number of persons who consume tobacco. The World Health Organization (WHO) estimated that the proportion of deaths that result from tobacco-related diseases will rise in India, from 1.4% of all deaths in 1990 to 13.3% of all deaths in 2020.17 The models presented in the 2002 report of the Economic and Social Council (ECOSOC) of the United Nations predict that the number of persons consuming tobacco is likely to rise.18 In India’s case, the population is expected to grow by about 300 million between 2000 and 2020.19 Most of the expansion will occur in the age group of 15-59 years. This is the age group most vulnerable to acquiring and continuing the tobacco addiction.
Some glamorous products and marketing innovations like flavored cigarettes are likely to target youth and have important potential implications of increased smoking experimentation and consumption.20 These observations foist upon us to raise a clamor for interventional steps in tobacco control before the tobacco epidemic goes berserk.
TOBACCO CONTROL- WHAT IS NEEDED?
Resourcing: Financial Resource Mobilization and Human Resource Development
Financial resources can be generated from a variety of sources: increased government allocations, an earmarked tobacco tax or cess, regulatory levies, penalties, private sector resources, civil society resources and international financial assistance. The revenues earned from such a tax/cess/levy have been utilized for funding not only tobacco control programs but also a variety of other health promotion activities.21 Regulatory levies are mechanisms by which funds for tobacco control can be generated, through a fee collected by the National Regulatory Authority (NRA) for testing and regulating tobacco products. This can be done both prior to the introduction of a new tobacco brand into the market, and also for annual renewal of the permission to market the brand, as is being practiced in Brazil.22 Adequate attention should be paid to developing committed human resources, including grass level workers, community-level activists and medical professionals.
Coordination: Establishment of a National Coordinating Mechanism
To implement the provisions of the Indian Tobacco Control Act and FCTC, establishing a national coordination mechanism is essential. Article 5.2 (a) of the FCTC obliges the ratifying parties to establish or reinforce and finance a national coordinating mechanism for tobacco control.23 This mechanism should have four types of agencies-a National Regulatory
Authority (NRA), a National Coordinating Body, an Interministerial Coordination Committee and a State-level Coordinating Body.
With the establishment of ANVISA (Agencia Nacional de Vigilancia Sanitaria) or National Health Surveillance Agency and National Commission on Tobacco Use (NCTU) Brazil has become a world leader in regulating and controlling tobacco products. (Government leadership in tobacco control, 2008) Similar bodies should be established in India to ensure smooth interaction between the coordinating agencies at the central and state level and this should leave no scope for ambiguity in interpreting the laws related to tobacco control at any level.
Integration of Tobacco Control into Health and Development Programs
Tobacco control can be integrated into the existing delivery systems such as the health care system and other developmental programs. The vast human resources available with various programs such as the AIDS Control Program and Malaria Control Program can be used additionally for tobacco control, especially for health education activities. This will have immense benefit coupled with a low incremental cost. As the relationship between tuberculosis and smoking is well known, the Tuberculosis Control Program may be used to impart health education as well as screen patients for tobacco use.
The tobacco control program in India should be kickstarted by integrating it into various developmental programs such as poverty alleviation, rural development, women and child development, and tribal welfare, with extensive reach and widespread presence at the grassroots level. Evaluation of Tobacco Control Programs
Evaluation helps ensure that only effective approaches are implemented and that resources are not wasted on ineffective programs. The Government should also routinely monitor the implementation of tobacco control policies. This includes tracking the development of ordinances, laws and rules. The national indicators which should be studied include: land area under tobacco cultivation, annual tobacco production, annual domestic consumption of home grown and manufactured tobacco (including major categories of tobacco products), annual export of tobacco, tax revenue from tobacco and cause specific mortality of tobacco-related diseases.
At least 10% of the budget of each local project should be used for tobacco control. Experience in California and Massachusetts has shown that these funds can be used both for statewide systems and to increase the technical capacity of local programs to perform evaluation activities.24
CHAPTER FOUR Conclusion
Tobacco use in India is projected to have devastating consequences. Given the low level of tobacco control activities so far and the sparse resources allocated till now for that purpose, a comprehensive well resourced National Program for Tobacco Control is likely to have a high impact. A ban on oral tobacco products too will have an immediate impact. The complete ban on advertising and the countrywide ban on smoking in closed places in India can go a long way to help eliminate this menace.
India should aim to achieve at least a 30% reduction in the prevalence of tobacco consumption by 2020 and a 25% reduction in tobacco-related mortality by 2050. These targets are not modest, considering the large projected rise in tobacco-attributable mortality that has been forecast for India. However, a comprehensive tobacco control program, which combines high levels of passion, planning, performance and perseverance, has a very good chance of accomplishing these goals, or even in fact bettering them.
BIBLIOGRAPHY
Books
S.F. Gambescia, Beginner’s guide to Tobacco Control Legislation (2013, Volume 1)
Robert L. Rabin & Stephen D. Sugarman, Regulating Tobacco (London University Press, 2011, Vol. 2)
Articles
Tarveen Jandoo & Naveen Mehrotra, Tobacco Control in India: Present Scenario and Challenges (Asian Pacific Journal of Cancer Prevention, Vol. 9, Pg. 805-810)
M. Rani, S. Bonu, P. Jha, S. N. Nyugen & L. Jamjoum, Tobacco use in India: Prevalance and predictors of smoking and chewing in a national cross sectional household survey (Tobacco Control 2003, Volume 12, Issue 4)
Jagdish Kaur & D.C. Jain, Tobacco Control Legislation: Implementation and Challenges (Indian Journal of Public Health, 2011, Vol. 5, Issue 3, Pg. 220-227)
Websites http://nmji.in/archives/Volume-23/Issue-6/Medicine-and-Societies-II.pdf (Visited at 7:00 P.M, November 14th, 2014) http://www.tobaccocontrollaws.org/ (Visited at 6:00 P.M., November 15th, 2014) http://www.who.int/tobacco/research/legislation/en/ (Visited 8:00 P.M, November 15th, 2014) http://www.tcc.gov.pk/ (Visited 7:00 P.M, November 16th, 2014) http://en.wikipedia.org/wiki/Cigarettes_and_Other_Tobacco_Products_Act (Visited 8:00 P.M., November 19th, 2014)
1. Introduction ………………………………………………………………………………. 2
2. Research Objectives ………………………………………………………………….… 2
3. Review of Literature …………………………………………………………….……... 3
4. Method of Study ………………………………………………………………….………. 3
5. Research Tools ………………………………………………………………….………… 3
6. Chapter One
Tobacco Control Legislations- Past and Present …………..………...4
7. Chapter Two
Other Acts relating to Tobacco Control & Recent case laws…... 11
8. Chapter Three
Challenges in Implementation & Suggestions ……………………… 19
9. Chapter Four
Conclusion ………………………………………………………………………….. 23 10.Bibliography …………………………………………………………………………………. 24 TABLE OF CASES
1. Doctors For You v. State of Bihar,
Civil Writ Jurisdiction Case No.14729 of 2013 ……………………………. 15
2. S. Cyril Alexander v. Union of India,
Writ Petition No. 9955 of 2014 …………………………………………………... 15
3. Love Care Foundation v. Union of India and Others,
Writ Petition No.1078 (M/B) OF 2013 ………………………………………… 16
4. Dharmendra Kansal v. Union of India & others,
Writ Petition (PIL) No. 37 of 2014 (2014) ………………………………….... 16
5. Anurag Kashyap v. Union of India,
Writ Petition No. 119 of 2014 ………………………………………………………. 16
6. Dinar Yashwant Sohoni v. State of Maharashtra,
PIL No. 98 of 2013 ……………………………………………………………………..... 17
7. Ravishankar v. Union of India,
W.P. No. 2497/2013 …………………………………………………………………….. 17
8. Doctors for You v. State of Bihar,
Civil Writ Case No. 14729 of 2013 …………………………………………………. 17
9. Health for Millions v. Union of India & Ors.,
Nos. 5912-5913/2013, SLP(C) Nos. 413 …………………………………………. 18
10. Rajat Industries v. Union of India,
Case No. 6024 of 2013 …………………………………………………………………… 18
INTRODUCTION
Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. Government of India has taken various initiatives for tobacco control in the country. Besides enacting comprehensive tobacco control legislation (COTPA, 2003), India was among the first few countries to ratify WHO the Framework Convention on Tobacco Control (WHO FCTC) in 2004. The National Tobacco Control Programme was piloted during the 11 th Five Year Plan which is under implementation in 42 districts of 21 states in the country. The advocacy for tobacco control by the civil society and community led initiatives has acted in synergy with tobacco control policies of the Government. Although different levels of success have been achieved by the states, non prioritization of tobacco control at the sub national level still exists and effective implementation of tobacco control policies remains largely a challenge.
The past decade has seen a significant paradigm shift in tobacco-related policies that has led to a significant curtailing of the use of tobacco in many countries. However, nearly all of these advances have occurred in industrialized countries. Unfortunately developing countries’ policies have lagged far behind, and tobacco consumption in these countries continues to rise. The Indian Parliament recently introduced a multifaceted tobacco control bill (the Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill of 2001).
RESEARCH OBJECTIVES
To synthesize the available scientific knowledge on tobacco use in India with a view to assessing the magnitude of the problem, identifying the gaps in knowledge, recognizing health hazards, reviewing the user practices and attempts to reduce the burden of tobacco as well as evolving future tobacco control policies.
To summarize tobacco use and its consequences in India and examine the major legislative control measures and recent case laws.
To discuss additional measures required to successfully implement these control legislations and curb tobacco use in India.
REVIEW OF LITERATURE
S.F. Gambescia, Beginner’s guide to Tobacco Control Legislation- The guide assumes the users—health officials, advocates, lawyers, leaders within non-governmental organisations—have little legislative and policymaking experience. Generally, the book takes a macro level approach in coaching users to introduce and implement meaningful tobacco control policies at the national or sub-national levels. It does not attempt to answer all questions related to the formidable task of passing tobacco control laws, but identifies the sundry of questions that need to be asked to facilitate success in effecting change in these areas. For example, the guide reinforces the need to create a broad based coalition to support a legislative effort, but does not attempt to answer how to form or manage a coalition.
Robert L. Rabin & Stephen D. Sugarman, Regulating Tobacco- This book analyzes specific strategies that have been used to influence tobacco use--including taxation, regulation of advertising and promotion, regulation of indoor smoking, control of youth access to cigarettes and other tobacco products, litigation, and subsidies of smoking cessation--and set them against the latest scientific findings about tobacco use and the changing cultural and political setting against which policy decisions are being made.
METHOD OF STUDY
The research method of collecting information related to this project is the doctrinal method.
RESEARCH TOOLS
Books, Journals, Websites, Articles, Case laws
CHAPTER ONE Tobacco Control Legislations- Past and Present
Effective tobacco control in other parts of the world has been achieved via multipronged strategies focusing on reducing the demand for tobacco products. These strategies include the following: raising taxes; publishing and disseminating information about the adverse health effects of tobacco, including adding prominent health warning labels to products; imposing comprehensive bans on advertising and promotion; restricting smoking in workplaces and public places; and extending access to nicotine replacement alternatives and other cessation therapies.
These demand reduction strategies are typically accomplished through national legislation. In India, health legislation has been historically enacted at state levels. National legislation has been reserved for major issues requiring country-wide uniformity.
India has a short history of tobacco-related legislation. The first national level bills were introduced not to curtail but to build a foundation for the tobacco industry and enable it to be competitive on the international market. Early attempts to enact tobacco control legislation were insufficient and only recently has there been significant impetus to come up with a multifaceted national control measure.
History of Tobacco use in India
The Portuguese introduced tobacco to India 400 years ago and established the tradition of tobacco trade in their colony of Goa. Two hundred years later the British introduced commercially produced cigarettes to India and established tobacco production in the country. Today, of the 1.1 billion people who smoke worldwide, 182 million (16.6%) live in
India. Tobacco consumption continues to grow in India at 2– 3% per annum, and by 2020 it is predicted that it will account for 13% of all deaths in India1. Tobacco use in India is more varied than in most countries. Only 20% of total tobacco consumption is in the form of cigarettes. A common alternative to traditional cigarettes is the bidi, a hand-rolled, filterless tobacco cigarette. Tobacco is also used in the hookah (a traditional water pipe), as pan masala or guthka (a chewing tobacco containing areca nut), as chutta (a clump of tobacco smoked with the lighted end inside the mouth), and mishri (a powdered tobacco rubbed on the gums as toothpaste). Bidis account for the largest proportion of tobacco consumption in India, at about 40%.
In India an estimated 65% of all men and 33% of all women use some form of tobacco. While the prevalence of smoking among men and women differs substantially — 35% of men and 3% of women — both use smokeless tobacco products to approximately the same extent2.
Nationally representative and reliable prevalence data on tobacco consumption are scarce in India. The 52nd National Sample Survey conducted by the National Sample Survey Organization in 1995-96 was the first nationally representative household survey to collect data on tobacco consumption in population, 10 years and older, using surrogate household informants. The prevalence rates of consumption of tobacco in any form were found to be 51.3% for men and 10.35% for women, 15 years and older.3 The study provided an insight into the socioeconomic, cultural and demographic correlates of tobacco consumption. It concluded that the prevalence of both chewing and smoking forms of tobacco was significantly higher in rural, poor and uneducated population. Sporadic studies have been undertaken to show that education and occupation have an important simultaneous and independent relationship with tobacco use and this requires attention from policymakers and researchers.4
India is now demonstrating a steely resolve to contain the menace of tobacco through a comprehensive control strategy that combines several demand and supply reduction measures. Many factors in the Indian tobacco control initiatives have collectively contributed to this national consensus. These include: increasing awareness of the health, environmental and developmental damages caused by tobacco; growing global support for tobacco control; developing policies and programs for effective action and decisive interventions by the activists, non-governmental organizations and the Indian Government.
Anti-Tobacco Policies and Practices in the Past
Pro-tobacco legislation dates back to 1975 with the Tobacco Board Act, introduced to develop the tobacco industry. It facilitated the regulation of production and curing of tobacco, fixed minimum prices, and provided subsidies to tobacco growers; the objective was to develop the Indian tobacco market and make the industry export competitive. Similarly, the Tobacco Cess Act of 1975 was enacted to collect duty on tobacco for the development of the tobacco industry. Anti-tobacco advocates have criticized these Acts because they nurtured the tobacco industry through subsidies and loose export policies.
India’s first national level anti-tobacco legislation was the single-faceted Cigarettes Act of 1975, which mandated health warnings on cigarette packets and on cigarette advertisements. This Act prescribed all packages to carry the warning ‘‘Cigarette smoking is injurious to health’’ in the same language used in the branding on the package. The text was to be a minimum of 3 mm in height, irrespective of the dimensions of the surface on which it appeared or of the dimensions of the brand name. While this Act was a major step in tobacco control, it did not apply to non-cigarette tobacco products. In the years following the Cigarettes Act of 1975, there were a number of other single-faceted national attempts at controlling tobacco use. For instance, in statutes dealing with the preservation of the environment, the Prevention and Control of Pollution Act of 1981 included smoking in the definition of air pollution. The Motor Vehicles Act of 1988 made it illegal to smoke or spit in a public vehicle. Finally, the Cable Television Networks Amendment Act of 2000 prohibited the transmission of tobacco, liquor, and baby food commercials on cable television across the country.
Many state-level governments in India have imposed different types of tobacco control legislation. The Delhi government was the first to impose a ban on smoking in public places, with the Delhi Prohibition of Smoking and Non- smokers Health Protection Act of 1996. In addition to prohibiting the sale of cigarettes to minors and prohibiting sale 100 m from a school building, this law allowed for enforcement in public places and public transport by the police and medical professionals. A first time offender is fined 100 rupees (US$ 2.40) and briefed by the police or medical officer about the law and the negative health consequences of tobacco use.
As expected, it has been difficult to enforce this ambitious programme, and it has probably had little real impact — the key problem being lack of manpower to enforce the law.
Other states too have enacted bans on public smoking. For example, in 1999 the Kerala High Court came out with a judgement prohibiting smoking in public places, including parks and highways. Similarly, the state of Goa introduced anti-tobacco legislation in 1999. Following intense lobby from pro-tobacco groups the final legislation was a diluted version of the original bill, but did maintain an important provision that banned smoking in public places. Spitting of residues from chewing tobacco in public places was also prohibited by the legislation. In the past 12 months, the states of Tamil Nadu and Andhra Pradesh have banned the marketing and sales of guthka.
In February 2001, Indian Prime Minister Vajpayee’s Union Cabinet introduced the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill, a multifaceted anti-tobacco legislation to replace the Cigarettes Act of 1975. Smoking in public places would be outlawed, the sale of tobacco to persons below 18 years of age would be prohibited, and tobacco packages would be required to have warnings the same size as that of the largest text in English or the local language. The proposed national Bill would prohibit tobacco companies from advertising and sponsoring sports and cultural events. Significantly, this Bill covers most tobacco products including not only cigarettes, but also cigars, bidis, cheroots, cigarette tobacco, pipe tobacco, hookah tobacco, chewing tobacco, pan masala, and guthka.
Recent Legislative gestures
The Cigarettes and Other Tobacco Products Act
The Indian Parliament passed the ‘Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Bill, 2003’ in April 2003. This Bill became an Act on 18 May 2003. Rules were formulated and enforced from 1 May 2004. This Bill became an Act on 18 May 2003. Rules were formulated and enforced from 1 May 2004. This law was intended to protect and promote public health, encompass evidence based strategies based strategies to reduce tobacco consumption and impose penalties to the violators.
Provisions of COTPA
The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels, restaurants and airports and open spaces. 5 Places where smoking is restricted include auditoriums, movie theatres, hospitals, public transport (aircraft, buses, trains, metros, monorails, taxis,) and their related facilities (airports, bus stands/stations, railway stations), restaurants, hotels, bars, pubs, amusement centres, offices (government and private), libraries, courts, post offices, markets, shopping malls, canteens, refreshment rooms, banquet halls, discothèques, coffee houses, educational institutions and parks. Smoking is allowed on roads, inside one's home or vehicle.6 The meaning of open space has been extended to mean such spaces which is visited by public, and includes open auditorium, stadium, bus stand.7
Advertisement of tobacco products including cigarettes is prohibited. No person shall participate in advertisement of tobacco product, or allow a medium of publication to be used for advertisement of tobacco products. No person shall sell video-film of such advertisement, distribute leaflets, documents, or give space for erection of advertisement of tobacco products. However, restricted advertisement is allowed on packages of tobacco products, entrances of places where tobacco products are sold.8 Surrogate advertisement is prohibited as well under the Act.
Tobacco products cannot be sold to person below the age of 18 years, and in places within 100 metres radius from the outer boundary of an institution of education, which includes school colleges and institutions of higher learning established or recognized by an appropriate authority.9
Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate pictorial warning, its nicotine and tar contents.10 Cigarette packets are required to carry pictorial warnings of a skull or scorpion or certain prescribed pictorial warnings along with the text SMOKING KILLS and TOBACCO CAUSES MOUTH CANCER in both Hindi and English.
The Act also gives power to any police officer, not below the rank of a sub-inspector or any officer of State Food or Drug Administration or any other officer, holding the equivalent rank being not below the rank of Sub-Inspector of Police for search and seizure of premises where tobacco products are produced, stored or sold, if he suspects that the provision of the Act has been violated.11
A person who manufactures tobacco products fails to adhere to the norm related to warnings on packages on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 5000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 10000.12
A fine up to Rs. 200 can be imposed for smoking in public place, selling tobacco products to minors, or selling tobacco products within a radius of 100 metres from any educational institution.13
A person who advertises tobacco products shall on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to Rs. 1000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with fine which can extend to Rs. 5000.14
The Act repealed The Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975.15
The owner/manager/in-charge of a public place must display a board containing the warning “No Smoking Area - Smoking here is an offence “ in appropriate manner at the entrance and inside the premises.16 In place where tobacco products are sold must display appropriate messages like “Tobacco Causes Cancer” and "Sales of tobacco products to a person under the age of eighteen years is a punishable offence”.
The WHO Framework Convention on Tobacco Control (FCTC) and its Implications for India
The World Health Assembly of the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC) at its 56th Session in May 2003. India ratified the convention on 5 February 2004 and commenced enforcement of the national tobacco control law in May 2004. It was the eighth and the largest country to ratify the treaty. India advocated strong provisions in the FCTC and was unanimously elected as the coordinator of the countries belonging to the WHO South-East Asian Region. The FCTC does not clearly lay down a law which shall be universally applicable, but sets out guidelines for various national and international measures to encourage smokers to quitand restrain non-smokers from taking tobacco as a habit. As a signatory to the treaty, the Indian Government has been pursuing a proactive and bold strategy for tobacco control.
CHAPTER TWO Other Acts relating to Tobacco control and Recent Case laws
The laws other than the COTPA and the WHO framework convention on Tobacco Control (FCTC) are listed below (in chronological order)-
The Railways Act, 1989 (Act No. 24 of 1989, w.e.f July 1, 1990)- The Railways Act among other things regulates smoking on trains. It prohibits smoking if objected to by another passenger and confers authority on the railway administration to prohibit smoking in any train or a part of a train. It imposes a maximum penalty of 100 rupees for those who contravene the Act’s no smoking provisions.
Ministry of Information and Broadcasting Notification S.O. 836 (E), Section 5B(2), Cinematograph Guidelines, December 5, 1991 (w.e.f December 6, 1991)- Issued pursuant to Section 5B(2) of the Cinematograph Act of 1952, the Guidelines require the Central Board of Film Certification to ensure that “scenes tending to encourage or glamorize consumption of tobacco or smoking” do not appear in movies.
Cable Television Networks (Regulation) Act, 1995 (w.e.f September 29, 1994)- The Cable Television Networks (Regulation) Act, 1995 (Act No. 7 of 1995) (CTNA) requires that all advertisements comply with a prescribed advertisement code. The most recent version of this code is contained in the 2009 CTNA Rules and prohibits direct advertising of cigarettes or tobacco products. The code, however, permits the indirect advertising of such products under certain circumstances. (Note that a July 2010 Ministry of Information and Broadcasting Directive, appears to prohibit indirect advertising on cable networks until guidelines called for by the CTNA Rules are issued.) CTNA does not regulate international cable television networks. The version uploaded here is as amended only through August 31, 2007.
Ministry of Health and Family Welfare Notification G.S.R. 561(E), September 1, 2004 (w.e.f December 1, 2004)- The Prohibition on Sale of Cigarettes and Other Tobacco Products around Education Institutions Rules, 2004, defines “educational institutions” which may assist with the interpretation of this term in the public place definition of COTPA.
Ministry of Health and Family Welfare Notification G.S.R. 345(E), May 31, 2005 (w.e.f November1, 2006)- G.S.R. 345(E) announces the Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Rules, 2005. G.S.R. 345(E) amends the first rules enacted to implement COTPA (the 2004 Rules) by substituting new provisions on point of sale advertising and adding a definition of “indirect advertising.”
Ministry of Health and Family Welfare Notification G.S.R. 417 (E), May 30, 2008 (w.e.f October 2, 2008)- G.S.R. 417(E) supersedes the first rules enacted to implement COTPA (the 2004 Rules) and announces the Prohibition of Smoking in Public Places Rules, 2008. These new rules (1) impose duties upon certain parties such as owners, managers to ensure that smoke free policies are followed; (2) specify the requirements of "smoking areas" in hotels, restaurants, and airports; and (3) authorize officers to collect fines for the violation of specified smoke free rules.
Ministry of Health and Family Welfare Notification S.O 2814(E), November 28, 2008 (w.e.f November 30, 2008)- S.O. 2814(E) amends a rule announced in G.S.R. 693(E) regarding the languages in which the health warnings are written.
Ministry of Health and Family Welfare Notification G.S.R. 693 (E), September 29, 2008 (w.e.f November 30, 2008)- G.S.R. 693(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling (Amendment) Rules), 2008. Issued after G.S.R. 182(E) (the Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008), G.S.R. 693(E) contains substitute language regarding health warnings on retail packaging, requiring warnings to be printed on external packaging such as cartons.
Cable Television Networks (Amendment) Rules, G.S.R 138(E), February 27, 2009 (w.e.f February 27, 2009)- G.S.R. 138(E) announces the Cable Television Networks (Amendment) Rules, 2009. These Rules amend the Cable Television Networks Rules, 1994 with regard to indirect advertisement and brand stretching, permitting such surrogate advertising under certain circumstances. (Note that a July 2010 Ministry of Information and Broadcasting Directive, however, appears to prohibit indirect advertising on cable networks until guidelines called for by the CTNA Rules are issued.)
Ministry of Health and Family Welfare Notification G.S.R 182(E), March 25, 2009 (w.e.f May 31, 2009) - G.S.R. 182(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling) Rules, 2008. Issued under COTPA, the Rules specify components of the health warnings (i.e., content, size, rotation, etc.), but various provisions in subsequent rules replace certain language in the 2008 regulations. Provisions prohibiting misleading descriptors and obscuring the health warnings on the package remain in G.S.R. 182(E) unaltered.
Ministry of Health and Family Welfare Notification G.S.R 305(E), May 3, 2009 (w.e.f May 31, 2009)- G.S.R. 305(E) announces the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2009. Issued after G.S.R. 182(E) (the Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008, G.S.R. 305(E) contains substitute language for the definition of “package” and for the location of the health warning. G.S.R. 305(E) deletes the requirement that the warning be located on both sides of box and pouch type packs.
Ministry of Health and Family Welfare Notification G.S.R 1866(E) (w.e.f July 30, 2009)- G.S.R. 1866(E) authorizes certain officers, in addition to those already designated in COTPA, to carry out the entry, search, and seizure provisions in COTPA Section 12 (with respect to any violation of the Act) and Section 13 (with respect to violations of tobacco product packaging and advertising).
Ministry of Health and Family Welfare Notification G.S.R 680(E), September 15, 2009 (w.e.f September 15, 2009)- G.S.R. 680(E) announces the Prohibition of Smoking in Public Places (Amendment) Rules, 2009. The Rules add to those issued in G.S.R. 417(E) by listing additional persons authorized to collect fines for the violation of specified smoke free rules.
Ministry of Health and Family Welfare Notification G.S.R 985(E), December 20, 2010 (w.e.f December 20, 2010)- Issued after G.S.R. 182(E) (Cigarette and other Tobacco Products (Packaging and Labelling) Rules of 2008), G.S.R. 985(E) contains substitute language on the issue of rotation, requiring that health warnings be rotated every 24 months instead of one year. The rule also re-establishes the May 2009 health warnings, ensuring that pictures of a lung x-ray and diseased lungs continue to be displayed on smoked tobacco product packages and a picture of a scorpion continues to be displayed on smokeless tobacco product packages.
Food Safety and Standards (Prohibition and Restriction on Sales) Rules, 2011 (w.e.f August 5, 2011)- The Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations, 2011 prohibit, among other things, tobacco and nicotine from being used in any food products. Courts in several states have relied on this provision to impose bans on the manufacture, distribution, and sale of "gutka" or "pan masala."
Ministry of Health and Family Welfare Notification G.S.R 619(E), August 11, 2011 (w.e.f August 11, 2011)- G.S.R. 619(E), entitled the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Amendment Rules, 2011, amends regulations related to the prohibition on the sale of tobacco products to and by minors.
Ministry of Health and Family Welfare Notification G.S.R 786(E), October 27, 2011 (w.e.f November 14, 2011)- G.S.R. 786(E), entitled Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) (Second Amendment) Rules, establishes rules for television and film including a prohibition on tobacco product placement and a requirement for health warnings when tobacco products or their use are displayed. For print and outdoor media, G.S.R. 786(E) requires cropping or masking brand names and logos of tobacco products.
Ministry of Health and Family Welfare Notification G.S.R 570(E), July 26, 2011 (w.e.f December 1, 2011)- G.S.R. 570(E), the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2011, amends a rule announced in G.S.R. 182(E) regarding the languages in which the health warnings are written and updates the components of the health warning.
Ministry of Health and Family Welfare Notification G.S.R 417 (E), May 27, 2011 (w.e.f December 1, 2011)- G.S.R. 417(E) announces the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2011. The rules establish new graphic health warnings for packages of smoked and smokeless forms of tobacco. The rules also increase the number of warnings for smoked tobacco products from two to four, and increases the number of warnings for smokeless tobacco products from one to four. The new warnings became effective December 1, 2011, but were subsequently replaced by the health warnings contained in G.S.R. 724(E).
Ministry of Health and Family Welfare Notification G.S.R 708(E), September 21, 2012 (w.e.f October 2, 2012)- G.S.R. 708(E) announces the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Amendment Rules, 2012. These rules amend provisions governing the display of tobacco products or their consumption in film and television.
Ministry of Health and Family Welfare Notification G.S.R 728(E), September 27, 2012 (w.e.f April1, 2013)- G.S.R. 724(E) announces the Cigarettes and other Tobacco Products (Packaging and Labelling) Amendment Rules, 2012. The Rules establish new health warnings for tobacco product packaging, effective April 1, 2013.
RECENT CASE LAWS
Doctors For You v. State of Bihar, Civil Writ Jurisdiction Case No.14729 of 2013, High Court of Judicature at Patna (2014)- Doctors for You, a non-governmental organization, sued the State of Bihar seeking implementation of various provisions of the Cigarette and Other Tobacco Products Act (COTPA). In response to the petition, the court ordered that signs informing the public about the negative effects of tobacco be posted at all government primary, secondary, and post-secondary schools as soon as possible. Additionally, the court ordered the local police to create a monthly report about enforcement of the Act and submit the report to various government agencies.
S. Cyril Alexander v. Union of India, Writ Petition No. 9955 of 2014, High Court of Judicature at Madras (2014)- A public interest lawsuit requested that the government exclude tobacco companies from the Corporate Social Responsibility requirements under Indian law in order to prevent the companies from earning goodwill through direct and indirect advertising. The petitioner asked for the money that tobacco companies would have spent on a corporate social responsibility campaign instead be paid to the government for medical expenses for people with tobacco-related diseases and other tobacco control programs. The court directed the government to determine how tobacco companies can best meet their corporate social responsibility obligations. The court asked for appropriate action to be taken within four months of the decision and disposed the petition.
Love Care Foundation v. Union of India and Others, Writ Petition No.1078 (M/B) OF 2013- A non-governmental organization seeking to reduce smoking among Indian youths petitioned the Indian government to adopt plain packaging of tobacco products. The organization argued that attractive packaging is a form of advertisement and sought a rule prohibiting the use of logos, colors, or brand names on tobacco product packaging. After reviewing evidence supporting the impact of a tobacco plain packaging law in Australia and a study of plain packaging in Brazil, the court concluded that plain packaging and health warnings reduce the ability of attractive packaging to mislead consumers about the harms of smoking. The court urged the Indian government to consider the feasibility of implementing the plain packaging of cigarettes and other tobacco products as early as possible.
Dharmendra Kansal v. Union of India & others, Writ Petition (PIL) No. 37 of 2014 (2014)- A public interest lawsuit requested that cigarette manufacturers and the Indian government comply with the provisions of the Cigarette and Other Tobacco Products Act (COTPA) regarding tar and nicotine levels. Specifically, the law requires manufacturers to provide the tar and nicotine content of cigarettes on the label. The law also requires the government to set maximum permissible limits for tar and nicotine, which are also to be displayed on cigarette packs. The court said that it did not have the power to compel the government to implement this provision of the law, even though the government had failed to set maximum tar and nicotine levels for cigarettes in the 11 years since the law was adopted. Instead, the court banned the sale of cigarettes in the State of Uttarakhand, effective one year after the date of the decision. The court said that the ban will not take effect if the government prescribes maximum nicotine and tar limits and manufacturers provide this information on their labels. Additionally, the court ordered that all loose cigarettes must be sold with the specified warning label on the cigarette or the packaging, effective six months from the date of the decision.
Anurag Kashyap v. Union of India, Writ Petition No. 119 of 2014, Bombay High Court (2014)- The makers of an Indian film challenged the rules issued under the Cigarettes and Other Tobacco Products Act (COTPA) requiring a static anti-tobacco health warning at the bottom of the screen during the time that tobacco products are displayed in the film. The filmmakers argued that the health warning would unnecessarily disturb the viewers’ attention and destroy the enjoyment of the movie. The court denied the filmmakers’ request, noting that granting a stay of the advertising rules would interfere with the government’s implementation of the rules. In particular, the court referred to another court decision ordering the government to rigorously implement the law and the rules promulgated under the law. However, the court noted that the filmmakers could ask the government to modify or delete the rules related to anti-tobacco health warnings in films.
Dinar Yashwant Sohoni v. State of Maharashtra, PIL No. 98 of 2013, High Court of Bombay (2014)- A public interest lawsuit requested implementation of the rule requiring educational institutions to post a sign stating that cigarettes and other tobacco products may not be sold within a 100 yard radius of a school. The court found this requirement mandatory and ordered the state government’s Education Department to instruct all schools to implement the rule before the start of the 2014-2015 academic year.
Ravishankar v. Union of India, W.P. No. 2497/2013, High Court of Karnataka at Bangalore (2013)- A tobacco control advocate filed a lawsuit against various government agencies seeking full enforcement of India's omnibus tobacco control law and the rules promulgated to implement the law. The advocate did not allege any specific violations of the law. After receiving information from government agencies that they plan to take appropriate action to enforce the law against violators, the court disposed of the petition. The court noted that it is not appropriate to go directly to the court for enforcement of a law if law enforcement agencies are designated.
Doctors for You v. State of Bihar, Civil Writ Case No. 14729 of 2013, High Court of Judicature at Patna (2013)- Doctors for You, a humanitarian organization, sued the State of Bihar seeking enforcement of various provisions of India's omnibus tobacco control law. The court ordered the government to undertake an educational campaign (including newspaper, electronic media, and radio communications as well as through displays at public places) on the harmful effects of smoking and chewing tobacco prior to taking any enforcement action.
Health for Millions v. Union of India & Ors., Nos. 5912-5913/2013, SLP(C) Nos. 413-414/2013, Supreme Court of India (2013)- The tobacco industry challenged rules implementing the advertising provisions of India's tobacco control law, particularly the restrictions on advertising at the point-of-sale and the definition of indirect advertising. In 2005 and 2006, the Bombay High Court ordered that implementation of the rules be stayed. Health for Millions, an NGO, challenged this decision, and, in July 2013, the Supreme Court of India found that there was not a sufficient reason for the earlier decisions staying the rules. The Court ordered the government to rigorously implement India's Tobacco Control Law and its rules. The legality of the rules, however, still is at issue in the Bombay High Court.
Rajat Industries v. Union of India, Case No. 6024 of 2013, High Court of Judicature at Patna (2013)- A company that manufactures gutkha sued the government of India objecting to letters sent by the Ministry of Health and Family Welfare to various state governments requesting that they consider banning smokeless/chewing tobacco in the form of gutkha, pan masala, zarda and other chewable products with nicotine. The court dismissed the claim as premature because it does not challenge any bans on gutkha and pan masala, merely the informational letters sent by the government.
CHAPTER THREE Challenges in implementation and suggestions
THE TOBACCO EPIDEMIC- THREATS AHEAD
The gloomy and mournful predictions about the growing magnitude of tobacco’s threat to India relate to a rise both in the proportion of deaths attributable to tobacco and in the absolute number of persons who consume tobacco. The World Health Organization (WHO) estimated that the proportion of deaths that result from tobacco-related diseases will rise in India, from 1.4% of all deaths in 1990 to 13.3% of all deaths in 2020.17 The models presented in the 2002 report of the Economic and Social Council (ECOSOC) of the United Nations predict that the number of persons consuming tobacco is likely to rise.18 In India’s case, the population is expected to grow by about 300 million between 2000 and 2020.19 Most of the expansion will occur in the age group of 15-59 years. This is the age group most vulnerable to acquiring and continuing the tobacco addiction.
Some glamorous products and marketing innovations like flavored cigarettes are likely to target youth and have important potential implications of increased smoking experimentation and consumption.20 These observations foist upon us to raise a clamor for interventional steps in tobacco control before the tobacco epidemic goes berserk.
TOBACCO CONTROL- WHAT IS NEEDED?
Resourcing: Financial Resource Mobilization and Human Resource Development
Financial resources can be generated from a variety of sources: increased government allocations, an earmarked tobacco tax or cess, regulatory levies, penalties, private sector resources, civil society resources and international financial assistance. The revenues earned from such a tax/cess/levy have been utilized for funding not only tobacco control programs but also a variety of other health promotion activities.21 Regulatory levies are mechanisms by which funds for tobacco control can be generated, through a fee collected by the National Regulatory Authority (NRA) for testing and regulating tobacco products. This can be done both prior to the introduction of a new tobacco brand into the market, and also for annual renewal of the permission to market the brand, as is being practiced in Brazil.22 Adequate attention should be paid to developing committed human resources, including grass level workers, community-level activists and medical professionals.
Coordination: Establishment of a National Coordinating Mechanism
To implement the provisions of the Indian Tobacco Control Act and FCTC, establishing a national coordination mechanism is essential. Article 5.2 (a) of the FCTC obliges the ratifying parties to establish or reinforce and finance a national coordinating mechanism for tobacco control.23 This mechanism should have four types of agencies-a National Regulatory
Authority (NRA), a National Coordinating Body, an Interministerial Coordination Committee and a State-level Coordinating Body.
With the establishment of ANVISA (Agencia Nacional de Vigilancia Sanitaria) or National Health Surveillance Agency and National Commission on Tobacco Use (NCTU) Brazil has become a world leader in regulating and controlling tobacco products. (Government leadership in tobacco control, 2008) Similar bodies should be established in India to ensure smooth interaction between the coordinating agencies at the central and state level and this should leave no scope for ambiguity in interpreting the laws related to tobacco control at any level.
Integration of Tobacco Control into Health and Development Programs
Tobacco control can be integrated into the existing delivery systems such as the health care system and other developmental programs. The vast human resources available with various programs such as the AIDS Control Program and Malaria Control Program can be used additionally for tobacco control, especially for health education activities. This will have immense benefit coupled with a low incremental cost. As the relationship between tuberculosis and smoking is well known, the Tuberculosis Control Program may be used to impart health education as well as screen patients for tobacco use.
The tobacco control program in India should be kickstarted by integrating it into various developmental programs such as poverty alleviation, rural development, women and child development, and tribal welfare, with extensive reach and widespread presence at the grassroots level. Evaluation of Tobacco Control Programs
Evaluation helps ensure that only effective approaches are implemented and that resources are not wasted on ineffective programs. The Government should also routinely monitor the implementation of tobacco control policies. This includes tracking the development of ordinances, laws and rules. The national indicators which should be studied include: land area under tobacco cultivation, annual tobacco production, annual domestic consumption of home grown and manufactured tobacco (including major categories of tobacco products), annual export of tobacco, tax revenue from tobacco and cause specific mortality of tobacco-related diseases.
At least 10% of the budget of each local project should be used for tobacco control. Experience in California and Massachusetts has shown that these funds can be used both for statewide systems and to increase the technical capacity of local programs to perform evaluation activities.24
CHAPTER FOUR Conclusion
Tobacco use in India is projected to have devastating consequences. Given the low level of tobacco control activities so far and the sparse resources allocated till now for that purpose, a comprehensive well resourced National Program for Tobacco Control is likely to have a high impact. A ban on oral tobacco products too will have an immediate impact. The complete ban on advertising and the countrywide ban on smoking in closed places in India can go a long way to help eliminate this menace.
India should aim to achieve at least a 30% reduction in the prevalence of tobacco consumption by 2020 and a 25% reduction in tobacco-related mortality by 2050. These targets are not modest, considering the large projected rise in tobacco-attributable mortality that has been forecast for India. However, a comprehensive tobacco control program, which combines high levels of passion, planning, performance and perseverance, has a very good chance of accomplishing these goals, or even in fact bettering them.
BIBLIOGRAPHY
Books
S.F. Gambescia, Beginner’s guide to Tobacco Control Legislation (2013, Volume 1)
Robert L. Rabin & Stephen D. Sugarman, Regulating Tobacco (London University Press, 2011, Vol. 2)
Articles
Tarveen Jandoo & Naveen Mehrotra, Tobacco Control in India: Present Scenario and Challenges (Asian Pacific Journal of Cancer Prevention, Vol. 9, Pg. 805-810)
M. Rani, S. Bonu, P. Jha, S. N. Nyugen & L. Jamjoum, Tobacco use in India: Prevalance and predictors of smoking and chewing in a national cross sectional household survey (Tobacco Control 2003, Volume 12, Issue 4)
Jagdish Kaur & D.C. Jain, Tobacco Control Legislation: Implementation and Challenges (Indian Journal of Public Health, 2011, Vol. 5, Issue 3, Pg. 220-227)
Websites http://nmji.in/archives/Volume-23/Issue-6/Medicine-and-Societies-II.pdf (Visited at 7:00 P.M, November 14th, 2014) http://www.tobaccocontrollaws.org/ (Visited at 6:00 P.M., November 15th, 2014) http://www.who.int/tobacco/research/legislation/en/ (Visited 8:00 P.M, November 15th, 2014) http://www.tcc.gov.pk/ (Visited 7:00 P.M, November 16th, 2014) http://en.wikipedia.org/wiki/Cigarettes_and_Other_Tobacco_Products_Act (Visited 8:00 P.M., November 19th, 2014)
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