Bidi habit poses hidden health risk

Rajeshree Sisodia, foreign correspondent

• Last Updated: May 21. 2008 12:48AM UAE / May 20. 2008 8:48PM GMT

New Delhi // Bhagwaan Samal holds the brown bidi in work-worn hands and inhales deeply.

The plumber, 44, has been smoking between 10 to 15 bidis a day for the past five years. He gives them up periodically, he said, but the stress of work makes him start again.

Mr Samal, who is married and a father of three, lived in the eastern state of Orissa before moving to the capital 24 years ago. He claims to not be suffering from any health problems. “But I know it’s bad for you; I tried to give it up. I’m older so I know I should. My children see me smoke. It’s not good. I’m really not that addicted. I will slowly give it up.”

Mr Samal earns between 5,000 rupees (Dh433) and 6,000 rupees a month and spends about 51 rupees a day on bidis: filter-less, hand-rolled cigarettes wrapped in leaves of tendu that are tied together with a piece of string. He is not alone.

The first worldwide study to compile existing information about bidi consumption and manufacture – and the health effects of smoking and producing bidis – was published last week.

The report, titled Bidi Smoking and Public Health, reveals that India, home to the world’s largest market of bidi consumers and producers, has more than 100 million bidi smokers. Of these, 2.3 per cent are children. The study was carried out over a five-year period and developed by the Healis – Sekhsaria Institute for Public Health based in Mumbai and the US Centers for Disease Control and Prevention.

It reported that 700,000 of the 800,000 tobacco-related deaths in India each year were caused by bidi smoking. Bidi smokers also had a higher risk of suffering from lung and oral cancer than cigarette smokers, while smoking bidis increased the likelihood of contracting chronic bronchitis, respiratory diseases and tuberculosis.

Though smoking tobacco products, including cigarettes and bidis, in public places has been banned in India since 2004, smoking remains a common sight in the country. Police officers are reluctant to enforce the law.

In a nearby neighbourhood in New Delhi, Satu Chaudhary, 40, said he started smoking bidis five years ago after giving them up because he had tuberculosis. The addiction was too strong, he said. Originally from the eastern state of Bihar, he has been a cycle-rickshaw driver in the capital for 30 years. The habit costs him 51 rupees a day, one-tenth of his daily income, which buys him about 25 bidis.

Mr Chaudhary, a father of three, said: “I don’t have TB any more because I took medicine. I also had liver problems. I still have health problems; breathing problems. It’s a horrible habit, but it’s difficult to give up. I’ll give up when I give up. If they increased tax on bidis, maybe I would give up. I know about the ban but the police don’t say anything.”

It is a view supported by Prakash Chandra Gupta, the report’s co-editor and a director at Healis. Health professionals at Healis claim that bidis are more harmful than cigarettes because they go out more often than cigarettes and are filled with small amounts of low-grade tobacco. This means bidi smokers make more effort to inhale when smoking and are more vulnerable to certain diseases than cigarette smokers.

“There’s a widespread misconception that bidis are safer than cigarettes because bidis are natural and the tobacco is not processed like it is in cigarettes,” Dr Gupta said. But the current findings are completely opposite. In laboratory experiments, the delivery of nicotine and tar from bidis appears to be as much or higher than in cigarettes. In terms of policy, bidi smoking gets short shrift.

“There’s a lot of talk about cigarettes but almost nothing on bidis by the government of India, as far as policy and development goes,” he said.

The report also highlighted health problems tobacco farmers and bidi makers suffer through exposure to tobacco. The results found farmers and bidi makers who did not smoke or chew tobacco had tobacco present in their blood, saliva and urine.

Studies have also shown India’s 4.4m full-time bidi rollers – the majority of whom are rural women and children who roll bidis by hand at home and are paid low wages – were more likely to contract anaemia, asthma and TB than other non-smokers not involved in bidi production.

It is an industry that is growing. More than 800 billion bidis are sold in India each year compared with 100bn cigarettes sold annually. Easily available and comparatively cheap, the bidi is smoked predominantly by people on lower incomes. India also produces more than 85 per cent of the world’s bidis.

Dr Gupta attributed the growth in the industry to a lack of awareness about the health effects of smoking bidis and their cheap price.

“We need to apply the same kind of policy to control bidis as are used to control cigarette smoking in the world,” he said. “We need pictorial warnings on bidi packets. Taxation needs to be addressed. Bidis are so cheap. They are probably the cheapest tobacco product in the world. That must change to reduce consumption.

“When you see annual figures, it’s clear that it has been increasing. We don’t have hard data available from year-to-year but now around 900bn bidis are made. Ten years ago it was 500bn. Bidis affect everyone, starting from farm workers to rollers to smokers. And it is the poorest of the poor also. The problem is already very serious, very huge. If something is not done, it will keep increasing.”

The report has been accepted by the federal ministry of health, which in its most recent figures for 2003, spent 350bn rupees treating cardiovascular diseases, cancer and chest diseases. Health professionals and ministry officials said the study would be used to guide existing and future policy.

The federal government has introduced legislation to monitor the bidi industry, protect bidi workers and guarantee them minimum wages and access to health care and education. But the majority of the bidi-making sector is “unorganised” and fragmented, which has made implementation of laws difficult. The sector is not regulated. People employed in it have no job security and do not pay taxes.

India has about 300 large bidi producers and thousands of small-scale manufacturers and contractors, according to the International Labour Organization. Many of these manufacturers do not register their employees, enabling them to avoid paying a health care tax on bidis, revenue from which is used to provide those registered as employed in the bidi industry with health care. The unorganised nature of the bidi industry has also made regulating the industry and collecting excise duty from bidi manufacturers difficult.

The bidi industry has also managed to stall implementation of the national tobacco-control law, the Cigarettes and Other Tobacco Products Act of 2003. The law would ban all tobacco advertising and make it compulsory for all tobacco products to carry pictorial health warnings.

Bhavani Thyagarajan, a consultant for the federal ministry of health, said the 2003 law would be implemented within “months” and added the federal government has started pilot schemes to find alternative crops tobacco farmers could grow. The programmes would be expanded across the country, she said.

“The bidi industry is mostly the unorganised sector and it is a little difficult to regulate, for example for excise duty increase. To that extent, yes it is hard. From the health ministry’s point of view, I don’t think we are neglecting this. For the packaging and labelling, it is a difficult issue for the government of India … The bidi industry can exert pressure to the government, the health ministry does its best. We’ve brought in the act. I’m confident it will change but these things take time.”

No one from the All-India Bidi Manufacturers’ Association was available for comment.

rsisodia@thenational.ae