Ministry of Health - Ban, Ban....

The Minister of Health in the Government of India, Mr. A. Ramadoss is young and enthusiastic.

But in his zeal to improve the health of the country, he is prone to go overboard. He seems to have a propensity to go for slapdash solutions and in doing so, give short shrift to some basic tenets of the Constitution of India, in particular Part III, to which he has sworn allegiance as a Minister.

Worried about the manner in which psychiatrists, neuro surgeons and other medical specialists were leaving the country to UK for jobs, practice or research, his first instinct was to ban their travel and practice abroad. This is what he said in an interview with a newspaper:

"Initially I was thinking of banning such specialists from travelling and practicing abroad."

His Ministry was also planning for a mandatory practice by the specialists for a certain period in India after passing out, another injudicious approach which, thankfully, was dropped.

He even took up the issue with the British High Commissioner in India, blaming the British National Health Service for the 'brain robbery' according to the news report.

His first thought then, was to ban the specialists from leaving the shores of India. For a Minister in the Government of India, he is expected to exhibit due restraint in expressing his private opinions in public. Even if in his private moments the Minister immediately thought of a lay person's solution of banning their travel, in making his views public, he only displayed a less than mature approach and naivette. He even stated: "But legally, we can't do that".

Not happy with the situation, he even 'took up the issue' with the British High Commissioner. To what end, pray? Perhaps, the British High Commissioner was also amused by the approach of a Minister who represents the Government of India.

As the Minister himself seems to have realized after discarding the half-baked ideas contemplated earlier, the only sensible approach to the problem would be to create more facilities for study and enrolment of larger number of candidates for the specializations.

The next issue about which the Minister seems to be quite exercised is that of the smoking in movies and has proposed a ban on smoking scenes in movies, a knee-jerk action behind which not much thought seems to have gone.

There is a background of his own party's protests a few years back against film star Rajnikanth for smoking and drinking on screen and that seems to be one of the reasons prompting the ban.

But rather than emphasize this past and blame him for taking an emotional and subjective decision, it is better to analyze the matter more objectively.

It cannot be denied that a ban on smoking scenes impinges on the fundamental freedom of artistic expression and for that reason, has been rightly objected to by the film-makers and others.

Further, the decision is sure to create serious difficulties for the implementing authority i.e. the I & B Ministry as it would give rise to a host of fundamental and practical issues. Such an arbitrary ban is likely to snow-ball into demands from various sectors for restrictions with respect to a host of other issues, whether movie-related or not, which the Government would be hard-pressed to handle.

Apart from these two overall considerations, there are other aspects also which need to be considered in an objective manner as regards the relevance as well as the efficacy of the ban on smoking scenes.

It is undoubtedly true that consumption of tobacco is a scourge which needs to be controlled. But the health risks from this menace are such that they cannot be effectively dealt with by the ad-hoc and superficial manner in which the Ministry is seeking to handle the issue.

There are two basic objectives in dealing with and reducing tobacco consumption:

a. Cessation of consumption by those who are already used to the tobacco habit.

b. Preventing the initiation of tobacco consumption by non-users, primarily adolescents and young adults

The proposed ban on movie scenes is obviously not aimed at the the User group as those who are already consuming tobacco are unlikely to cease smoking if they do not see any smoking scenes in movies. Therefore, for this group, it is irrelevant whether scenes involving smoking are shown or not.

Consequently, it is to be assumed that the measure is meant to prevent initiation of consumption by the susceptible group.

Teens smoking...

The reasons why adolescents and young persons take to smoking are complex, involving a mix of economic, cultural and social factors which affect the living environment of each person. In young persons, the two reasons traditionally considered as primary factors are : peer pressure and accessibility of tobacco products. Accessibility is taken both in the sense of affordability and ease of acquiring. Other factors are, promotions and advertising, consumption behavior by parents, friends and siblings and social acceptability.

Celebrities and others.....

Of late, attention is being focused on another possible cause as far as smoking is concerned i.e. depiction of smoking scenes in movies. This view is inspired by the fact that in most of the new movies (in the West) smoking scenes are shown. It is believed that such scenes, especially positive depictions, are particularly likely to induce adolescents at their impressionable age, to take to smoking. A few studies have been done which show the considerable extent to which smoking is shown in movies. A study has also tried to determine how or in what manner smoking scenes might influence young minds. Studies have been made and evidence has been found in the USA, about the unethical practices of cigarette manufacturers in trying to influence smoking behavior by using the film medium. But the real issue is to establish a demonstrable, unequivocal and significant link between the exposure to smoking scenes and actual influence of the same on smoking behaviour.

In proposing the ban, the Minister appears to have simply applied the hypotheses of studies made in other countries to the Indian situation. However no systematic studies seem to have been initiated by the Ministry itself to assess the Indian situation. At least, no evidence has been made available to the general public to show that the ban is indeed essential.

Several measures have already been taken by the Government in the past to try and restrict the consumption of tobacco e.g. age restrictions on selling tobacco, ban on smoking in public places, ban on sponsoring of public events by tobacco manufacturers etc. as well as high level of duties. If at all the Government is really serious about preventing, controlling and reducing consumption of tobacco, it needs to evolve a COMPREHENSIVE strategy after independently studying in depth, various factors affecting tobacco consumption in the country, not blindly following a few studies made in other countries. The Strategy should include economic, regulatory, clinical and educational aspects. As far as economic aspect is concerned, in India at least, the Excise and other taxes seem to have been placed at a sufficiently high level to reduce affordability amongst the adolescents. As far as regulations are concerned, rather than placing a frivolous ban on smoking scenes, regulations for advertising and promotion of tobacco need to be tightened. In the context of films, any sponsorship or paid placements may be prohibited. Alternatively, the film maker could be obliged to disclose at the beginning of the movie, any paid placements accepted in the film. The Government should also be prepared to engage in counter-marketing to discourage use and make it socially unacceptable. The Government needs to also focus its attention on the extremely disturbing trend of more and more adolescent girls taking to smoking.

As far as the Ministry's fear about impact of smoking scenes in movies is concerned, it needs to immediately commission, in conjunction with any other concerned administrative Ministry, studies(see proposed outline) by a reputable institution like Tata Institute of Social Sciences before any conclusion can be reached.

Any measure the Government takes must be relevant, credible and evidence-based.

to be continued...

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