Editorial: Up in smoke

The good news from India’s somewhat occasional war on tobacco is that we are on course to achieve the World Health Organisation’s target of reducing tobacco use by 30% by 2025, relative to 2010. When that target was set up in the WHO Global Action Plan back in 2013, 38.3% of Indian men and women were tobacco consumers in various forms. That is now expected to decrease to 21.8%. Well done.

The bad news comes from the Union Health Ministry’s latest India Tobacco Control Report. It shows that smoking as one form of tobacco use is increasing among teenagers, particularly girls. It’s up to 6.2% for teenage girls, rising by 380 basis points relative to 2009. In comparison, smoking among boys is up by 2.3 percentage points.

These facts are contrary to the general trend of declining tobacco use. More young people are smoking at a time when older men and women are kicking the butt. Among girls, smoking prevalence is 6.2 per cent compared to 1.5% for women. The point of concern is that a seriously high proportion of youngsters (7.4% of girls, 9.4% boys) are using tobacco in various forms.

The public health case for curbing tobacco use can hardly be overstated. A recent KPMG report shows that India with some 250 million smokers ranks second globally on tobacco use and loses value equivalent to 1% of GDP due to its adverse health effects. Respiratory and cardiovascular diseases and cancers on account of tobacco use form the bulk of the disease burden of India’s most productive age classes. Similarly, there is increasing literature on health risks specific to women smokers. These range from reproductive and fertility issues such as premature births, smaller foetuses, birth defects and earlier menopause to cancers of the cervix and the breast.

However, it’s important how we address the issue of smoking prevalence among young women. All too often, smoking is portrayed as a fashion statement by women, the product of peer pressure or the desire to be cool. A more indulgent view is afforded to young men, though, who apparently need the cigarette as a stressbuster. This is a superficial approach and arises out of society’s tendency to arrange all facts concerning young women within a patriarchal framework in the hope that it might elicit conformity. This framework misuses concern for health as cover for conservatism, and therefore receives pushback from those it purports to rescue.

A more useful approach would be to acknowledge the historic and cultural context of women using the languid cigarette as a small act of rebellion against restrictive societal norms. In fact, mid-19th century photographers used the cigarette as a prop in the hands of aristocratic women to challenge the contemporary notion of smoking as an activity by comfort women. In the first wave of feminism in the early 20th century, the cigarette, called ‘Torches of Freedom", was a symbol used to encourage women to aspire for a life equal to men. In the 1960s, the cigarette in the hands of a young woman accompanied the slogan ‘you’ve come a long way baby.’

There is a cultural context to women smoking. The cigarette is a symbol of rebellion, even if not a healthy one. Of course, women's health is best protected by giving the cigarette a wide berth, but that aim is better achieved by snipping away all the invisible forms of control by which they are hemmed in, so that they are free enough to make their own choices. Isn’t there a pile of evidence that, left to themselves, women make the better choices on health, family, economy, war and peace?