A System Dynamics Approach to Discourage Smoking

smoke-that-cigarette

 

  • Nearly 80% of the world’s 1 billion smokers live in low- and middle-income countries.
  • Tobacco kills around 6 million people each year. More than 5 million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke.
  • Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and hookah (water-pipes).  
  • In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.
  • Smoking should be therefore banned where people agglomerate and should be discouraged at the personal level.

 

“Tobacco is universally regarded as one of the major public health hazards and is responsible directly or indirectly for an estimated eight lakh deaths annually in the country. It has also been found that treatment of tobacco related diseases and the loss of productivity caused therein cost the country almost Rs. 130,500 million annually, which more than offsets all the benefits accruing in the form of revenue and employment generated by tobacco industry”.

— Supreme Court of India, Murli S. Deora vs Union of India and Ors on 2 November 2001

[This observation is valid even today with perhaps a stronger statistics to support]


 

The Union Health Minister of India J P Nadda (JP) was fed up with the tactics of the opposition and the lobbying of the Tobacco Czars (like ITC, Godfrey Phillips) to stall his proposed amendments to the bill on Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) or simple called COTPA.

The amendments suggested to the bill were very well intended and were proposed after a lot of internal discussions and stakeholder consultation. The bill proposed raising of fine to Rs 1000 from Rs 200 on smoking in public places as well as recommended removal of designated smoking zones in hotels and restaurants.

A ban was also proposed on sale of loose cigarettes and raising the minimum age of a person buying tobacco products to 21 years from existing 18. This was expected to reduce consumption of illicit cigarettes. (The age group between 18-21 years was found to be 83 % of the first time smokers)

The Finance Minister in the 2015-2016 budget raised excise duty on cigarettes by a whopping 15%. The idea was to discourage smoking and certainly not build a revenue stream (I suppose)

JP’s secretary called me for a discussion on the COTPA “problem” and get my Professor friend along. “I have heard a lot of good things about your Professor Friend from the PMO. Let us see how he can help me” He told me when the secretary connected me on the phone.

Fortunately, Professor agreed to join (though he himself is a cigar smoker) and we took a flight from Mumbai to Delhi the very next day. As we were getting out of the airport, we bumped into Y C Deveshwar (YC), Chairman of ITC.

YCDeveshwar

(Y C Deveshwar, Chairman of ITC)

“Where you heading YC?” I asked.

YC spoke in a hush hush voice” London. I better rush. It seems the Union Health Minister has appointed some high level Consultant to advise him on how to ban smoking in India. If this really happens, then the business of ITC will be severely hit. Will have to make alternate arrangements as I am answerable to my British investors. Just the announcement of proposed COTPA led to a fall in ITC’s share price by 7% at Bombay Stock Exchange so if the new bill actually works, then we will lose even more”

I couldn’t disagree. Good that YC did not know that the high level Consultant was standing right next to me, i.e. the Professor.

“Good Bye Dr Modak. Incidentally I am going by the same flight as taken by my friend Dr Vijay Mallya – i.e. Jet Airways departing at 12 10 pm to London. This will perhaps give some “fuel for the News hour” to our dear friend Arnab Goswami of Times Now. He will wonder why this particular flight gets chosen for any escape”

Vijay_Mallya

(Dr Vijay Mallya)

“You are right YC – but there is nothing common between you and Dr Mallya. You are a very respectable person – except that both of you are devils in disguise – one sells cigarettes with the mask of “Sustainability” (ITC has bagged several sustainability awards) and the other one sells “liquor” like a “King” and “fishes” around with the Banks.

But YC did not have any appetite to listen to my observations. He swiftly left and mingled in the crowd.

While we were driving to JP’s office, I briefed the Professor on the laws and regulations related to smoking in India and fed him with some interesting statistics.


There are approximately 120 million smokers in India. According to the World Health Organization (WHO), India is home to 12% of the world’s smokers. Approximately 900,000 people die every year in India due to smoking as of 2009. This figure could well be now close to 1500,000 or 1.5 million.

Anti-smoking advertisements are now screened at the beginning of the movie and during the interval. In addition, a disclaimer must be displayed on-screen during each scene where smoking is present. This requirement is well taken by the Bollywood and the Theater Owners.

According to the latest data on cigarette consumption given by the health ministry in Parliament, the consumption in 2014-15 was 93.2 billion sticks — 10 billion less than in 2012-13. But the production of cigarettes too fell from 117 billion to 105.3 billion sticks in the same period.

A nationwide smoke-free law pertaining to public places came into effect from 2 October 2008. Places where smoking is restricted include auditoriums, movie theaters, hospitals, public transport (aircraft, buses, trains, metros, monorails, taxis, autos) 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. Professor said that this was terrible as it would lead to secondary or passive smoking. The proposed amendment by Naddi addressed this concern.

Smoking was permitted in airports, restaurants, bars, pubs, discothèques and some other enclosed workplaces if they provide designated separate smoking areas. Professor said that these areas look like “gas chambers” of Nazis except here people volunteered to get in and were not there on the gun-point. The amendment to COTPA asked for a ban of such areas.

Anybody violating this law is charged with a fine of ₹200. The sale of tobacco products within 100 yards of educational institutions is banned – something difficult to enforce. The Cable Television Network (Regulation) Amendment Bill, in force since 8 September 2000, completely prohibited cigarette and alcohol advertisements. The proposed amendment is asking for increase in the fine from Rs 200 to Rs 1000.  

Today more than 60 per cent of the total tobacco crop produce is used for making cigarettes. Rest is exported and used to make the bidis. India earns around Rs 300,000 million as excise duty on cigarettes. We will in fact earn more money as the Finance Minister in the new budget as increased the excise duty by 15%. The per capita consumption of cigarette in India is 96 per annum which is one of the lowest in the world. Some smokers said that we have a lot of scope to improve! 

There is a significant export of unprocessed Tobacco from India. The Government collects good revenue out of this export. More than 6 million people in India are employed in farming Tobacco. 


When we reached JP’s office, after some preliminaries, JP asked the Professor to give his reactions and suggestions on the proposed amendments.

On the ban and enforcement, Professor told JP that the “Statistics from Global Adult Tobacco Survey (GATS) indicates that 60% of the smokers are not affected by the ban on consumption of cigarettes in public places. So no matter how pervasive are the bans on smoking since the turn of the century, global cigarette volume sales have increased by about 8%. This trend will continue”

JP was rather disappointed with this “opening” remark.

He retorted “Professor, are you not aware that Tobacco alone is the leading cause of 90% of the diseases affecting the mouth, 80% of the chronic obstructive pulmonary disease, 60% of heart diseases, 50% of cancers and 20% of all deaths. According to the Tata Memorial Centre in Mumbai, tobacco use is linked to 85% of head and neck squamous cell cancer cases”

I supported JP further saying that “There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer. There is no safe level of exposure to second-hand tobacco smoke.”


Although a single cigarette is small in size and typically weighs less than 1 gram, a cigarette typically emits between 7 and 23 milligrams (mg) of PM2.5 when it is smoked, depending on the manner of smoking and the brand (see References 1 and 2 on the reference citation list). When people congregate in an airport baggage area or enter a smoking lounge where many brands are smoked, the average amount of PM2.5 mass emitted per cigarette is about 14 mg. Although 14 mg may not seem like a lot of mass emitted, each cigarette weighs only about 0.9 grams total, making it an extremely potent source of air pollution for its weight.  


“Shouldn’t we then promote the Electronic or E-Cigarettes?” I asked the Professor

“On the Contrary”. The Professor said

“The E-cigarettes may be smokeless but are essentially the Trojan horses, capable of a wreaking havoc as an addictive device. E-cigarettes help to maintain the habit, not quit it. Flavoring agents used in the E-cigarettes or the Electronic Nicotine Delivery Systems (ENDS) is just another way of luring young potential clients. The nicotine contained in these cartridges is much more than the legal threshold of 30 mg. Adverse effect of nicotine on the cardiovascular system and foetal brain impairment are also well documented. Also, propylene glycol, which is the main solvent in e-cigarettes is used as an industrial poison. It will de-normalize many of the tobacco-control rules”

E-Cigarette

JP’s Secretary butted in “The State-run Food and Drug Administration has declared selling of e-cigarettes illegal in Maharashtra. But the national laws on these slender Electronic Nicotine Delivery Systems (ENDS) remain hazy. Maharashtra is the second state after Punjab to crackdown on e-cigarettes. Unfortunately, they are freely available for sale online”

“Sir, I would highly recommend you to introduce a ban on E-cigarettes in the proposed amendment of COTPA” Professor said this rather strongly and in a high pitch to JP

“Oh don’t give me another new point to battle” JP exclaimed and continued his point on the adverse impact of cigarettes on the environment. “Smoke is not the only culprit but the Cigarette butts are the worst” he said “they dot sidewalks, clog gutters, and soil our breaches. Cigarettes contain toxins that, when littered, leak into the surrounding environment. It only takes a single cigarette butt to contaminate a liter of water. Animals can also mistake littered butts for food”

Here the Professor had interesting information to share “Many cigarette filters are made of cellulose acetate, a high-grade plastic that’s also used in sunglasses. The plastic from the cigarette buts can be recovered to make plastic products. You should invite  companies like TerraCycle who have found a way to recycle these unwelcome discards. The program is known as Cigarette Waste Brigade. The program has gone global. To date in the United States alone, TerraCycle has set up over 7,000 cigarette recycling bins and more than 38 million butts having been collected. Visit https://www.terracycle.com/en-US/”

“That is truly inspiring Sir”, I said.

As usual Professor had another point of view. He said that while framing policies on banning or discouraging smoking of cigarettes, we must look at the economics and employment of theperipheral industries” that thrive on smoking. “You have to protect them too as much as Public Health” he said.

“Today, cigarette lighters represent a multi-billion dollar industry on a global basis and are growing annually at 3-4%. Region-wise, Asia Pacific represents the world’s biggest market for cigarette lighters followed by Eastern and Western Europe. But more than 80% of the world’s lighters are made in Wenzhou, a town that has built unbeatable moulding, tooling capabilities for mass producing the product. Following the message from the PM of “Make in India”, we should be boosting the production of cigarette lighters and take on China”

“What about cigarette ash tray makers? Most belong to informal sector and handicraft industry. And there are even more stakeholders like home air purifier makers, medical counselors, chest physicians, drug and chewing gum makers who are essentially thrive on the smoking business. So “a bit” of smoking of cigarettes must continue” I added another dimension.

JP was completely lost after listening to us. Both of us had quoted the  “pros” and “cons” of discouraging smoking with data and statistics. JP asked for a service of strong coffee.

While I spoke to JP on other matters and moved to his desk, the Professor continued to sit on the conference table and was busy doing some sketching. As usual, he had started smoking his pipe for the interest of his “inspiration”.

In just 10 minutes, he walked across to us and presented a complex diagram. I am pasting this diagram below.

SMOKING - Systems Dynamics

“This is the depiction of Smoking of Cigarettes in India in the style of System Dynamics. See the various linkages we talked about, complexities such as “delays” and “switches” and the “step functions”, positives and the negatives that affect smoking while considering interests of various stakeholders. The reforms we are talking will essentially drive the “system” and must be set in a judicious “combination”. We need to simulate the possibilities and scenarios upfront to come up with something realistic, doable or practical. Ad-hoc decisions will not work. If you are interested then I can code this diagram in VenSIM (a software that is used in SD applications)”

With this proposal, typically put in his trademark smokers voice, the Professor went to the loo.

JP took a close look at Professor’s “system dynamics” representation.

“I think this Professor Friend of yours has made a very interesting diagram –telling us how complex is making amendments to the existing policies. And I like his approach on the “systems thinking” but shouldn’t lead to “policy paralysis”.

“However, I just hate the guy. He had the guts to smoke his cigar in my room and put both of us under the risk of passive smoking and ironically so when we were talking about discouraging smoking. I don’t think I will hire him for this job. Wish him good luck on my behalf”

We took the evening return flight to Mumbai with no conversation between us during the flight.


Systems Dynamics (SD) is an invaluable and exciting tool to introduce and train environmental scientists, engineers, planners and economists of understanding “systems”. I did three courses on SD  during my doctoral research and thoroughly enjoyed.

Very few post graduate programs in India have SD in the curriculum.

If you are interested in knowing more about SD,   then don’t miss reading the monumental work done by Professor Jay Forester of MIT (see https://en.wikipedia.org/wiki/Jay_Wright_Forrester)

To students: Note that Professors Systems Diagram was done in a hurry. See if you can improve and send me a “proper” version at prasad.modak@emcentre.com

Professor Om Damani of IIT Bombay recommends a “tutorial” at http://jsterman.scripts.mit.edu/docs/Sterman%20Sustaining%20Sustainability%2010-2.pdf

 

Take a look


Image of E-cigarette sourced from http://shlyahoviva.blogspot.in/2013/07/cost-of-1-pack-of-cigarettes-in.html

Disclaimer – The story of the consultation meeting with the Union Health Minister and bumping into Y C Deveshwar, Chairman of ITC at the Delhi airport is not real. No offences made or implied. I hope their mention is taken in good spirit & humor. The data and statistics presented in the post are however real.

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