How India enacted groundbreaking rules to blunt the effects of onscreen smoking

In 2012 India implemented groundbreaking rules to blunt the effect of onscreen smoking and other tobacco use. Any film with smoking has to have a warning and advertisement about the dangers of tobacco use produced by the Ministry of Health and Family Welfare before the film or video at at the intermission. (Most Bollywood films have intermissions.) In addition, there has to be a static warning displayed on screen during any tobacco use (see figure above).

Amit Yadav and I just published Tobacco imagery in entertainment media: evolution of tobacco-free movies and television programmes rules in India that details the 7 year battle to secure these rules. Thanks to strong support of the Minister of Health, supported by NGOs, the WHO and members of Parliament, the health forces were able to overcome strenuous opposition from Bollywood and the Ministry of Information and Broadcast.

Even through the Central Board of Film Certification (part of the Ministry of Information and Broadcasting) has not fully implemented the rules, they seem to have contributed to a substantial drop in the appearance of onscreen smoking.

This is a good model for many other countries seeking to implement Article 13 (advertising and promotion) of the WHO Framework Convention on Tobacco Control as they apply to the use of entertainment media to promote tobacco.

Here is the abstract from the paper:

Introduction: Tobacco imagery in films and television increased in India after it ended conventional tobacco advertising in 2004. The Ministry of Health and Family Welfare (MoHFW) introduced rules to eliminate this tobacco imagery in 2005 which took effect in amended form in 2012. This study presents the enablers and barriers in development and implementation of the regulations to curb tobacco imagery in films and television in India.

Method: We reviewed legislation, evolving regulations, parliamentary questions, judicial decisions, Bollywood trade publications and relevant news articles from 2003 to 2019 and interviewed key informants.

Results: Based on the WHO reports and civil society demands, the MoHFW issued a complete ban on tobacco imagery in movies and television programmes in 2005. The Ministry of Information and Broadcasting (MoIB) joined the film industry in opposing the rules. A filmmaker challenged the rules in court, which ruled that they violated constitutional freedoms. On appeal by MoHFW, the Supreme Court allowed the rules to take effect. Continuing opposition by MoIB and the film industry weakened the rules and delayed implementation until 2012. As of 2020, rather than a ban, all films with tobacco imagery require strong editorial justification, 100 s of antitobacco messages produced by the MoHFW, and a static health warning at the bottom of screen during tobacco imagery display. In 2015, less than 48% of movies had tobacco imagery compared with 89% in 2005.

Conclusions: Although, not a ban, MoHFW, supported by local advocates and WHO, issued regulations that resulted in a substantial drop in on-screen tobacco imagery and increased exposure to antitobacco messages. India’s experience informs WHO Framework Convention on Tobacco Control parties as they develop and implement policies to curb tobacco imagery in entertainment media.

Here is the press statement that The Union in India (where Amit now works) released:

Groundbreaking paper documents history of tobacco use promotion in Indian television and cinema—and critical legislation to combat it—over past two decades

The Union’s Dr. Amit Yadav and Professor Stan Glantz from the Centre for Tobacco Control Research and Education at the University of California San Francisco are co-authors of the important new study, “Tobacco imagery in entertainment media: evolution of tobacco-free movies and television programmes rules in India.”

Published in BMJ Global Health on 6 January (http://gh.bmj.com/cgi/content/full/bmjgh-2020-003639), this seminal paper is the product of a comprehensive nine-month qualitative research investigation involving media searches as well as review of Parliamentary discussion, litigation, and judicial observations. Yadav and Glantz documented and analyzed India’s regulations regarding tobacco depiction in film and television for the seventeen-year period between 2003 to 2020. The resulting paper tells a powerful transformation story—one in which India eventually became, in 2012, the global leader in tobacco-free entertainment content.

India grapples with one of the world’s most severe tobacco epidemics: more than 1.3 million people die each year from tobacco-related diseases; more than 635,000 children use tobacco products; and the adult tobacco use prevalence hovers over 28 per cent. At the same time, the country is home to an incredibly vibrant entertainment industry. India produces between 1500-2000 films each year, reaching over 2.2 billion moviegoers, as well as audiences well beyond the subcontinent. Bollywood is, in fact, such a powerful influencer—young people are particularly enamored with its films—that the tobacco industry relentlessly pursued prominent product placement in films for decades. A 1952 Cinematograph Act from the Ministry of Information and Broadcasting (MoIB) prohibiting undefined “glamorisation” of tobacco and smoking did little to deter these efforts for nearly fifty years.

Early in the twenty-first century, however, things began to change with active efforts to regulate tobacco use in Indian films. Introduced in 2001 by the Ministry of health and Family Welfare (MoHFW), the Cigarettes and Other Tobacco Products Act (COTPA) was signed into law in 2003. In addition to this complete ban on direct and indirect tobacco product advertising, the MoHFW also issued 2005 regulations prohibiting tobacco presentations in films and television programmes.

Outraged, the tobacco industry partnered with the MoIB to challenge the regulations, embarking on a seven-year battle to derail, delay and dilute key provisions to keep tobacco products off the silver and small screen.

Yadav and Glantz carefully document and detail this epic fight, pitting tobacco industry tactics against the valiant efforts of NGOs, public health authorities, civil society, the World Health Organization, and then Health Minister Dr Ambumani Ramadoss, who led efforts to regulate tobacco imagery in films and television.

“This study documents the complicated history of India’s movie rules,” said Dr. Prakash Gupta, Director Healis Sekhsaria Institute for Public Health, Navi Mumbai. “It also shows how Dr. Ramadoss forged critical partnerships with film industry allies who would become strong tobacco control champions.”

Indian films changed dramatically over a ten-year period, with regulations resulting in substantial decreases in on-screen tobacco imagery as well as increased exposure to anti-tobacco messages. In 2005, 89 percent of films included tobacco imagery, compared to just 48 percent in 2015.

While much work remains to be done—the study authors note that television programming and online medium compliance levels needs to be improved—this success story’s lessons can help inform other countries. The paper is also relevant to important policy discussions; this includes the FCTC’s COP8, which formed a special working group to expand guidelines to implement FCTC Article 13, which addresses tobacco advertising, promotion and sponsorship (TAPS). in entertainment media.

“This is a tremendously important piece of work,” said The Union’s Dr. Gan Quan. “Its compilation of India’s film rules—and their implementation—is enormously useful to policy makers and tobacco control advocates who are both interested in the Indian experience and eager for lessons they can apply to their own country context.” 

The citation is Yadav A, Glantz SA. Tobacco imagery in entertainment media: evolution of tobacco-free movies and television programmes rules in India. BMJ Glob Health 2021 Jan;6(1):e003639. doi: 10.1136/bmjgh-2020-003639. PMID: 33402376. It is available here for free.

In addition, we published a much more detailed history, The Development and Implementation of Tobacco-Free Movie Rules In India that was published through the University of California eScholarship initiative. (The full citation is Yadav, A., & Glantz, S. A. (2020). The Development and Implementation of Tobacco-Free Movie Rules In India. UCSF: Center for Tobacco Control Research and Education. Retrieved from https://escholarship.org/uc/item/75j1b2cg.)

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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