A ban on tobacco in Indian cinemas and TV serials comes into effect on August 1, 2005. It has kindled a nationwide debate on freedom of creative expression and the hazards of tobacco. The Union Health Minister Dr. Ambumani Ramadoss needs our salutations for taking such a bold decision. This ban may not have a great impact on smoking per se, but it has a more potent subtle impact. Smoking in the movies fosters a culture that encourages young people to smoke, and also legitimizes unhealthy behaviour. The act of smoking on screen has no impact whatsoever on the success of a movie, moreover. A good actor/director does not need smoking to depict a macho hero, cruel villain or a liberated girl.

Dr. Ramadoss has also triggerred something more: a public debate on an important health issue. This kind of discussion is itself beneficial to society, and a welcome step. Let's look at the contours of the debate.

Smoking in the movies

India has the world's biggest cinema industry, producing nearly one thousand films in more than eight languages every year. Bollywood, the Hindi cinema industry, has an estimated 15 million viewers visiting cinema halls every day. India now has several hundred TV channels and the number is evergrowing. WHO youth researchers reviewed more than 440 Bollywood films between 1991 to 2002 and found that tobacco portrayal was prevalent in nearly 3 out of four movies. In earlier films only the villains smoked, but increasingly most Bollywood films also showed heroes smoking. The superstar Shahrukh Khan has been shown to smoke on screen 109 times in the last 12 years, and the legendary south Indian actor Rajnikant has smoked 103 times! Portrayal of smoking as 'cool' or 'normal' is wide-spread.

Most people who criticize the above move are ignorant of several studies that have reported a correlation between smoking on screen and public smoking. A famous study reported that adolescents who watched extensive smoking in movies were nearly three times more likely to try smoking than their peers who had seen movies with less smoking. There are several other reports that have shown similar results of impact of smoking by role models on vulnerable minds of adolescents. In short, children imitate the behavior of cinema superstars, especially those they admire. I invite all those who oppose the government's recent move to come to Tata Memorial Hospital and spend a day with us; I am confident they will change their minds.

Some actions on screen are also in violation of the laws. When a cinema star smokes on a set with others present, he subjects other members of the film-unit to passive smoking - a clear violation of the law which bans smoking in public places. If a star is shown smoking in a restaurant, bar, airport or an office, he is again acting above the law!

Tobacco and public health

India loses 8 lakh citizens every year to tobacco related diseases. This shocking figure does not include several million Indians who are crippled or disabled by this habit. Nearly fifty percent of the cancers in Indian males are due to tobacco use, and 25% of cancers in females are again due to tobacco. India has one of the highest incidence of oral cancer in the world, chiefly caused by tobacco. Increasingly, children and young adults are taking up the habit. Crackdowns against tobacco use in developed countries is driving companies manufacturing and selling cigarettes and other tobacco products to look for markets in less regulated third world nations.

Some actions on screen are also in violation of the laws. If a star is shown smoking in a restaurant, bar, airport or an office, he is again acting above the law.
 •  Blowing back the smoke
The Salaam Bombay foundation survey reported that every second, 2 children in India try tobacco for the first time. We will be shocked to know that 4 million children below the age of 15 years regularly use tobacco. Nearly half of the children surveyed in Mumbai and elsewhere in Maharashtra between 13-15 years of age think smoking is cool. Shockingly, early signs of mouth cancers have been reported in patients less than 18 years of age. Although there are laws prohibiting the marketing of tobacco products to minors, enforcement of these laws needs to be improved, especially to protect impressionable minds.

Nor is smoking on screen simply an incidental thing that merely happens; often the act is a deliberate placement of advertisement on behalf of a company. It is well established that smoking on screen is a form of surrogate advertising. With a complete ban on tobacco product advertising, companies are using this medium to promote their products.

There are many more steps that Dr Ramadoss should take, with same courage, to save our youngsters from dying or falling ill prematurely. The entire medical fraternity would plead an early solution to this problem. The few laws that are on the books are not adequately enforced, and simply raising the level of enforcement on these can help dramatically. A public culture of antipathy to smoking also needs to be actively developed. The Health Minister's biggest contribution by this action may be that he is providing impetus for the development of such a public culture.