Television as a public health awareness tool to reduce tobacco use: Are we doing enough in India? Key words: Television, India, tobacco control, rural Authors: Dr. Vishal Rao, Dr. Pragati Hebbar, Dr. Upendra Bhojani

Tobacco continues to be a major social and health menace across the globe. It is estimated that by 2030, it would account for the death of about 10 million people per year; half of them aged between 35–69 years. But the intensity of damage from use of tobacco is much amplified in the developing nations, where more than 80% of the world’s smokers reside (Eriksen M, Mackay J & Ross H 2012 pg.16). Currently about 250 million people aged 10 years and above consume tobacco in India. According to the findings of Global Adult Tobacco Survey (GATS) 2009-10, 34.6% adults in India use tobacco in some form or another – 47.9% males and 20.3% females.2 Nonetheless, a vast majority of these habits are rampant in the low socio-economic strata. To complicate issues further, a large number of these tobacco products are locally manufactured without any form of quality control and are loosely available from local vendors. Although several laws targeting tobacco usage have been passed, much of it still needs to be strongly implemented. Majority of these laws lack robust implementation on the end user residing in semi urban or rural belt.

The present population of India is estimated to be about 1.2 billion according to the latest census data 2011, with 68.84% of the population living in about 640,867 villages and the remaining 31.16% living in more than 7,935 towns. Despite a high economic growth rate, 75% of our population still lives on less than $2 a day (purchasing power parity - PPP) as per the Human Development report 2009. This bears significant importance especially, in a country, where the government expenditure on health as a percentage of total government expenditure constitutes only 3.4% In India, it has also been noted that general government expenditure on health as a percentage of total expenditure on health constitutes just 18% and the remaining 82% is out of pocket or private expenditure (John RM 2005).

As a result, the need of the hour is to reinforce our efforts towards rural and semi-urban population and devise strategies that also target this set of population. In a country like India with its diverse linguistic and cultural backgrounds, mass media especially television can be utilized as an effective tool to break these barriers. We would now argue why utilizing

television as a mass media tool to educate and raise concern on tobacco hazards could serve as a useful public health strategy, something that remains largely underutilized in India.

Doordarshan (DD) is the public television broadcaster of India nominated by the Government of India. A webpage regarding DD reveals it is one of the largest broadcasting organizations in the world. The terrestrial signals of DD can reach 89.6% of the country's 1 billion people. DD offers programmes at the national, regional and local levels. There are about 119 million homes in India which have a television set, with a total viewership at 415 million which is amongst the highest in the world. Television is at present relatively easily accessible in the rural homes.

In 1975 there was only one television channel, which increased to about 300 by 2005 and 550 by 2010. Similarly the number of cable television subscribers has seen an almost 40% growth every year from just about 410,000 in 1992 to more than 91 million by the end of 2009 (Telecom Authority of India. Recommendations 2010). The year 2000 saw the introduction of interactive television in India with the launch of the Indian version of ‘Who wants to be a millionaire’ called ‘Kaun banega crorepati (KBC)’ hosted by Hindi film star Amitabh Bachan. KBC and several other programmes such as Indian Idol, The great Indian laughter challenge etc. brought back the masses to mass media. These and many other such programmes appealed to the masses at large and reached out to the rural population as well. The impact and reach of these programmes can be made out by the number of phone calls with KBC season 1 registering 100 million calls in 305 episodes and KBC season 2 registering 90 million calls in 55 episodes and Indian idol registering 55 million calls (Tej KB 2007).

Focusing on the rural population of India there are a few agencies that use various modalities such as print, electronic media, dramas, plays, pamphlets etc. The Directorate of Advertising and Visual Publicity (DAVP) is the nodal multimedia advertising agency for the Government of India reaching both the urban and rural populations. Its major focus is to inform and educate people about the Government’s policies and programs to motivate them to make use of the various facilities. Recently it has also started utilizing a mobile exhibition van to reach to the remotest areas of the country (DAVP annual report 2001- 2012). Similarly the Directorate of Field publicity (DFP) represents an interactive media unit of the Ministry of Information and Broadcasting in the Government of India which focuses on rural India. It

serves as a two-way communication channel between the Government and people as it provides information to the people and receives inputs from them regarding the same and communicates to the government for corrective measures. The Song and Drama Division (SDD) an arm of the Ministry of Information and Broadcasting focuses mainly on the traditional and folk media (Tej KB 2007). In the 12th Five year plan according to planning commission of India the need for integrating these various media such as DAVP, DFP and SDD has been envisioned for greater impact of Government information campaigns.

The National tobacco control cell developed 13 anti-tobacco television advertisements that targeted the entire spectrum of tobacco products used in India during the period of 20012002. During the same period, the Ministry of Health launched a health programme (Kalyani) on the regional channels of Doordarshan for half an hour a week. Each of the eight states covered makes its own programme in the local dialect revolving around a common theme. The official DD website states that Kalyani channel aired a weekly programme with World No Tobacco Day as the theme after its launch on 30th May 2002.

Another campaign undertaken in India from November 2009 to December 2009 utilized radio and television to air advertisements targeting population using smokeless tobacco products for 6 weeks. The study included samples from North, South, East as well as West of India. More than 70% of the people aware of this campaign reported of obtaining new information as well as contemplating over their current tobacco usage. It was also observed that television was able to reach out to the people of lower socio economic strata where the awareness of tobacco health hazards is less (Nandita M et al 2012)

Currently with the focus on social media and its impact one of the papers reported in 2012 demonstrates 3 case studies. The case studies show how public pressure via social media platforms like Facebook, twitter and change could be harnessed for tobacco control advocacy (Marita H, Becky F, Simon C 2012). In the Indian context television has a wider outreach even in the remote village areas where internet and social media may still not be freely accessible.

As can be witnessed by the above arguments television in India is largely underutilized to convey public health issues especially relating to tobacco control. Only around the World No tobacco Day a spurt of activities and advertisements are aired. As per the Cigarettes and

Other Tobacco Products Act 2003 direct advertising of tobacco products is prohibited. This caters to half of the issue as promotive advertisement is banned but preventive and educative advertising to convey the harms and prompt users to quit tobacco remains lacking.

How can this powerful tool be utilized to reach the masses and convey health related messages creatively? How do we prevent fatigue and loss of message impact over the time when airing public health messages? How do we make scientific public health messages more appealing and impactful to the masses? What kinds of messages are well perceived and accepted by the masses – serious, funny, or scary?

Attempts to answer these and many other such questions call for retrospective analysis as well as prospective efforts on the part of the Government as well as private media channels.

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