Tobacco and Public Health - TCSC Indonesia

treatment and premature death were assessed. A cohort of 195 cancer patients was
followed for three years from 1990. The average cost per cancer patient, discounted at
the 1999 level, amounted to Indian Rupees (INR) 350 000, with direct costs amounting to
13% of total cost. Curative intent of treatment was associated with higher expenditures.
The cost of 163 500 incident tobacco-related cancers diagnosed in 1999, thus amounted
to INR 57.225 billion (US Dollars 1.34 billion).
Cost information was collected for one year on 500 patients of CAD, 423 of COLD, and
28 patients of both CAD and COLD. The average yearly per capita costs in 1999 terms for
CAD and COLD respectively amounted to INR 29 000 and INR 23 300 (USD 679 and
USD 546), with direct costs accounting for 57% and 19% respectively. The national cost
of all CAD cases due to tobacco in 1999 was estimated at INR 129.05 billion and that of
COLD at INR 91.336 billion (USD 3.02 billion and USD 2.14 billion, respectively).
Thus during 1999, the three major diseases put together, cancers, CHD, and COLD,
cost the country INR 277.6 billion or about USD 6.5 billion (ICMR 2001). For
comparison, in 1998, total excise revenues from tobacco corresponded to INR 55.40
billion or USD 1.29 billion, and the nationwide sale value of all tobacco products was
INR 244 billion or around USD 6 billion (ICMR 2001; Reserve Bank of India 1999;
PriceWaterhouse 2000). Clearly the economic benefit of tobacco to the country is
unable to outweigh the costs accrued due to the diseases it causes.
Interventions
PRAKASH C. GUPTA AND CECILY S. RAY 261
Primary prevention
Sporadic attempts have been made by NGOs to conduct educational campaigns
through various media. Two recent ones have been conducted in Mumbai and Delhi.
In Mumbai, the Preventive Oncology Department of the Tata Memorial Centre, a cancer
diagnosis and treatment centre, organized an anti-tobacco campaign in July–August,
2002, through college students volunteering in the National Social Service Scheme.
After being informed of the harmful effects of tobacco use, the students developed
street plays on the topic. They performed these plays in schools and public places. In
Delhi, a controlled anti-tobacco intervention among adolescent students of 30 schools
was conducted to raise their awareness and involve them in activities like peer interaction
within and between schools, family discussions, a signature campaign in the community,
and an appeal to the Prime Minister. The post-test showed that students in the
intervention group were significantly less likely than controls to have been offered,
received, experimented with, or have intentions to use tobacco.
Efforts in persuading illiterate villagers to stop or reduce their tobacco use have been
attempted in rural areas. A large, controlled, educational intervention trial in tobacco
users with 10 years of annual follow-ups was conducted during 1967–88 in three areas
of India. Personal communication with visual aids after oral examination addressed factors
for decision-making on tobacco use. Messages through personal communication