BMJ  2004;328:1498-1499 (19 June), doi:10.1136/bmj.328.7454.1498-b

Letter

Patterns and distribution of tobacco consumption in India

Impact of religion was not considered

EDITOR—Subramanian et al have confirmed in their study what we in the field have suspected for a long time¹: tobacco consumption in the South Asian communities based in the United Kingdom reflects what is happening in their countries of origin.²

Smoking and tobacco chewing is still a matter of health inequalities, and the strategy adopted by the UK Department of Health in tackling health inequalities has raised the profile of smoking cessation in addressing these health inequalities in the South Asian communities.³ South Asian communities have the highest smoking rates.⁴

However, what Subramanian et al have not looked at closely is the issue around religion and tobacco use. In 2001 the UK census was the first one of its kind to ask about religion. We now find that Sikh Punjabis who had been included within the Indian category have the lowest tobacco consumption rates both in the United Kingdom and in India on account of a decree set on 13 April 1699 (Baisakhi) in the Sikh Commonwealth of North India, which banned tobacco use through a baptism ceremony called the Amrit ceremony.⁵ On 13 April 2004 some one million Sikhs refreshed their vows not to smoke in this year's Baisakhi baptism. The Sikh leaders have taken a strong position against tobacco and have banned its sale around the Golden Temple in Amritsar.

If the World Health Organization's framework convention on tobacco control treaty and its application is handed to the many Indian religious groups, then, like the Amrit ceremony in Punjab, they could tackle tobacco sale and consumption far quicker than the state. As the World Bank reported in 1999, many states are still hooked on tobacco taxes to balance budgets and dare not put bans into place.

Quit, 211 Old Street, London EC1V 9NR k.sehmi{at}quit.org.uk

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Competing interests: None declared.

References

1. Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ 2004;328: 801-6. (3 April.)[Abstract/Free Full Text]
2. Samarasinghe D, Goonaratna C. BMJ Tobacco related harm in South Asia. 2004;328: 780 (3 April.)[Free Full Text]
3. Department of Health. Tackling health inequalities: a programme for action. London: Stationery Office, 2003.
4. Department of Health. Health survey of England—the health of minority ethnic groups. London: Stationery Office, 1999.
5. McAuliffe MA. Sikh religion: its gurus, sacred writings, and authors. London: Oxford University Press, 1909.

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