Article Text

Diverse and competing interests around tobacco: qualitative analysis of two decades of parliamentary questions in India
  1. Amiti Varma,
  2. Latha Chilgod,
  3. Upendra Bhojani
  1. Cluster on Chronic Health Conditions and Public Policy, Institute of Public Health, Bengaluru, Karnataka, India
  1. Correspondence to Dr Upendra Bhojani; upendra{at}iphindia.org

Abstract

Introduction India continues to enhance tobacco control regulations protecting the public health while housing a widespread tobacco industry. This implies complexities in regulating tobacco. As part of a broader inquiry on the political economy of tobacco, we aimed to understand the concerns of Indian parliamentarians around tobacco.

Methods We sourced transcripts of tobacco-related questions asked by parliamentarians between the years 1999 and 2019 from the electronic archives of both the houses of Indian parliament. We analysed the frequency of questions during different regimens, segregated by the states and the political parties that parliamentarians belonged to, as well as by the government ministries to which these questions were posed. We also conducted thematic content analysis of these questions, identifying specific themes defining parliamentarians’ concerns.

Results 729 unique parliamentarians asked 1315 questions about tobacco, conveying varied concerns related to health, commerce, labour and agriculture sectors. Over time, the focus of the questions shifted from majorly trade to majorly health-related concerns. We show how the tobacco regulations in India are multi-institutional and are a result of negotiations of several legitimate and competing, interests. We found important state-level differences in the number and nature of these questions.

Conclusion Parliamentary questions constitute a useful resource in studying tobacco politics. Tobacco regulations are a product of complex negotiation of varied and competing concerns. We identify core arguments in favour and against tobacco control that would help tobacco control advocates and agencies to better prepare and engage with diverse political voices around tobacco.

  • health policy
  • public health
  • qualitative study
  • descriptive study

Data availability statement

Data are available in a public, open access repository. Data were publicly available data sourced from the official web pages of the upper and lower houses of the Indian Parliament, the Loksabha (https://loksabha.nic.in/) and the Rajyasabha (https://rajyasabha.nic.in/rsweb.asp)

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Key questions

What is already known?

  • Globally, India is the second largest consumer of tobacco, and among the leading producers and exporters of the tobacco leaf signifying complexities and contestations in tobacco control regulations.

  • There is limited documentation of diverse political voices around tobacco in India

What are the new findings?

  • Lack of long-term and dynamic account of parliamentary discourse around tobacco, especially in post-1990s India signifying trade liberalisation and incremental tobacco control regulations.

  • Lack of documentation on how the elected parliamentarians shaped these debates around tobacco within parliament houses, a legitimate avenue for raising peoples’ voices and seeking governmental accountability.

What do the new findings imply?

  • Usefulness of parliamentary discussions and debates as a resource to deepen our understanding of tobacco politics in India

  • Incremental tobacco control measures are possible despite continuing contestation of diverse interests in tobacco over the last two decades in India.

  • The varied engagement and the concerns around tobacco by parliamentarians representing different Indian states highlights the importance of subnational contexts in shaping tobacco policies and politics in India

Introduction

Globally, India is the second largest consumer of tobacco where 28.6% of the Indian population, 390.8 million individuals, consume tobacco in some form and the resultant health harms are a significant public health challenge.1 2 India is also the third largest producer of tobacco leaf in the world with an estimated annual production of around 800 million kgs, and thus, a major source of livelihoods and revenue.3 This dynamic of intense but competing interests make tobacco regulation a complex affair.4 5

As health researchers studying tobacco control, we wish to better understand the role of State and industry in tobacco control in India through the Deciphering an Epidemic of an Epic Proportion (DEEP) project, a multimethod research initiative. We are specifically interested in the period of economic liberalisation in India post 1990 with reforms in trade and labour policies. This period also coincides with intense reforms in tobacco control policies including the Cigarettes and Other Tobacco Products Act, 2003 (COTPA)6; ratification of the WHO Framework Convention on Tobacco Control (WHO FCTC) 20047; ban on smokeless tobacco product/s through the Food Safety and Standards (Prohibition and Restrictions on Sales Regulations) Act 20118; the introduction of the Goods and Service Tax, (GST), 20179 and ban on Electronic Nicotine Delivery Devices (ENDS) through The Prohibition of Electronic Cigarettes Ordinance, 2019 among others.10 While we do not have data to show change in tobacco consumption for our study period, estimates show that tobacco consumption reduced from 34.6% in 2009 to 28.6% in 2017, which in part could be related these tobacco policies and reforms. One of the tools we are using in the DEEP project to understand the politics of tobacco is to analyse tobacco-related parliamentary questions in India.

India is a federal democracy and a union of states, therefore, shares powers of the government at the level of the central state through a constitutional mechanism. Thus, the structure of the parliament is designed to include representatives from all states in India and provide state level contexts; it is a powerful institution with the potential to represent the voices of people and demand accountability in public policy (and by extension, public health).11 Previously, parliamentary discussions and debates have been studied in India to shed light on issues such as economic policies, gender, caste and religious minorities.12–15 In this paper, we map and analyse the questions raised by parliamentarians concerning tobacco.

Methods

Design

Our work is designed and presented in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines recommended by the EQUATOR network.16 We conducted thematic analysis of publicly available transcripts of tobacco-related questions, raised in both the houses of Indian parliament—the Lok Sabha and the Rajya Sabha—during October 1999 until February 2019, identifying elected leaders’ concerns related to tobacco, as this time period corresponded with economic liberalisation as well as the introduction of crucial tobacco policy. Both Houses of the Parliament conduct ‘Question Hour’ sessions where parliamentarians from the ruling and the opposition parties pose questions to the Ministers.17 A maximum of 250 questions can be presented any given day of the session, so these questions form a large dataset and a useful repository of information.14 Parliamentarians can ask details about government activities, highlight gaps in administration or convey public grievances concerning administration. Through the Question Hour governments learn the ground realities, clarify their positions and at times institute formal inquiries and policy reforms.18

Data collection and management

We sourced the transcripts (each containing specific questions and answers transacted in the parliament) from the web portals of both the houses, separately. We ran search commands on the respective search bars using settings that matched the search term ‘tobacco’ to ‘any word’ within the ‘full text’ of transcripts concerning questions asked within February 1999 to February 2019, corresponding to the dates of the Lok Sabha term XIII–XVI. We sourced 2130 transcripts, which we reviewed to exclude 815 transcripts where the term ‘tobacco’ appeared incidentally, often in the answer and not as a substantive part of the question, resulting in a final selection of 1315 transcripts.

These transcripts were then organised using NVivo software (NVivo V.12 plus from QSR International) classifying them based on the attributes of the questions (ie, date the question is answered; the ministry to which the question is asked) as well as the parliamentarians who asked these questions (ie, the state, the electoral constituency and the political party that the parliamentarian was associated with).

Data analysis

We used thematic analysis of the content of the questions using open coding of data with inductive reasoning. We chose not to use any specific theory/framework apriori given the exploratory nature of our inquiry to ‘understanding varying concerns about tobacco by Indian parliamentarians’. The lack of similar work in the Indian context further supported such an open approach. The data were sourced by interns pursuing public health degrees who did preliminary analysis under the guidance of the UB. The two researchers, AV and LC revisited the work, they created a continuous dataset for the study period and redid the analysis under the guidance of UB. All the authors had formal training in qualitative research while UB had over a decade of experience in tobacco control research and had a fair degree of familiarity with other sectoral (non-health) interests in tobacco. Data were coded twice by independent researchers to ensure coder reliability. AV, LC and UB periodically discussed the coding patterns and emerging categories as a team and, through an iterative, consultative process identified major themes defining the parliamentarians’ concerns about tobacco over time.

Results

During the 20-year study period (1999–2019), we found a total of 1315 tobacco related questions out of 519 454 parliamentary questions (around 0.25%) raised in both houses of the parliament over the 20 years of our study period (the full list of questions is available in online supplemental appendix 1). We found an even split among the two houses, where 664 questions were asked in the Lok Sabha and 651 questions in the Rajya Sabha. Overall, 729 unique parliamentarians asked a total of 1315 questions (out of the 729 parliamentarians, 83 individuals asked tobacco related questions across multiple sessions). We present select attributes of the questions and the parliamentarians asking these questions in table 1.

Supplemental material

Table 1

Description of tobacco-related parliamentary questions in India Parliament between 1999 and 2019

As shown in table 1, the number of tobacco-related questions reduced consistently over the two decades of our study period. Over these two decades, we found that most questions were posed to the ministries of Commerce and Industry, Agriculture, and Health and Family Welfare. Further, among these, the number of questions posed to the Ministry of Commerce and Industry (as well as a few other ministries including the Ministries of Agriculture and Finance) reduced consistently, while those to the Ministry of Health and Family Welfare increased across time.

Overall, we found diversity in the nature of questions asked about tobacco in parliament. Most parliamentarians’ questions referred to policies adopted by the parliament, either enquiring about specifics of these policies or seeking information on implementation (or lack of it) of these policies. In some instances, parliamentarians also made suggestions on the kind of policies needed for tobacco. Interestingly, and unlike our belief that there would be a greater number of tobacco-related questions during the times when tobacco policies were being adopted, we found no clear relationship between the number of questions being asked and the chronology of tobacco policies adopted by the parliament.

When analysed across states in India, we found that Andhra Pradesh, Maharashtra, Karnataka and Uttar Pradesh consistently accounted for the highest number of parliamentarians asking tobacco-related questions across the 20-year period. Questions on tobacco were asked by representatives of most states, though representation from the north eastern states (except Assam) was absent. And finally, to examine any overall linkages between the questions and the political party, we found most tobacco questions were asked by representatives of the two major political parties in India, the Indian National Congress and the Bharatiya Janta Party, across the study period. However, we believe this could be indicative of greater party presence rather than party-specific interests in tobacco. We now describe the major themes that defined the concerns of parliamentarians around tobacco (refer box 1).

Box 1

Themes defining Indian parliamentarians’ concerns about tobacco (1999–2019)

Health concerns

  • Consumption patterns.

  • Health harms of tobacco.

  • Promoting tobacco cessation.

  • Role and influence of media and communication.

  • Understanding and monitoring tobacco control regulations.

  • Conflict between health goals and industry goals.

Trade concerns

  • Role and functioning of tobacco board.

  • Trends in tobacco markets (production and exports).

  • Tobacco taxation.

  • Policy enquiries and implementation.

Agriculture concerns

  • Support available or required by farmers.

Livelihood/welfare of tobacco growers and workers

  • Concerns on working conditions.

  • Negative impact of tobacco control measures.

  • Alternative livelihoods.

Health concerns

Health-related concerns accounted for the majority of questions asked over time. Concerns increased consistently over time, both in terms of the absolute number as well as relative to concerns around tobacco trade. Health concerns dominated the concerns expressed by parliamentarians in the second decade. Mostly, these were questions posed to the Ministry of Health and Family Welfare and the Ministry of Information and Broadcasting.

In the early 2000s, these questions were mostly clarifying queries which then shifted over time to queries on the procedural aspects of relevant health policies. The most prominent queries in health were the ones on tobacco consumption patterns, the addictive and harmful nature of tobacco, and the details of tobacco control measures and their implementation. The questions on the need for and the details of tobacco cessation services were fewer. These health-related concerns were voiced by parliamentarians across most (participating) Indian states.

Consumption patterns

Parliamentarians often sought information on tobacco consumption as a precursor to more specific policy-related questions. These queries ranged from trends in tobacco use over time; use of specific tobacco products (eg, cigarettes, beedi or smokeless tobacco); use among specific populations (eg, women or youth) and comparison across groups (eg, rural vs urban). These queries increased in number in the second decade of our study period.

whether there is a rise in the number of people, particularly women and children, addicted to cigarettes and other tobacco products despite the anti- tobacco measures and campaigns; (Unstarred question 2230. Loksabha, 2012).19

Addictive and hazardous nature of tobacco

Parliamentarians asked about the nature and extent of health harms from tobacco consumption.

…(d) whether certain studies have also estimated that India accounts for one-fifth of tobacco attributable diseases and is likely to face an exponential increase in tobacco related mortality from 1.4 per cent in 1990 to 13.3 per cent in 2020; (Unstarred question 4869. Loksabha, 2011).20

Many questions were about tobacco’s potential to cause cancer, its relation to tuberculosis and other health conditions such as blindness, deformities or low birth weight of a fetus when a pregnant woman is exposed to tobacco. Questions also compared harms caused by specific tobacco products.

Tobacco cessation services

Parliamentarians expressed concern about the need for the governments to help tobacco users quit tobacco, though these questions were few in comparison. They asked about the existence, functioning and funds allocated to tobacco cessation centres, as well as the effectiveness of various treatment methods:

(a)whether the World Health Organisation (WHO) has recommended Nicotine Replacement Therapy (NRT) as an effective measure for smoking cessation; (c)the benefits of NRT along with the steps taken/proposed to introduce and popularize such therapy in the country; (Starred question, 267. Loksabha 2011).21

Role and influence of media and communication

Parliamentarians were concerned about the promotion of tobacco in the media and the impact of smoking scenes in films on viewers. They often enquired about the regulations restricting tobacco advertising and smoking on screen, as well as the implementation (and violations) of these regulations, including the extent of surrogate or misleading advertisements promoting tobacco. An example is listed below:

(a) whether indirect advertisement is used by smokeless tobacco products/ chewing tobacco product manufacturers to circumvent increasingly restrictive tobacco control law; (b) if so, the details thereof; and (c) the details of such erring companies along. (Unstarred question, 1925. Loksabha 2017).22

Understanding and monitoring tobacco control regulations

This theme accommodated the greatest number of health-related questions. There were queries seeking information on prevailing tobacco control measures: about the National Tobacco Control Programme, India’s participation in WHO FCTC, and funds allocated for tobacco control activities, among others.

…(d) the steps taken by the Government to curb the availability of cigarettes at stores, indicating easy availability? (Unstarred Question, 214. Rajyasabha 2019).23

Many parliamentarians asked about the implementation of these tobacco control measures. They expressed concerns about violations of these policies including issues of smuggling of tobacco products, non-compliance to pack warnings and exceeding the permissible ingredient levels.

…(c) whether illegal marketing and sale of gutkha, tobacco, pan masala and similar articles at higher prices have been reported in the above States following the ban; (d) if so, the details thereof along with the action taken/proposed by the Government against the offenders; (Unstarred question, 4527. Loksabha 2012).24

Finally, there were also new measures and ideas proposed by some parliamentarians to curb tobacco use, though these were relatively less frequent.

…(d) whether the Government proposes to counteract the promotions of tobacco products through a comprehensive legislation including counter-advertising in order to appropriately inform the consumers; (Unstarred question 4220. Loksabha 2013).25

Conflict between health goals and industry goals

A few questions explicitly addressed the incompatibility between governments’ efforts at tobacco control and government actions that might promote the tobacco industry. These were questions asked to the Ministries of Health, Finance and Commerce and Industry. An example below discusses a government-owned life insurance company’s investment in cigarette companies:

…(a) whether it is a fact that the Government owned company the Life Insurance Corporation of India (LIC) has invested in cigarette companies; (b) if so, the details thereof; (c) whether Government considers any investment made by a Government company in any cigarette company illegal; and (d) if so, the action to be taken against LIC? (Unstarred question 2208. Rajyasabha 2011).26

Trade concerns

Trade-related queries around tobacco, in contrast to the health queries, decreased consistently over the study period. During the first decade, trade-related queries topped the list of questions, with over half the total questions asked, but gradually became less frequent in the second decade, where trade-related queries were less than a quarter of the total questions asked. This seemed to reflect the shift in the focus, although not a radical shift, away from commercial aspects of tobacco and towards health within the parliamentary sessions. The queries around trade were directed mainly to the Ministries of Commerce and Industry, and the Ministry of Finance.

Role and functioning of the tobacco board

Throughout the study period, parliamentarians asked several questions concerning the role and functioning of the Tobacco Board, a government body under the Ministry of Commerce and Industry mandated to promote Flue-cured Virginia (FCV) tobacco, a specific variety of tobacco used in cigarette production. The questions sought to understand and ascertain the role played by the Tobacco Board in promoting tobacco growth and trade. These included registration of FCV growers, setting up of auction platforms, obtaining better prices for tobacco crops, the quality, quantity and storage of tobacco produced, changes in the weighing system for tobacco, penalties for producing excess, and the necessity of tobacco barns for curing FCV tobacco.

…(a) whether the Government / Tobacco Board have studied the problems of the tobacco industry; (b) if so, the outcome thereof and the steps proposed to remove the said problems; (Unstarred question 3970. Loksabha, 2002).27

…(a) the number of tobacco growers from each State registered with the Tobacco Board; (b) whether large quantity of tobacco is being grown by the farmers who have not registered themselves with the Tobacco Board; (d) if so, the estimated quantity of tobacco being grown in the different States by these unregistered farmers? (Unstarred question: 5302, Loksabha 2000).28

Some of the parliamentarians were more direct in expressing their concerns and at times doubts about the effective functioning of the board:

(a) Whether the Government is aware that the Tobacco Board must increase the number of tobacco barns (required for curing tobacco) for the Virginia tobacco sector; (c) what are the reasons for the step-motherly treatment of the Virginia tobacco economy; (d) what steps will be taken to make Virginia tobacco exports competitive. (Unstarred question: 2335, Rajyasabha 2011).29

Trends in tobacco markets

Parliamentarians sought information on various aspects of tobacco markets including tobacco production, growth, competition, exports, demand and quality. These factual queries about tobacco markets dominated the questions to the Ministry of Commerce and Industry.

…(a) the share of India’s tobacco export in the international market during the last 3 years, year-wise; (Unstarred question 638, Rajyasabha 2008).30

…(a)whether the domestic demand of cigarettes and other tobacco products has increased during the last 2 years; (Unstarred question 3360, Loksabha, 2013).31

Tobacco taxation

Parliamentarians asked questions on the specifics of excise duty and tax reforms such as Value Added Tax (VAT) and GST introduced in the parliament during the study period and their impact to tobacco:

…(a) Whether tobacco farmers have demanded reduction in central excise duty on cigarettes and waiver of interest on bank loans and their reschedulement; (Unstarred question 553. Rajyasabha 2002).32

Parliamentarians also raised concerns about malpractices in the collection of tobacco taxes as well as tax evasion by tobacco companies.

Policy enquiries and implementation

These were general queries on implementation of tobacco regulations. Though not a widespread concern, a few of the parliamentarians were keen to understand implications of the Free Trade Agreements between the countries and the Foreign Direct Investments in tobacco sector:

…whether the Government has decided to allow Foreign Direct Investment (FDI) in Tobacco processing and cigarette manufacturing sectors in near future; (Unstarred question 4459, Loksabha 2007).33

Additionally, parliamentarians also expressed concern about stringent tobacco control measures that were counterproductive and resulted in violation of certain policies leading to illegal trade in tobacco and the potential loss of revenues therein:

…whether Government is aware that due to illegal trade of tobacco products, Government is losing revenue worth several crore per year; (Unstarred question 176, Rajyasabha 2010).34

Agriculture concerns

Questions specific to agriculture raised by the parliamentarians were negligible when compared with the number of questions under the trade and health themes, constituting to not more than 5% of the total number of questions. A majority of these questions were asked during the first 5 years of the study period. Agriculture-related questions were almost exclusively raised by parliamentarians representing the major tobacco-growing states (Andhra Pradesh, Karnataka and Maharashtra) in India.

…(a) Whether the tobacco growers in the country, particularly in Karnataka and Andhra Pradesh, are facing acute problems on various fronts; (b) if so, the details thereof; (Starred question 166, Loksabha 2003).35

The questions also included details about the government support provided to the farmers in terms of Minimum Support Price for tobacco, Price Stabilisation Fund, and alternatives to tobacco farming.

…(d) whether minimum support prices fixed by the Government for different varieties of tobacco are much less than the cost of production of tobacco for which Tobacco Board has been taking resort to minimum guarantee prices; (Unstarred question 880, Loksabha, 2002).36

Questions regarding the role of the Central Tobacco Research Institute in assisting farmers also stood out.

…(a) the number of farmers trained by Central Tobacco Research Institute during the last year; (b) whether CTRI has given any importance to training of farmers of Andhra Pradesh;(c) whether it is a fact that the CTRI has not given sufficient importance to extending the full benefits or research in tobacco to middle level tobacco farmers in Andhra Pradesh; (d) the steps proposed by Government to assist farmers through the CRTI in 2006–07; and (e) the reasons for low emphasis on this matter?; (Unstarred question 3641, Rajyasabha, 2006.37

Livelihood or welfare of tobacco growers and workers

A few of the Parliamentarians expressed concern about the livelihoods and welfare of tobacco growers and workers throughout the study period. These questions were addressed to multiple ministries, including the Ministries of Labour, Agriculture, Health and Family Welfare, and Commerce and Industries. The questions addressed the occupational harms and health hazards due to work with tobacco or security of livelihoods in view of strict tobacco regulations.

Concerns on working conditions

These were mostly querying the health harms and occupational hazards of tobacco growers and workers (beedi workers and children). Some questions specifically addressed issues of compliance to labour laws, especially concerns around child labour in the beedi industry, and concerns around debt and finances of beedi workers.

…(a) the details of medical facilities as provided by Government to beedi workers in the country; (b) whether any effort had been made by Government to extend medical facilities to beedi workers who in large numbers work in their residences outside the beedi factories; …; (e) whether any special package of medical facilities is provided to beedi workers in the country, in view of their work being involved with tobacco which is very injurious to their health causing several lung problems; (Unstarred question 3783 Rajyasabha 2005).38

Negative impact of tobacco control

Parliamentarians also asked about the impact of the tobacco control regulations on tobacco growers and on the tobacco industry.

…(d) whether is it a fact that several beedi manufacturing companies have closed down their units in the country particularly in Andhra Pradesh in protest against the above order and as a result several beedi workers have been rendered jobless? (Unstarred question 1889 Rajyasabha, 2006).39

A few questions also explicitly addressed the view that the Government did not sufficiently consider the tobacco industrial sector while creating regulations focused on health.

…(a) whether Government is aware that harsh and extreme health legislation had a deep and negative impact on employment in the beedi sector and marginal farm workers in the unorganized sector; (b) whether Government has taken any steps to counter this targeted negative impact on the millions of beedi workers; (d) the reasons for the muted reaction by Government to protect the large tobacco sector? (Unstarred question 1467.40

Alternative Livelihoods

Certain questions also raised propositions for alternative livelihoods, a recurring concern asked to various ministries across our study period.

…(a) whether Tobacco Board has done any study of the impact of anti-tobacco legislation on the farmers; (b) if so, the details of this study; (c) what are the salient findings; (d) in what way does Government propose to protect tobacco farmers from a host of anti-tobacco laws and harassment; and (e) the steps proposed to evolve a proactive policy in this regard? (Unstarred question. 1635 Rajyasabha, 2007).41

…(c) whether the Government provides or proposes to provide alternative livelihood opportunities to the people who are completely dependent on tobacco/tobacco products; (Starred question no. 486, Loksabha 2018).42

Discussion

We analysed tobacco-related questions raised in both houses of the Indian parliament between the years 1999–2019 to understand the varied concerns of parliamentarians around tobacco. We found the parliamentary questions a useful resource in understanding concerns and debates around tobacco-related policy. While the parliamentary questions have been used in policy analysis13 15 in India, they have not been routinely used in health policy research. Their availability in the public domain in a searchable electronic format makes the parliamentary questions a particularly accessible resource, though we believe the search engine could be better optimised. Additionally, the answers to the questions in parliament often yield information about certain programmes and policies that may not be available elsewhere in the public domain. The strengths of this study lie in our unique method and the significant time period of two decades covered in the study.

However, there are a few limitations in our study. While in a representative democracy, the parliament remains a key institution for elected representatives to bring in voices of people they represent in policy debates, we are mindful that this representation itself is a political process. The presence of organised and powerful groups, industry lobbying and parliamentarians’ own interest, experiences and rootedness among others, shapes whose voices and which voices get represented in parliament. Furthermore, the parliamentary questions in a large and diverse country such as India, would, at best, provide a glimpse into a complex phenomenon of decoding interests around a specific public policy. We hope to analyse these questions further to better understand these parliamentarians, and the actors they represent, as part of the DEEP project. A minor limitation was that we used a single search term, ‘tobacco’, in sourcing the questions/transcripts, without including the names of myriad tobacco products consumed in India. However, a clarificatory search through the questions archive using synonyms of tobacco confirmed that this did not impact our results significantly.

We found that parliamentarians’ questions related to tobacco emerged from competing, but seemingly legitimate, interests around issues of health, commerce, labour and agriculture. Our findings, of the heterogeneity in the nature of the questions as well as the ministries addressed, highlight the complex nature of tobacco as a product. Tobacco serves as a significant source of income within a profitable industry, but the addictive nature of the substance leading to health harms, positions it in a unique intersection of multiple, competing interests. The findings here are consistent with other studies, highlighting the complexities within tobacco control43 as well as the competing interests between tobacco promotion and tobacco control both in India4 and at a global level.44 45 However, similar research on policymakers in Turkey highlighted the politicians as crucial players in shaping the narrative and comprehensive policies around tobacco control.46 While the health-related and trade-related concerns defined most of the tobacco-questions asked by parliamentarians, the questions to the agricultural and the labour ministries, though smaller in number, did raise strong concerns on the negative impact of tobacco control regulations on livelihoods of tobacco farmers and workers.

Yet, within these complexities, we found that over time there was a comparative shift: the number of questions related to trade and commerce reduced while the questions related to health increased. We believe this shift in priority reflects the growing awareness on tobacco harms as well as the introduction of several tobacco control reforms during the study period, especially in the later decade. These included enactment of COTPA (a national tobacco control legislation), ratification of the WHO FCTC by India, prohibition of one or more forms of chewing tobacco by several Indian states, imposition of VAT on tobacco in states and later its inclusion in the GST, and the prohibition of the ENDS (e-cigarettes) among others. This is stark in comparison to before 1999, when the health-related reforms at reducing tobacco use were few and far apart.5 Beyond questions directly related to the specific policy interventions, we also encountered questions about health harms associated with tobacco often making references to national and academic reports as well as anti-tobacco campaigns, suggesting the reach of efforts from the tobacco control movement.

Across India, our analysis showed some states consistently had a greater number of parliamentarians asking tobacco-related questions, highlighted in figure 1, a map created by the authors for this study. Interestingly, these states were not the states with the highest parliamentary representation. A possible explanation is that more parliamentarians representing tobacco-producing states were asking tobacco-related questions, where the five states with the highest number of parliamentarians asking tobacco-related questions were also the five states with the highest tobacco production in India.47 Andhra Pradesh and Karnataka are the major producers of FCV tobacco in India FCV tobacco is used in making cigarettes and is a major part of the tobacco exported from India in the international market and there are dedicated statutory agencies (eg, Tobacco Board) that regulate the FCV tobacco and promote its trade. Thus, several policy related questions came from parliamentarians representing these states. The only exception to this logic is Gujarat, the second largest producer of tobacco,48 with a possible explanation being Gujarat produces beedi tobacco and not FCV tobacco. A similar pattern is seen with Bihar. However, it is beyond the scope of this study to authoritatively comment on the exact role and influence of the industry on parliamentarians. While parliamentarians are expected to voice concerns pertaining to their own constituencies, studies have shown that the tobacco industry lobbies parliamentarians and parliamentarians sometimes have direct commercial interests in tobacco.49

Figure 1

Select measures indicating tobacco industry presence in Indian states. Map created by authors for this study. Data sources: Tobacco in India, Euromonitor 2018; Agriculture Statistics at a Glance 2019, Directorate of Economics & Statistics; National Sample Survey, 2005–2006.

Unlike tobacco production, tobacco consumption and cessation patterns did not seem to have an equally strong association. There were almost no tobacco-related questions from parliamentarians representing the north eastern states, despite these states being among the highest tobacco consuming states in India as well as Assam being home to the regional quitline centre for the North-Eastern States. There could be multiple reasons for this, including a low participation in parliamentary questions in general by North-Eastern state representatives.50 And finally, we found that major concerns regarding livelihoods and welfare of beedi workers were raised by parliamentarians representing states with a large number of beedi workers. What is evident is that each state has a unique set of concerns and priorities and this makes a case for further studies on the political economy of tobacco at the state level in India.

Conclusion

The parliamentary questions could be a valuable resource in studying public policy including tobacco control. In our analysis, we found heterogeneity in the nature of tobacco-related concerns by parliamentarians as well as the government ministries to which they were expressed. We highlight how regulatory measures around tobacco in India are multi-institutional and are negotiated around legitimate, competing interests related to health, trade, economy, agriculture and labour welfare. The engagement and the nature of concerns varied widely among parliamentarians representing different Indian states, highlighting the importance of sub-national contexts in shaping tobacco policies and politics in India. We have summarised the key arguments, both in favour of and against tobacco control reforms, and the nature in which they are articulated by parliamentarians. We believe this work would be particularly useful to tobacco control advocates and agencies to better prepare and engage with diverse political voices when tobacco control reforms are planned, executed or implemented, enhancing political support across sectors and constituencies for tobacco control.

Data availability statement

Data are available in a public, open access repository. Data were publicly available data sourced from the official web pages of the upper and lower houses of the Indian Parliament, the Loksabha (https://loksabha.nic.in/) and the Rajyasabha (https://rajyasabha.nic.in/rsweb.asp)

Ethics statements

Ethics approval

The Institutional Ethics Committee at the Institute of Public Health (Bengaluru) reviewed the broader research proposal that included the research thread reported in this paper. The research was exempted from a full review by the committee as the research design and analysis was approved as well as the use of publicly available secondary data sources (IPH/18–19/E/260).

Acknowledgments

We are grateful to Nesa Aurlene, Gururaj Ajagol, Abirami Kaliyaperumal, Syeda Narmeen, Krishna Subedi & Chaitra Srinivas who worked as interns at the Institute of Public Health and offered their support in sourcing parts of the data and in the early stages of analysis. We also extend our gratitude to Dr. Pragati Hebbar and Adhip Amin who provided crucial inputs at various stages of the project.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • AV and LC are joint first authors.

  • Handling editor Seye Abimbola

  • Contributors UB conceived the study design and mentored the six interns who helped in early stages of the data extraction and analysis. AV along with UB initiated a revised conceptualisation of the project. AV and LC worked on data management and LC anchored a majority of data review and management. AV and LC did data analysis with inputs from UB. AV anchored writing the manuscript. AV and LC developed a first draft of the manuscript which was substantially edited by UB. All the authors approved the final version of the manuscript submitted to the journal.

  • Funding This work was funded through the DBT/Wellcome Trust India Alliance fellowship awarded to Upendra Bhojani (IA/CPHI/17/1/503346).

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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