|Year : 2011 | Volume
| Issue : 3 | Page : 234-239
Local Governments and civil society lead breakthrough for tobacco control: Lessons from Chandigarh and Chennai
Mina Kashiwabara1, Rathinum Arul2, Hemant Goswami3, Jai P Narain4, Francisco Armada5
1 Consultant, Kobe, Japan
2 Pasumai Thaayagam Foundation, Chennai, India
3 Burning Brain Society, Chandigarh, India
4 World Health Organization, South-East Asia Regional Office, Delhi, India
5 World Health Organization, Centre for Health Development, Kobe, Japan
|Date of Web Publication||16-Nov-2011|
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Smoke-free legislation is gaining popularity; however, it must accompany effective implementation to protect people from secondhand smoke (SHS) which causes 600,000 deaths annually. Increasing numbers of smoke-free cities in the world indicate that municipalities have an important role in promoting smoke-free environments. The objectives were to describe the local initiative to promote smoke-free environments and identify the key factors that contributed to the process. Observations were based on a case study on the municipal smoke-free initiatives in Chandigarh and Chennai, India. India adopted the Cigarette and Other Tobacco Products Act in 2003, the first national tobacco control law including smoke-free provisions. In an effort to enforce the Act at the local level, a civil society organization in Chandigarh initiated activities urging the city to support the implementation of the provisions of the Act which led to the initiation of city-wide law enforcement. After the smoke-free declaration of Chandigarh in 2007, Chennai also initiated a smoke-free intervention led by civil society in 2008, following the strategies used in Chandigarh. These experiences resonate with other cases in Asian cities, such as Jakarta, Davao, and Kanagawa as well as cities in other areas of the world including Mexico City, New York City, Mecca and Medina. The cases of Chandigarh and Chennai demonstrate that civil society can make a great contribution to the enforcement of smoke-free laws in cities, and that cities can learn from their peers to protect people from SHS.
Keywords: Health policy, Local government, Second-hand tobacco smoke, Tobacco control
|How to cite this article:|
Kashiwabara M, Arul R, Goswami H, Narain JP, Armada F. Local Governments and civil society lead breakthrough for tobacco control: Lessons from Chandigarh and Chennai. Indian J Public Health 2011;55:234-9
|How to cite this URL:|
Kashiwabara M, Arul R, Goswami H, Narain JP, Armada F. Local Governments and civil society lead breakthrough for tobacco control: Lessons from Chandigarh and Chennai. Indian J Public Health [serial online] 2011 [cited 2019 Jun 20];55:234-9. Available from: http://www.ijph.in/text.asp?2011/55/3/234/89937
| Introduction|| |
Promoted by the World Health Organization (WHO), the first international health treaty focusing on tobacco control, the WHO Framework Convention on Tobacco Control (WHO FCTC), came into force in 2005. Parties to the WHO FCTC number are 174 Member States as of July 2011. Based on common agreement that exposure to secondhand tobacco smoke (SHS) has negative health impacts, Article 8 of the Convention Framework demands that parties implement effective measures to protect people from SHS in public places.  However, with only 17 countries having so far secured universal protection from SHS, progress is still limited at country level, and exposure to SHS continues to kill more than 600,000 people every year. ,
Meanwhile, smoke-free environments have been actively pursued at subnational level using different mechanisms such as local legislation for smoking bans and enforcement of national laws. Among the 100 most populous cities in the world, 13 are smoke-free owing to city or state legislation that prohibits smoking in public places.  WHO has been recognizing and encouraging the subnational tobacco control measures which may be realized before national action takes place.  The population protected from SHS would further increase if more subnational jurisdictions that are capable of implementing local smoke-free interventions take action.  Acknowledging this fact, WHO launched the Smoke Free Cities project to facilitate cities' potential for smoke-free action by documenting and collecting evidence from local initiatives to make public places free from tobacco smoke in different jurisdictions worldwide.
This paper describes the initiatives in Chandigarh and Chennai and identifies key factors that contributed the processes.
| Materials and Methods|| |
Employing a descriptive case study approach, two research teams in Chandigarh and Chennai, respectively, reviewed grey literature including government documents and media and conducted interviews with key stakeholders focusing on background, development and implementation processes, and the impact of the interventions in each city.  Based on the results, a case study comparing the experiences of Chandigarh and Chennai was developed.
Smoke-free initiatives in Chandigarh
Chandigarh, home to nearly one million people, is one of the seven union territories under the direct administration of the national government of India and has no legislative authority in terms of tobacco control. Yet the city officially declared itself smoke-free in 2007 - by initiating full enforcement of the existing national tobacco control law.
In 2003, a year before the national ratification of the WHO FCTC, India adopted the Cigarette and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, and Supply and Distribution) Act (COTPA), of which enforcement responsibility was given to subnational governments. This first comprehensive tobacco control law in India comprises provisions covering smoking in public places, tobacco sales, advertising, and packaging.  As summarized in [Table 1], the provisions on public smoking were tightened through COTPA Rules before COTPA came into force in May 2004.  Despite the enactment of its provisions, subnational engagement in enforcement was minimal and sporadic.
As elsewhere in India, Chandigarh had made no progress in enforcing COTPA 2003 in the first two years. None of the mandatory signboards indicating smoking/non-smoking areas had been erected, and the media reported on the close relationships between local government officials and the tobacco industry. , The first local action was in 2005 by a Chandigarh-based civil society organization, Burning Brain Society (BBS), with a petition that resulted in ending the relationship between the city and the tobacco industry [Figure 1]. , However, the laws remained unimplemented even in government-owned buildings and police stations. 
|Figure 1: Timeline of key events of the smoke-free interventions in Chandigarh and Chennai|
Click here to view
Meanwhile, the BBS continued its activities to promote law enforcement by organizing workshops for young people and police officers and briefing media. , The enactment of the Right to Information Act (RTI) in 2005 accelerated its tobacco control activities. The RTI allowed the public to access governmental records.  The BBS began making petitions demanding to know how each public facility was enforcing the tobacco control provisions. Between 2005 and 2007, requests to nearly 300 government offices were filed by the BBS. Immediate changes were observed among the government offices that received requests - for example, 1800 signboards were placed within a year after the requests began to be sent. , This initiative raised awareness of the existing provisions among officials and triggered a partnership between the city and civil society.
In early 2007, the BBS and a governmental unit had the first meeting where the city expressed its commitment to becoming smoke-free and implementing the national provisions. BBS was asked to prepare a road map.  Two months later, a joint meeting of all city departments and enforcement agencies was organized to discuss an enforcement plan and tasks for each unit.  In the meeting, implementation and enforcement guidelines were developed and a cross-sectoral unit comprising members from civil society, health care, media, and the city, called the Chandigarh Tobacco Control Cell, was established and given responsibility for supervising, monitoring, and implementing the provisions.  Following the meeting, the city's intention to become smoke-free by July 2007 was announced and guidelines for different stakeholders were disseminated through the media. 
Anticipating opposition from hospitality and tobacco businesses, civil society organizations collected evidence from preceding cases around the world. Possible challenges and counter-arguments identified were shared with the city and then publicized through the media to pre-empt the counter-campaign by the tobacco industry, including negotiation with city officials, litigation, and media propaganda. Civil society also organized workshops for educators and young people to further raise awareness. 
Enforcement activities were assigned to the police and the food and drug inspectors of the Department of Health as a routine task. Since the police had no experience in such activities, the BBS organized a workshop to aid understanding of the provisions as well as enforcement procedures. The police were given the authority to fine premises and individuals violating the laws, while a team of food and drug inspectors from the Department of Health conducted inspections to check compliance in food-related facilities. As a result, more than 800 requests for fines, most of which were for smoking violations, were issued between May 2007 and November 2008. In the meantime, the BBS continued its activities to strengthen enforcement and filed nearly 400 cases of violation.
A survey conducted in 2009 reported a high level of compliance with the smoke-free provisions in the city: 99% compliance from hotels, restaurants and public offices on mandatory signboards display; nearly 94% compliance on smoking in enclosed public places; and 82% compliance on smoking in open public places.  In addition, a random sample study in 2008 indicated a decline in individual tobacco consumption among 20% of smokers. 
While news of Chandigarh's smoke-free declaration and the role of civil society in its success was spreading nationwide, civil society was initiating smoke-free action in Chennai as well. A leading local non-governmental organization, Pasumai Thaayagam Foundation (Green Motherland), began developing a smoke-free policy in partnership with the Chennai City Corporation. A drafting committee comprising legal and tobacco control experts drafted a policy and finalized it as the Smoke-Free Chennai Citizen's Policy. The policy was shared with the legislators, Chennai City Corporation councilors, and political leaders and discussed in a city council meeting which led to official support from the mayor and council.
Smoke-free initiatives in Chennai
In 2008, a local initiative was launched in Chennai, the capital city of the state of Tamil Nadu and India's fifth most populous city with a population of over 4 million, aiming to make the city smoke-free by 2010. The Smoke-Free Chennai Policy has the following aims: Reduction of SHS health risks, protection of the right to clean air, support for smoking cessation, protection of the health rights of Chennai citizens and prevention of tobacco-related diseases and deaths. The policy itself was in line with the national smoke-free provisions - public places where smoking bans are applicable, penalties, and enforcement roles were reaffirmed. The local health authority became responsible for monitoring compliance, and authority to impose penalties was granted to police officers, food and drug inspectors, excise inspectors, gazette officers, teachers, lecturers, professors, bank officers, and doctors in each area of responsibility.
In November 2007, the Tamil Nadu Tobacco Control Coalition was officially launched by the then Union Health Minister as a first step in the initiative, and the mayor officially announced that Chennai would be smoke-free by 2010.  In addition, the Smoke-Free Chennai Coalition was established in each of the ten zones of the city, comprising representatives from NGOs, schools, and groups of youths, students, health workers, businesses, professionals, and consumers. In each zone, a task force works on a voluntary basis and is responsible for monitoring compliance, providing support to implement the provisions and guidance to report violations, and making referrals to smoking cessation services.
In the meantime, India adopted the Prohibition of Smoking in Public Places Rules in May 2008 as an amendment to COTPA 2003 and COTPA Rules of 2004. The 2008 Rules added workplaces as a target of smoking prohibition and further specified conditions for designated smoking areas such as location and purpose of use and for public places such as prohibition of the placement of ashtrays and matches. 
On the same day when the 2008 Rules came into force in October 2008, the Chennai Smoke-Free Initiative was launched with the support of the media. Rallies involving the Governor of Tamil Nadu, legislators and the then Union Minister of Health were held as well as information campaigns.
Upon launching the initiative, the Smoke-Free Chennai team conducted outreach activities. Over 200 legislative members and political party leaders were individually contacted and peer supporters were identified to facilitate the discussion in the state assembly. Individual consultations were held with 29 selected members of the local state assembly where they were briefed on the initiative and other smoking-related information such as the existing national provisions and health impacts. The team also briefed 150 city councilors, followed by two sensitization workshops participated in by councilors from all political parties. A series of workshops targeting different sectors was also organized in order to raise awareness, seek support, and engage them in the smoke-free initiative, which involved managers of public facilities including public offices, schools, restaurants and hotels, police officers, and health officials. Meanwhile, following the strategies used in the Chandigarh's smoke-free initiative, civil society exploited the RTI to urge government offices to enforce the provisions.
The Chennai initiative has reported positive public feedback. According to the opinion poll conducted by the city in 2009, 92% of people in Chennai expressed strong support for the smoke-free policy.  Earned media coverage on the initiative was significant. Every smoke-free event was reported by the print media, television, and radio.
Chandigarh and Chennai both demonstrated the potential of cities to leverage national laws to clear the air even in the face of umpteen constraints and challenges. The cities launched initiatives to enforce the existing national laws, using some common approaches [Table 2]. Officials in these cities were unaware of the laws and some were even in close relationships with the tobacco industry.
|Table 2: Commonalities and differences between the Chandigarh and Chennai interventions|
Click here to view
The role of civil society in engendering necessary support for enforcing tobacco control measures was very essential. By establishing a partnership with city governments, local NGOs can take leadership in developing and implementing the smoke-free activities and communicating with different stakeholders, which finally generated strong commitment from local governments. The use of the RTI, a national law not directly related to tobacco control, boosted compliance among government units - this is one example that demonstrates how civil society can take advantage of other legislation to close loopholes and urge governmental engagement.
Establishing mechanisms is an important component in sustaining enforcement. This meant making enforcement of smoke-free areas a routine activity of the police and food and drug inspectors in Chandigarh, while the task forces took responsibility for these activities in Chennai.
Harnessing of media was vital to generate support from the public and prevent and minimize counteraction by opponents. In Chennai, partnerships developed with the media helped to disseminate the knowledge on the smoke-free policy and raise public pressure on those responsible for enforcing and monitoring the smoke-free provisions. In Chandigarh, the city anticipated the opposition from the tobacco industry and countermeasures based on existing evidence were taken through media communication, which helped the city and civil society to deal with the propaganda campaign launched by the tobacco industry.
The smoke-free efforts by both cities exerted wide influence in other jurisdictions. The Chennai-Tamil Nadu initiative was indeed facilitated by the experiences of Chandigarh.  Two neighboring cities of Chandigarh, namely Panchkula and Mohali, also decided to go smoke-free.  Chennai's intensive focus on the smoke-free provisions gave it the momentum to enforce other provisions under COTPA 2003. Chennai's efforts were officially given recognition by the Union Ministry of Health and Family Welfare, which encouraged other jurisdictions to imitate the initiative.
As the first smoke-free city in India, Chandigarh's influence over neighbouring jurisdictions and the country was significant and resulted in smoke-free initiatives in other cities and states including Delhi, Mumbai, Bhubaneswar, Mizoram and Ahmadabad in addition to Chennai and Tamil Nadu. The efforts were also followed by other cities in the region, including Jakarta and Bogor in Indonesia.
Indeed, smoke-free initiatives are becoming popular in other subnational jurisdictions of Asia using strategies depending on respective political capacity. Cities with legislative bodies able to pass local legislation such as Davao, Philippines and Jakarta and Bogor, Indonesia have adopted local ordinances to prohibit smoking in public places. , Kanagawa Prefecture in Japan, where outdoor smoking restrictions have blossomed in recent years, has implemented an ordinance to restrict indoor public smoking. ,
Beyond Asia, the biggest city in the world, Mexico City, has introduced a smoke-free law with a focus on protection of workers' and non-smokers' health in 2008.  New York City, in addition to the city's existing smoking ban in indoor public places such as restaurants, has introduced outdoor smoking bans in parks and beaches.  Furthermore, Mecca and Medina, visited by millions of visitors every year due to their religious characteristics, have implemented tobacco-free initiatives that aim to promote smoke-free environments by focusing on the restriction of tobacco sales. Like the smoke-free efforts in Chandigarh and Chennai, these initiatives have triggered similar actions in neighbouring jurisdictions, indicating that the smoke-free strategies studied here are also applicable in cities everywhere. Indeed, there are certain common lessons to which cities anywhere can refer to in order to implement effective local smoke-free interventions. Based on the results of the WHO Smoke Free Cities Project, the "Twelve Steps" and a model ordinance for smoking bans in public places were developed to assist cities considering local smoke-free interventions.  Lessons from Chandigarh and Chennai, such as the potential of using existing laws, participation of civil society and intensive use of media, were also incorporated while developing this set of guides. Dissemination of WHO's practical information is useful in supporting the implementation of smoke-free initiatives at the subnational and local levels. Taking advantage of the lessons learnt from the experiences of smoke-free cities, local governments can contribute to further increase the population benefiting from the fresh air of smoke-free environments and urge global action to protect people from SHS.
| Acknowledgements|| |
We would like to thank the Smoke Free Cities research team in Chandigarh and Chennai and Dr Jacob KUMARESAN from WHO Centre for Health Development for providing background information and assistance, and Mr. Richard BRADFORD from WHO Centre for Health Development for the editing support.
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[Table 1], [Table 2]
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