A beedi worker smokes at her rest.

The use of skulls and bones in the pictorial warnings on tobacco packs will be made optional by amending The Cigarette and other Tobacco Products Act (2003), the Union Cabinet of India decided on 20 July 2007. Tomorrow on August 13 it is likely to come up in the Parliament.

This is another major setback for public health advocates with Indian tobacco control Act being diluted. Ironically just last month (July 2007), 148 nations including India met at the Second Conference of Parties (COP2) to the global tobacco treaty and committed themselves to develop specific guidelines for protecting health policy from tobacco industry interference. The global tobacco treaty, formally known as the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), will save millions of lives and change the way tobacco corporations operate around the world. Article 5.3 of the FCTC obligates Parties to "protect these [public health] policies from commercial and other vested interests of the tobacco industry."

Earlier on 10 April 2007, India's Union Health and Family Welfare Minister Dr Ambumani Ramadoss had announced that "all tobacco products would from 1 June 2007, bear photographs of patients suffering from cancer caused by tobacco consumption as further warning." Health warning labels, both on cigarette packages and on all tobacco marketing materials, help create informed consent between tobacco companies and their customers and are an inexpensive and important first step in a national health education programme.

Several instances in the past few months to weaken the provisions of Indian tobacco control Act are as follows:

On 15 December 2006, GK Sanghi had raised the question in Rajya Sabha about Government's response to the 'beedi' workers agitating against the proposed printing of skull and bones on 'beedi' packs.

In May 2007, Gutkha (chewing tobacco) manufacturers in India were attempting to get a court injunction to delay the directive requiring all tobacco products to carry health warnings. Gutkha manufacturers were required to change the packaging of their products so that the pouch measures 7x7 cms and carries a photograph of a skull with two crossed bones. In addition, the pouches should carry health warnings in both English and Hindi stating that "tobacco use leads to painful death" covering 80% of the pack area while the remaining 20% space could be used to print the name of the brand, company, ingredients and weight.

Another interesting attempt was made in the same month (May 2007) when External Affairs Minister Pranab Mukherjee suggested in his letter that the sign will likely offend the Muslim community, who are employed in the beedi industry of Murshidabad, as they unlike Hindus bury their dead, and do not burn them.

The third major move to water down the Indian tobacco control Act also happened in May 2007 when Tamil Nadu Chief Minister M Karunanidhi called on the central government to defer implementation of the legislation, saying that "the move has threatened the livelihood of 1.5 million beedi workers in the State." Karunanidhi said beedi manufacturers in the State have stopped production with some tobacco industry players threatening to go on an indefinite strike from 1 June 2007 if the Act is enforced.

Also in May 2007, The Karnataka Beedi Association in India said that the directive to print skull and bones on beedi packs from 1 June 2007 would result in a steep decline in beedi sales adversely affecting the welfare of beedi workers.

Unfortunately, Big Tobacco's interference in health policy continues to be one of the greatest threats to the global tobacco treaty's implementation and enforcement. Philip Morris/Altria, British American Tobacco (BAT) and Japan Tobacco (JT) use their political influence to weaken, delay and defeat tobacco control legislation around the world. While the industry claims to have changed its ways, it continues to use sophisticated methods to undermine meaningful legislation.

The warnings have already been delayed twice. Further inaction on it will undermine the voice of the public, the will of the Parliament that enacted the law and result in loss of precious lives to the deadly effects of tobacco.

Pictorial warnings may also be appropriate, particularly in countries like India with low literacy rates.