Summary of a case study published in 2019
In 2008 a series of new smoke-free rules came into force in India, strengthening national tobacco control legislation and empowering action to protect the public from second-hand smoke exposure. It was a positive step for tobacco control, but in reality compliance on the ground was variable.
To change this, in 2010 Howrah’s District Administration announced their intention to create a “Smoke-free Howrah”: a plan to build on the existing national rules and make the whole city a smoke-free space, in line with the World Health Organization’s definition of the term. A comprehensive workplan was developed and from 2010-2014 the campaign worked with civil society organizations and the national Department of Health and Family Welfare to improve enforcement in tobacco control.
With commitment from the city Mayor, the District Administration and the local police, local smoke-free rules were expanded to cover educational institutes, healthcare facilities and other public and private workplace environments. Compliance was a major focus, and compliance studies were conducted to identify the most common violations and where enforcement needed to be strengthened. This included indicators such as the presence of no-smoking signage, the absence of observed smoking in public places, and the absence of cigarettes or noticeable tobacco smoke.
To ensure capacity, teams of officials from various departments were created to help implement the laws, and additional police officers were deployed to increase enforcement capacity. School teachers, students, media and civil society were also encouraged to be vigilant and report violations of the smoke-free law. Several other activities were undertaken to ensure high compliance, including regular inspection of major public places, wide visibility of “No Smoking” signage, and public awareness efforts including through the media.
Howrah was officially declared smoke-free in 2017. In a local survey over 94% of smokers reportedly supported the campaign, citing that smoke-free public places encouraged them to quit and helped ex-smokers avoid relapse. The survey also found that the smoke-free law was considered practical, with most of those surveyed preferring enforcement over educational and awareness approaches.
As well as being a success story for city-level tobacco control, Howrah’s experience has wider implications for the implementation of smoke-free legislation in India. It shows that clear leadership among stakeholders, allocation of clear roles, and support from media and civil society are all important elements of implementing smoke-free policies in complex urban settings. It also shows that compliance studies can be useful for monitoring, for informing the public and policymakers about the success of smoke-free interventions.