Vision of a Tobacco-Free India – Strengthening Control Measures

Tobacco use in India poses a severe threat to both public health and the national economy. As per 2017 estimates, the annual economic burden of tobacco consumption among individuals aged 35 years and above amounted to ₹1,773.4 billion, representing 1.04% of the country’s GDP. In addition, second-hand smoke exposure alone contributed ₹566.7 billion (0.33% of GDP) in healthcare-related costs. These figures account for a combination of direct medical and non-medical expenses as well as losses arising from morbidity and mortality. Given this massive burden, India faces an urgent imperative to revisit and strengthen its tobacco control policies to achieve the vision of a tobacco-free nation.

Shortcomings in Existing Legislative Framework

• Despite the Cigarettes and Other Tobacco Products Act (COTPA), 2003, being one of the more robust legislative measures against tobacco, its enforcement remains uneven and weak across various Indian states. Furthermore, several critical gaps persist within the Act that require immediate rectification.
• One such gap lies in the inadequate regulatory focus on smokeless tobacco (SLT). Although SLT products are generally cheaper, socially accepted, and carry less stigma, they are, in fact, more carcinogenic than smoked forms of tobacco. While the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations, 2011, provide some legal tools for control, their implementation is feeble and inconsistent.
• Another loophole exists in the form of surrogate and indirect advertising. Tobacco companies continue to circumvent advertising restrictions by promoting brand recognition through surrogate products like mouth fresheners, and by leveraging media platforms such as movies, OTT content, and social media to indirectly promote tobacco use. Although direct advertisements are banned, these tactics exploit psychological conditioning and demand the imposition of stringent bans on both surrogate advertising and media-based promotions.
• COTPA also falls short in its fiscal approach. The Act lacks explicit provisions on taxation as a means to deter tobacco consumption, even though increasing excise taxes is globally acknowledged as the most effective strategy to reduce usage. In India, tax rates remain suboptimal and inconsistent—bidis, the most consumed form of smoked tobacco, face a mere 22% tax burden, while cigarettes are taxed at around 50%, both well below the 75% benchmark recommended by the World Health Organization. Since the rollout of the Goods and Services Tax (GST) in 2017, tobacco tax increases have been marginal, leading to only a 4% overall tax hike. Rising income levels, combined with minimal taxation, have made tobacco products more affordable, thereby undermining both public health and potential government revenue.
• In addition, health warnings on tobacco products lack sufficient impact. Although India mandates that 85% of tobacco packaging display graphic health warnings—updated biennially—there is limited evidence of their effectiveness in changing user behaviour. These warnings, often relying solely on fear-based images, contrast with practices in many European countries, where packaging educates consumers about a broader range of health risks. There is a pressing need to evaluate these warnings regularly and adopt plain packaging to further diminish the appeal of tobacco.
• While India has been proactive in banning electronic cigarettes through the Prohibition of Electronic Cigarettes Act (PECA), 2019, enforcement remains weak. E-cigarettes continue to be easily available online, especially to adolescents, exacerbating public health risks. This highlights the need for more stringent implementation of existing laws and surveillance mechanisms.

Need for a Holistic Approach to Tobacco Control

India’s current tobacco control efforts, led by the National Tobacco Control Programme (NTCP), remain limited in scope. The NTCP primarily focuses on awareness generation and the enforcement of COTPA provisions. However, it fails to address the broader social determinants that influence tobacco use, such as poverty, unemployment, and psychological stress. Furthermore, the reach of tobacco cessation clinics is minimal when compared to the vast user base across the country.

The Tobacco Free Education Institute (ToFEI), though well-intentioned, also lacks the scientific rigor necessary for impactful interventions. Its current strategy of promoting awareness through school posters and biannual activities falls short of global best practices. In contrast, institutions like the U.S. Centers for Disease Control and Prevention (CDC) advocate for more comprehensive school-based prevention approaches. These include the enforcement of tobacco-free school policies, integration of tobacco education from kindergarten through 12th grade, training of educators, active family involvement, cessation support for students and staff, and the regular evaluation of programmes for effectiveness.

Towards Stronger Regulation and Oversight

A significant challenge facing public health professionals in India is the lack of access to real-time tobacco consumption data. In contrast, the tobacco industry is equipped with dynamic sales data that allows them to adjust marketing strategies promptly. This data asymmetry puts researchers and policymakers at a disadvantage in formulating timely and targeted interventions.

To overcome this gap and move toward a tobacco endgame strategy, a multi-sectoral approach is essential. This would involve collaboration among various ministries—including Health, Finance, Education, Law, Social Justice, Commerce, Information and Broadcasting, and Consumer Affairs. Additionally, there is a need for increased investment in research institutions to support the design, implementation, and continuous evaluation of tobacco control measures, underpinned by regularly updated data.

An independent oversight body should be established to monitor tobacco industry practices and expose instances of interference. Simultaneously, India must employ a balanced mix of demand-side interventions—such as taxation, public awareness campaigns, and cessation support—and supply-side regulations, including stricter enforcement and control measures.

Conclusion

Achieving a tobacco-free India requires a well-rounded and sustained strategy that tackles the issue from multiple angles. This includes tightening existing legislation, increasing tobacco taxes, enhancing public awareness, providing comprehensive social and psychological support, introducing rigorous school-based education initiatives, and establishing independent regulatory oversight. Crucially, a unified effort involving policymakers, researchers, and implementers is essential to reduce the tobacco burden and realise the vision of a healthier, tobacco-free India.

Uses of Wastewater Surveillance for Public Health and Environmental Protection

In a significant public health move, the Indian Council of Medical Research (ICMR) is set to launch an expanded wastewater surveillance initiative that will monitor ten different viruses across 50 cities within the next six months. Currently in operation in five cities, this initiative is designed to detect early warning signs of viral transmission and monitor patterns of spread, thereby enabling timely and effective public health interventions. The goal is to establish a nationwide system capable of identifying potential outbreaks before they escalate, strengthening India’s overall disease surveillance capacity.

Understanding Wastewater and Its Relevance

Wastewater refers to any water that has been impacted by human activity. This includes water discharged from residential sources such as sinks, toilets, and showers, as well as effluents from industrial and agricultural processes. In essence, wastewater is the used water that must undergo treatment before it can either be safely released into the environment or reused. Its composition provides valuable insights into the health status of the community it originates from, making it a key resource for monitoring disease spread and environmental contaminants.

ICMR’s Strategy for Expanding Surveillance

ICMR’s plan to expand wastewater and environmental surveillance (WES) aims to scale up its reach nationwide, allowing for the detection of rising viral loads within communities. While current surveillance focuses on COVID-19 and polio, the expanded scope will include pathogens responsible for fever, diarrhoea, acute encephalitis syndrome, and respiratory distress. In addition, ICMR will initiate targeted surveillance of the Avian Influenza Virus (AIV) by testing surface water and wastewater in areas prone to outbreaks. This will serve as an early warning mechanism, enhancing India’s preparedness for viral epidemics.

This expanded network will complement the country''s existing disease monitoring frameworks, particularly the Influenza-Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) surveillance programmes led by ICMR and the Integrated Disease Surveillance Programme (IDSP). Together, these systems will form a more cohesive and responsive health surveillance infrastructure.

Significance of Wastewater Surveillance in Public Health

The ICMR underscores the growing necessity for proactive public health measures, given the increasing emergence and re-emergence of infectious diseases driven by factors such as rapid urbanisation, environmental changes, population growth, and intensified interactions between humans and animals. In this context, Wastewater-Based Epidemiology (WBE) has proven to be an invaluable tool, particularly since the global outbreak of COVID-19.

WBE enables health authorities to obtain real-time data on infection trends at the community level. This includes capturing viral presence even among individuals who are asymptomatic or pre-symptomatic—cases that might otherwise go undetected. By facilitating early identification of hotspots and aiding in the efficient allocation of public health resources, WBE supports more targeted interventions such as testing drives, community engagement, and vaccination campaigns. Importantly, it is a cost-effective and non-invasive method that can cover large populations and bolster global health security by forecasting and preventing future outbreaks before clinical cases become apparent.

Mechanism of Wastewater Surveillance

The U.S. Centers for Disease Control and Prevention (CDC) provides a detailed understanding of how wastewater surveillance works. Individuals infected with viruses or bacteria shed pathogens during routine activities such as using the bathroom, bathing, or doing laundry. These microbial fragments enter the sewage system, where wastewater samples are collected—typically before treatment at wastewater facilities—and sent to laboratories for analysis.

Within a time frame of five to seven days, laboratories can identify the presence of infectious agents circulating in the population. Public health authorities then use this data to monitor disease dynamics and determine appropriate interventions. These might include increasing testing capacity, promoting preventive health measures, or launching targeted vaccination campaigns based on the detected trends.

Broader Environmental and Public Health Applications

Beyond tracking infectious diseases, wastewater surveillance also plays a critical role in identifying pollution sources on land that threaten aquatic ecosystems. It provides valuable data for the protection and management of freshwater and marine environments and helps ensure the continuation of vital ecosystem services. The United Nations Environment Programme (UNEP) recognises the role of wastewater monitoring in strengthening both public health systems and environmental governance. However, the programme also stresses the need for expanded and standardised approaches to ensure consistent water quality monitoring.

Similarly, the World Health Organization (WHO) is actively working to enhance global capacity in wastewater and environmental surveillance. WHO views this dual-purpose approach as essential for safeguarding public health and achieving long-term environmental sustainability. These efforts reflect a growing international consensus on the importance of integrating wastewater surveillance into broader public health and ecological strategies.

Conclusion

The expansion of wastewater surveillance by ICMR represents a pivotal development in India’s approach to disease prevention and environmental monitoring. By leveraging wastewater as a diagnostic and environmental tool, the country stands to significantly improve its early warning capabilities, enhance resource allocation, and better protect both public health and ecosystems. As global health threats continue to evolve, wastewater-based surveillance offers a timely, scalable, and multifaceted solution that supports both current disease control and long-term environmental resilience.

Africa’s Distorted Map Representation and the Push for the Equal Earth Projection

The African Union (AU) has officially endorsed the Correct the Map campaign, advocating for the global replacement of the Mercator projection with more geographically accurate alternatives such as the Equal Earth projection. The Mercator map, despite being widely used in educational systems and media, is known for misrepresenting the true scale of countries and continents—most notably by drastically shrinking Africa while exaggerating the size of Europe, North America, and Greenland. The AU contends that this distortion has contributed to centuries of symbolic marginalisation, and asserts that adopting a fairer cartographic model will help restore Africa’s rightful geographical scale and dignity on the world map.

Criticism of the Mercator Projection

Originally created by Gerardus Mercator in 1569 to aid in sea navigation, the Mercator projection revolutionised mapmaking during the Age of Exploration by enabling sailors to plot straight-line courses—called rhumb lines or loxodromes—across the ocean. These lines, which cross all meridians at a constant angle, appear as straight paths on the Mercator map, making it exceptionally useful for maritime travel.

However, the projection achieves this navigational convenience at the expense of accurate representation. The further a landmass is from the equator, the more it is visually enlarged. This leads to dramatic distortions: Greenland, which spans roughly 2.1 million square kilometers, appears nearly the same size as Africa, which is over 30 million square kilometers—approximately 14 times larger. Similarly, Europe appears comparable in size to Africa, despite being only one-third as large. Over time, these distortions became embedded in educational materials, government documents, and digital interfaces, helping to reinforce a Eurocentric worldview that prioritised the Northern Hemisphere while diminishing Africa, South America, and Asia. Critics argue that such cartographic choices have subtly influenced global perceptions of political power, development, and importance.

Understanding Map Distortion

All two-dimensional world maps are inherently distorted because it is mathematically impossible to project the Earth’s spherical surface onto a flat rectangle without compromising at least one of the following: area, shape, direction, or distance. The Mercator projection, for example, preserves shape and angle, which makes it excellent for navigation, but significantly distorts size—especially near the poles.

In contrast, the Equal Earth projection was introduced in 2018 by cartographers Bojan Šavrič, Tom Patterson, and Bernhard Jenny to provide a more accurate visualisation of landmass proportions. This projection maintains the relative sizes of continents and countries, especially those near the equator like Africa and South America, though it results in more curvature in the shapes of landmasses. Another projection, the orthographic map, offers a visually realistic depiction of the Earth as it appears from space but limits the view to one hemisphere at a time and compresses peripheral areas. Each projection presents a unique compromise between accuracy and functionality, and all have implications that go beyond technical cartography into the realms of politics, education, and perception.

Consequences of Map Misrepresentation for Africa

The long-standing use of the Mercator projection has had a profound impact on Africa’s global image. By consistently portraying Africa as significantly smaller than it actually is, the projection has helped sustain a narrative of the continent as less important or powerful. This diminished portrayal has been internalised through generations of textbooks, policy frameworks, and media representation, subtly reinforcing ideas of Africa as marginal, less developed, and geographically insignificant. Critics argue that this skewed representation served political purposes, particularly during colonial times, making the continent appear more manageable or conquerable and thereby aiding imperial ambitions. The Mercator map, in this view, functions as a “political tool” that contributed to Africa’s historical and psychological subordination.

Path Forward: Correcting the Map

In the effort to correct this entrenched misrepresentation, the Equal Earth projection has emerged as a preferred alternative. Introduced in 2018, it preserves the true proportions of countries and continents, especially those in equatorial regions like Africa. Though the map features more curved and stretched landforms, its emphasis on area accuracy makes it a more equitable representation of global geography.

Other projections, such as the Gall-Peters map, also aim to preserve landmass area, though they visually distort shapes by elongating countries vertically. Creative alternatives like Stuart McArthur’s 1979 “Universal Corrective Map,” which flips the traditional orientation of the world and places Australia at the top, challenge conventional cartographic norms and invite rethinking of spatial hierarchies.

The AU’s support for the Correct the Map campaign marks a significant institutional move toward cartographic reform, with additional backing from influential organisations such as the World Bank, NASA, National Geographic, and a growing chorus of public petitions urging the United Nations to adopt more accurate global maps. Nevertheless, replacing the Mercator projection poses substantial logistical and cultural challenges. Given its deep entrenchment in global education systems, public policy, navigation tools, and digital platforms, a transition would require major curriculum overhauls, redesigning user interfaces, and shifting long-held perceptions about geography and global relations.

In conclusion, while the path toward cartographic justice is complex and fraught with institutional inertia, the growing momentum behind the Correct the Map campaign represents a meaningful step toward addressing historical distortions. By adopting projections that reflect the true scale and significance of all continents—particularly Africa—this effort holds the potential to reshape global understanding, promote equity, and foster a more balanced worldview.

ICMR Introduces ‘CEREBO’ to Diagnose Brain Injury: A Breakthrough in Portable, Radiation-Free Diagnostics

In a major advancement for emergency and rural healthcare, the Indian Council of Medical Research (ICMR) has introduced CEREBO, a portable and indigenous device designed to diagnose traumatic brain injuries (TBI) quickly and without radiation. This innovation addresses a critical healthcare gap in India, where advanced imaging facilities remain out of reach for many, especially in rural and emergency settings.

Introduction: The Urgent Need for Rapid TBI Diagnosis

India reports one of the world’s highest rates of head injuries, with more than 100,000 fatalities and over a million serious cases every year. A particularly alarming statistic is that nearly half of all TBI-related deaths occur within the first two hours of injury. In such time-sensitive cases, early diagnosis is essential to saving lives and minimising long-term damage. However, conventional diagnostic technologies such as CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) remain largely unavailable in rural areas and emergency contexts due to cost, infrastructure requirements, and the need for specialised personnel. In response to this systemic limitation, ICMR has developed CEREBO, a compact, safe, and affordable diagnostic tool that holds the potential to transform brain injury care across the country.

About the CEREBO Device

CEREBO is a handheld diagnostic instrument developed using near-infrared spectroscopy in combination with machine learning algorithms. Unlike traditional imaging technologies, it is entirely radiation-free, making it particularly safe for use in sensitive populations such as infants and pregnant women. Its design focuses on accessibility and ease of use—it can be operated by paramedics or even unskilled personnel with just 30 minutes of training. Capable of detecting critical conditions such as intracranial bleeding and brain oedema within under a minute, the device facilitates rapid triage and medical decision-making in high-pressure situations. Its output includes colour-coded results, which further simplifies interpretation for first responders and emergency healthcare workers. Additionally, by eliminating the need for expensive imaging equipment, CEREBO offers a highly cost-effective diagnostic solution.

Development and Institutional Collaboration

The development of CEREBO was made possible through a collaborative effort between ICMR, the Medical Device and Diagnostics Mission Secretariat (MDMS), AIIMS Bhopal, NIMHANS Bengaluru, and Bioscan Research. The device has already undergone rigorous clinical validation and secured regulatory approvals. Its performance was tested through multi-centre clinical trials supported by ICMR’s mPRiDE (Medical Product Innovation Development and Evaluation) scheme. Feasibility studies conducted at leading trauma and neurosurgical centres further assessed its diagnostic accuracy and its seamless integration into existing emergency care protocols. With this extensive groundwork, CEREBO is fully prepared for deployment across a variety of healthcare environments, including ambulances, hospitals, rural health clinics, and disaster response units.

Significance for India’s Healthcare System

CEREBO directly tackles multiple systemic issues plaguing brain injury diagnosis in India. First, it bridges the accessibility gap by bringing diagnostic capability to rural and semi-urban areas where CT and MRI machines are often unavailable. Second, it drastically reduces the cost of diagnosis, both by removing the need for expensive equipment and by minimising reliance on highly trained personnel. Third, its speed and precision allow for immediate medical intervention, improving survival rates and reducing the risk of permanent disability. Finally, its portability and simplicity make it ideal for deployment in ambulances, trauma centres, military field hospitals, and natural disaster zones—thereby strengthening India’s response to both everyday emergencies and large-scale crises. By offering an effective, locally developed alternative to imported diagnostic devices, CEREBO also contributes to national self-reliance in healthcare technology.

Public Health Implications

According to data from the Indian Head Injury Foundation, nearly 50% of TBI-related deaths occur within two hours of trauma, primarily due to the delayed detection of secondary brain injuries caused by internal bleeding and swelling. In such cases, early diagnosis is crucial to preventing deterioration. CEREBO’s ability to rapidly identify these conditions has the potential to significantly reduce mortality rates and improve the chances of full recovery. Additionally, it can ease the long-term disability burden often carried by TBI survivors and their families. This innovation supports India''s broader public health goals, particularly in delivering affordable and accessible healthcare to underserved populations. It also enhances the emergency response capacity in high-risk zones such as highways, rural regions, and areas affected by conflict.

Future Outlook and Global Potential

Looking ahead, ICMR is actively engaging with State governments to integrate CEREBO into tertiary care networks. The objective is not only to enhance early diagnosis but also to streamline access to CT and MRI imaging when necessary. By facilitating better triage in overburdened trauma wards and reducing the overall cost of imaging services, the adoption of CEREBO could lead to more efficient use of healthcare resources. Furthermore, there are plans to scale up its application within military operations, emergency response frameworks, and even international healthcare systems, particularly in developing countries facing similar diagnostic challenges.

If widely implemented, CEREBO could become a global model for affordable and effective TBI diagnosis, offering a blueprint for how indigenous innovation can solve critical gaps in medical care, especially in resource-constrained settings.