In this city of nearly 20 million people, there is order to the chaos if you pay attention.  Cars, taxis (by the millions), bicycles, carts, and pedestrians do a dance we in the West cannot even imagine. Here you have Bollywood on one extreme and an astounding 55% of the population (nearly 10 million people) living in shantytowns and slums.

But this week there are an extra 2,000 people in Mumbai who are attending the 14th World Conference on Tobacco or Health.  Three of those 2,000 are from Free & Clear. In a city that goes and goes 24 hours a day it seems amazing that anyone would even notice they are in town.  But notice they did with a huge newspaper spread in the Sunday Times of India illustrating efforts underway to reduce tobacco use in India.

In October last year, India went smoke-free in their restaurants, bars, and most public areas.  And they did it India-style with huge No Smoking signs.  My favorite says "No Smoking ---- Smoking is an Offense!"  The smoke-free effort is working, with a decrease in particulate matter in public facilities of 65%.

Like the US, India is one of the world’s leading producers of tobacco.  Men in India smoke at about twice the rate that men do in the US, but over 4 times as many women in the US smoke compared to Indian women.  Look a little closer though and India leads the world in the use of chewed tobacco, with more Indian women using this form of tobacco than Indian women who smoke cigarettes.

India is a difficult country for the western mind to understand.  It has always been that way.  First the Portuguese and then the British occupied India.  They certainly left their mark, but the spirit of India survives and thrives.

One thing public health advocates in India share with those in the West is a commitment to reduce death and disease from the use of smoked and chewed tobacco.  Many challenges face them, but India is an amazing country and we watch with great anticipation as they tackle the health problems associated with tobacco use.