India smoking: A ban in Mumbai sticks.

MUMBAI, India — The comedian wraps up his act, and announces a seven-minute intermission. Audience members rise and file towards the door. Seven minutes – exactly enough time to get in a smoke. A group of friends forms a circle on the street. All light up.

Such a scene is common in cities like New York, San Francisco and London. But this is India. It’s Mumbai, to be precise, a city not exactly known for its cleanliness and public hygiene.

In Mumbai — with 18 million people and not enough space for all of them — the masses eat, shop, sleep, spit, defecate and throw their trash directly onto the streets.

Many men do not look twice before spitting onto the sidewalk red juice from chewing paan, a leaf wrapped around spices, nuts and often tobacco. Drivers lean out their rickshaws, which carry stickers reading “Spitting causes TB [tuberculosis],” and hack phlegm directly onto the road, often less than a foot away from other cars and pedestrians. Some people open the windows to their cars and houses and casually chuck trash outside.

When a ferry reaches Alibag, a coastal town south of Mumbai, passengers gather their garbage and throw it into the water. Children in slum areas squat over open sewers. Even in middle class suburbs, it is not unusual to see naked street children defecating on the side of a busy road.

But not everywhere.

For all the grime on the outside, step into one of Mumbai’s restaurants, cafes, bars or even discos, and you find another world: a fresh and clean one.

India, where about 240 million people use tobacco, implemented a ban on smoking in public places in 2008. Unlike efforts to outlaw public urination, clean up the streets, provide enough clean drinking water and sanitation to its poor or improve the congested roads and trains overwhelmed with commuters, Mumbai’s ban on smoking has, in many ways, worked.

A strong commitment on behalf of the government and non-governmental organizations as well as public awareness and public initiatives around anti-smoking have made the ban, which carries a fine of up to 200 rupees ($4.30), relatively successful, say anti-tobacco advocates.

The government, led by former Health Minister Anbumani Ramadoss, battled the tobacco industry – which sells an estimated 102 billion cigarettes in India every year – and won.

The ban, unlike previous ones that had loopholes, made rules regarding where people can smoke extremely clear, says Prakash Gupta, the director of the Healis-Sekhsaria Institute for Public Health in Mumbai. A restaurant can only have a smoking area, for example, if the section is physically separate, follows special air pressure rules and does not serve food or drinks.

Compliance with the ban is also due to a high level of public support for smoke-free public places, Gupta says. Ninety-two percent of respondents in cities across India and 96 percent in Mumbai strongly favor regulations to make public places and work places smoke free, according to a poll published by the institute in September 2008.

Advocacy groups have found it easier to show the direct impact of second-hand smoke than of other public health risks like spitting, says Devika Chadha, a program director at Salaam Bombay Foundation, an anti-tobacco group. Eighty-four percent of people across India said they believe second-hand smoke is a serious health hazard, according to the Healis poll.

Stafford Braganza, one of the men who left the comedy show at HQ (Headquarters) to have a cigarette outside, says that even though he smokes, he thinks the ban is “fabulous” because he wants to respect the space of non-smokers.

Non-smoking Mumbaikars are also quick to keep smokers in line, and this helps the implementation, say advocates and smokers. Non-smokers will either tell the smoker himself to stop or complain to the restaurant owner.

“If I went in there and smoked,” says Braganza as he points to HQ, “people would be very vocal about it.”

While the enforcement of the ban is generally high, and extends to workplaces and train and bus stations, it is far from universal. A smoker can still find public places indoors to light up, such as so-called country liquor bars that serve cheap alcohol and in hookah lounges.

During a recent visit to Mocha, a hookah lounge in the Mumbai suburb Juhu, young people drinking beer, eating snacks and smoking cigarettes and hookahs filled the open-air section.

“Here we only have a young crowd who comes for smoking,” says the manager, Navin Patil, as we sit inside the non-smoking and rather boring indoor section. “That’s why this place is vacant, and it’s full outside.”

India has also been unsuccessful at cracking down on smoking in rural areas and on the use of other forms of tobacco like local cigarettes called beedis and paan, says Vidya Krishnan, who covers public health for the Indian Express.

“The sheer size of the population makes it impossible for the government to actually implement anything successfully,” she says.

In Mumbai, it may not be totally comprehensive, but the ban works more effectively than in places like New York and Los Angeles. Even if you are sitting in an outdoor cafe, even if you try negotiating with the waiter – “But sir, we are outside!” – he won’t budge.

“Smoking,” he says, “is not allowed.”