Tobacco control failure dampens India’s vision of Viksit Bharat 2047

In a bustling Indian city, a corporate executive at a multinational corporation has been a smoker since his teenage years, spending a significant portion of his income on tobacco. His smoking habit began innocently after seeing a family member light up, driven by curiosity and peer pressure. What started as a social habit evolved into a coping mechanism for stress. Despite knowing the health risks and making numerous attempts to quit, he finds it difficult to stop. This story is not unique; it echoes across millions of households in India, highlighting the profound challenge of tobacco control in the country, dampening India’s vision of Viksit Bharat 2047.

The Vicious Cycle of Poverty and Tobacco Use

Tobacco control in India presents a complex challenge, particularly due to its large economically disadvantaged population. This situation perpetuates a vicious cycle of poverty, especially in low- and middle-income countries (LMICs), where tobacco consumption predominantly comes from the lower economic class. This cycle is driven by three main factors:

Increased Taxes: Higher taxes on tobacco products force individuals like Ramesh to spend more of their limited income on these products, exacerbating their financial difficulties.

Illicit Tobacco Trade: Elevated taxes also fuel the illicit tobacco trade, reducing government revenues and impacting social welfare programs, further affecting the poor.

Healthcare Costs: Tobacco users face high healthcare costs due to tobacco-related diseases, further straining their finances.

The Landscape of Tobacco Use in India

The Human-Centric Approach to Tobacco Control report provides a detailed snapshot of tobacco and nicotine product usage in India:

India has one of the highest rates of tobacco usage globally, with a 27% prevalence among individuals aged 15 and above as of 2020. Both smoking and oral forms of tobacco are prevalent, with 250 million smokers aged 16 to 64 as of 2018, making India the country with the second-highest number of tobacco users. Notably, legally produced cigarettes account for only 8% of overall tobacco consumption, with the remaining 92% being cheaper products like bidis and chewing tobacco.

The National Family Health Survey 2019-21 (NFHS-5) highlights a significant disparity in tobacco usage between men and women. While tobacco consumption among females is gradually increasing, driven by factors such as stress and shifting social norms, males still have a significantly higher rate of tobacco consumption.

Tobacco use is more prevalent among economically weaker sections, who are at greater risk of tobacco-related harms. Loose and affordable cigarettes are common and preferred by lower and middle-income groups. In rural India, bidis are widely consumed due to their affordability, despite being more harmful than cigarettes because of their higher concentration of toxic substances and lack of filters. Rural areas also experience lower government oversight, allowing bidi production and marketing to persist unchecked, which poses a significant health risk to the rural population with limited access to healthcare.

The affordability of tobacco products, while seemingly beneficial for the economically disadvantaged, comes at a significant public health cost. The sale of cheap tobacco products perpetuates a poverty trap, with increasing taxes potentially leading to higher expenses for the lower-income classes or pushing consumers towards illicit tobacco sources. The prevalence of smoking among young adults (ages 20-44) is alarming, with this demographic forming a significant part of the workforce. A survey indicates that 45% of young adults cannot quit smoking or chewing tobacco due to a lack of alternatives like nicotine gums, patches, lozenges & other technologies like heat-not-burn (HnB), despite nearly half attempting to quit in the past year.

The persistence of tobacco consumption among young adults highlights the need for tailored, India-specific policies based on regulations and science. Understanding the sociocultural factors contributing to tobacco use is crucial. The survey in the report ‘Human-Centric Approach to Tobacco Control’ found that 66% of respondents began using tobacco between the ages of 20-25, significantly increasing their risk of long-term health problems.

Much Needed Comprehensive Approach

A complete ban on tobacco is impractical, as it would negatively impact farmers engaged in tobacco cultivation, reduce tax income, and boost illegal trade. Instead, India needs to adopt an approach that combines scientific evidence with emotional appeal, focusing on both cessation and education. India's tobacco control strategy must evolve beyond fear-based tactics to a more holistic approach that includes practical education and regulation.

With 74% of both smokers and oral tobacco users having an adult smoker in their family, intergenerational education and support are essential. By leveraging science-based solutions, progressive policies, and fostering collaboration among government bodies, healthcare professionals, educators, and community stakeholders, India can effectively curb tobacco consumption and break the cycle of poverty and disease associated with it.

In conclusion, addressing the tobacco epidemic in India requires a multifaceted approach that balances regulation, education, and cultural sensitivity to create lasting change and promote a healthier society.