Can stronger awareness drives on the benefits of quitting tobacco help?

The Household Consumption Expenditure Survey (HCES) 2023-24 also reveals that Indian households spend more on tobacco than on nutrition. It has become a persistent public health issue rooted in socio-cultural structures, labour conditions, and poverty. 

As rising economic growth is not leading to healthier nutrition choices, it is also seen as a threat to India’s efforts to achieve Sustainable Development Goal (SDG) 3 Good Health and Well-Being. 

Tobacco consumption, death and disease in India

According to the World Health Organization (WHO), tobacco consumption is one of the major causes of death and disease in India, accounting for nearly 1.35 million deaths every year. The WHO links ultra-processed foods, alcohol, tobacco and fossil fuels to cause 19 million deaths per year, or 34 per cent of all deaths globally. 

HCES 2023-24 reveals that rural Indians allocate 1.5 per cent of their Monthly Per Capita Consumption Expenditure (MPCE) to tobacco. The rate is 1 per cent in urban areas. These rates indicate an increase from 59.3 per cent to 68.6 per cent in rural India in just over a decade. In urban India, there has also been a 59 per cent increase. 

Tobacco consumption includes cigarettes and bidis, as well as pan masala, khaini, gutka, snuff, smokeless tobacco, and local intoxicants.

Tobacco, public health and nutrition

The high rates of tobacco consumption present a distorted picture of food or calorie sufficiency. This is especially true when tobacco is consumed alongside sugar and ultra-processed foods, as is the case in India. Calories can come from non-food appetite suppressants, such as tobacco, which fills the stomach but does not provide real nutrition. Nicotine decreases appetite, food intake and body weight. Tobacco competes directly with food expenditure and, along with ultra-processed foods, presents a threat to nutritional security. 

Studies, such as Rijo M. John’s research paper, Crowding out effect of tobacco expenditure and its implications on household resource allocation in India (2008), suggest that tobacco-consuming households have lower consumption of other commodities, including milk, education, clean fuels, and entertainment. This has a direct bearing on women and children in these households, particularly in lower-income ones. 

Spending on tobacco is an opportunity cost, meaning it undermines the opportunity to spend the same money on other beneficial purposes. As such, reducing tobacco expenses and properly reallocating resources will improve and optimise nutrition and other essential goods. Similar observations have been made in studies in other developing countries, such as Nepal and Bangladesh. 

Tobacco consumption also has a causal relationship with nutritional parameters like underweight. In Yesuvadian Selvamani et al.’s study, Tobacco Use, Food Insecurity, and Low BMI in India’s Older Population (2024), it was shown that older adults who used smoking tobacco were twice as likely to be underweight as non-users.

In spite of heavy taxation, the revenue that tobacco products generate does not outweigh the opportunity cost it causes for society. Tobacco use has a disproportionate impact on lower socio-economic groups in India. It pushes people into poverty due to either direct tobacco-related expenditures or healthcare spending, as shown in Rijo M John and Estelle P Dauchy’s study, A Quantitative Exploration of the Influence of Tobacco Use on Poverty in India (2025). 

Need for drives on the benefits of quitting

Tobacco manufacturers target vulnerable populations. As such, awareness campaigns on the harmfulness of tobacco are not sufficient. Instead, we also require drives on the benefits of quitting, which offer hope and restoration to tobacco users. There also needs to be increased funding for the Tobacco Cessation Centres (TCCs) under the National Tobacco Control Programme (NTCP). 

Notably, Bassi et al’s 2023 study, Programme and Policy Perspectives Towards a Tobacco-free Generation in India: Findings From a Qualitative Study, shows poor implementation of the NTCP at the sub-national level. Thus, there needs to be stronger mechanisms to measure the actual reach and effectiveness of the TCCs. Adolescents can be engaged in co-creating interventions, along with integrating national tobacco control programs into existing school and adolescent health programmes. 

The gaps in multi-sectoral coordination between health, education and law enforcement departments mean that tobacco control is not holistic. Challenges in tobacco cessation delivery also exist at various levels of health care, as well as at the level of tobacco users, caregivers, and their communities. Gupta et al.’s 2022 study Strategic Initiatives to Improve Tobacco Cessation Delivery in India shows that the reduction of tobacco consumption is assigned low priority by these departments. There needs to be more focus and funding for this cause. 

Reducing tobacco use to strengthen human capital

Restrictions on the manufacturing, sale, and marketing of tobacco products need to be strengthened. From February 2026, tobacco products, including cigarettes and paan masala, will be subject to the new 40 per cent goods and services tax (GST) rate. They have been categorised as ‘sin goods’, and the GST will be calculated on the retail selling price (RSP) to avoid tax leakage and prevent misuse by tobacco companies. 

Additional excise duties on tobacco products have also been reintroduced. These taxation schemes are directed towards deterring the consumption of tobacco products. Heavy taxation on tobacco products is seen as a pro-health and pro-equity measure since vulnerable populations are more price sensitive. This scheme will move India closer to the 75 per cent target recommended by the WHO. 

Despite the increase, it is still substantially lower than the WHO’s recommendation and will require continued monitoring to prevent smuggling and black market sales. Public health advocates and representatives of the tobacco industry have been at loggerheads over its production and consumption. 

Farmers prefer to grow tobacco as it is drought-resistant, and given the assured market, it stands out in comparison to other cash crops. This will require state intervention and a willingness to provide them with better support in case of failure, to motivate them to cultivate other crops.

Tobacco consumption is not only about health risks and deaths, but also a burden on household expenditure, nutritional security, and poverty. As such, it requires immediate public policy attention. Focusing on reducing tobacco consumption would be a way to also move towards Viksit Bharat @2047 and valuing the country’s human capital. 

Post read questions

How does the Biopharma SHAKTI scheme, announced in the Union Budget 2026, aim to address the rise in non-communicable diseases, like diabetes, cancer and autoimmune disorders?

As rising economic growth is not leading to healthier nutrition choices, it is also seen as a threat to India’s efforts to achieve Sustainable Development Goal (SDG) 3 Good Health and Well-Being. Discuss in the context of rising household expenditure on tobacco consumption. 

Tobacco manufacturers target vulnerable populations. As such, awareness campaigns on the harmfulness of tobacco are not sufficient. Instead, we also require drives on the benefits of quitting. Comment.

The gaps in multi-sectoral coordination between health, education and law enforcement departments mean that tobacco control is not holistic. Do you agree? 

Farmers prefer to grow tobacco as it is drought-resistant, and given the assured market, it stands out in comparison to other cash crops. How can this be addressed? 

(Rituparna Patgiri is an Assistant Professor at the Indian Institute of Technology (IIT), Guwahati.)

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