India has the largest tobacco chewing population in the world and the second largest population of those who smoke it, shows the Global Burden of Disease Study (GBD) 2019 by the Institute of Health Metrics and Evaluation (IHME).

On World No-Tobacco Day, FactChecker analysed all credible data sources on tobacco and the dangers of using it to show where the world and India stand in claiming the right to health.

With over 186 million users in India, two in every three people who chew tobacco around the world are Indians. 22.4% men in the age group of 15-54 years in the country are tobacco smokers. Around one in every two men and two in five women smoke more than five cigarettes or bidis (hand-rolled cigarettes) a day.

Among youngsters aged 13-15 years in India, tobacco prevalence was 8.5% in 2019, according to the Global Youth Tobacco Survey (GYTS). This figure saw a 6.1 percentage point dip in 10 years. The survey points out that 9.6% boys and 7.4% girls are tobacco users in India.

154 Die of Tobacco Every Hour

Tobacco use is the leading single preventable cause of deaths worldwide, according to the Global Adult Tobacco Survey conducted by the Ministry of Health & Family Welfare (MoHFW), the World Health Organisation (WHO) and Tata Institute of Social Science (TISS). Globally, an estimated 8 million deaths are attributed to the use of tobacco every year, and 1 in every 5 male deaths is due to the harmful effects of tobacco. It has been shown that around 50% of long-term smokers die from causes directly linked to smoking, such as cancer, lung disease, cardiovascular disease and stroke. Smokers' average life expectancy is 10 years lower than that of never-smokers.

One of the major causes of death in India that accounts for nearly 1.35 million fatalities every year, is tobacco use. This means 3,699 deaths a day on average, 154 every hour. The National Cancer Registry Programme Report 2020, released by the Indian Council of Medical Research (ICMR), revealed that 27% of all cancer cases in the country can be attributed to tobacco or tobacco products.

According to a research published by the WHO, the direct health expenditure on treating tobacco-related diseases accounts for 5.3% of total annual private and public health spending in India. The lost income for households due to hospitalisation and hospital visits amounted to Rs 6,181 crore, whereas the cost from premature death was estimated at Rs 1.32 lakh crore. This shows tobacco consumption exacts a heavy toll on the public health system as well as on people's livelihoods.

Smokers Increase, Population Share Dips

The state with the highest usage of tobacco is Mizoram, for both men and women. According to the National Family Health Survey-5, 61.6% women and 72.9% men in the state consume tobacco in some form or another. The state with the lowest tobacco prevalence was Punjab (12.9% men and 0.4% women).

Among all states, Nagaland displayed the highest reduction in tobacco consumption (20.8%) from NFHS-4 to NFHS-5. Overall, 11 out of 36 surveyed states and union territories (UTs) showed a reduction of 10% or more. One state and 3 UTs showed a marginal increase in usage of tobacco or tobacco products across the two surveys — Sikkim, Jammu and Kashmir, Puducherry, and Lakshadweep.

The total tobacco consumption in India came down by 6 percentage points in men and 3 percentage points in women. Data from IHME highlighted that the reduction in percentages of tobacco users globally have not kept in pace with the population growth. So the total number of current smokers has increased, even though their percentage in the total population might have declined.

Inhaling second-hand smoke by being in close proximity to someone who is smoking is also extremely harmful. Long-term exposure to second-hand smoke causes lung cancer, coronary heart disease and cardiac death. Non-smokers who live with smokers are at increased risk of coronary heart disease by 25%-30% and lung cancer by 20%-30%.

In India, more than half (54.3%) of teenagers (15-19 years) are exposed to second-hand smoke, either at home or in public places. And, 29.5% of the GYTS respondents between 13-15 years also reported being exposed to second-hand smoke at their home or in public places.

The state with the highest number of women exposed to second-hand smoke was Mizoram (95%), followed by Manipur (75.2%) and Tripura (71.9%). The states where the maximum men were exposed to SHS were Mizoram (91.5%), Uttarakhand (85.8%) and Delhi (81.4%).

Tobacco Tax Not As Per WHO Recommendation

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty in response to the globalisation of the tobacco epidemic. It lays down recommended legislative guidelines for countries to follow on taxation of tobacco, protection from exposure to second-hand tobacco smoke, packaging and labelling of tobacco products, advertising and sponsorship, among others.

The Government of India launched the National Tobacco Control Programme (NTCP) in 2007-08, three years after the country ratified the FCTC in 2004. The programme is implemented through national, state, and district level Tobacco Control Cells (TCC). At a micro level, it works through training of key stakeholders such as health and social workers, NGOs, school teachers and enforcement officers. The National Health Policy 2017 sets out the target for achieving 30% relative reduction in prevalence of tobacco use by the year 2025 from the levels in 2009-10.

WHO has maintained that raising prices through taxation is the most effective way to reduce tobacco use. Tobacco taxation is a highly effective measure, particularly when combined with a progressive approach to redistributing revenue from taxation to tobacco control programmes, health care, and other social support services. Decreasing affordability is particularly effective in reducing smoking rates among young people.

Even though tobacco products are taxed at the highest slab of 28% with the introduction of the Goods and Services Tax (GST) in 2017, tax as a percentage of retail price on tobacco products was approximately 53% on cigarettes, 22% on bidis, and 60% for smokeless tobacco (SLT). This is far below the WHO recommended tax level of at least 75% of retail price for all tobacco products.

The Union Budget presented in February 2022 kept cigarette taxes unchanged for the second year in a row. There has been a small increase in the National Calamity Contingent Duty on tobacco products in the central government budget for FY 2020–2021. This was not applied on bidis despite it being one of the most heavily used tobacco products in India.

Quitting smoking at any stage of one's life has multiple health benefits, both short and long term. WHO estimates that within 1 year of cessation, one's risk of coronary heart disease dips by about half than that of a smoker's. Stroke risk keeps decreasing progressively between 5 and 15 years of quitting. It can enhance one's life expectancy anywhere between 3-10 years depending on the age one stops consumption of tobacco products.

Only around 6% of global deaths attributable to smoking tobacco use occurs among individuals who have quit smoking at least 15 years previously, highlighted IHME's GBD 2019.

The report also goes on to show that almost two-third (65.5%) of all current smokers began smoking by age 20, and nearly 9 in 10 smokers began by age 25. This highlights "a critical age window during which individuals develop nicotine addiction and transition to become established smokers".