Tobacco affordability fuelling cancer epidemic in India
Nicotine addiction doesn’t start by accident.
The industry has come up with over 16 000 flavours.
They're not “fun” or “cool“ – they’re calculated traps.
Flavours are often cited as the number 1 reason young people start
using nicotine and tobacco products. These products are designed to mask
harshness, manipulate impressions and build lifelong addiction.
Unlike in other countries where higher prices have deterred
smoking, prices remain low in India; tobacco affordability undermines the World
Health Organization’s MPOWER framework and weakens control, hindering efforts
to reduce tobacco-related cancers; implementing robust policies are the need of
the hour to curb tobacco use
World No Tobacco Day (31st
May 2025)
“Sutta (smoking) breaks” a
creative escape. “It’s time to take a break from work stress and make
connections. The chai-sutta break is where ideas flow as freely as the smoke.”
But for many non-smokers, this come at a cost — involuntary exposure to
second-hand smoke.
According to GATS2 data, nearly 42% of men and 14% of women in
India use tobacco. Home to 70% of the world’s smokeless tobacco (SLT) users,
SLT is preferred over smoked tobacco in the country. In smoked tobacco, the
bidi is favoured over cigarettes, especially in rural and low-income groups.
Despite the preference for bidis, India has seen the largest increase in the
market share of cigarettes globally.
Now even in villages, people want to try cigarettes because they
think it’s modern.”
Both SLT and smoked tobacco drastically increase cancer risk,
particularly for lung, head, neck, stomach, and pancreatic cancers. “
India ranks first globally in male cancer incidence and mortality
rates. Among tobacco-related cancers in males, lung cancer leads globally,
while in India, lip and oral cancers top the list, followed by lung cancer.
Along with the health burden, tobacco use imposed an economic cost
of ₹1.77 lakh crore (1.04% of India’s GDP) in 2017-2018. Smoking accounted for
74% of these costs, while SLT use made up 26%. With tobacco use on the rise,
both health and economic costs are projected to increase.
Smoking doesn’t just cost you money — it costs you your life and
the lives of those who depend on you.”
India faces a dual challenge of significant health and economic
burdens from tobacco-related cancers and the complexities of lung cancer
screening in a tuberculosis-endemic country. This underscores the urgent need
for evidence-based anti-tobacco policies as a primary prevention strategy.
However, the tobacco industry’s influence — through policy interference,
pricing tactics to maintain affordability, targeted marketing, dense tobacco
shop networks, and a lack of political will — ensures widespread tobacco
accessibility.
“The fact that a bidi costs less than a cup of tea is a tragedy,”
"How cheap tobacco
ruining lives.”
Taxation is a critical yet underutilised tool in reducing tobacco
use.
Despite the proposed GST increase to 35%, it falls short of the
World Health Organization’s recommendation of taxing tobacco at 75% of its MRP
to effectively deter use.
Even with the steep increase in tobacco tax, its impact decreases
if consumers’ income increases significantly.
Unlike in many countries where higher prices have curbed smoking,
rising incomes in India — especially among the 450 million middle class — have
outpaced tax hikes. With more purchasing power, tobacco remains affordable.
The 2024 Union Budget’s unchanged tobacco taxes worsened the issue,
enabling “undershifting,” where manufacturers absorb tax hikes to grow their
markets.
Unit pricing
A key factor in tobacco affordability is its unit pricing. A pack
of bidis has a median price of ₹12 but can be found for as little as ₹5.
Similarly, smokeless tobacco products have a median price of ₹5, with some
being sold for as low as ₹1. While
cigarette packs have a median price of ₹95, cheaper options are available for
as low as ₹5.
“Cigarettes are so cheap
that they’re easy to buy. The government needs to make it harder for
people to afford them.”
To enhance affordability, cigarettes are often sold as single
sticks — a practice banned in 88 countries but not in India.
Priced at approximately ₹15, single sticks become easily affordable
and bypass graphic health warnings. Research shows that 87% of Indian cigarette
vendors sell single sticks, frequently operating near tea stalls, reinforcing
the widespread “chai-sutta” culture.
In India where a significant proportion of the population earns
₹170-180 per day, along with the addictive potential of tobacco, makes the
current tobacco pricing affordable to fulfill their cravings.
Tobacco affordability undermines the WHO’s MPOWER framework and
weakens tobacco control, hindering efforts to reduce tobacco-related cancers.
Reducing tobacco use is vital for cutting cancer incidence. Implementing robust
anti-tobacco policies can be effective in curbing tobacco use.
Regular tax hikes that outpace income growth can make tobacco
products unaffordable, discouraging their use. Additionally, banning
single-stick sales can reinforce health warnings and curb impulse purchases.
Further, allocating tobacco tax revenue towards public health initiatives, such
as cancer screenings in underserved areas, can have a significant impact.
Enforcing plain packaging with prominent health warnings can also reduce
tobacco’s appeal, while restricting sales near tea stalls can help break the
‘chai-sutta’ association. Robust enforcement, through regular inspections and
penalties, is essential to uphold these regulations.
THE GIST
India ranks first globally in male cancer incidence and mortality
rates. Among tobacco-related cancers in males, lung cancer leads globally,
while in India, lip and oral cancers top the list, followed by lung cancer
Along with the health burden, tobacco use imposed an economic cost
of ₹1.77 lakh crore (1.04% of India’s GDP) in 2017-2018. Smoking accounted for
74% of these costs, while SLT use made up 26%
India faces a dual challenge of significant health and economic
burdens from tobacco-related cancers and the complexities of lung cancer
screening in a tuberculosis-endemic country. This underscores the urgent need
for evidence-based anti-tobacco policies as a primary prevention strategy
I loved this blog, we Indians are demanding for smart cities but we can't make ourselves responsible and smart citizens
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