Tobacco - A Multi-Dimensional Public Health Crisis
India is home to 267 million adult tobacco users, with tobacco causing around 1.35 million deaths annually.
It is among the world's largest tobacco consumers and producers, posing major public health, economic, and environmental challenges.
WHO Recognition in 2025 Report
- The WHO Global Tobacco Epidemic 2025 recognizes India as
“best‑practice” for:
- 85% pictorial warning labels on cigarette packs covering both front and back
- Strong cessation services, including: national quitline (2M+ users), mobile cessation (mCessation), and tobacco cessation clinics/centres
Challenges of Tobacco use:
- Health Burden: Causes over 1.35 million deaths annually; major contributor to cancer, TB, heart and lung diseases.
- Economic Impact: ₹1.8 lakh crore+ in annual economic loss due to healthcare costs and productivity decline.
- Youth Vulnerability: Easy access to single-stick sales near schools; flavored tobacco and surrogate ads attract youth.
- Weak Law Enforcement: COTPA provisions (public smoking bans, warnings) are poorly implemented, especially in rural areas.
- Tobacco Industry Interference: Political lobbying, misleading marketing, and government stakes in tobacco companies delay reforms.
- Regulatory Gaps: Low taxation on bidis and smokeless tobacco; loopholes in surrogate advertising and packaging.
- Social Acceptance: Cultural normalization of chewing tobacco, especially in rural and tribal communities.
- Low Awareness: Limited understanding of health risks and warnings among illiterate and rural users.
- Judicial Delays: Industry litigation hinders timely implementation of stronger tobacco control laws.
Key Policy Measures
- Packaging & Health Warnings
- As per COTPA 2003 and amendments, 85% of pack surface is dedicated to graphic warnings (60% pictorial, 25% text) and quitline info
- These visuals evoke strong emotional response and prompt quitting intentions
- National Tobacco Control Programme (NTCP)
- Launched in 2007 to implement COTPA and the WHO FCTC.
- Includes Tobacco Cessation Clinics/Centres (TCCs) offering behavioral counselling, NRT, medication, and public outreach
- Coordinated nationally through NIMHANS, Bangalore
- Cessation & Support Services
- Quitline 1800-11-2356 and mCessation (SMS-based service) have reached over 2 million users; ~7% quit successfully at 6 months
- Local cessation centers and mobile outreach continue expanding, especially in rural areas.
- Legislative & Regulatory Actions
- COTPA 2003: bans advertising, prohibits smoking in public and near educational institutions, and regulates trade
- PECA 2019: total ban on e-cigarettes, including flavored variants
- Stricter penalties & OTT regulations: anti-tobacco health spots and disclaimers mandated for online content showing tobacco
- Taxation & Price Control
- Tobacco taxes (~53% of retail price) high by Indian standards but still below WHO’s 75% benchmark.
- Uniform taxation across products remains a goal to reduce affordability, especially of bidis and smokeless tobacco
- Smoke-Free Environments & Enforcement
- Nationwide ban on public smoking since 2002; major cities like Bengaluru and Chandigarh enforce smoke-free rules actively
- Bengaluru achieved a 27% reduction in public smoking from 2017–2021 through enforcement and awareness campaigns
Challenges & Areas for Improvement
- Industry tactics: Single-stick sales evade warnings and taxes; surrogate advertising
- Weak enforcement: Fines outdated; smuggling and low compliance in pictorial warnings continue
- Tax shortfall: Below WHO threshold, reducing impact on affordability
- Policy interference: Lobby influence and government stakes in tobacco firms complicate regulation .
