Opinion | The Tobacco Crisis in India: Health, Regulation, and the Path Forward

Even today, tobacco use continues to be one of India’s biggest public health challenges, with serious consequences for millions of people. According to the Global Adult Tobacco Survey (GATS) 2016–17, India, a country of over 1.4 billion people, is home to more than 266 million tobacco users. Despite significant efforts by the government and other organizations, tobacco use still remains a deep-seated concern in India’s cultural, social, and economic structure. Growing up in India, I have witnessed firsthand how tobacco consumption is not just a personal choice but often a community norm. It is something that transcends social and economic status, especially in rural areas where people view chewing tobacco or smoking bidis as part of daily life. The health risks of tobacco use are undeniable, and its continued frequency has widespread consequences for the country’s healthcare system, economic productivity, and overall well-being. Having known people personally affected by tobacco-related diseases, it’s clear that more needs to be done to address this urgent issue of public health threat.

Tobacco use is widespread across various demographic groups in India, with higher rates observed among men, rural populations, and marginalized communities. While cigarettes are commonly used, smokeless tobacco products such as gutka, pan masala, and khaini are also widely consumed, and addiction rates in certain regions are particularly concerning. I have seen in my community how people from low-income backgrounds often turn to smokeless tobacco as a cheaper alternative, with little awareness of the destructive long-term effects. A particularly significant trend, especially in rural areas, is the growing use of tobacco among women. States like West Bengal, Bihar, and Uttar Pradesh have concerning rates of tobacco consumption, and the lack of healthcare information and education about the risks just makes the problem even worse.

Another challenge is India’s reliance on bidis, hand-rolled cigarettes wrapped in tendu leaves. They are incredibly affordable and widely available, especially in rural areas. In my own experience while travelling to rural areas or small towns I’ve seen how bidis have become more common for the farmers, workers and even children, mainly because they’re so affordable that even children can buy them with their pocket money. The deep cultural ties that bind tobacco consumption to certain communities make bidis a particularly difficult issue to address. Moreover, small-scale manufacturing and a vast informal trade network give the tobacco industry a dominant position in India, complicating efforts to regulate and implement tobacco control laws. As much as the government tries to implement changes, the tobacco industry’s hold on society is well established, making the task seem almost unbeatable.

Tobacco use in India has severe public health implications, with an estimated 1 million deaths annually attributed to it. Personally, I’ve seen the devastating toll tobacco takes on individuals. I once saw an advertisement on television about how a woman was affected by this, after years of smoking, she was diagnosed with chronic obstructive pulmonary disease (COPD), and eventually, the toll of years of smoking caught up with her. This story is far from unique in a country where oral cancer, lung cancer, and heart disease have become so common, particularly due to the high rates of smoking and smokeless tobacco use. Products like gutka are especially harmful, containing over 4,000 chemicals, many of which are carcinogenic. The chemicals are absorbed through the oral mucosa, significantly raising the risk of tooth decay, gum disease, and mouth ulcers. I’ve seen friends and family members who chew gutka and struggle with oral health issues, yet the addiction to these products seems too strong to break.

Moreover, secondhand smoke remains a silent killer in India. I remember sitting in crowded public spaces, like local markets or train stations and even hospitals, where the air would be thick with cigarette smoke. For non-smokers, particularly women and children, this passive smoking poses a serious health risk. I have seen children coughing in the presence of smokers in public spaces, and it breaks my heart to know that these innocent individuals, especially the younger ones, are paying the price for others’ unhealthy habits.

Thankfully, the Indian government has taken significant steps to regulate tobacco use. The Cigarettes and Other Tobacco Products Act (COTPA) of 2003 has laid the foundation for tobacco control in the country. From banning tobacco advertisements in mass media to requiring graphic health warnings on cigarette packaging, the law aims to discourage tobacco consumption and raise public awareness. The first time I saw the graphic warning on a cigarette pack, it made me reflect on how serious the issue really is, especially since many people around me still view tobacco as harmless or just a part of daily life. COTPA also mandates that smoking in public places such as government offices, restaurants, and public transport be prohibited, which aims to protect non-smokers from the harmful effects of secondhand smoke. In my own experience, these regulations have certainly made public spaces more comfortable for nonsmokers. However, putting it into action is still a major challenge, particularly in rural areas where law enforcement is limited and tobacco use is deeply rooted in local culture.

Community-drive campaigns led by organizations like the Public Health Foundation of India (PHFI) and the Voluntary Health Association of India (VHAI) have had a significant impact, particularly in underserved regions. I have personally witnessed a few workshops in rural areas, where health workers ran public awareness campaigns to raise awareness about the dangers of tobacco use. These efforts are crucial because they speak directly to the local community, using local language and experiences to make the message resonate. Hearing real stories from survivors of tobacco-related diseases, shared by local health workers, makes the issue feel more personal and relatable to people.

To reach younger populations, schools and colleges play an essential role in tobacco prevention. I remember my school and college hosting anti-tobacco events during which senior students and teachers or professors and even healthcare professionals led discussions about the harmful effects of tobacco use, and it had a lasting impact on me. Social media campaigns are also an effective way to engage youth and educate them about the dangers of tobacco, with a strong focus on nicotine addiction and its long-term health consequences. In today’s digital age, where social media is a powerful tool, campaigns targeting young people can help spread anti-tobacco messages quickly and effectively.

Communities can also get involved in tobacco control by joining local rallies and taking part in national events like World No Tobacco Day. Media campaigns through radio, television, and social media, are powerful tools for spreading anti-tobacco messages to a wide audience. Survivor stories, awareness videos, and graphic advertisements are compelling ways to communicate the health risks associated with tobacco consumption. These campaigns provide the necessary push to change public perception and reduce tobacco consumption.

To successfully tackle the tobacco epidemic, a comprehensive approach is needed. Stronger implementation of tobacco control laws, including frequent inspections of tobacco vendors and stricter penalties for violations, will help control tobacco use. Public health programs should also provide accessible and affordable quitting programs, including counseling and nicotine replacement therapy (NRT), to help users quit. Increasing tobacco taxes is another proven method to reduce consumption, as higher costs make tobacco less affordable.

In conclusion, even though we’ve made meaningful progress in tobacco control, India’s fight against tobacco is far from over. From what I’ve seen, the damage it does to both individuals and entire communities is undeniable. What’s even more worrying now is how vapes are becoming the new trend, especially among young people, who see them as cool or harmless. That’s why it’s more important than ever to push for stronger laws, better support for those trying to quit, and more awareness campaigns. It’s only through a shared effort, from the government, health workers, and local communities, that we can hope to create a tobacco-free India and a healthier future for the next generation.

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