Smokeless Tobacco Use In Work And Public Places Must Be Prohibited, Akin To Smoking Ban

Did you know that for every Rs 100 received as excise taxes from tobacco products, the Indian economy loses Rs 816? According to the study, Economic Costs of Diseases and Deaths Attributable to Tobacco Use in India, 2017–2018, the economic cost from all diseases and deaths attributable to tobacco use for persons over 35 years between 2017 and 2018 was USD 27.5 billion (INR 1,773.4 billion). Published in a journal by Oxford Academic, this paper also says that during the same time frame, the tax revenue from tobacco was 12.2% of its economic costs, smoking contributed 74%, and smokeless tobacco use (SLT) contributed 26% of the costs. The economic burden of diseases and premature deaths attributable to smoking and SLT use by persons over 35 years of age in India represents more than 1% of India's gross domestic product. The direct health expenditure on treating tobacco-related diseases alone accounts for 5.3% of total private and public health spending in India annually—a drain on both the public health system and the economy that no country can afford. In India, tobacco-related cancers accounted for 27% of the country’s cancer burden in 2020, according to the Indian Council of Medical Research. With nearly 29% of adults using tobacco, India is the second leading consumer of tobacco products after China. The result is a catastrophic death toll of close to 1.35 million preventable deaths per year. 

The most worrisome picture involves the use of SLT among adults; the highest rates of consumption are in South and Southeast Asia. Geographically, more than 85% of the SLT-related burden is in South and Southeast Asia, with India accounting for 70%, Pakistan for 7%, and Bangladesh for 5% of all disability-adjusted life years (DALYs) lost. According to the Global Adult Tobacco Survey (GATS), some of the countries with a high prevalence of SLT use include India, Bangladesh, Egypt, Nigeria, and the Philippines. However, among the global 248 million SLT users, 232 million belong to India and Bangladesh, while India alone carries more than 83% of the global burden. In India, according to the latest GATS survey (2016-2017), 12.8% of women aged 15 years and older were using any form of SLT. In absolute numbers, this corresponds to nearly 58.2 million women consuming any form of SLT in India. The SLT use among women was higher than 10% in 16 states of India. Nearly 17% of women in India initiated SLT use before the age of 15, much higher than the rate among men (11%). Among the various SLT products that women in India consume, the predominant types are betel quid with tobacco (4.5%), oral tobacco (4.3%), khaini (4.2%), and gutka (2.7%). Moreover, the National Family Health Survey (NFHS-4; 2015-2016) further suggested that nearly 5% of lactating women in India consume SLT, which may directly harm neonatal health and nutrition.

To achieve the Indian health target that aims to reduce tobacco use by 15% by 2020 and by 30% by 2025, culture- and context-specific strategies addressing the inequalities in tobacco use must be devised, accompanied by strict implementation of tobacco control policies pertaining to SLT. Southeast Asian countries share the highest disease burden not only due to the popularity of SLT, but also due to the carcinogenic properties of SLT products. The number of deaths attributable to SLT use in India is estimated to be 368,127 (217,076 women and 151,051 men), with nearly three-fifths (60%) of these deaths occurring among women.  The problem is that several tobacco-control policies applicable to smoking products do not apply to SLT products. Government must take this issue seriously and consider prohibiting SLT use in work and public places, similar to the ban on smoking.