From Tea Stalls to Tumours, Tobacco Affordability Fuelling Cancer Epidemic in India

According to a recent survey India ranks among the top countries globally for male cancer incidence and mortality, with tobacco-related cancers being a significant contributor.

Tobacco Use in India

• Tobacco Consumption: According to GATS2 data, nearly 42% of men and 14% of women in India use tobacco. India is home to 70% of the world’s smokeless tobacco (SLT) users.
  • SLT is more popular than smoked tobacco, especially in rural and low-income communities.
• Preferences: Within smoked tobacco the bidi is preferred over cigarettes due to affordability, particularly in villages. However, India has witnessed the largest global increase in cigarette market share.
• Health Impact: Both SLT and smoked tobacco significantly increase the risk of multiple cancers, including lung, head, neck, stomach, and pancreatic cancers
• India’s Global Cancer Rank: India ranks first globally in male cancer incidence and mortality rates. Among tobacco-related cancers in Indian males lip and oral cancers are most prevalent followed by lung cancer
• Ineffective Enforcement: Despite an official ban on gutkha, it remains widely available and used. The continued visibility and use of gutkha underscore the weak enforcement of existing laws.

Economic cost of Tobacco

• Economic Burden: In 2017–2018, tobacco use imposed an economic cost of ₹1.77 lakh crore, accounting for 1.04% of India’s GDP. 
  • Smoking contributed to 74% of this cost Smokeless Tobacco (SLT) accounted for the remaining 26% With rising tobacco use, both health and economic costs are projected to increase further
• Prevention Dilemma: India faces a dual challenge. A high burden of tobacco-related cancers, especially lung and oral cancers.
• • The complexity of lung cancer screening in a TB-endemic country. This calls for evidence-based anti-tobacco policies focused on primary prevention.
• Policy Resistance: Policy resistance in tobacco control arises due to the tobacco industry’s influence, which impedes reform through policy interference, pricing tactics to maintain affordability, targeted marketing, dense shop networks, and a persistent lack of political will.
• Taxation Gaps: Though there’s a proposal to raise GST on tobacco to 35%, it still falls short of the WHO recommendation of 75% of MRP.
  • Rising disposable incomes among India’s 450 million-strong middle class have outpaced tax hikes
  • 2024 Union Budget kept tobacco prices unchanged, enabling undershifting (where manufacturers absorb tax increases to expand market reach)
• Pricing Disparities: Tobacco pricing in India reveals stark disparities bidis have a median price of ₹12, with some available for as low as ₹5; smokeless tobacco products are even more accessible, with a median price of ₹5 and lowest prices at just ₹1
  • In contrast, cigarettes have a median price of ₹95, yet cheapest options are still available for ₹5, undermining price-based deterrence strategies.
• Accessibility: Single stick sales keep cigarettes affordable and help bypass graphic warnings
  • Banned in 88 countries, this practice remains legal in India
  • 87% of cigarette vendors in India sell single sticks
  • Often sold near tea stalls, reinforcing the “chai-sutta” culture
• Impact on Low income earners: In India, where many earn just ₹170–180 per day (≈ $2), tobacco remains affordable due to low unit prices, its highly addictive nature, and easy availability in small packs or single sticks, making it accessible even to the poorest.

Way Forward

• Early Detection: Tobacco affordability undermines the WHO’s MPOWER framework, which aims to reduce tobacco use through comprehensive control measures. 
  • Weak enforcement and low prices hinder progress in cutting tobacco-related cancers. 
  • Reducing tobacco use is vital for lowering cancer incidence .
  • To succeed, health systems must also be strengthened to enable early detection and treatment
• Taxation: Regular tax hikes that outpace income growth are essential. This makes tobacco increasingly unaffordable, discouraging new and continued use
• Ban on Single-Stick Sales: Eliminating single-stick sales can reinforce health warnings on packs and reduce impulse purchases, especially among youth
• Public Health Investment: Allocate tobacco tax revenue to cancer screenings in underserved areas, public health programmes for awareness and treatment
• Retail Regulation: Implement plain packaging with prominent health warnings to reduce tobacco’s visual appeal and restrict sales near tea stalls to dismantle the “chai-sutta” culture
• Enforcement and Monitoring: Ensure robust enforcement through regular inspections and strict penalties for violations

Conclusion

To effectively combat tobacco-related harm, it is essential to invest in robust cancer screening infrastructure, expand tobacco cessation programmes, and support ongoing research to strengthen and refine evidence-based policies.