doi:10.1038/nindia.2014.76 Published online 29 May 2014
The newly elected government in India made a bold commitment to tobacco control in the country today when its Health Minister Harsh Vardhan addressed an anti-tobacco meet saying he takes out a cigarette from the lips of a smoker when he spots one.
Harsh Vardhan, a trained surgeon, was releasing a report on the economic burden of tobacco related diseases in India. The report has been put together by public health researcher Rijo John of IIT Jodhpur and scientist Sarit Rout of the Public Health Foundation of India (PHFI).
“The financial burden of tobacco attributable diseases will continue to push families of millions of tobacco users towards poverty. We can’t and must not let that happen,” Harsh Vardhan said.
The minister also unveiled an anti tobacco campaign featuring cricketer Rahul Dravid. The PHFI report supported by India’s health ministry and the World Health Organization (WHO) was released to mark 'World No Tobacco Day'. It has some startling figures to show why it makes poor economic sense for India not to control tobacco use urgently.
According to the researchers, in 2011 the total economic costs due to tobacco use from diseases such as cardiovascular and respiratory as well as tuberculosis and cancers in India was Rupees 1, 04,500 crores – amounting to 1.16 per cent of the country's GDP. “What came as a surprise is that this figure is 12 per cent more than what the country had spent on healthcare as a whole in 2011,” says Rout.
Co-author of the study John said they used data from the National Sample Survey for tobacco users within the age range of 35-69 years to find that the indirect costs of tobacco use were far higher than the direct costs. “84 per cent of the costs are from indirect morbidities and premature deaths while only 16 per cent are direct medical costs of treating tobacco related diseases,” he said.
The researchers found cardio vascular diseases to be the major contributors to this economic burden at Rs 3600 crores followed by respiratory diseases which cost the country Rs 2800 crores in direct morbidity costs due to tobacco use in 2011. Tuberculosis made a dent of Rs 2300 crores and cancers Rs 1400 crores during that period, John said.
Thirteen Indian states were studied and Uttar Pradesh stood out as the highest contributor to this economic burden followed by West Bengal and Andhra Pradesh. Lov Verma, secretary to the ministry of health and family welfare, said while everyone might not be able to do something as drastic as “pulling out cigarettes from the mouths of smokers”, his government will actively consider raising taxes on tobacco products.
The Director General of Health Services (DGHS) Jagdish Prasad said that while the government machinery wishes to ‘eradicate’ tobacco related disease such as malaria or polio rather than merely ‘controlling’ it, the tobacco ‘mafia’ was coming in the way of this goal. At a policy level, the government should now take a decision to stop manufactures of bidis in the country, he urged. In 53 high consumption districts of the country, the government wants to decrease or abolish tobacco use. “The idea is to control tobacco use by 60 per cent in the 12th plan period,” he said.
According to J. V. R. Prasada Rao, United Nations special envoy for AIDS Asia and the Pacific and also a board member of PHFI, some issues that hamper tobacco control in India are a thriving bidi industry in the absence of better livelihood options for tobacco growers, and extensive tobacco growth in some states due to ignorance about alternative crops. “Also the inherent contradiction where we have banned gutkha effectively but continue to sell cigarettes at duty free shops,” he pointed out.
The new government will have to make policy level changes to address these contradictions to reduce tobacco related mortality, he added.