In 2023, India became the first country in the world to mandate anti-tobacco warnings on over-the-top (OTT) streaming platforms like Netflix and Amazon Prime. This was an ambitious step, reflecting India’s commitment to fight tobacco addiction.

Yet, behind the scenes, the country’s fight against tobacco has been filled with setbacks, fragmented policies, and missed opportunities.

Despite early adoption of the World Health Organization’s Framework Convention on Tobacco Control (WHO-FCTC) and enactment of the Cigarettes and Other Tobacco Products Act (COTPA) in 2003, India remains one of the world’s largest consumers of tobacco, with approximately 300 million users. One of them remains. Most depend on smokeless tobacco.

With a population of over 1.4 billion and growing, India’s struggle against tobacco is not just a public health issue, but a profound national challenge. Tobacco is a significant contributor to cancer, respiratory diseases and cardiovascular diseases in the country. Every year, tobacco-related diseases kill 1.35 million people and drain Rs 1773.4 crore from the economy, which is about 1 percent of India’s GDP.

This amount is significant considering that India’s health budget for 2024-25 was only Rs 90,171 crore. These disadvantages undermine efforts to achieve the goals of initiatives like Ayushman Bharat, which aims to provide affordable healthcare to millions of people.

India’s tobacco control problem: a policy failure

India’s tobacco control policies, supported by the Cigarettes and Other Tobacco Products Act (COTPA) and the National Tobacco Control Program (NTCP), have primarily focused on awareness and punitive deterrence. However, these policies often measure success by the volume of activities rather than concrete outcomes.

In the government’s 2022 report on tobacco control in India, then Union Health Minister Mansukh Mandaviya highlighted India’s position as a “global leader” in tobacco control, with overall tobacco use declining from 34.6 percent to 28.6 percent in 2009–10. Was cited to be. In 2016-17. But the report fails to address two important issues: it is outdated, relying on data from nearly a decade ago, and it avoids discussing the actual number of tobacco users, focusing instead on the percentage who Obscures the raw scale of continuously increasing tobacco use. population.

Even the reported successes appear questionable when seen in context. While tobacco use among teens has declined by 42.5 percent between 2010 and 2019, according to the Global Youth Tobacco Survey, the absolute number of users remains surprisingly high due to India’s huge population base and growing youth demographics.

The report paints a picture of success but ignores the fact that, in real numbers, India still adds millions of new tobacco users every year. Population growth, combined with high usage rates, has mitigated the impact of any relative reductions, making real progress difficult to discern.

Challenges of tobacco control

India’s tobacco control strategy faces many challenges.

Misaligned metrics and activity-based success: NTCP, through District Tobacco Control Cells (DTCC), emphasizes activity reports on result-oriented metrics such as quit rates or reduction in consumption – number of campaigns, public awareness campaigns and monitoring. This approach has created a bureaucratic system that is more concerned with meeting procedural requirements than achieving real behavior change.

A significant aspect of the 2022 report is the absence of data on successful completion, while over 600 district cells are reportedly working towards this goal. Attrition rates, even when mentioned, are self-reported and unreliable, with termination rates hovering at just 2 percent. This figure is a reflection of the systemic failure of user behavior to provide low, meaningful termination support.

Taxation and rise of illicit market: High tobacco taxes imposed in India intended to curb consumption have had mixed results. While they have made factory-made cigarettes expensive, they have also driven users toward cheaper alternatives such as beedis and unregulated smokeless tobacco products. The shift to these products has sustained high consumption levels and fueled the black market for illicit tobacco.

Only 8 percent of India’s tobacco consumption comes from legally produced cigarettes, with the remaining demand met by informal, often dangerous, alternatives. This is ironic as India is one of the top tobacco producing countries supplying high quality and pharma-grade nicotine across the world. This underground trade avoids taxation, reducing government revenues and undermining public health initiatives.

Limited access to stigma and termination support: Tobacco addiction is not just a habit; This is a deep socio-economic problem, particularly in low-income and rural populations where tobacco use is culturally embedded and accessible in affordable forms such as smokeless tobacco. Unfortunately, termination services are sporadic, especially in rural areas where more than two-thirds of users live.

Government-funded cessation programs and nicotine replacement therapy (NRT) are inaccessible to many people. The few detention centers that exist lack the necessary infrastructure and personnel to handle India’s huge tobacco-using population. Many healthcare providers in rural areas are untrained in providing cessation support, and treatments such as NRT are out of reach for most Indians. There is also a marked lack of participation by private healthcare providers, and the costs associated with cessation treatments are generally not covered by insurance, further limiting their uptake.

Rethinking tobacco control: toward a cessation-oriented strategy.

India’s approach to tobacco control should move from awareness and prevention to tobacco-oriented, evidence-based strategies. This means restructuring the NTCP and DTCC to measure success in terms of actual reductions in tobacco use, providing affordable and accessible cessation support, and promoting a health care system that prioritizes tobacco cessation as a primary objective. Is.

Cessation programs should be integrated into primary health care settings, and NRT and counseling services should be expanded nationwide.

If India is to overcome its tobacco crisis, it will have to shift its focus from activity-based achievements to outcome-driven success. For a country that has introduced many anti-tobacco measures, this is not a time for rhetoric, but to move forward with results.