India's Poor Sink Deeper into Tobacco Trap

The Household Consumption Expenditure Survey (HCES) 2023-24 indicates a worrying increase in tobacco consumption across India, disproportionately affecting poorer households. Between 2011-12 and 2023-24, inflation-adjusted per capita tobacco spending rose by 58% in rural areas and 77% in urban areas.

The number of tobacco-consuming households has dramatically increased. Rural areas saw a 33% rise, while urban areas experienced a 59% jump. Gutkha consumption has surged sixfold in rural India, now representing 41% of all rural tobacco expenditure. Cigarette consumption remains high in cities, but gutkha use is rapidly gaining ground.

Geographically, gutkha consumption is concentrated in central India, with states like Madhya Pradesh and Uttar Pradesh showing very high prevalence. Worryingly, urban consumption patterns are starting to mirror rural trends. Southern states also show troubling increases.

Poorer households are bearing the brunt, with over 70% of the bottom 40% income group in rural areas consuming tobacco. In urban areas, over half of the bottom 40% consume tobacco, spending a significantly larger portion of their income on it compared to wealthier households.

This rise in tobacco use, especially among the poor, poses a threat to public health and the financial sustainability of expanding public healthcare schemes like Ayushman Bharat. While government health expenditure has increased, the increased burden of tobacco-related diseases on the state is a growing concern. Weak fiscal offsets and continued surrogate advertising exacerbate the issue.

The data highlights a critical policy challenge: the unchecked rise in addictive product consumption undermines efforts in human capital development and social protection. The government's commitment to universal health coverage is at odds with this escalating tobacco epidemic, signaling an urgent need for intervention.