Quitting tobacco could boost incomes of millions of households in India

Quitting tobacco could give a major economic uplift to the incomes of more than 20 million households in India, suggests an economic analysis published in the open access journal BMJ Global Health.

While the greatest impact would be felt in rural areas and among the poorest households, 7 million middle income families would also stand to benefit, the estimates suggest. 

Around 80% of tobacco users live in low and middle income countries, where a significant proportion of household income is spent on tobacco products, point out the researchers. 

The treatment of tobacco-related disease and subsequent lost productivity due to illness and premature death add up to global economic losses of more than US$1 trillion every year, they add. And money spent on tobacco means less for essentials, such as food, education, and healthcare, they explain. 

They wanted to quantify the long term economic benefits of ditching tobacco for households in low and middle income countries, and estimate how many families could therefore be lifted out of poverty. 

They therefore extracted data from the Indian National Sample Survey (NSS) 2022–23 Household Consumption Expenditure Survey (HCES), for the period spanning July 2022 to June 2023.

The survey included 261,746 nationally representative households, 59% of which were located in rural areas of the country. It was structured according to household characteristics; food items; consumables, including tax (pan), tobacco and alcohol and services; and durable items. 

Household consumption of tobacco products was recorded for 7 day periods and included bidis, cigarettes, gutka, zarda, kiman, suri, leaf tobacco, cheroot, snuff and other forms.

Monthly household expenditure was estimated using Deaton's equivalence scale-a rigorous economic framework that measures how household needs vary with size and age of the occupants. 

The data showed that the poorest households allocated the highest monthly expenditure per head to tobacco (6.4%), as did households in rural areas (6.6%). 

And the proportion of spend on tobacco fell as household income rose: it was 4.4% in poorer households; 3.6% in middle income households; 2.8% in richer households; and 2% in the richest. 

Rural households allocated a larger share of income to tobacco across all economic groups, suggesting the influence of specific cultural, social, and accessibility factors in rural areas, say the researchers. 

A comprehensive analysis of the potential for economic mobility after quitting tobacco indicated that 20.5 million (11%) households in India would receive a major economic boost, moving up one economic class. 

There were noticeable geographical disparities, with greater economic uplift potential in rural areas, where 17 million (12%) households would benefit compared with 3.5 million (just over 7%) in urban areas. 

Another 129,841(0.1%) households could potentially move up two economic categories, and 10,781 could potentially move up three, the estimates indicate. 

Middle income households would also stand to benefit, with 5 million (13%) advancing to richer categories. Again, more rural households (14%) than urban households (9%) would potentially benefit. 

This is an observational study, and based on estimates. As such, no definitive conclusions can be drawn about the actual economic benefits of giving up tobacco use. And it doesn't always follow that if money isn't spent on tobacco, it would be spent on essentials, including food or education, point out the researchers. 

Nevertheless, they suggest their findings indicate that: "Tobacco consumption functions as a significant barrier to economic advancement for millions of households. 

"The finding that 20.49 million households could transition to higher economic classes represents unprecedented documentation of tobacco's direct economic constraints and cessation's liberation potential," they write.

"Our results demonstrate that tobacco cessation is not only a health imperative but also a powerful economic tool for poverty reduction," they add. 

"In the Indian context, where childhood malnutrition remains a significant challenge, the economic benefits of tobacco cessation could contribute meaningfully to achieving better health outcomes for children, particularly in rural households where the economic impact is most pronounced," they say. 

"The substantial resources freed through tobacco cessation-averaging 6.6% of [monthly expenditure per head] for the poorest rural households-represent meaningful opportunities for improved child nutrition, healthcare access, and educational investments," they continue. 

And they conclude: "International development organisations should consider tobacco cessation support as a poverty reduction strategy, not merely as a health intervention, given its potential to achieve dual objectives of improved health outcomes and economic development with particular effectiveness in rural areas of [low and middle income countries]."