Article
India’s latest Household Consumption Expenditure Survey (HCES) 2023–24 exposes a deeply uncomfortable reality: tobacco consumption is rising rapidly across the country, even as the state expands publicly funded healthcare. The surge is most pronounced among poorer households, creating a dangerous feedback loop of preventable disease and rising fiscal burden on welfare systems.
Adjusted for inflation, per capita tobacco spending rose 58% in rural India and 77% in urban areas over the past decade. The number of tobacco-consuming households has surged dramatically, with nearly 69% of rural and 46% of urban households now consuming tobacco products. Gutkha has emerged as the dominant driver, especially in rural India, where its consumption has increased nearly sixfold.
The impact is most severe among the poor. Over 70% of rural households in the bottom 40% income bracket consume tobacco, spending a higher share of their limited resources on addictive products than wealthier households. In several states, including Uttar Pradesh, Madhya Pradesh and Bihar, prevalence exceeds 85%.
This trend has serious implications for public health and public finances. Tobacco-related illnesses contribute to nearly 13 lakh deaths annually, while non-communicable diseases now account for 63% of all deaths in India. As schemes like Ayushman Bharat expand coverage and reduce out-of-pocket expenses, the long-term cost of tobacco-induced disease increasingly shifts to the state.
Despite this, tobacco contributes only 2.4% of gross tax revenue, and regulatory enforcement remains weak. Surrogate advertising and celebrity endorsements continue largely unchecked. The HCES data signals a clear policy alarm: without stronger taxation, regulation and prevention, India risks undermining its own welfare and human capital goals.
Short Summary
The HCES 2023–24 reveals a troubling paradox in India’s welfare trajectory: while publicly funded healthcare is expanding, tobacco consumption especially gutkha is rising sharply, particularly among poorer households. Tobacco use has spread widely across rural and urban India, imposing severe health risks and threatening the fiscal sustainability of welfare schemes like Ayushman Bharat. Without stronger taxation, regulation, and public health intervention, the state risks subsidising preventable disease while undermining human capital development.