India needs 100 per-cent smoke-free public places, say health experts

Health experts have called for 100 per cent smoke-free public places in India, citing 325,600 deaths attributable to second-hand smoke in 2023. They said stronger protection was needed as 444 million Indians were estimated to have been exposed to tobacco smoke

New Delhi: Leading health experts have called for 100 per cent smoke-free public places in India to protect millions from second-hand smoke, pointing to an estimated 3.25 lakh deaths attributable to passive smoking in the country in 2023 and stressing that non-smokers can also suffer serious health consequences from tobacco smoke exposure.

Dr V K Paul, former Member of NITI Aayog, said India had made progress in reducing exposure to second-hand smoke, but the scale of the problem remained substantial.

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Referring to a recently published Global Burden of Disease study in The Lancet Public Health, Paul said the proportion of India’s population exposed to second-hand smoke had declined significantly since 1990, but the absolute burden remained high because of population growth.

“Second-hand smoke exposure is still happening. The Lancet study shows that in 1990, 43 per cent of India’s population was exposed to second-hand smoke. This has now come down to 31 per cent,” Paul said.

“But because the population has increased, the problem is still very large. Globally, 1.7 million deaths are occurring because of second-hand smoke. In India, more than 3.25 lakh deaths are attributable to second-hand smoke,” he said.

Paul stressed that India needed to move towards 100 per cent smoke-free public places.

The experts were speaking at a webinar organised by Tobacco Free India, a citizen-led initiative working towards a tobacco-free India, to strengthen protection against second-hand smoke.

The webinar was among the first major public conversations in India on the issue following the publication of the new Lancet Public Health study.

Held on October 2, Gandhi Jayanti, it also marked 18 years since India’s smoke-free public-place rules came into force.

The webinar was moderated by health communicator Mukesh Kejriwal.

The latest GBD study estimates that 325,600 deaths in India in 2023 were attributable to second-hand smoke, compared with 217,700 in 1990.

It also estimates that around 444 million Indians were exposed to second-hand smoke in 2023. The study notes that its exposure estimates cover exposure at home and workplaces, and do not capture exposure occurring exclusively in settings such as restaurants, public transport and private vehicles.

Former Director General of the Indian Council of Medical Research and president of the Tuberculosis Association of India, Dr V M Katoch, said the evidence on the dangers of passive smoking was well established and warranted stronger protection in public spaces.

“Passive smoking is very dangerous. It has been proven by many studies and has a substantial impact. People are affected in public places, workplaces, and even in their homes,” Dr Katoch said.

He said exposure to tobacco smoke could damage the respiratory system and affect different organs of the body over time.

“Those who are exposed to smoke experience similar harmful effects. Their respiratory system is damaged and different organs of the body are affected. Over a period of time, it becomes equally harmful,” he said.

Senior cardiologist Dr K K Talwar said India had taken several important tobacco-control measures, including taxation and health warnings on tobacco packs, to discourage tobacco use.

But second-hand smoking, he said, created a separate concern because people could become victims without using tobacco themselves.

“Even if you don’t smoke and somebody else is smoking, you also become a smoker. It can be as harmful as active smoking,” Dr Talwar said.

“This is one of the reasons why public places should be entirely smoke-free,” he said.

Dr Uma Kumar, Head of Rheumatology at AIIMS-Delhi, emphasised the need to protect women and children from involuntary exposure to tobacco smoke.

Referring to the new Lancet Public Health study, Dr Kumar said the sheer scale of exposure demonstrated that passive smoking was a major public-health concern rather than an issue affecting only individual smokers.

With hundreds of millions of Indians exposed, she stressed the importance of protecting people who may have little control over the environment in which they live, work or spend time.

Dr Kumar also called for a progressive approach to smoke-free policies, saying that after years of implementing smoke-free rules, India should move away from the concept of designated smoking zones and work towards completely smoke-free public environments.

Dr Katoch cautioned that public-place restrictions alone could not address the entire problem. He said greater attention was needed to exposure within homes, particularly where children and other non-smokers may be unable to control their surroundings.

He said India needed to bring smoking in public places down to zero while also addressing exposure in domestic environments.

The issue is particularly relevant 18 years after India’s smoke-free rules came into force.

The Prohibition of Smoking in Public Places Rules came into effect on October 2, 2008, prohibiting smoking in public places while allowing designated smoking areas in certain large hotels, restaurants and airports.

Globally, WHO says almost 40 per cent of countries now have completely smoke-free indoor public places. Its tobacco-control guidance identifies comprehensive smoke-free environments as the way to protect people from second-hand tobacco smoke.

Paul said, however, that the larger objective should extend beyond protecting people from second-hand smoke to eliminating tobacco use itself.

“India needs to be tobacco-free, not just free from second-hand smoke. There should be no smoking and no chewing tobacco. Both have harmful effects,” he said.

“The ultimate goal is to protect the next generation from this deadly habit and its harmful effects,” he added.

The second-hand smoke burden comes against the backdrop of India’s much larger tobacco epidemic. Tobacco use accounts for nearly 1.35 million, or 13.5 lakh, deaths every year in India, according to the World Health Organization.

A WHO study estimated the economic cost of diseases and premature deaths attributable to tobacco use at Rs 1.77 lakh crore in 2017-18, equivalent to about 1 per cent of India’s GDP.

India’s tobacco burden extends well beyond cigarettes.

The WHO identifies smokeless tobacco as the most prevalent form of tobacco use in the country, with products including khaini, gutkha, tobacco-containing betel quid and zarda, alongside smoking products such as bidis, cigarettes and hookah.

The experts said stronger protection from second-hand smoke should therefore form part of a broader effort to reduce tobacco use in all its forms and protect the next generation from tobacco addiction and its health consequences.