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Counting 15 million more poor in India, thanks to tobacco
  1. Rijo M John1,
  2. Hai-Yen Sung2,
  3. Wendy B Max2,
  4. Hana Ross1
  1. 1International Tobacco Control, American Cancer Society, Atlanta, Georgia, USA
  2. 2Institute for Health and Aging, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Rijo M John, Director, International Tobacco Control, American Cancer Society, 250 Williams Street, Atlanta, GA 30044, USA; rijo.john{at}


Objective To quantify the impact of tobacco use and the related medical expenditure on poverty in India.

Methods Tobacco expenditure and associated medical expenditure attributable to tobacco use were subtracted from the household monthly consumption expenditure in order to derive an appropriate measure of household disposable income. The 2004 National Sample Survey, a nationally representative survey of Indian households, was used to estimate the true level of poverty.

Results Our estimates indicate that accounting for direct expenditure on tobacco would increase the rural and the urban poverty rates by 1.5% (affecting 11.8 million people) and 0.72% (affecting 2.3 million people), respectively. Similarly, the out-of-pocket costs of tobacco-attributable medical care result in 0.09% higher poverty rates in rural areas (affecting 0.7 million people) and in 0.07% higher poverty rates in urban locations (affecting 0.23 million people).

Conclusions Tobacco consumption impoverishes roughly 15 million people in India. Hence tobacco control measures would not only improve public health, but would also reduce poverty in India.

  • Tobacco
  • smoking
  • poverty
  • India
  • economics
  • public policy

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.