Author : Oommen C. Kurian

Expert Speak Health Express
Published on May 30, 2024

As the two most populous countries with high tobacco consumption rates, India and China have undertaken tobacco control efforts to curtail the rise of e-cigarette consumption among youth

Tobacco control in India and China: A comparative perspective

Tobacco is a major contributor to different noncommunicable diseases that burden many developing-country health systems and economies. Continuing use of tobacco remains a significant public health challenge, especially so in India and China, the two most populous countries with high tobacco consumption rates. The issue has gained new dimensions with the rise of e-cigarettes, particularly among the youth, posing fresh challenges to tobacco control efforts. As we approach World No Tobacco Day on 31 May, themed Protecting Children from Tobacco Industry Interference, it is timely to examine the historical and comparative aspects of tobacco control in these large countries, which are also the world’s largest growers of tobacco. This article aims to provide an analysis of the evolution of tobacco use and control efforts in India and China, highlighting key developments and current trends.

Historical context and status as tobacco producers 

Tobacco arrived in China during the Ming Dynasty and became culturally significant through the use of cigarettes and pipe smoking. The 20th century witnessed an expansion of the tobacco industry, solidifying its economic and social importance. China is now the world's largest tobacco producer, with the China National Tobacco Corporation (CNTC) playing a pivotal role. In 2021, China harvested 938,468 hectares, yielding 2,122,877 tonnes of tobacco, and currently covers 30 percent of the global area harvested and 36.2 percent of tobacco cultivated globally (Figure 1). The industry not only caters to vast domestic demand but also contributes significantly to exports. China's tobacco sector is integral to its economy, with the CNTC contributing over 7 percent of the government's total revenue.

China is now the world's largest tobacco producer, with the China National Tobacco Corporation (CNTC) playing a pivotal role.

In India, tobacco was introduced during the Mughal era and quickly became integrated into cultural practices such as smoking bidis and hookahs as well as tobacco-laced paan. By the 17th century, tobacco had quite a prominent place in Indian society. The colonial period saw the tobacco industry grow substantially, establishing itself as a vital economic sector in the post-colonial period. Today, India is the second-largest producer of tobacco globally, both in terms of area harvested and product volumes. In 2021, India harvested 432,840 hectares of tobacco, producing 757,513 tonnes, 13. percent and 12.9 percent of global totals respectively. Key industry players, such as ITC Limited, dominate the market, and the sector supports substantial employment through farming and manufacturing. The economic significance of tobacco in India is underscored by its role in providing livelihoods to millions of farmers and labourers, with approximately 36 million people estimated to be involved in tobacco cultivation and processing.

Source: https://data.un.org/Data.aspx?d=FAO&f=itemCode%3a826

Current tobacco use statistics and Government responses 

The implementation of the WHO Framework Convention on Tobacco Control (FCTC) in China and India has been significant. In China, cigarette smoking is the most prevalent form of tobacco use, deeply entrenched in cultural practices. Data from the Global Adult Tobacco Survey (GATS) indicates that 26.6 percent of adults (50.5 percent of men and 2.1 percent of women) in China are current smokers. China's tobacco control policies are shaped by the Tobacco Monopoly Law and various national and local regulations. Efforts to introduce health warnings and advertising bans often face challenges due to the significant influence of CNTC on policy enforcement. China's public health campaigns, including media campaigns and school-based programmes, aim to reduce tobacco consumption and its associated health risks.

Surveys in India, such as the Global Adult Tobacco Survey (GATS), reveal a high prevalence of tobacco use, with notable variations across age, gender, and urban-rural divides. As of the latest available GATS survey from 2016-17, 28.6 percent of adults (42.4 percent of men and 14.2 percent of women) in India use tobacco products. One in three adults (32.5 percent) in rural areas and one in five adults (21.2 percent) in urban areas used tobacco at the time of the survey. Bidis, cigarettes, and smokeless tobacco are the predominant forms of consumption. India's key tobacco control initiatives include the Cigarettes and Other Tobacco Products Act (COTPA) and the National Tobacco Control Programme (NTCP), which aim to enforce health warnings, advertising bans, and smoke-free laws. Despite progress, challenges remain.

E-cigarettes are marketed as a safer alternative to traditional tobacco products, yet their long-term health effects remain uncertain.

The rise of e-cigarettes, especially among the youth, has added a new dimension to the tobacco control landscape in both countries. E-cigarettes are marketed as a safer alternative to traditional tobacco products, yet their long-term health effects remain uncertain. In China, the prevalence of e-cigarette use among middle- and high-school students has been increasing. In India, although e-cigarettes are banned by the government, the availability of Chinese-made e-cigarettes on the street remains a significant policy challenge. This new trend threatens to undermine progress made in reducing tobacco use among younger populations.

The way forward 

China and India differ in the stringency and enforcement of their tobacco control policies. While both nations have seen varying success, China's relatively larger economic dependence on tobacco complicates efforts to reduce consumption. Cultural attitudes towards tobacco use in both countries significantly impact consumption patterns and cessation efforts. Socioeconomic factors also play a crucial role in shaping tobacco use, with the tobacco industry remaining economically significant in both countries.

Recent studies show that China's tobacco control efforts have seen mixed results despite significant government initiatives. The country ratified FCTC in 2005, leading to the implementation of various measures such as tobacco taxation, advertising bans, and public smoking restrictions. However, enforcement remains inconsistent, particularly due to the influence of the powerful public sector monopoly industry. According to the GATS comparison data for China from 2010 and 2018, the prevalence of current tobacco smoking among adults remained relatively stable, with a slight decline from 28.1 percent in 2010 to 26.6 percent in 2018. Among men, smoking prevalence decreased from 52.9 percent to 50.5 percent, while among women it slightly decreased from 2.4 percent to 2.1 percent. The government's Healthy China 2030 agenda aims to reduce smoking prevalence, but challenges such as low tobacco taxes and weak warning labels persist, necessitating stronger policies and better enforcement to achieve significant public health improvements.

The country ratified FCTC in 2005, leading to the implementation of various measures such as tobacco taxation, advertising bans, and public smoking restrictions.

On the other hand, recent evaluations have shown that India has made significant strides in tobacco control through legislative measures and public health programmes. Both COTPA and NTCP have led to notable reductions in tobacco use prevalence, with GATS data indicating a decline from 34.6 percent in 2009-10 to 28.6 percent in 2016-17 among adults. Despite these advancements, implementation remains inconsistent across states due to varying political and administrative contexts, social acceptance of tobacco use, and enforcement challenges. Continued efforts to enhance policy enforcement and public awareness are essential for further progress. At the same time, tobacco production in India has shown an increasing trend.

Comparative studies have found that both China and India have made substantial efforts in implementing FCTC, yet they face unique challenges and varying degrees of success. In China, the influence of the industry has limited the impact of FCTC measures, resulting in modest declines in smoking prevalence. As discussed, data from GATS shows only slight reductions in smoking rates, and issues like low tobacco taxes and weak warning labels persist, necessitating stronger policies and enforcement. Conversely, India has seen more significant progress through legislative measures such as COTPA and the NTCP, leading to notable reductions in tobacco use. However, implementation varies across states due to differing political and administrative contexts. As we observe World No Tobacco Day, protecting children from tobacco industry interference and addressing the emerging challenge of e-cigarettes should be at the forefront of global and national tobacco control strategies.


Oommen C. Kurian is a Senior Fellow and the Head of Health Initiative at the Observer Research Foundation

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Author

Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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