Now, chew on this!

Suppose you are a man aged between 35 and 39 years, you are most likely to bear a part of the whopping Rs 15,000 crores in today’s value spent on treating just four diseases — three types of mouth and oral cancers and stroke — that are caused by consuming smokeless tobacco such as gutka, khaini, and pan masala. For women, similar figures are Rs 5,833 crore for those aged between 40 and 49 years old.

Suppose you have never used smokeless tobacco... given how strongly this culture is embedded in South Asian culture, coupled with poor implementation of existing tobacco control laws and policies, you are likely to start consuming it at some point in your lifetime. If you are one of those who have finally quit taking any form of smokeless tobacco, you are likely to be surrounded by a social and economic environment where using smokeless tobacco is acceptable, cheap to buy, and even sold to minors near schools despite the laws prohibiting it. Moreover, it is celebrated as well because offering it to guests at weddings, for example, signifies one’s prestige and social status. This could easily make you relapse.

Gutka has one secret weapon, nicotine, that is addictive enough to make it extremely hard for you to give up this habit. On average, only 4 in 10 Indian users of smokeless tobacco make a quit attempt, and of that group, only 7 in 100 succeed.

This woefully small number is due to their strong presence both socially and culturally and the suboptimal implementation of existing laws and policies to tackle smokeless tobacco.

In a recent study published in the scientific journal Nicotine and Tobacco Research, we considered these compounding interactions of social, economic, regulatory, and policy environments that people in South Asia are surrounded by. The aim was to predict the lifetime costs of smokeless tobacco use. This involved considering not only the current usage pattern of smokeless tobacco but also possible future use and relapsing behaviours if the current tobacco control policies and their implementation stayed the same. The underlying idea was to see whether India, for example, needs to consider positive changes in its smokeless tobacco policies and speed up the implementation of its existing laws and policies.

Our findings are alarming. These companies are causing India to bear a staggering lifetime cost of Rs 1.6 lakh crore in today’s value. These estimates are conservative, as we just focused on the link between smokeless tobacco and the diseases caused by it based on the strongest and most relevant evidence available for the region. The actual costs are likely to be much higher than this. Putting these costs into perspective, if we eliminated smokeless tobacco today, a typical 15-year-old adolescent in India would not have to spend Rs 1,500 to contribute to the national treatment pot to deal with the diseases caused by consuming gutka! What does it all mean to a common person? Saying ‘no’ to gutka is both safer and wiser!

Some people have strong willpower, and they can stop consuming smokeless tobacco right away. However, for many, the nicotine contained in these products might make it hard to stop. Therefore, as a country, we need to start thinking about how best to support individuals to help them stop smokeless tobacco use and implement these programmes nationally. Behavioural support (counselling) and medication might be useful to this end. Additionally, we need to strengthen our existing laws and regulations to make sure that smokeless tobacco is not sold near schools, to minors, or smuggled into the country.

Our study has shown that for both men and women, the greatest burden of such gutka companies falls on the younger age brackets who are not current smokeless tobacco users but go on to initiate its use at some point in the future.

An average Indian spends about Rs 13 on a single count of smokeless tobacco purchase, but they might not realise that this private cost would escalate to trillions of rupees for the country as a result of their decision to spend money in this way. Surely, Rs 13 could buy better things for them! Therefore, it is both safer and wiser to say ‘No’ to gutka to stop the scourge of smokeless tobacco.

(Subhash Pokhrel is a professor of Health Economics while Ravi
Mehrotra is an honorary professor of Global Health at Brunel University London, UK.)