The gutkha nation and the welfare state, Pg11

Key Highlights:

• The Household Consumption Expenditure Survey (HCES) 2023-24 reveals a rapid increase in tobacco consumption across India, particularly in poorer households.
• Per capita spending on tobacco surged between 2011-12 and 2023-24, with a 58% increase in rural areas and 77% in urban areas after adjusting for inflation.
• Gutkha consumption has seen a nearly sixfold increase in rural households, rising from 5.3% to 30.4%.
• Tobacco-related deaths in India are estimated at 13 lakh annually, contributing significantly to non-communicable diseases (NCDs).
• Over 42 crore Ayushman cards have been issued as of October 2025, saving households an estimated Rs 1.52 lakh crore in health spending.

Detailed Insights:

• The rise in tobacco consumption is no longer limited to traditional demographics, becoming mainstream in both rural and urban India, with rural tobacco-consuming households increasing by 33% and urban households by 59% over a decade.
• Gutkha is the primary driver of increased tobacco use in rural areas, accounting for 41% of all rural tobacco expenditure, while cigarettes remain dominant in urban areas, though gutkha consumption is also rising.
• Geographically, gutkha consumption is concentrated in the central belt of India, including Madhya Pradesh, Uttar Pradesh, Bihar, Chhattisgarh, and Rajasthan, with prevalence rates exceeding the national rural average of 30%.
• Tobacco use is disproportionately concentrated among poorer households, with over 70% of households in the bottom 40% of the income distribution consuming tobacco in rural areas.
• The rise in tobacco consumption, especially among poorer households, poses a moral hazard to publicly funded healthcare schemes like Ayushman Bharat, potentially straining their long-term financial sustainability.
• Despite the health and economic consequences, tobacco products contributed only 2.4% of gross tax revenue in FY23, indicating weak fiscal offsets.
• Surrogate advertising by celebrities promoting gutkha and pan masala under the guise of "silver-coated cardamom" continues unabated, requiring stronger regulatory oversight.

Key Concepts Involved:

• MPCE (Monthly Per Capita Consumption Expenditure): The average amount of money spent by each person in a household per month on goods and services.
• NCDs (Non-Communicable Diseases): Chronic diseases that are not infectious and cannot be spread from person to person, such as heart disease, cancer, and diabetes.
• Ayushman Bharat: A national health scheme providing financial protection to vulnerable families by offering health coverage for various medical treatments.