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A patchy record Even as the prevalence of daily smoking among men in India has come down from about 34 to 23 per cent between 1980 and 2012, the absolute number of smokers has risen from about 69 million in 1980 to 98 million in 2012. In the case of women, while the prevalence has increased only marginally from 3 per cent in 1980 to 3.2 per cent in 2012, the number of smokers has more than doubled from 5.3 million to 12.1 million during the same period. The increase in the absolute number of smokers is due to the growth in population outpacing the percentage reduction in prevalence. These are some of the findings of a study published in the Journal of the American Medical AssociationThe only silver lining is the reduction in the mean daily consumption of cigarettes and bidis per smoker from 11.6 to 8.2 between 1980 and 2012. All these clearly illustrate why tobacco use (smoking and chewing) kills nearly a million people annually in India. Large-scale studies undertaken in a few countries, India included, have found that mortality among middle-aged people who smoked was two to three times more than those who have never smoked. Thus, on an average, the life span of smokers is reduced by 10 years. The prevalence of smoking reaches its peak at 45 per cent in the 45 to 49 age group, and then falls. Except for facilitating individual States to ban chewing tobacco under the Food Safety and Standards Regulation Act 2011, most of the measures to rein in tobacco use have not been implemented in earnest. It is shocking that there is near-absolute apathy on the part of the government despite the huge health implications and economic costs of tobacco use. According to the Ministry of Health own admission before the Supreme Court in October last year, the total economic cost of tobacco use is over Rs.10,500 crore ($1.7 billion). The 2013 WHO report on the global tobacco epidemic reveals India shortcomings in implementing key tobacco control policies aimed at cutting consumption. For instance, it has achieved just 50 per cent compliance in banning all forms of direct and indirect advertising. Not surprisingly, it has got a dismal rating of two on a five-point scale for the small health warning on cigarette packages. Besides violating the WHO Framework Convention on Tobacco Control, to which India is a signatory, by deciding to rotate pictorial warnings only once every two years instead of every year, it is yet to change even the ineffective ones first introduced in 2009. Thousands of deaths that take place every year represent the huge and tragic cost of deferring to the interests of the tobacco industry and tobacco growers.