India is in the grips of a smoking epidemic that is likely to cause nearly a million deaths a year by 2010, more than half of them among poor and illiterate people, according to a study released Thursday.
One in five of all male deaths and one in 20 of all female deaths between the ages of 30 and 69 will be caused by smoking, said the study, conducted by a team of doctors and scientists from India, Canada and Britain and published in the New England Journal of Medicine.
"The results we found surprised us, because smokers in India start later in life and smoke fewer cigarettes or 'bidis' than those in Europe or America, but the risks are as extreme as in the West," said Prabhat Jha of the Center for Global Health Research at the University of Toronto, the lead author of the study.
The study, one of the most comprehensive ever in India, sent 900 field workers to survey 1.1 million homes across the country. They compared the smoking history of 74,000 adults who died from 2001 to 2003 with 78,000 living adults.
The study says there are currently about 120 million smokers in India. More than 30 percent of men and 5 percent of women between 30 and 69 years of age smoke either cigarettes or "bidis," small, cheaply made cigarettes which contain about one-fourth the tobacco of a regular cigarette, the study said.
Bidis are popular among poor Indians because they are significantly cheaper. A packet of 10 costs about 2 rupees (about 5 cents) while the cheapest cigarettes cost 1 rupee (2 cents) apiece.
Jha said the study found more than 50 percent of smoking deaths are likely to be among poor, illiterate Indians, suggesting that pictorial health warnings on packages — instead of the current written warnings — may be part of an effective anti-smoking strategy. Raising taxes on bidis could also help, he said.
The study also found that only 2 percent of adult smokers in India quit before falling ill. "Typically people quit smoking only after disease strikes," Jha said.
A World Health Organization official in New Delhi said the study was "very representative of India."
"It's going to be a good tool for advocacy and a good tool for policy in intervention," said Poonam Khetrapal Singh, a WHO deputy regional director.
Health Minister Anbumani Ramadoss said he was alarmed by the study's findings.
"The government of India is trying to take all steps to control tobacco use — in particular by informing the poor and the illiterate," he said in a statement.
While an increasing number of countries prohibit smoking in public places, people in India freely puff away in playgrounds, railway stations, sidewalk cafes and even hospitals.
Ramadoss has helped enact a number of laws banning smoking in various public places, but most are routinely ignored. Last month he asked some of the country's top movie actors to stop smoking on screen.
A recent government effort to introduce pictorial health warnings recommended by WHO has run into legal delays, with tobacco companies fighting to keep them off cigarette packets.
According to a WHO study released last week, nearly two-thirds of the world's smokers live in 10 countries led by China, which accounts for nearly 30 percent, and India with about 10 percent. They are followed by Indonesia, Russia, the United States, Japan, Brazil, Bangladesh, Germany and Turkey.