Thiruvananthapuram, Nov 9 : The poorest men in India are twice more likely to smoke as the richest, reveals a recent study conducted to assess the socio-economic inequality in smoking in low and middle income countries.
The study based on data from the World Health Survey (WHS) of the World Health Organisation (WHO) found that 46.7 per cent of the poorest men smoke in India as against 21.8 per cent of the richest men, a press release said here yesterday. Though the findings are in line with common knowledge regarding smoking prevalence, what is distressing is that well over a quarter of India's population are under the addictive spell of tobacco.
According to figures of the Planning Commission, Government of India, there are as many as 3546.8 lakh people Below the Poverty Line (BPL) in India, which is nearly 29 per cent of the total population. Titled 'Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey', the study was initiated in the context of the fact that the risk of dying from smoking is significantly higher in the lowest socio-economic groups as compared to higher socio-economic groups.
A total of 213,807 men and women of 48 low and middle income countries were covered in this study that aimed at comparing the magnitude of within-country variation of smoking according to wealth. The study developed an index of long-running economic status of households based on ownership of selected assets and use of selected services to indicate wealth. The derived index was divided into five measures called quintiles within each country. Quintile 1 or Q1 represents the poorest wealth quintile, and quintile 5 (Q5), the richest.
The study points out that inequality in tobacco use translates into inequality in tobacco-related premature death and disease and calls for specifically designed prevention measures to address the pattern of smoking inequality in order to close the gap between the rich and the poor. Outlining some possible prevention strategies, Dr M A Oommen, renowned economist, said, 'While linking high incidence of smoking with poverty is a simplistic correlation, the issue has to be tackled in a multi-pronged manner such as incentivising the poor to get out of the habit, moral suasion, higher incidence of excise duty on tobacco products, expanding capability building of the poor and structural reforms through better employment opportunities.'
Indian men come under the 'pro-rich inequality of smoking' with Relative Index of Inequality (RII) value of 1.62. RII takes into account the distribution of smoking as well as the distribution of population across wealth quintiles. The study conducted by researchers at the WHO and the Miguel Hernández University of Elche, Spain, among others, defines RII as a 'relative measure of inequality that is adjusted for variation in overall prevalence across countries.' A RII value greater than 1 indicates that the prevalence of smoking is greater among populations of lower wealth. The study notes that pro-rich inequality of smoking exacerbates health-related inequality adding on factors that go beyond direct health effects.
Further, the already scarce income gets diverted from things such as healthcare, housing or quality food, in order to purchase cigarettes. According to the Global Adult Tobacco Survey India Report 2009-10, conducted jointly by Union Ministry of Health and Family Welfare and WHO, smokers in India spend an average of Rs 399 on cigarettes and Rs 93 on bidis monthly. The poverty line monthly per capita for 2009-10, as per Planning Commission figures, is Rs 672 for rural India, and Rs 859 for urban India. Among Indian women, prevalence of smoking is more than four times among the poorest in relation to the richest.
The prevalence percentage of smoking among the poorest group of women (Q1) is 12.4 per cent as compared to 3.1 per cent of richest women (Q5). RII value among Indian women is 3.80. Overall, the study brought out that 35.3 per cent of men and 7.6 per cent of women smoke in India, which finds classification as a low-income group country in the study. Smoking prevalence among poorest men is the highest in Hungary with 82.6 per cent and the lowest is in Ethiopia with 5.3 per cent.
Again, poor Hungarian women have the highest prevalence of smoking among the surveyed countries with 65.6 per cent, and the lowest is among women of Morocco and Ethiopia. Commenting on the study, Dr R Jayakrishnan, Assistant Professor, Community Oncology Division, Regional Cancer Centre said, 'The findings reinforce the trend seen during clinical practice. Majority of tobacco-induced cancer patients who visit the Centre are from the lower income strata of the society. The need of the hour is to develop prevention strategies that specifically focus on the more vulnerable sections.'