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Analysis Health in South Asia

Raising taxes key to accelerate tobacco control in South Asia

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1176
  1. Prabhat Jha, professor1,
  2. Javaid Khan, professor2,
  3. Sujata Mishra, researcher1,
  4. Prakash Gupta, professor3
  1. 1Centre for Global Health Research, St Michael’s Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  2. 2Aga Khan University, Karachi, Pakistan
  3. 3Healis-Sekhsaria Institute for Public Health, Mumbai, India
  1. Correspondence to: P Jha prabhat.jha{at}

South Asian countries must prioritise higher tobacco taxation and other control measures to raise the low levels of tobacco cessation and thus avoid millions of premature deaths, say Prabhat Jha and colleagues

On current smoking patterns, tobacco will kill about 1 billion people worldwide this century,12 including substantial numbers in the South Asian countries. All South Asian countries have signed the Framework Convention on Tobacco Control and have committed to the United Nations (UN) sustainable development goals (SDG), including to reduce premature mortality from non-communicable diseases by one third by 2030.3 Achieving this goal will depend on effective implementation of the tobacco control measures set out in the framework convention.4 The most important of these is large increases in the excise tax on tobacco products.

Here, we mostly focus on initiatives to control smoking because smoked tobacco causes more systemic diseases and has higher overall risks for the user than other forms of tobacco use. We also briefly review the status of smokeless tobacco.


We examined nationally representative surveys of tobacco use in India, Bangladesh and Nepal5678 and relied upon WHO reports on surveys done in the South Asian countries.4 To estimate the number of tobacco users, we applied the prevalence of smokers and smokeless tobacco users at ages 15+ in these surveys to the UN 2010 population estimates.9 To estimate the number of future smokers under 35 years, we applied the smoking prevalence at ages 25-34 to the UN 2010 population under age 25, and added current smokers at ages 25-34. We applied the Indian ratios of smoking prevalence at ages 25-34 for countries where prevalence was not reported by age.5 To estimate the number of deaths from smoking, we assumed that half of the <35 smokers would …

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