Bidi smoking costs India over Rs 80,000 crore in ill health and early deaths every year which is equivalent to 0.5 per cent of the goods and services (GDP) the country produces and more than two per cent of its total health spend, says a study.

Direct costs – tests, drugs, doctors’ fees, hospital stays, and transport – make up around a fifth of this total with the remainder made up of indirect costs – accommodation for relatives/carers and loss of household income, showed the findings published in the journal Tobacco Control.

The findings, based on National Sample Survey data on healthcare expenditures, data on bidi smoking prevalence from the Global Adult Tobacco Survey and relative risks of all-cause mortality from bidi smoking, were for the year 2017.

However, the tax revenue derived from bidi smoking came to just Rs 4.17 billion in 2016-17, said the study.

Nearly one in five households in India faces “catastrophic expenditures” due to healthcare costs, with more than 63 million people pushed into poverty, as a result, said study author Rijo M John from Centre for Public Policy Research in Kochi, Kerala.

“Diseases associated with bidi smoking add to this, potentially pushing more people into poverty,” he said, suggesting that about 15 million face poverty because of spending on tobacco and associated health costs.

The findings suggest that unhindered use of bidi smoking could push more households into poverty.

“Expenditure on tobacco also crowds out expenditure on food and education in India, especially among the poor,” he added.

Bidi is very popular in India, accounting for over 80 per cent of the tobacco smoked and 72 million regular users over the age of 15.

Although bidi contains less tobacco than conventional cigarettes, the nicotine content is significantly higher.

And the relatively low burn point forces smokers to breathe in more of the harmful chemicals produced.

Bidi smoking is implicated in several types of cancer, tuberculosis, and various long term lung conditions.

But despite its impact on the nation’s health, it has been taxed at a rate that is a fraction of that applied to cigarettes, John said.