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Deaths linked to passive smoking in India have increased by nearly 50% since 1990, with second-hand smoke claiming an estimated 325,600 lives in 2023, according to a study published in The Lancet Public Health. The findings highlight the continuing health impact of tobacco smoke on people who do not smoke themselves.
The study also shows a troubling contrast in India’s second-hand smoke exposure. While the age-standardised prevalence of exposure declined over the past three decades, the absolute number of people exposed increased significantly because of population growth.
In 2023, an estimated 444 million people in India were exposed to second-hand smoke, making the country the second-largest affected population globally after China.
Passive Smoking Deaths Rise Despite Lower Exposure Prevalence
According to the reported findings, India’s age-standardised prevalence of second-hand smoke exposure fell from 43.2% in 1990 to 30.6% in 2023.
However, the number of people exposed increased from approximately 375 million in 1990 to 444 million in 2023, representing an 18.4% rise.
The same period also saw a significant increase in deaths attributed to second-hand smoke.
Fatalities rose from around 217,700 in 1990 to 325,600 in 2023, illustrating how passive smoking continues to represent a substantial public health challenge despite improvements in exposure prevalence.
The figures underline an important distinction: a lower percentage of people exposed does not necessarily translate into a lower total number of exposed individuals when the population itself grows.
More Than 9 Million Healthy Years Lost
The burden of passive smoking extends beyond mortality.
The study estimated that second-hand smoke was responsible for approximately 9.28 million disability-adjusted life-years (DALYs) in India in 2023. DALYs combine years lost because of premature death with years lived with illness or disability.
This means passive smoking affects public health not only through deaths but also through long-term disease, disability and reduced quality of life.
The findings reinforce the need to view tobacco smoke exposure as a broader environmental health issue rather than a risk affecting smokers alone.
Women and Men Both Face a Rising Death Toll
The reported data show increases in passive-smoking-related deaths among both women and men.
Among women, deaths attributed to second-hand smoke increased from approximately 113,400 in 1990 to 156,900 in 2023.
Among men, the number rose from around 104,300 to 168,700 during the same period.
These figures demonstrate that exposure to tobacco smoke can affect entire households and communities, particularly when smoking occurs in shared indoor environments.
Children Remain Particularly Vulnerable
Children are among the groups most vulnerable to second-hand smoke.
Because their lungs are still developing, exposure to tobacco smoke can increase the risk of respiratory problems and other health complications. The study identified lower respiratory infections as the leading contributor to the disease burden among children associated with second-hand smoke.
Health experts have therefore emphasized the importance of keeping children away from tobacco smoke, particularly inside homes and other enclosed spaces.
Dr. G.C. Khilnani, chairperson of pulmonary and critical care at PSRI Hospital, said children and women are particularly vulnerable and called for greater awareness around second-hand smoke exposure.
Second-Hand Smoke Linked to Major Diseases
Passive smoking is not simply an issue of temporary discomfort caused by exposure to cigarette smoke.
The reported Lancet study linked second-hand smoke exposure to a range of serious health conditions, including:
- Ischaemic heart disease
- Stroke
- Lung cancer
- Chronic obstructive pulmonary disease (COPD)
- Breast cancer
- Type 2 diabetes
- Asthma
- Lower respiratory infections
These conditions can result in significant healthcare costs and long-term disability in addition to premature deaths.
Previous medical research has also established an association between passive smoking and cardiovascular disease. A meta-analysis published in the New England Journal of Medicine, for example, found an increased risk of coronary heart disease among non-smokers exposed to environmental tobacco smoke.
India Has the World’s Second-Highest Number of Exposed People
India’s position in the global second-hand smoke burden is particularly significant because of its large population.
In 2023, approximately 444 million Indians were exposed to second-hand smoke, placing India behind only China, which had an estimated 664 million exposed people.
Globally, around 2.71 billion people were exposed to second-hand smoke in 2023, contributing to an estimated 1.66 million deaths and 44.8 million DALYs.
China, India and Indonesia together accounted for nearly half of the world’s exposed population.
The global figures demonstrate that passive smoking remains a major international public health concern.
Why the Numbers Matter
The rise in passive-smoking deaths presents an important challenge for tobacco-control policies.
India has made progress in reducing the prevalence of exposure, but the absolute number of affected people remains extremely high. The difference between prevalence and absolute exposure is particularly important when evaluating the country’s long-term public health strategy.
Reducing the number of people exposed requires more than encouraging smokers to quit.
It also involves creating smoke-free environments, strengthening enforcement of existing tobacco-control measures, increasing public awareness and protecting vulnerable populations from involuntary exposure.
Smoking Outdoors Can Help Reduce Exposure
Health experts have urged smokers to avoid smoking inside homes and other enclosed areas.
Dr. Khilnani emphasized that smoking should be done outdoors to reduce exposure among family members and others nearby.
However, the safest way to eliminate second-hand smoke exposure is to eliminate tobacco smoking altogether.
For households with children, pregnant women or people with respiratory and cardiovascular conditions, maintaining a smoke-free environment can be especially important.
Public Awareness Remains Critical
The new findings also highlight the importance of public education.
Many people may understand that smoking damages the smoker’s health but underestimate the consequences for people nearby. Second-hand smoke can expose non-smokers to tobacco-related toxic substances without their consent.
Awareness campaigns can therefore play an important role in changing social attitudes toward smoking in homes, workplaces and public spaces.
The challenge is particularly significant in densely populated communities, where exposure can occur across multiple settings.
A Long-Term Tobacco Control Challenge for India
The increase in deaths since 1990 suggests that the health consequences of passive smoking cannot be addressed through short-term measures alone.
India will need sustained tobacco-control efforts that combine prevention, smoking cessation support, smoke-free environments and public education.
The latest Lancet findings provide another reminder that progress should be measured not only by smoking rates but also by the number of people who remain exposed to tobacco smoke and the resulting health burden.
The latest Lancet Public Health study paints a concerning picture of passive smoking in India. Although the age-standardised prevalence of second-hand smoke exposure declined from 43.2% in 1990 to 30.6% in 2023, the absolute number of exposed people increased to 444 million. At the same time, deaths attributed to second-hand smoke climbed from 217,700 to 325,600.
The findings show that passive smoking remains a major public health issue, particularly for children, women and other vulnerable groups.
With millions of people still exposed to tobacco smoke and millions of healthy life-years lost, stronger tobacco-control measures and greater public awareness remain essential.
The message is clear: protecting non-smokers from tobacco smoke is an important part of preventing avoidable disease and premature death.
