Here’s a sobering number: deaths from second-hand smoke in India have jumped nearly 50% since 1990. That’s according to a new study in The Lancet Public Health, put together by researchers working under the Global Burden of Disease (GBD) 2023 project, who tracked passive smoking and its health toll across 204 countries.
The strange part is that individual risk has actually gone down. Death rates improved by about 30% over the same period. So what’s driving the overall rise? Simple math — more people. India’s population exposed to second-hand smoke grew from 375 million in 1990 to 444 million in 2023, an 18.4% increase, and that growth was enough to cancel out the gains from lower risk per person.
Broken down by gender, the toll looks like this: female deaths went from 113,400 a year in 1990 to 156,900 in 2023, while male deaths rose from 104,300 to 168,700. India now trails only China for the largest population exposed to passive smoking anywhere in the world.
However, age-standardised exposure prevalence, which adjusts for population changes, fell from 43.2% to 30.6% over the three decades. So fewer people, proportionally, are breathing in someone else’s smoke. It’s just that the country has grown so much that the absolute numbers still look grim.
The human cost goes beyond deaths, too. Second-hand smoke was responsible for 9.28 million lost healthy years (DALYs) in India in 2023. Children take a disproportionate hit globally, accounting for over 12% of the disease burden, mostly from lower respiratory infections — a reminder that young, still-developing lungs are especially vulnerable.
Doctors point out that the issue is one of the more preventable public health problems out there. Smoking outdoors, away from family and children, can significantly reduce exposure.
Source: The Lancet Public Health, GBD 2023 Second-hand Smoke Collaborators