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This paper examines the various issues surrounding tobacco use in India, using National Sample Survey and other data. The study demonstrates that 150 million Indians used tobacco in 1998 and that during the 1990's, the prevalence increased for both rural and urban areas, as well as in both sexes and in all age groups. Such large numbers have staggering implications for the country's economy, health outcomes and resources, and the magnitude of tobacco control challenges. Bidis hand-rolled cigarettes remain the most commonly used form of tobacco. However, major differences in rates and types of tobacco used were seen among various sex, age, economic and social class groups, suggesting that public health efforts to reduce consumption will require focused initiatives to target various populations and products.

We have examined the findings from various studies and corroborated other evidence that the large and continuous increase in India's urban population, and the concomitant growth of the population residing in slums and shanty towns, has resulted in over-straining of infrastructure and a deterioration in public health. Inadequate civic amenities, lack of purchasing power, and lack of knowledge and awareness among the urban poor have resulted in urban poverty which is very different from its rural counterpart. While a few policies have specifically targeted the urban poor, these have been neither sufficient nor effective. Also, the deteriorating health status of urban people needs urgent attention because many of the recent health problems can take an epidemic form if neglected. A resurgence of malaria, dengue and tuberculosis indicates that much of the poor health emanates from a lack of basic amenities such as sanitation, clean water and housing, coupled with a lack of awareness about the need to take precautionary measures against preventable and infectious diseases. To tackle these problems effectively, it is important for policy-makers to recognize that certain groups are more susceptible to ill health than others; they are vulnerable to the severe impact of illnesses and also the likely sources of infection for the population at large. There is an urgent need for research on the factors that prevent the urban poor from availing the services provided to them. It is possible that this is due to the lack of awareness-generating policies which should accompany any supply-side policies such as the provision of basic facilities (e.g. Sulabh Sauchalaya). To reduce the private costs as well as the negative externalities of ill health, it may be necessary to target such populations by cost-effective strategies based on holistic research on all the factors that determine well-being.