Tobacco consumption has emerged as a major public health challenge in Nepal. According to the STEPS Survey conducted in 2019 by the Nepal Health Research Council and others, around 29% of the population in Nepal used tobacco products. Experts now estimate that this number has exceeded 32%.
Professor Dr. Vivek Acharya, Head of the Clinical Oncology Department at Bir Hospital, states that tobacco use has recently become a fashion among youth, which is alarming.
Dr. Acharya, a senior cancer specialist, notes that cancer cases in Nepal are rising at an unusual rate. “These days, I get two to three calls a week from acquaintances saying someone they know has been diagnosed with cancer,” he shared. “This wasn’t the case around 2004 when I was studying.”
He states that about 30% of cancers globally are caused by tobacco products, and Nepal reflects the same trend. Lung cancer is most common due to tobacco use, but it also contributes to cancers of the mouth, stomach, and other organs.
Dr. Acharya warns that tobacco doesn’t only cause cancer but also increases the risk of other diseases, particularly heart disease. It can lead to blocked blood circulation in vessels, giving rise to related conditions. Many patients are now being diagnosed with “small vessel disease,” a condition where blood flow to the brain is obstructed, potentially caused by cigarette smoking.
He adds that tobacco use also affects cognitive functions and productivity. The growing trend of vaping and hookah among youth is particularly worrisome due to the presence of even more harmful chemicals. He calls for serious government intervention.
“After dark, youths gather in restaurants to smoke hookah and vape—it’s becoming fashionable,” says Dr. Acharya. “But the consequences will appear 20–30 years from now. We need to worry about that now, or the situation could turn dire.”
Dr. Acharya notes that such addictions among youth pose risks to future generations, as children born to tobacco users may inherit health issues and genetic damage. “Babies born to smokers can be weak in terms of health from birth. It’s a frightening situation,” he said.
In Nepal alone, tobacco-related diseases are estimated to cause more than 39,000 deaths annually.
Despite its massive impact on public health, experts express concern that tobacco use continues to rise due to ineffective control measures. Public health expert Dr. Baburam Marasini believes this is due to weak policy implementation.
Lack of Commitment to Tax Increases
Health experts and anti-tobacco advocates point out that taxes on tobacco products in Nepal are significantly lower than in other countries. In 2005, the World Health Organization (WHO) introduced the Framework Convention on Tobacco Control (FCTC), which Nepal’s cabinet and parliament ratified in 2006. As of now, 183 countries have endorsed it.
Article 6 of the FCTC outlines price and tax measures to reduce tobacco demand. However, Dr. Marasini says Nepal’s government has failed to act effectively, especially the Ministries of Finance and Industry. “They have forgotten Nepal’s commitment to the WHO,” he says.
In comparison, India imposes a 57.3% tax on tobacco, Pakistan 51.8%, Bangladesh 58.4%, and Sri Lanka 66.9%. Nepal’s combined excise, VAT, and health risk tax is only 34.38%. Other countries, such as Brazil (80.2%), Thailand (81.3%), and Finland (89.4%), have much higher taxes. Anand Bahadur Chand, Chairperson of Action Nepal (an anti-tobacco organization), calls Nepal’s tax rate extremely low.
Dr. Marasini emphasizes that Nepal’s tax rate is nearly half that of other South Asian nations, which is a policy failure.
Why a Tax Hike is Necessary
Experts argue that raising tobacco taxes would reduce its use. Chand from Action Nepal explains that various countries have seen consumption decline after raising prices. WHO reports show that a 10% increase in the retail price of cigarettes results in a 4% decrease in consumption in high-income countries and up to 8% in middle-income countries.
In Vietnam, the smoking rate fell from 23.8% in 2015 to 19.5% in 2022 due to high taxation. A study across 16 African nations showed that a 10% price increase led to a 11.5–14.6% decline in youth smoking.
Chand argues that higher prices reduce users and the disease burden. When people quit smoking, they can redirect their spending toward food, housing, and education, ultimately improving their quality of life.
He also reveals that the economic losses from tobacco-related diseases in Nepal exceed the revenue generated from tobacco taxes. In the last fiscal year, Nepal collected NPR 26.63 billion from excise duty and NPR 6.59 billion from the health risk tax, while annual economic losses from tobacco exceeded NPR 33 billion.
Chand states that raising tobacco taxes could boost government revenue and fund other beneficial programs. Dr. Marasini believes that Nepal should at least match India’s tax levels. Since India’s cigarettes are still more expensive, price parity is essential to prevent cross-border smuggling due to open borders.
The Health Ministry’s Policy Direction
Health and Population Minister Pradeep Paudel has expressed intent to raise tobacco taxes and allocate the proceeds to the Health Insurance Fund.
Health Secretary Dr. Vikas Devkota confirms that a proposal has been submitted to the Finance Ministry to raise taxes on tobacco and other harmful food products after consulting stakeholders. “We have proposed this to include it in the insurance program, but the Finance Ministry hasn’t given a clear response yet,” he said.
Dr. Devkota emphasized that raising taxes and prices is a key tobacco control strategy. Compared to other nations, Nepal’s tobacco tax is low, and the Ministry of Health is lobbying for an increase.
According to WHO standards, 25% of revenue from tobacco taxes should be invested in health. However, Dr. Devkota said the Ministry receives only NPR 380–400 million, whereas it should be around NPR 600–700 million if the full 25% were allocated.
The Ministry has already corresponded with the Finance Ministry to demand the full 25%. WHO has also expressed appreciation for Nepal’s policy requiring 100% pictorial health warnings on tobacco packaging.
Beyond Tax Hikes: Phasing Out Tobacco
Chand of Action Nepal argues that due to weak government policies, the tobacco industry is making massive profits while burdening citizens with disease.
According to STEPS Survey data, tobacco use is highest in Lumbini Province, followed by Sudurpaschim, Karnali, and Madhesh. Studies indicate that the poor are the highest users, and they suffer the most harm.
Dr. Marasini stresses that only significant price hikes—not minor ones—can reduce consumption. “If you raise cigarette prices by half a rupee or a rupee, people will still smoke. But if prices rise sharply, people start thinking about quitting,” he said.
He adds that passive smoking is a serious problem. “In a room, one man smokes, and it harms women and children around him. This needs attention too.”
Senior cancer specialist Prof. Dr. Vivek Acharya argues that the government should not only raise taxes but work toward a complete phase-out of tobacco products.
“A tax hike might reduce consumption slightly—maybe someone will go from four cigarettes a day to two—but the damage continues,” he said.
Dr. Acharya explains that as developed countries tighten controls on tobacco, the industry shifts to underdeveloped nations like Nepal.
“Cigarettes didn’t exist in the beginning—it was man-made,” says Dr. Acharya. “Now humans need to phase them out.”
He urges the government to start working on a 10- or 20-year strategy to completely ban the production and import of tobacco products.