The burden of the tobacco epidemic is always tragic, but it is particularly problematic for those in economic need. Losing a breadwinner to a tobacco-related disease often means years in poverty for the smoker’s family. More often, though, increased tobacco consumption leads to decreased family budget to purchase other essential goods—e.g., food, clothes, and hygiene products—and services, such as education, healthcare and transportation. This phenomenon is known as the “crowding out” effect because tobacco expenditures directly reduce the share of other goods in household budgets. For example, a study from Bangladesh compared tobacco expenditures to spending on food and education in rural and urban low-income communities, finding that households with the lowest income spend half as much on health as on tobacco, and almost ten times as much on tobacco as on education. The purchasing of tobacco products by adults has a significant negative effect on children in the same household because as more income or money is dedicated to tobacco products, less is dedicated to the children’s food, shelter, clothing, healthcare and education.

Those tobacco expenditures can displace quite a bit of a household’s food budget: comparing the costs of cigarettes and rice, we see that in India the cost of one pack of Marlboro cigarettes would purchase a family 39 portions of rice; in the United States the number would be closer to 198 servings of rice.

Because tobacco use disproportionately affects vulnerable populations, the benefits of quitting for those individuals are significant. In the Bangladeshi example, if just 69% of the money impoverished Bangladeshi spent on tobacco were re-allocated to food, over 10.5 million fewer people in that country would have been malnourished in 2000. The same study found that redirecting tobacco expenditures to buy food could have saved half of the many thousands of children who were dying from malnutrition in Bangladesh at that time.

The existence of this crowding-out effect, in which people will choose tobacco over sustenance, is a powerful illustration of tobacco’s addictive nature and insidious effects.  It is happening in countries all around the world, perhaps even all of them.  Beyond the obvious need to prevent young people from starting to use tobacco, governments and other stakeholders must work to help tobacco users to quit tobacco, so we can save lives and improve health equity.

By Nikisha Sisodiya


Efroymson, D., Ahmed, S., Townsend, J., Alam, S. M., Dey, A. R., Saha, R., ... & Rahman, O. (2001). Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tobacco control, 10(3), 212-217.

Economist Intelligence Unit. Worldwide Cost of Living Survey. The Economist; 2017. Proprietary Subscription-Based Data.