In the corridors of power in Islamabad, a silent calculation is being made—one that pits human lives against financial returns.
Tobacco, a product linked irrefutably with disease and death, continues to be a powerful player in Pakistan’s economy.
As the death toll climbs and the burden on the healthcare system swells, the government remains caught in a moral and fiscal bind: should it curb tobacco’s reach, or continue to benefit from the billions it pours into the national treasury?
The figures are sobering. Each year, tobacco use claims around 164,000 lives in Pakistan, according to the World Health Organization (WHO).
These are not just numbers but mothers, fathers, workers, and youth lost to cancer, cardiovascular ailments, respiratory diseases, and strokes.
According to health experts, tobacco-related illnesses now form a major share of the non-communicable disease burden, which continues to rise across the country.
Yet, despite this growing crisis, tobacco products remain widely available, heavily advertised in subtle ways, and dangerously underregulated in many parts of the nation.
Pakistan’s relationship with tobacco is paradoxical.
On the one hand, the state recognises the dangers. Multiple health ministries and public service campaigns have acknowledged that tobacco is a leading cause of preventable deaths. On cigarette packs, grotesque images warn of the consequences—mouth cancer, blackened lungs, and premature death.
On the other hand, tobacco continues to be treated as a fiscal asset, a source of crucial tax revenue that fills state coffers even as it empties hospital beds.
According to the Federal Board of Revenue (FBR), the tobacco industry contributed more than 200 billion Pakistani rupees (approximately $709 million) to the national exchequer in the fiscal year 2023–24.
This includes federal excise duties and sales tax, primarily levied on cigarettes.
For a country perennially struggling with budget deficits, circular debt, and IMF loan conditions, these figures are difficult to ignore.
In a fragile economy teetering under inflationary pressure and limited tax compliance, the tobacco industry presents a rare source of consistent, large-scale revenue.
But that revenue comes at a steep cost. A 2021 study by the Pakistan Institute of Development Economics (PIDE) estimated that the economic burden of smoking-related illnesses and deaths exceeds 615 billion Pakistani rupees (approximately $2.1 billion) annually—roughly three times the revenue generated by tobacco taxation.
This figure accounts for direct medical costs, productivity losses, and premature mortality. In other words, for every rupee earned from tobacco, the country spends three mitigating its impact.
Still, the political influence of the tobacco lobby remains robust.
Industry players frequently highlight their contributions to employment, agriculture, and the tax base.
They argue that abrupt policy moves could trigger illicit trade, cost jobs, and reduce government income.
These arguments are often echoed by lawmakers from tobacco-growing regions, where the crop is seen not only as an economic staple but also a political issue.
Moreover, enforcement of existing tobacco control laws remains patchy at best.
While Pakistan is a signatory to the WHO Framework Convention on Tobacco Control (FCTC), its implementation has been uneven.
Laws prohibiting the sale of tobacco to minors, banning smoking in public spaces, and restricting advertisements exist on paper, but violations are rampant, and penalties are rarely enforced.
Vendors openly sell single cigarettes to children, smoke wafts through public transport and cafes, and surrogate advertising through sports and cultural sponsorships continues largely unchecked.
One of the most worrying trends is the rising number of young smokers.
Data from the Global Youth Tobacco Survey indicates that around 10% of school-going children aged 13–15 in Pakistan use tobacco products.
This points to a deep failure in public health communication and societal attitudes.
In many communities, smoking is still seen as a rite of passage, a marker of adulthood or masculinity.
The glamorization of smoking in the media and the lack of meaningful deterrents have only reinforced these perceptions.
Adding to the complexity is the emergence of novel nicotine products—such as e-cigarettes and heated tobacco devices—which have found a market among urban youth.
While these are often marketed as “harm reduction” alternatives, health experts warn that their long-term effects are still unknown and that they often serve as a gateway to traditional cigarette use.
Yet, regulation on these newer products is still underdeveloped, and their online availability remains virtually unrestricted.
The situation is further complicated by the presence of a vast illicit tobacco trade.
Smuggled, counterfeit, and non-duty-paid cigarettes not only evade taxes but also flood the market with cheaper options, undermining efforts to price tobacco out of reach.
Industry sources estimate that illicit cigarettes make up over 30% of the total market, although this figure is contested by independent observers.
Regardless of the precise number, the sheer scale of this trade erodes state revenue while making tobacco more accessible, especially to low-income populations.
Meanwhile, the healthcare system struggles under the weight of tobacco-induced illnesses.
Oncology wards are overcrowded, and public hospitals often lack the resources to manage the long-term complications of smoking-related diseases.
In rural areas, access to specialised care is virtually non-existent.
The result is not only widespread suffering but also diminished national productivity, as tobacco-related diseases often strike individuals in their most economically active years.
Public health advocates have repeatedly urged the government to treat tobacco as a public health emergency rather than a revenue stream.
But in a political climate dominated by economic anxiety and short-term priorities, long-term health planning often takes a backseat.
Attempts to raise tobacco taxes are frequently diluted or delayed, and enforcement campaigns come in bursts of activity followed by long silences.
There is also a notable absence of high-profile political leadership on the issue.
Unlike in some countries where presidents or prime ministers have taken bold public stances against smoking, Pakistan’s political elite has largely remained silent—perhaps wary of alienating rural constituencies, industry lobbies, or segments of the electorate that see tobacco as an economic necessity.
As Pakistan stares down a demographic shift—with a young and rapidly urbanising population—the stakes could not be higher.
The choices made today will shape the health outcomes of millions in the decades to come.
Yet for now, tobacco’s deadly toll continues to climb, weighed against a ledger that measures revenue over lives. It is a national dilemma unfolding in real time—a silent epidemic where the victims are counted in the shadows, and the benefits tallied in balance sheets.
