Dr. Golam Sarwar Liaquat Hossain Bhuiyan
Every year, nearly two lacs people die in Bangladesh from tobacco-related diseases. Yet the product responsible for this immense burden of death and various non-communicable diseases (NCDs) remains one of the cheapest and most readily available products in the country. Despite longstanding warnings from public health experts, tobacco use is not declining at the desired rate.
According to the Global Adult Tobacco Survey (GATS) 2017, approximately 37.8 million (35.3%) adults in Bangladesh use tobacco. Data from the Tobacco Atlas 2025 indicate that nearly 200,000 people die annually in Bangladesh from tobacco-related diseases. A significant proportion of these deaths are premature and could be prevented through effective policy interventions.
Approximately 71% of all deaths in Bangladesh are caused by non-communicable diseases. Tobacco is one of the leading risk factors for heart disease, cancer, stroke, chronic respiratory diseases, and diabetes. Therefore, the harm caused by tobacco extends beyond individual health; they impose a long-term burden on families, the healthcare system, and the national economy.
According to a collaboration study conducted by Johns Hopkins University and the University of Dhaka, the economic burden of health and environmental damages attributable to tobacco use amounted to approximately BDT 87,000 crore in the 2023-24 fiscal year. In contrast, government revenue from the tobacco sector during the same period was approximately BDT 41,000 crore. In other words, the cost of addressing tobacco-related harms far exceeds the revenue generated from tobacco taxation.
The government has declared the prevention of non-communicable diseases a national priority. In the proposed budget for FY 2026-27, a record allocation of BDT 69,409 crore has been made for the health sector, alongside initiatives to expand primary healthcare services, recruit healthcare workers, and improve access to cancer and kidney disease treatment. These measures are undoubtedly commendable.
However, if tobacco taxation and pricing policies are not made more effective, the benefits of these initiatives will remain limited. On the one hand, the government is investing in the prevention of NCDs; on the other hand, tobacco products remain cheap and easily accessible. These two positions are fundamentally contradictory.
In the proposed FY 2026–27 budget, the retail price of a pack of 10 low-tier cigarettes has been increased from BDT 60 to BDT 62, representing only a 3.33% increase. The price of mid-tier cigarettes has increased from BDT 80 to BDT 92 (15%), high-tier cigarettes from BDT 140 to BDT 160 (14.29%), and premium cigarettes from BDT 185 to BDT 210 (13.51%).
While these price increases may appear significant on paper, they are minimal compared to inflation and rising incomes. As a result, the real price of tobacco products is declining, making them increasingly affordable and accessible. In economic terms, this phenomenon is known as a decline in real prices.
A similar pattern is evident in the proposed budget for bidis. The retail prices and tax rates for packs of 25 non-filter bidis and 20 filter bidis have remained unchanged. Consequently, inflation will further reduce the real price of bidis.
This is particularly concerning from a public health perspective. Approximately 75% of Bangladesh’s cigarette market is occupied by low-tier cigarettes, which are predominantly consumed by young people and low-income populations. Similarly, the use of bidis, jarda, and gul is more common among lower-income and marginalized groups. If the real prices of these products continue to decline, health inequalities will further widen.
According to the World Health Organization, increasing tobacco taxes to raise tobacco prices is the single most effective measure for reducing tobacco use. Particularly, young people are highly sensitive to price changes. Higher prices discourage tobacco initiation and encourage many existing users to quit.
However, Bangladesh’s current tobacco tax system is complex and flawed. The existence of multiple price tiers and tax rates allows consumers to switch easily from higher-priced products to cheaper alternatives. As a result, the intended public health benefits of tax increases are not fully realized.
For this reason, public health experts and health economists have long advocated for a simpler and more effective tobacco tax structure. According to their proposal, the low and mid-price cigarette tiers should be merged, and the minimum retail price for a pack of 10 cigarettes should be set at BDT 100. In addition, a specific excise tax of BDT 4 per pack of 10 cigarettes should be imposed alongside the existing supplementary duty.
At the same time, it has been recommended that the prices and tax rates of all tobacco products including bidis, Jarda, and gul be increased in line with inflation, preventing consumers from switching to relatively cheaper alternatives.
The greatest advantage of a specific tax system is that it prevents tobacco companies from exploiting price gaps between tiers to manipulate the market. It also simplifies tax administration, reduces opportunities for tax evasion, and increases government revenue.
Had these proposals been implemented, the government could have generated approximately BDT 44,000 crore in additional revenue compared with the current fiscal year. At the same time, nearly 500,000 adult smokers would have been encouraged to quit, and approximately 372,000 young people would have been prevented from initiating smoking. In the long term, nearly 400,000 premature deaths could have been averted.
Thus, an effective tobacco tax policy is not merely a means of increasing revenue; it is one of the most cost-effective and impactful public health interventions for preventing non-communicable diseases.
Unfortunately, the proposed budget does not reflect this approach. As a result, a significant opportunity to protect public health while increasing revenue has been missed.
International experience also shows that bold tobacco tax policies can bring about rapid positive change. In 2012, the Philippines implemented comprehensive sin tax reforms despite strong lobbying by the tobacco industry. Within a decade, the country’s smoking prevalence was nearly halved, while additional revenues were used to expand universal healthcare coverage.
Bangladesh can follow a similar path. However, because no fundamental reform has been made to the existing tax structure, a significant portion of the recent cigarette price increases will likely be absorbed as additional profits by tobacco companies. There is a risk that these profits will be reinvested by expanding the tobacco business, posing further threats to public health.
Tobacco control is not solely a health-sector issue; it is closely linked to human capital development, poverty reduction, and sustainable economic growth. There is no alternative to reducing tobacco use if Bangladesh is to build a healthy, productive, and capable population.
Before the final budget is passed, the government still has an opportunity to take effective action. By adopting evidence-based tobacco taxation and pricing policies, it is possible to achieve both public health protection and increased government revenue.
Making tobacco products less affordable and less accessible will reduce tobacco use, lower the burden of non-communicable diseases, decrease healthcare expenditures, and prevent thousands of premature deaths.
Dr. Golam Sarwar Liaquat Hossain Bhuiyan is the Director of the National Institute of Diseases of the Chest and Hospital (NIDCH) and the Secretary General of the Chest and Heart Association of Bangladesh.
