Upendra Bhojani extends beyond public health and draws the historical, colonial, and social dimensions of tobacco use in India.
It has been nearly two decades since I began working in tobacco control in India. It all started when I was studying dentistry at a government dental college and hospital in Ahmedabad, Western India. I used to see many patients, especially young people in their twenties and thirties, presenting with pre-cancerous lesions and occasionally cancers in their mouths. India is often referred to as the ‘oral cancer capital’ of the world, as it accounts for about a third of all mouth cancers globally (Das and Shilpa 2021, pp. 99-100). Much of this burden is linked to the use of tobacco in various forms. While my dental curriculum had little to offer beyond mentioning tobacco as a risk factor for oral cancer, many of us became interested in how the tobacco industry shapes this epidemic and continues to put profit before people (World Health Organisation, 2019).
I had not previously known how businesses and politics could affect peoples’ health so profoundly. My curiosity took me to public health and, over the next two decades, I engaged deeply with research and activism in a pursuit to reduce tobacco use in society. I worked with folks from different walks of life: healthcare workers, lawyers, journalists, environmentalists, consumer rights groups, public officials, and politicians. I was determined not to frame tobacco use as merely an individual choice or lifestyle, but rather wanted to foreground how the tobacco industry, alongside broad social and economic structures, engineers addiction (Tobacco Tactics 2025). My research focused on understanding and influencing the political economy of tobacco, tobacco industry behavior, and tobacco-related public policy.
While this work was challenging, stimulating, and deeply satisfying, it was also isolating. Policies are often seen as magic wands that will change the world. In policy making, people appear as numbers in the form of disease and death statistics. Policy consultations and dialogues comprise a circus of representatives of all kinds, barring people whose lives were already being impacted by tobacco. Amidst the policy-focused spaces, what appealed to me was engaging with people living with tobacco-related cancers, who chose to speak directly with the powers that mattered. Their demands came from their daily lived struggles, from what was lost, and their concern for others (Chaturvedi et al. 2014). However, tobacco also remains a major economic sector in India, and there are many people, especially those from socially and economically marginalised sections, who work in tobacco supply chains: collecting Tendu leaf from forests, rolling tobacco in a leaf in homes, or selling tobacco on streets (Nayak 2018, 59-61). While I had some estimates about the number of these workers, did I really know them? I had some interactions with such workers as part of research, but how do I connect with them the way I connected with cancer survivors?
When one works for tobacco control in India, one soon realises the sheer diversity of ways of consuming tobacco. Tobacco is chewed, sucked, sniffed, smeared, smoked, and drunk in India (Reddy and Gupta 2014, 43-48). As I took more interest in history and anthropology, I realised how the tobacco plant that originated in South America, where it was regarded as a shamanic ‘master plant’ by the Indigenous communities, was exploited for economic gains under the colonial and neocolonial forces into a global economic commodity (Russell 2017). Tobacco spread through colonialism into colonies. Following the ‘discovery’ of the oceanic route to India in pursuit of the riches of the East, Portuguese traders brought tobacco to India in the 16th century (Reddy and Gupta 2014, 7-19). Towards the end of the 18th Century, the British East India Company started growing tobacco as a cash crop in India (Ibid). Later, the Imperial Tobacco Company promoted the large-scale plantation of Virginia tobacco and industrial production of cigarettes in India (Reddy and Gupta 2014, 7-19). So, add colonisation and imperialism to the other spheres of tobacco determinants.
Tobacco products have come to signify the gender, caste, and class of their users (Agrawal et al 2012; Bhojani et al 2026). For many Indigenous communities in India, tobacco is not just for leisurely consumption, but has ceremonial use related to weddings, friendship, and death rituals (Bhojani 2026, 2). From my early engagement with the global tobacco control treaty, wherein the cigarette epidemic is often synonymous with the global tobacco epidemic, I have embarked on a journey to understand the complex socio-cultural worlds of tobacco in India (Bhojani et al. 2026, 189-209).
I have not found all the answers. But I found solace in art. What’s a better way to bring up and visualise these tobacco worlds? Sometime in early 2023, I attempted to bring my hazy ideas about tobacco and society onto sketch papers. I felt drawing was a better way to visualise the sociocultural worlds of tobacco, especially concerning the vulnerable stakeholders who were largely invisiblised in mainstream scholarship. I am not sure what prompted it: was it about dealing with a near burnout at work? Was it about expressing tobacco complexities I was discovering? Was it to bring a human touch to the work that had become so abstract? Maybe all of it and more. But I was surprised that I could do reasonable drawings. I took an online introductory course to get basics of pencil drawings.
Let me briefly introduce three of the tobacco-related drawings that form part of the first ever exhibit titled ‘Tobacco and Society’ that I created in May 2023 and displayed as part of an annual workshop bringing together researchers, practitioners and community stakeholders associated with the Centre for Training Research and Innovation for Tribal Health within the BR Hills Tiger Reserve in Karnataka. It was later made into a digital exhibit (Bhojani 2025). These drawings carry with them unique stories that blend colonial, commercial, and social worlds of tobacco in India.
Figure 1: The arrival of tobacco in India
Vasco da Gama, a Portuguese explorer, on finding a sea route to India and arriving at Calicut, met the local ruler, Samoothiri, in 1498 (Subrahmanyam 1997). Portuguese traders introduced tobacco, which was native to the Americas, into India in the early 17th century (Reddy and Gupta 2014, 9). Colonialism spread tobacco across the colonies and led to industrial-scale production, extracting revenues for the empire, and building a global cigarette trade (Reddy and Gupta 2014, 19-32).
Figure 2: Hookah smoking
Here is a man and his son from a Gujjar-Bakarwal tribe from Jammu and Kashmir region of India. They live nomadic life moving high up the mountains in warmer seasons and retreating to plains in colder months looking for green pasture for their cattle. The man is smoking a Hookah (waterpipe), an apparatus used to heat tobacco, the smoke of which is then passed through water before inhalation. Hookah was possibly invented in later half of the 16th century by a Persian physician, who wanted to “purify” smoke when tobacco was first introduced to the Mughal emperor, Akbar (Bhojani et al 2026). At some point, sharing a hookah became a way to socialise in groups.
Figure 3: Bidi smoking
Here is a woman pilgrim at the Gangasagar Mela, a large annual congregation of Hindu pilgrims at the confluence of the river Ganga (Hooghly) and the Bay of Bengal. Pilgrims take a dip in Ganga seeking forgiveness for their misdeeds. She is smoking a Bidi, made of uncured tobacco rolled into leaves and tied with a thread at one end. Bidis were possibly invented in the 17th century in southern Gujarat, a region where tobacco was initially cultivated (Lal 2009). Labourers rolled tobacco leftover in broad leaves of certain trees. Compared to hookah, bidis provided an easier and portable means for individuals to smoke tobacco that was also beyond the confines of castes.
I found the engagement with the arts comforting. It became a medium to be intimate with people I intended to connect with. It helped me understand their social and cultural contexts. It made me engage deeply, and without prejudice, with the many historical and sociocultural worlds of tobacco, broadening my understanding of what tobacco meant, and what it means to others, in past and in present times. That way, it helped me to understand tobacco harms in a broader sense, beyond mere empirical understanding of health harms.
I made drawings just for me. At least that is how it started. Later, on a suggestion of a colleague, I started using them to tell stories to others: stories of these people, stories of tobacco through physical and virtual exhibits.
About the author
Upendra Bhojani is a Senior fellow (Professor) at the Centre for Commercial Determinants of Health at the Institute of Public Health Bengaluru – India. He is a DBT/Wellcome Trust India Alliance Senior Fellow.
References
Agrawal, S; Karan, A; Selvaraj, S; Bhan, N; Subramanian, SV; Millett, C. 2013 “Social-economic patterning of tobacco use in Indian states” International Journal of Tuberculosis and Lung Diseases. 17(8):1110-1117.
Bhojani, Upendra. 2026 “Tobacco-related health harms among Indigenous communities in India: commercial determinants of health perspective” Indian Journal of Medical Ethics
Bhojani, Upendra; Sreekumar, Sreenidhi; Lal, Pranay. 2026 “Beyond the ‘colonial’ cigarette: a short history of the major ‘Indigenous’ tobacco products in India (1600-1900)” In Tobacco Through Time: Interdisciplinary Perspectives edited by Sarah Inskip and Jason Hughes. Bloomsbury Academic: London.
Bhojani, Upendra. 2025 “Tobacco and Society” a series of art works published by Nivarana https://nivarana.org/frames-of-reality/tobacco-and-society
Chaturvedi, Pankaj; Gupta, Prakash C; Seth, Sanjay; Sarin, Ashima. 2014 “India: powerful ‘voice of tobacco victims’ campaign wins BMJ health advocacy award” Tobacco Control https://blogs.bmj.com/tc/2014/10/30/india-powerful-voice-of-tobacco-victims-campaign-wins-bmj-health-advocacy-award/
Das, Hindol; Motghare, Shilpa. 2021 “India as “the oral cancer capital of the world”: the rising burden of oral malignancies across the nation. International Journal of Science and Healthcare Research 6(2):99-107
Lal, Pranay. 2009. “Bidi – A short history” Economic & Political Weekly. 96(10):1335-1337.
Nayak, Nayantara S. 2018. “Estimates of tobacco-dependent employment in India” Economic & Political Weekly. LIII(40):58-62.
Reddy, S; Gupta, PC. “Report on Tobacco Control in India” Ministry of Health and Family Welfare, Government of India.
Russell, Andrew. 2017. “Tobacco: colonial futures of a master plant.” Webinar, November 3. Posted by the Institute of Public Health Bengaluru. You Tube. https://www.youtube.com/watch?v=Wj5OYH9pGkk
Subrahmanyam, Sanjay. 1997 “The career and legends of Vasco Da Gama” Cambridge University Press: Cambridge
Tobacco Tactics. 2025. “Architects of Addiction: How Industry Designs Products to Be Appealing and Addictive” updated 29 May 2025, https://www.tobaccotactics.org/article/architects-of-addiction-how-industry-designs-products-to-be-appealing-and-addictive/
World Health Organisation. 2019. “Tobacco industry: decades of deception and duplicity” https://applications.emro.who.int/docs/FS-TFI-198-2019-EN.pdf
