According to a landmark study published in The Lancet Public Health, deaths attributed to second-hand smoke in India have soared by nearly 50% over the last three decades, claiming an estimated 325,600 lives in 2023 alone.India now holds the grim distinction of having the world’s second-highest number of people exposed to passive smoking, trailing only China. A staggering 444 million Indians are regularly inhaling toxic tobacco smoke from those around them.On one hand, India’s age-standardized exposure rate has steadily improved, falling from 43.2% to 30.6% in the last 3 decades. On the other hand, rapid population growth has completely offset these epidemiological gains.Also read: Buried aspirations: Grieving families say, if this isn’t murder, what is? after losing CA and IAS aspirants to Satya Niketan PG disasterBetween 1990 and 2023, the total number of individuals exposed to passive smoke grew by 18.4%, rising from 375 million to 444 million. As exposure expanded, the annual death toll mounted relentlessly from 217,700 to 325,600.The mortality data reveals a sharp escalation across both genders:Women: Annual deaths rose from 113,400 in 1990 to 156,900 in 2023.Men: Annual deaths rose from 104,300 in 1990 to 168,700 in 2023.Beyond immediate mortality, passive smoking exacted a massive physical toll, accounting for 9.28 million disability-adjusted life-years (DALYs) in India in 2023, a metric measuring the total loss of healthy years due to illness, disability, or premature death.Highlighting the urgent need for behavioral change, Dr G C Khilnani, chairperson of pulmonary, critical care at PSRI Hospital, said, "Second-hand smoke contributes not only to illness and disability but also to premature deaths and loss of healthy years. Kids and women are particularly vulnerable, with children's developing lungs making them more susceptible to respiratory issues. Smoking should be done outdoors, and greater public awareness is needed."Also read: Security breach case: NIA files chargesheet against Van Dyke, other foreigners; does not invoke UAPAIndia’s struggle is part of a massive global health crisis. Worldwide, 2.71 billion people were exposed to second-hand smoke in 2023, resulting in 1.66 million deaths and 44.8 million DALYs.Nearly half of the world's entire exposed population resides in just three Asian nations: China, India, and Indonesia. China recorded the highest burden, with 664 million people exposed to passive smoke.