3.36 The global tobacco pandemic

Last updated: April 2015

Suggested citation: Bellew, B, Greenhalgh, EM & Winstanley, MH. 3.36 The global tobacco pandemic. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2015. Available from http://www.tobaccoinaustralia.org.au/3-36-the-global-tobacco-pandemic

 

According to a recent review of mortality trends, world life expectancy is currently slightly above 70 years; most deaths earlier than that are avoidable, and are primarily caused by non-communicable diseases.1 Although communicable diseases, for example influenza and influenza-like illnesses, have a tendency to capture news headlines and possibly the attention of policy-makers more dramatically than many other health issues, an examination of the disease burden of influenza2-5 compared with the disease burden of tobacco6-8 leaves little doubt about the salience of tobacco as an issue in global public health. Death and disease caused by tobacco use now constitutes a pandemic;  its use is the leading cause of preventable death and is estimated to kill more than five million people each year worldwide.9-11 This constitutes one death about every six seconds.12 In 2004, 12% of all deaths worldwide among adults over 30 were attributed to tobacco.12 In 2010, smoking caused about a quarter of all cancer deaths in Europe and America, and even greater numbers from other diseases. Smoking is also a major cause of death in China, India, and other countries throughout Asia.1 In several Asian and African countries, more than 25% of male deaths are now related to smoking, matching regions in Europe and North America that previously had the highest proportion of tobacco-related mortality. More than two thirds of tobacco deaths occur in low- and middle-income countries,13 with the gap in deaths between low  and middle income countries and high income countries expected to widen further over the next several decades if effective prevention measures are not implemented.9 If current trends persist, tobacco will kill more than eight million people worldwide each year by the year 2030,14 and about 1 billion by the end of this century.13 

By 2030, it is projected overall that there will be approximately 26 million new cancer cases and 17 million cancer deaths per year.15, 16 This compares with about 12 million new cases and 7.6 million cancer deaths estimated to have occurred globally in 2007. The projected increase will be driven largely by growth and ageing of populations and will be largest in low- and medium-resource countries. Under current trends, increased longevity in developing countries will nearly triple the number of people who survive to age 65 by 2050. This demographic shift will be compounded by entrenched modifiable risk factors such as smoking, which is the leading risk factor for cancer mortality in countries of low, middle and high income.15, 16 On the basis of current tobacco consumption patterns, it has been estimated that approximately 450 million adults will be killed by smoking between 2000 and 2050. At least half of these adults will die between 30 and 69 years of age, losing decades of productive life. Cancer and the total deaths due to smoking have fallen sharply in men in high income countries but will rise globally unless current smokers, most of whom live in low and middle income countries, stop smoking before or during middle age.17

Projections of global mortality and burden of disease from 2002 to 2030 have been undertaken by Mathers and Loncar using three scenarios–'baseline', 'optimistic' and 'pessimistic'.8 The projections highlight tobacco-related mortality and burden of disease as a major threat to public health and allow comparisons with other major threats to public health such as human immunodeficiency virus (HIV) infection18 or obesity.15,19,20 In these projections, global HIV/AIDS deaths rise from 2.8 million in 2002 to 6.5 million in 2030 under the 'baseline' scenario, which assumes that coverage with antiretroviral drugs reaches 80% by 2012. Under the 'optimistic' scenario, which also assumes increased prevention activity, HIV/AIDS deaths drop to 3.7 million in 2030. By contrast, total tobacco-attributable deaths rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under the 'baseline' scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally.8

Tuberculosis (TB), HIV and chronic obstructive pulmonary disease (COPD) are burgeoning epidemics in developing countries. The link between TB and HIV is well established. Less well recognised is the strong relationship between tobacco smoking and the development and natural history of TB. These associations are of considerable relevance to public health and disease outcomes in individuals with TB. Moreover, tobacco smoking, a modifiable risk factor, is associated with poorer outcomes in HIV-associated opportunistic infections, of which TB is the commonest in developing countries. It is now also becoming clear that TB, like tobacco smoke, besides its known consequences of bronchiectasis and other pulmonary morbidity, is also a significant risk factor for the development of COPD.18 Almost 90% of COPD deaths occur in low- and middle-income countries, and it has been estimated that COPD will be the third leading cause of death in 2030 globally.13 Thus, the harmful synergistic interaction between TB, HIV, tobacco smoking and COPD in a large proportion of the world's population that deserves urgent attention in developing countries.18

International research on current smoking prevalence and behaviours among youth aged 13–15 has reported disturbing trends for the future. The Global Youth Tobacco Survey, assessing data from more than 130 countries and principalities, has found that:21

  • the gap in smoking rates between school-aged girls and boys is decreasing, a finding of particular importance for those countries in which smoking has previously been negligible among the female population,
  • use of tobacco products other than cigarettes is widespread,
  • a sizeable proportion of children who currently do not smoke are contemplating adopting the behaviour, and
  • children are widely exposed to secondhand smoke.

Each of these findings can be expected to have a significant impact on morbidity and mortality from tobacco use in forthcoming decades.21

While the current burden of death is distributed evenly between developing and industrialised countries,22 most of the future burden of death will occur in low and middle income countries, where more than 80% of the world's smokers live.23 Smoking rates are for the most part well in decline in Western Europe, the UK, the US, Canada, New Zealand and Australia. However in some countries in Asia, South America and Africa, the prevalence of smoking is still increasing.24,25 In China, home to one-third of the world's population, the death toll from smoking currently stands at about 800 000 per year and it has been estimated that smoking will cause three million Chinese deaths annually by the middle of this century.26 Tobacco smoking rates vary; men usually smoke more than women in overall consumption and in prevalence. Current available estimates are 49% for men and 8% for women in low and middle income countries, and 37% for men and 21% for women in high income countries.27 This is reflected in the proportion of mortality attributable to tobacco, which is higher among men than women.12 A series of country profiles on non-communicable diseases made available by the World Health Organization points out that since prevalence varies greatly, these country profiles provide a useful way of examining this aspect of the pandemic and are illustrative of the importance of tobacco as a cross-cutting risk factor for non-communicable diseases.28

The global tobacco pandemic is characterised by an escalating burden of death and disease that is increasingly being borne by developing countries; efforts to promote global health equity must therefore prioritise reductions in tobacco consumption.29 The scale of this global tobacco pandemic8, 15-18, 27, 30 and the globalisation of tobacco use31 provide a clear rationale for a global response such as that set out in the World Health Organization Framework Convention on Tobacco Control (FCTC)33 and the supporting MPOWER package.33 The World Health Organization's Report on the Global Tobacco Epidemic describes some of the progress achieved as a result of the FCTC, such as 739 million people in 31 countries being afforded protected by comprehensive smoke-free laws;34 but an earlier World Health Organization report also implicitly acknowledges that much more needs to be done because it notes that less than 10% of the world's population is covered by any one of the MPOWER measures by the year 2008.14 Chapman, while acknowledging that an acceleration of policy development in tobacco-control policy has been ushered in by the FCTC, has also noted the optional nature of some aspects of the treaty and thus the particular importance of intensified strategies in harm reduction, demand reduction, denormalisation of tobacco use (especially among health workers in nations where use remains high) as well as further efforts to regulate the tobacco industry (especially plain packaging, under-the-counter retail sales and the regulation of tobacco products).35

Chapter 1 provides international prevalence comparisons while Chapter 2 gives international comparisons on tobacco consumption. The global nature of the industry is covered in Chapter 10. The WHO Framework Convention on Tobacco Control is described in detail in Chapter 18.

Relevant news and research

For recent news items and research on this topic, click here.(Last updated September 2018)

 

References

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