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Recent data have confirmed that the risks of smoking are substantially higher than previously thought. With prolonged smoking, smokers have a death rate about three times higher than nonsmokers at all ages from young adulthood. Tobacco products are known or probable causes of over two dozen diseases or groups of diseases . If, as is likely, much of the excess mortality from these diseases is directly attributable to tobacco use, then this implies that the lifetime risk of a smoker being killed by the use of tobacco products is at least 50%. Therefore, a lifelong smoker is as likely to die as a direct result of tobacco use as from all other potential causes of death combined !
Other problems ensue because the negative health consequences of tobacco are not as immediate as with other hazardous substances. The health risks of tobacco are vastly underestimated by the public, and even by many of those who are responsible for protecting and promoting public health. Yet the risks of smoking are very high when compared to other risks faced in everyday life (See Table 1). Widespread underestimation of risks associated with tobacco use, is a major reason why tobacco products are still widely available, and why lenient tobacco policies have been allowed to occur. But nothing can alter the fact that tobacco use is one of the major public health challenges facing the world as it enters the twenty-first century.
Cancers of the :
Cardiovascular diseases :
Lung cancer and possibly other diseases caused by passive smoking
Fires caused by smoking materials
Table 1. Estimated Annual Risk of Death Selected Causes,
Tobacco products have no safe level of consumption, and are the only legal consumer products that kill when used exactly as the manufacturer intends. Researchers have rated nicotine as even more addictive than heroin, cocaine, marijuana or alcohol. The Tenth Revision of the International Classification of Diseases reserves classification F17.2 for "tobacco dependence syndrome". Yet tobacco products continue to be aggressively marketed by tobacco companies. The result is that global tobacco consumption has doubled since medical science conclusively proved, 30 years ago, that these products were unrivalled killers. And consumption is still increasing in many areas of the world.
An analysis of trends in cigarette consumption for WHO regions indicates that the two regions with the highest average per capita (adult) consumption in 1990-1992 were Europe (2290 cigarettes per adult per year) and the Western Pacific (2000). The lowest consumption was observed in the African Region (540). For the developed countries as a whole, per capita adult consumption is currently about 2400 cigarettes, which is still significantly greater than the average consumption in the developing world (1370 cigarettes).
The gap is rapidly narrowing, however. In 1970-1972, consumption per adult in the developed countries was 3.25 times higher than in the developing world (see Figure 1). By 1980-1982, this ratio had narrowed to 2.38, and by 1990-1992, to 1.75. During the last decade, per capita consumption has declined by an average of 1.4% per year in developed countries, but has risen by 1.7% annually in developing countries. If these trends were to continue, consumption of cigarettes per adult in the developing world will exceed levels in the developed world some time between the years 2005 and 2010, i.e., within two decades.
There have been very noticeable differences in trends among WHO regions. Over the last decade, the fastest decline in per capita consumption occurred in the Americas. Nor was this entirely due to declines in consumption in Canada and the United States of America; excluding those two countries, per capita consumption in the Region still declined by an annual average of 1.7%. On the other hand, the increasing consumption in the Western Pacific (2.2%) and South-East Asia (1.8%) is primarily due to the trends in China and India respectively. From 1983, per capita (adult) consumption in China rose by 3.9% per year to reach 1990 cigarettes in 1990-1992. In India, where about 90% of cigarettes are consumed in the form of bidis (traditional hand-rolled cigarettes), adult consumption has risen by about 2% per year over the last decade and now exceeds 1200 cigarettes (including bidis).
WHO estimates that there are about 1100 million regular smokers in the world today. About 300 million (200 million males and 100 million females) are in the developed countries, and nearly three times as many (800 million: 700 million males and 100 million females), in developing countries. In developed countries, 41% of men are regular smokers, as are 21% of women (see Figure 2). Half the men living in developing countries are smokers, compared with about 8% of women.
The health consequences of the smoking epidemic in developed countries have been quantified by WHO, in close collaboration with the Imperial Cancer Research Fund's Cancer Studies Unit at the University of Oxford, UK. A major report giving detailed estimates of the numbers and rates of smoking-attributed deaths for over 50 countries or groups of countries, has been published. Between 1950 and 2000, it is estimated that smoking will have caused about 62 million deaths in the developed countries (12.5 % of all deaths: 20% of male deaths and 4% of female deaths). More than half of these deaths (38 million) will have occurred at ages 35-69 years. Currently, smoking is the cause of more than one in three (36%) male deaths in middle age, and about one in eight (13%) of female deaths. Each smoker who dies in this age-group loses, on average, 22 years of life compared with average life expectancy. During the 1990s, the report estimates that almost 2 million people a year will die from smoking in developed countries (1.44 million men and 0.48 million women).
As regards cigarettes the health consequences of tobacco use are much more difficult to estimate in developing countries owing to lack of data. Currently, it is estimated that tobacco causes about 1 million deaths a year in developing countries, but there is substantial uncertainty about this figure. If current trends continue, and if the risks of death from tobacco use are similar in developing countries to those that have been observed in the industrialized world, then the annual toll of mortality from tobacco will rise dramatically to around 7 million deaths per year in the 2020s or early 2030s (see Table 2). The chief uncertainty is not whether, but rather when, these deaths will occur if current trends in tobacco use persist.
Table 2. Estimated number of Deaths caused every year by Tobacco