The latest data has shone a spotlight anew on one of the foremost global public health menaces: tobacco use. Focusing on tobacco control is vital.
Published in The Lancet ahead of World No Tobacco Day – observed May 31st – the research posits the number of deaths due to tobacco use in 2019 alone at almost eight million. This staggering death toll is a grim reminder of the manifold detrimental health impacts of tobacco use. As the research shows, tobacco use in 2019 was associated with 1.7 million deaths from ischaemic heart disease; 1.6 million deaths from chronic obstructive pulmonary disease (COPD); 1.3 million deaths from tracheal, bronchus, and lung cancer; and almost one million deaths from stroke. It is unsurprising, therefore, that the World Health Organization (WHO) identifies “the tobacco epidemic [as] one of the biggest public health threats the world has ever faced.”
This is not to say that the global rate of tobacco use has not declined – since 1990, 27.5 percent fewer men and 37.7 percent fewer women smoked. Nor is it to say, however, that the problem has gone away. This is far from the case. In 2019, the number of smokers globally tallied at 1.1 billion whilst twenty countries saw a significant increase in smoking rates among men and twelve saw significant increases among women. Chewing tobacco remains a scourge, especially in south Asia. India accounted for the world’s largest chewing tobacco-using population, at 185.8 million. This, the report states, underscores the need for tighter regulations.
Of particular concern when it comes to tobacco use is the addictiveness of tobacco products. Nearly ninety percent of new smokers become addicted by the age of 25, whilst more than half of countries have failed to make progress in the reduction of smoking among those in the 15-24 age demographic. This cohort of the population ought to be foregrounded in the discussion surrounding tobacco control according to senior author Professor Emmanuela Gakidou of the Institute for Health Metrics and Evaluation (IHME) at the University of Seattle, Washington. “Persistently high smoking prevalence among young people in many countries, along with the expansion of new tobacco and nicotine products, highlight an urgent need to double down on tobacco control,” Gakidou said. “If a person does not become a regular smoker by age 25, they are very unlikely to become a smoker. This presents a critical window of opportunity for interventions that can prevent young people from starting smoking and improve their health for the rest of their lives.” India, Egypt, and Indonesia account for the largest absolute increases in the number of young male smokers – underscoring the sinister nature of campaigns by tobacco companies to entice young smokers as reported in years past.
To address the continued scourge of tobacco and engender effective policies to foster tobacco control, we ought to be looking towards risk reduction. The question is: are we doing so? “We’ve seen, I think, the fairly dramatic availability of a range of tobacco harm reduction products that both increase cessation abilities of people and, maybe as importantly, help those who are unable or unwilling to quit to actually have a chance of using a reduced risk product,” Dr Derek Yach, a global health expert and president of the Foundation for a Smoke-Free World, told me. “We believe these products – heated tobacco products, e-cigarettes, nicotine patches, have a potential to lower the death rates dramatically.”
This, Dr Yach said, is a gap in the Lancet report’s findings. “What The Lancet article fails to address is the entire category of harm reduction,” he said. In addition, he told me, “the other important gap” is the discussion surrounding tuberculosis. “WHO acknowledges that [a] significant portion of tuberculosis (TB) is both caused by smoking and made worse by smoking,” he said. “About sixty to seventy percent of TB patients smoke.” For India, this is concerning. As previously reported by Health Issues India, “government figures indicated that India had an estimated tuberculosis incidence of 2.7 million in 2018. The country accounts for 25 percent of the global tuberculosis burden, while also accounting for a significant proportion of ‘missing cases’ (i.e. cases that are undetected). As such, it lags behind significantly on tuberculosis reduction targets both in terms of cases and mortality.”
The problem can be attributed in large part to the lack of availability of risk reduction products in low- and middle-income countries. As Dr Yach told me, “we have seen the greatest uptake of reduced risk products in advanced industrialised countries. But these products are not available in lower middle income countries and remember that eighty percent of the world’s smokers live in these countries. Some governments have prematurely banned such products on poor advice from WHO. For others, products have not been adapted to local pricing and sensory needs.
“As an epidemiologist I’m always interested in the numbers and, on current projections, we are likely to have anywhere between 6.5 to eight million deaths from smoking for the next many, many, many decades. That’s assuming that we’re going to continue making the slow progress that is underway. If we introduced reduced risk and harm reduction products into the market, premature deaths could be cut by about 3 million a year over the next few decades.. Such products are one of the most sensible cost effective impactful interventions that we have in global health and the health benefits will be overwhelming.”
Article on global trends in smoking tobacco can be accessed here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01169-7/fulltext
Article on youth initiation can be accessed here: http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00102-X/fulltext
Article on chewing tobacco can be accessed here: http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00065-7/fulltext