More than half the world’s population — 63 percent — is covered by one or more comprehensive tobacco control measures. In the past 10 years alone, that number has more than doubled, says a new report from the World Health Organization on the “global tobacco epidemic.”
An international push for policies, like strong graphic warnings, a ban on tobacco advertising and smoke-free public spaces, has touched the lives of 4.7 billion people.
Such policies have saved millions of lives, but millions of more people remain in danger, say WHO experts, as tobacco kills seven million people a year. Male smokers living in middle-income countries are by far the largest group of smokers in the world, numbering 765 million, or 68 percent of all smokers.
Around half of the world’s female smokers (85 million) live in high-income countries, and women’s average overall smoking rates have decreased from 8 percent globally in 2007 to 6 percent in 2015.
Men’s average overall smoking rates are declining slowly, from 39 percent globally in 2007 to 35 percent in 2015. The biggest drops are occurring in high-income countries.
“The good news is, tobacco prevalence is going down,” Rosa Sandoval, a regional adviser tobacco control for the WHO, said in an interview. “The bad news is, it is not going down as fast as we would like to see.”
Tobacco advertising is identified as one of the biggest hindrances to progress in use of tobacco. According to the report, major companies “spend tens of billions of US dollars worldwide each year” on promotions to increase sales and boost profits. Health officials say companies use targeted marketing to encourage nonsmokers to start.
The report identifies women and young children in low- and middle-income countries as most vulnerable to these business strategies.
“You might imagine that it would be rare for an adult to be smoking a bubblegum flavored cigarette,” said Dr. Kelly Henning, who leads the Bloomberg Philanthropies Public Health program, which includes a nearly $1 billion campaign to curb the tobacco epidemic in low- and middle-income countries. “That product is almost surely targeted towards children and young adults to get more and more of those age groups hooked on tobacco.”
Sandoval said that WHO hoped to see the prevalence of tobacco drop 30 percent from 2010 to 2025. However, prevalence is currently decreasing at a rate of only 4 percent every five years, so the goal is far out of reach. That is not to say that countries have done a poor job fighting what advocates call the tobacco epidemic so far.
The report defines tobacco as cigarettes and other forms of smoked tobacco (e.g. cigars, pipe, bidis, water pipes); and smokeless tobacco products, such as chewing tobacco and snuff.
According to the report, the MPOWER initiative, a WHO program to reduce tobacco demand, has not only saved millions of lives but also hundreds of billions of dollars since it began in 2008. MPOWER works on six strategies: “Monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn people about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco.”
The report notes that eight countries have fully implemented at least four of the MPOWER measures: Brazil, Britain, Iran, Ireland, Madagascar, Malta, Panama and Turkey. Five of the countries are classified as low- or middle-income. Sandoval said these gains have showed a key advantage of the MPOWER’s ability in fighting the influence of tobacco companies. But 57 countries have yet to adopt a single MPOWER measure.
“The good news is, you do not need to be a rich country to implement these policies,” Sandoval said. “In the new WHO report, you will see how low- and middle-income countries have implemented successful policies to curb the tobacco epidemic in the region of the Americas.”
In the United States, for example, cigarette smoking has dropped to historic lows, yet tobacco use remains the leading cause of preventable disease and death in the country, killing more than 480,000 people a year. The Food and Drug Administration recently announced a new program to tackle the addictive nature of tobacco through tighter regulation of nicotine.
Sandoval deals specifically with the Americas in her work, but the report shows that its findings apply globally as well. In addition to MPOWER’s success, Sandoval said that 18 countries have banned smoking entirely in public places and workspaces. She said that this policy not only discouraged current smokers but also potential smokers.
“It communicates a strong message to society that this is a product that harms your health, so if you want to smoke it, you have to do it outside,” she said. “You cannot expose other people to secondhand smoke.”
Sandoval said that tobacco taxes have proven to be the most cost-effective measure under the WHO Framework Convention on Tobacco Control to cut consumption and encourage users to quit. Nevertheless, the report demonstrates that taxes are the tool least adopted by UN member states.
One problem the report identifies is that “tobacco excise tax structures in many countries are quite complex, with different (tiered) taxes that are applied to the same product based on sometimes minor differences in product characteristics. Tobacco companies take whatever actions they can to keep taxes low.”
The report recommends a single, specific high tax on all tobacco products that adjusts with the economy’s growth. Tobacco taxes, it says, are especially important because increased government revenues can be used to finance treatment and prevention of noncommunicable diseases nationally.
The report says that tobacco is a “leading common risk factor” for noncommunicable diseases, which are responsible for around 70 percent of deaths globally each year.
For most low- and middle-income countries, however, a uniform tobacco tax is a distant reality. The report says that only 11 countries, or 8 percent of low- and middle-income countries, levy taxes at rates in accordance with WHO recommendations. Sandoval said these countries also suffer socially and economically because of the structure of the tobacco industry.
“Many of the children that are part of families growing tobacco are working and studying at the same time, and a high percentage of these children are not going to school,” Sandoval said.
If children are focusing less on school and more on work, she said their families and their countries alike suffer in the long run. She also stressed the link between tobacco-production and poverty.
“This is a product that is associated [with] diseases that require large budgets to be cured or to be taken care of, and usually people live with these diseases or conditions for a long time,” she said. “So, this is a distress not only on the families but also the public budget in the health sector.”
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Andrew Seger is a student at Fordham University and an anchor and reporter for WFUV, the NPR affiliate based at the university.