Numbers of smokers threatens to rise with population growth if unchecked
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* Elizabeth Rasmussen

Without strong public health interventions, tobacco-related diseases and mortality, long seen as health problems for high-income countries, now threaten low- and middle-income countries, experts warn.

According to an April 5 study in *The Lancet*, most high-income countries have seen reductions in the number of smokers. However, policies to stop initiation and encourage quitting in low- and middle-income countries are necessary to prevent a global epidemic of tobacco-related diseases, such as lung cancer and emphysema.

Though worldwide smoking has decreased by around 30 percent for both sexes, study authors estimate that over 933 million people are still daily smokers — around 1 in 4 men and 1 in 20 women. This number becomes increasingly dangerous to air quality and global health as populations grow, the study said, which based its analysis on data from the 2015 Global Burden of Disease, Injuries and Risk Factors study.

Without intervention, the increased populations of middle-income countries such as China and India threaten to proportionally increase the number of smokers, and therefore increase the burden of tobacco-related disease worldwide, the study said. Increased aging and life expectancy, coupled with population growth, has led to an increase in tobacco-related diseases in low- to middle-income countries, offsetting the progress made by decreased smoking worldwide.

Smoking is the second leading risk factor for death, and is responsible for over 5 million premature deaths every year. Half a billion people alive today will die prematurely before they quit smoking, according to the study. People from only four countries — China, India, the United States and Russia — will make up half of those deaths.

“The persistence of smoking in the countries first affected by the tobacco epidemic reflects decades of failure, first to recognize smoking as a health problem, and second to take decisive action to implement the policies currently promoted by the WHO Framework Convention on Tobacco Control,” warned John Britton, MD, director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham in an article accompanying the study.

The Framework Convention on Tobacco Control, a treaty signed by members of the United Nations, seeks to reduce global demand for tobacco in the name of protecting public health. The treaty makes recommendations for regulation of secondhand smoke, advertisements and taxation of tobacco products.

“Despite progress in some settings, the war against tobacco is far from won, especially in countries with the highest number of smokers,” the study concluded. “The staggering toll of smoking on health echoes well beyond the individual, especially as tobacco threatens to exact long-term financial and operational burdens on already resource-constrained healthy systems.”

*   Copyright The Nation’s Health, American Public Health Association