WHO. Tobacco: Ending an unhealthy trend

MARCH 2015. There was a time, not long ago, when smoking was trendy.Televisions, billboards and magazines were covered in advertisements glorifying smoking.

Concerts and sporting events were places for the tobacco industry to hand out free products and branded promotional items. And, everyone from your dad to your doctor smoked in all places – cars, elevators, restaurants, houses and even hospitals. This was the 1980s. The same time I began treating lung cancer patients at a hospital in Brazil and saw first-hand the impact of smoking. During my 6 years there I saw many patients lose their lives, often within 2 years of diagnosis.

I also lost my mother to cancer. Some years later, my father died of the same disease. Both were exposed to smoke. My father was a smoker and my mother spent years breathing in his second-hand smoke.

As a result, I saw the need to prevent cancer by specifically targeting its biggest risk factor – tobacco.

Need for prevention

World Cancer Day is a day to recall that tobacco is the single biggest cause of cancer in the world and the leading cause of preventable deaths. Every year, 8.2 million people die from cancer; at least 1.6 million or 20% of these are tobacco-related. In total, more than 6 million people will die this year from tobacco-related diseases including cardiovascular diseases, chronic lung diseases and cancer.

Celebrating 10 years of tobacco control

Later this month, we will celebrate the 10th anniversary of the WHO Framework Convention for Tobacco Control (WHO FCTC) – the first intergovernmental treaty established to dramatically change tobacco control worldwide. Entered into force in February 2005, WHO FCTC enacts a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide.

In 10 years, WHO FCTC has become one of the most widely embraced treaties in the history of the United Nations. Its 180 parties cover 90% of the world’s population.

Today, 80% of the countries that ratified the convention have adopted new or strengthened their existing tobacco control legislation. The average price of a packet of cigarettes has increased by almost 150% in the past 5 years and many countries require graphic health warnings to cover at least 75-85% of cigarette packages.

Comprehensive smoking bans covering both indoor workplaces, public places and public transport with no exemptions have been introduced in 48 parties, an almost ten-fold increase since 2005. Outdoor spaces, such as beaches and public parks, have now started to become smoke-free. And, there are many countries who have set high targets to become smoke-free or have less than 5% of the population using tobacco.

A smoke-free society

The world looks a lot different than it did when I worked at the cancer hospital in the ‘80s.

Smoking is no longer a socially acceptable behaviour and is banned in many places. Public health information on the dangers of smoking is widely available. And, countries are standing together against the advances of the tobacco industry in order to protect the health of their people.

The 10th anniversary of the WHO FCTC shows how coordinated and multisectoral national and international action in the area of tobacco control can de-normalize a risk-factor and move the health agenda forward. It demonstrates that health can indeed persuade other sectors to take action, through taxes, graphic health warnings, legislation and marketing bans to save lives.

But the war on tobacco is not over yet. We still expect 8 million people to be dying each year by 2030 – because they have smoked tobacco or have been exposed to second hand smoke. The use of alternative products such as water pipes, smokeless tobacco and electronic nicotine delivery systems are gaining in popularity and will need to be addressed through tobacco control measures. The illicit tobacco market still counts for 1 in every 10 cigarettes consumed globally.

To prevent this, we must stand together against the tobacco industry. Tobacco companies still spend tens of billions of dollars each year on advertising, promotion and sponsorship of tobacco products. They continuously challenge the regulatory measures governments are taking to protect our children and grandchildren from getting addicted to their products.

Cancer deaths due to tobacco are preventable. Premature deaths due to tobacco can be reduced. On World Cancer Day, we must recommit to further reduce tobacco use so that a tobacco-free world becomes a reality.


Dr Vera Luiza da Costa e Silva, Head of the Convention Secretariat, Framework Convention on Tobacco Control



Key facts

·         Tobacco kills up to half of its users.

·         Tobacco kills nearly 6 million people each year. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke. Unless urgent action is taken, the annual death toll could rise to more than eight million by 2030.

·         Nearly 80% of the world’s one billion smokers live in low- and middle-income countries.


Leading cause of death, illness and impoverishment

The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing nearly six million people a year. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco, accounting for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease.

Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.

In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to « green tobacco sickness », which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.

Gradual killer

Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease and death has just begun.

Tobacco caused 100 million deaths in the 20th century. If current trends continue, it may cause one billion deaths in the 21st century.

Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. More than 80% of those deaths will be in low- and middle-income countries.

Surveillance is key

Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Only one in four countries, representing just over a third of the world’s population, monitor tobacco use by repeating nationally representative youth and adult surveys at least once every five years.

Second-hand smoke kills

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water pipes. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.

There is no safe level of exposure to second-hand tobacco smoke.

·         In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.

·         Almost half of children regularly breathe air polluted by tobacco smoke in public places.

·         Over 40% of children have at least one smoking parent.

·         Second-hand smoke causes more than 600 000 premature deaths per year.

·         In 2004, children accounted for 28% of the deaths attributable to second-hand smoke.

Every person should be able to breathe tobacco-smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.

Over 1 billion people, or 16% of the world’s population, are protected by comprehensive national smoke-free laws.

Tobacco users need help to quit

Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey in China revealed that only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it causes stroke.

Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed.

National comprehensive cessation services with full or partial cost-coverage are available to assist tobacco users to quit in only 21 countries, representing 15% of the world’s population.

There is no cessation assistance of any kind in one-quarter of low-income countries.

Picture warnings work

Hard-hitting anti-tobacco advertisements and graphic pack warnings – especially those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit.

Graphic warnings can persuade smokers to protect the health of non-smokers by smoking less inside the home and avoiding smoking near children. Studies carried out after the implementation of pictorial package warnings in Brazil, Canada, Singapore and Thailand consistently show that pictorial warnings significantly increase people’s awareness of the harms of tobacco use.

Just 30 countries, representing 14% of the world’s population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs. Most of these countries are low- or middle-income countries.

Mass media campaigns can also reduce tobacco consumption, by influencing people to protect non-smokers and convincing youths to stop using tobacco.

Over half of the world’s population live in the 37 countries that have implemented at least one strong anti-tobacco mass media campaign within the last two years.

Ad bans lower consumption

Bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption.

·         A comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7%, with some countries experiencing a decline in consumption of up to 16%.

·         Only 24 countries, representing 10% of the world’s population, have completely banned all forms of tobacco advertising, promotion and sponsorship.

·         Around one country in three has minimal or no restrictions at all on tobacco advertising, promotion and sponsorship.

Taxes discourage tobacco use

Tobacco taxes are the most cost-effective way to reduce tobacco use, especially among young people and poor people. . A tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and about 5% in low- and middle-income countries.

Even so, high tobacco taxes is a measure that is rarely used. Only 32 countries, less than 8% of the world’s population, have tobacco tax rates greater than 75% of the retail price. Tobacco tax revenues are on average 175 times higher than spending on tobacco control, based on available data.

WHO response

WHO is committed to fighting the global tobacco epidemic. The WHO Framework Convention on Tobacco Control entered into force in February 2005. Since then, it has become one of the most widely embraced treaties in the history of the United Nations with 178 Parties covering 89% of the world’s population. The WHO Framework Convention is WHO’s most important tobacco control tool and a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance.

In 2008, WHO introduced a practical, cost-effective way to scale up implementation of provisions of the WHO Framework Convention on the ground: MPOWER. Each MPOWER measure corresponds to at least one provision of the WHO Framework Convention on Tobacco Control.

The 6 MPOWER measures are:

·         Monitor tobacco use and prevention policies

·         Protect people from tobacco use

·         Offer help to quit tobacco use

·         Warn about the dangers of tobacco

·         Enforce bans on tobacco advertising, promotion and sponsorship

·         Raise taxes on tobacco.

For more details on progress made for tobacco control at global, regional and country level, please refer to the series of WHO reports on the global tobacco epidemic.

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