The world's largest tobacco use survey, published today in The Lancet, underscores the enormity of the global tobacco epidemic – especially in low- and middle-income countries that are being targeted by the tobacco industry – and the urgent need for countries to implement proven strategies that reduce tobacco use and save lives. This study demonstrates how quickly the burden of tobacco use is moving to low- and middle-income countries and is a wake-up call for these countries to act now and address a crisis they can ill afford.
Consisting of surveys in 14 low- and middle-income countries conducted between 2008 and 2010, the Global Adult Tobacco Survey provides the most comprehensive information to date on the tobacco epidemic in countries where it is growing most rapidly. The study also includes data from the United States and the United Kingdom for comparison purposes.
In just these 16 countries, the study finds there are 852 million tobacco users – 661 million smokers and 247 million smokeless tobacco users. The study shows alarming rates of tobacco use. In the 14 low- and middle-income countries surveyed, nearly half of all men (49 percent) use tobacco. While women's tobacco use rates remain low, women are starting to smoke as early as men, indicating the harmful impact of tobacco marketing aimed at women and girls.
The study also demonstrates once again that strong tobacco control policies work. The percentages of smokers who have quit are highest in the U.S., the U.K., Brazil and Uruguay, where tobacco control policies are strongest. Brazil and Uruguay have dramatically reduced tobacco use by implementing tobacco control policies such as higher tobacco taxes, comprehensive smoke-free laws, graphic cigarette warnings and tobacco advertising bans. In contrast, nations such as China, India, Russia and Bangladesh are paying the price for inaction.
Other key findings in the study include:
China has the most tobacco users (300.8 million), followed by India (274.9 million). China has the most smokers (300.7 million), while India has the most smokeless tobacco users (205.9 million).
Russia faces a looming crisis. Russia has the highest smoking rate among men (60.2 percent). Particularly alarming is the fact that the percentage of Russian youth who smoke (both male and female, ages 15 to 19) is higher than in any other country in the study.
India and Bangladesh face unique risks because of high rates of smokeless tobacco use, with these two countries having a combined 94 percent of the smokeless tobacco users in the survey. Just over 25 percent of Indians (205.9 million altogether) use smokeless tobacco. Bangladesh has the highest smokeless tobacco rate in the survey (27.9 percent) and the highest rate among women. It's no surprise that India and Bangladesh have the highest rates of oral cancer in the world.
This study comes at a critical time for both Bangladesh and Russia. Each country is currently considering proposed tobacco control legislation that is being vigorously opposed by the tobacco industry. Whether Russia and Bangladesh enact the pending proposals will have a major impact on the health of their citizens for decades.
Unless effective tobacco control measures are implemented in low- and middle-income countries, the burden of tobacco-related death and disease in those countries will continue to increase. The study states "to reduce worldwide smoking prevalence by 30 percent in 2025, countries are exhorted to fully implement the Framework Convention on Tobacco Control (FCTC)." The World Health Organization's first public health treaty calls on countries to implement proven strategies to reduce tobacco use, including higher tobacco taxes, 100 percent smoke-free laws, large, graphic health warnings, and comprehensive bans on tobacco advertising, promotion and sponsorships.
Without urgent action, tobacco use will claim one billion lives this century. It already kills six million people a year, accounting for one in 10 deaths among adults worldwide. Governments must act now to reduce the devastating global toll of tobacco products on health, lives and economies.
Data on tobacco use for the 14 low- and middle-income countries came from the Global Adult Tobacco Survey (GATS), a national survey of adults 15 years and older conducted in Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. The research was funded by Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, the Bill and Melinda Gates Foundation, and the Brazilian and Indian governments.