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The current death toll attributable to tobacco-related illnesses is estimated at one in eight in the developing world, one in four in developed countries, and one in six for the world as a whole. In 1993 alone, tobacco use was responsible for 3 million deaths (1). In the mid-1990s, about 25 percent of all male deaths in developed countries were due to smoking (2). In the United States and other industrialized countries where smoking has been prevalent for decades, lung cancer and ischemic heart disease are the leading causes of tobacco-related deaths. The total number of deaths caused by tobacco in these nations was more than 1.8 million in 1990 and is expected to reach 20 million during the last decade of this century (3). However, the rate of increase in the epidemic of smoking-caused mortality is slowing somewhat among men, but continues to increase rapidly among women in the industrialized world (4).
In most of the developing world, smoking has only more recently become a widespread habit, but medical researchers expect that within the next 25 to 30 years the mortality pattern associated with smoking will approximate that of the industrialized countries. This trend has already become apparent in countries such as China, where unpublished evidence in a nationwide study suggests that tobacco is already causing half a million deaths annually, of which about one half are due to chronic lung disease. The effects of the smoking epidemic on mortality rates in China will certainly worsen substantially during the next century, given the fact that between 1978 and 1992, consumption of manufactured cigarettes in that country more than tripled, from 500 billion to 1,700 billion (about 30 percent of the world total) (5).
According to the World Health Organization (WHO), there are about 1.1 billion smokers worldwide, or about one third of the population 15 years and older. The vast majority – 800 million smokers – are in developing countries; 700 million of these smokers are men. In the developed countries, an estimated 42 percent of men and 24 percent of women smoke; corresponding figures for the developing world are about 48 percent of men and 7 percent of women (6). In China, however, where most of the world’s smokers now reside, 63 percent of men and 3.8 percent of women are current smokers (7).
The number of deaths annually attributable to tobacco is expected to increase from 3 million in 1993 to 8.4 million in 2020, of which 6 million are projected to occur in the developing world (8)(9). In fact, within 25 years, tobacco will surpass infectious diseases to become the leading threat to human health worldwide (10). Currently, the global cost of tobacco-related illnesses is nearly $200 billion a year in direct health-care expenses and lost productivity related to morbidity and premature mortality. One third of this loss occurs in the developing world (11).
The Food and Agricultural Organization of the United Nations (FAO) estimates that tobacco consumption in developing nations has increased at a rate of 2.1 percent annually during 1985-90 and is increasing at a rate of 1.9 percent during 1995-2000 (12). Various factors may explain this increase, including larger than ever amounts of disposable income coupled with widespread advertising and promotion of tobacco products, and insufficient legislation regarding product warning labels and smoke-free workplaces and public areas. This scenario reflects a lack of awareness of the health risks that tobacco presents, and this ignorance may relate to the approximate 25- to 30-year lag time between the onset of persistent tobacco use and the actual deaths attributable to smoking. Thus, policymakers and health officials in the developing world may not yet focus on tobacco as a source of preventable mortality and morbidity.
1. Howard Barnum, “The Economic Burden of the Global Trade in Tobacco,” Tobacco Control