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What we know about the worldwide decline in tobacco use

Almost every country on the planet has reduced its tobacco intake in 2020, according to the WHO’s latest findings.

AFP

Over 75 percent of countries worldwide have at least one effective tobacco reduction measure in place as of 2021, according to a new study by the WHO.

Tobacco usage is one of the world’s leading causes of premature death, accounting for more than 8 million fatalities and costing the global economy $1.4 trillion annually.

Cigarette smoking in particular is the leading cause of preventable death in the United States, resulting in nearly one in five deaths each year, according to the Centers for Disease Control and Prevention (CDC).

In response to these risk factors, the global prevalence of tobacco use has been declining steadily over the past two decades, according to The World Health Organisation (WHO).

Last month, the WHO published its latest findings in the fourth edition of its Global report on trends in prevalence of tobacco use 2000–2025.

The report pulled data from surveys conducted by 165 countries to show that 22.3 percent of all people aged 15 and older used tobacco in 2020, down from 32.7 percent in 2001.

At least 150 countries are seeing tobacco use decline with 60 of them on track to meet reduction goals set under the WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020.

One of the main targets set in the action plan is to reduce the global prevalence of tobacco use by 30 percent by 2025 compared to 2010.

WHO’s Assistant Director-General of Universal Health Coverage, Dr. Naoko Yamamoto said the report “comes at a time of precious little good news in public health.”

“Despite the Covid-19 pandemic diverting attention, countries have continued the good work on tobacco control because its benefits for health and wellbeing are immediate and clear,” said Yamamoto.

So what do we know about this decline so far?

There is a huge gender and age divide among consumers

Tobacco use has been dubbed “the male vice” by Statistica, and they’re not wrong.

Men consume tobacco almost five times more than women across the globe, according to WHO estimates.

The prevalence among women aged 15 and older was at 7.8 percent in 2020, compared to 36.7 percent among men in the same age group.

In 2000, one in four tobacco users in the world were women, and by 2025 the ratio is expected to be one in six.

The gender difference is widest in the Western Pacific region where one in 18 tobacco users is female, compared to the Americas and the European regions, where one in three tobacco users are female.

However, for both genders there has been a steady decline in tobacco use in each age group from 2000–2020.

Among the ages, tobacco use is higher in older groups. The WHO reported that 28.5 percent of 45 to 54-year-olds worldwide consumed tobacco in 2020, compared to 14.2 percent among 15 to 24-year-olds.

The tobacco use rates peak at age group 45–54 for men, and for women peak at age group 55–64.

3/4 of the world is taking effective action

The South-East Asia region has the highest average rate of tobacco use at around 29 percent in 2020, compared with 50 percent in 2000. Meanwhile, the African region has the lowest rates at around 10 percent in 2020, compared to 18 percent in 2000.

Despite their differences, every region is doing its part to reduce tobacco usage.

Earlier this year, the WHO published its eighth report on “the global tobacco epidemic” for 2021. The report tracks progress made by countries in tobacco control since 2008

75 percent of countries worldwide have at least one effective tobacco reduction measure in place as of 2021. These measures protect 5.3 billion people, or 69 percent of the world’s population.

50 percent of countries have adopted at least two policies, and the number of countries enacting WHO measures continues to rise year-on-year.

The measures are a part of a policy package known as MPOWER, intended to assist countries in reducing the demand for tobacco, as ratified by the WHO Framework Convention on Tobacco Control (FCTC).

WHO member states in 2003 unanimously adopted the FCTC treaty in response to the threat posed by tobacco use to public health.

“While pandemics caused by viruses are difficult to prevent, the stealthy and ever-growing pandemic caused by tobacco is wholly and morally preventable,” said Head of the FCTC Secretariat, Dr. Adriana Blanco Marquizo in the 2021 report.

Turkiye and Brazil are the only two countries that have adopted all WHO measures at best-practice level.

Five countries have four measures at the highest level (Jordan, Ireland, Madagascar, New Zealand, and Spain) and 31 countries have three measures at the highest level of achievement.

While 49 countries have not yet taken on any MPOWER measures at the highest level, 38 of them have policies in place that are only one level below best practice for one or more measures.

In 2021, seven countries that had no best-practice measures in place took action to reach the highest level on one or more measures, according to WHO.

These countries were Cook Islands, Côte d’Ivoire, Ethiopia, Iraq, Morocco, Paraguay, and Tonga.

READ MORE: US mulls ban on menthol cigarettes

Covid-19 may have helped efforts

The deadly interplay between Covid-19 and tobacco use is undeniable with strong evidence pointing to the higher risk of people who smoke developing more complications from the disease.

Not only has Covid-19 put tobacco users at a higher health risk than non-tobacco users, it has disrupted global political agendas, coming at the expense of tobacco control actions.

However, surprisingly the pandemic also provided opportunities for advancing tobacco control measures.

To prevent spread of the virus, several countries have banned tobacco consumption in public places and raised taxes to mobilise funds to fight the pandemic.

For example, 17 countries in the Eastern Mediterranean region alone banned waterpipes (shishas) in public places, and South Africa temporarily halted tobacco sales as part of a pandemic response to ban “non-essential” products

“Despite the challenges of the Covid-19 pandemic, over the past year many countries have persisted in advancing tobacco control as a key health priority,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

ENDS may renormalise smoking

For the first time in history, the WHO report on the ‘global tobacco epidemic’ included data on electronic nicotine delivery systems (ENDS).

Electronic cigarettes, e-cigarettes, vapes or vape pens are all a form of ENDS.

The report found that a total of 111 countries regulate ENDS in some way, including 32 countries who ban the sale of them entirely.

The other 79 countries have adopted one or more measures to regulate the e-liquids, protecting 3.2 billion people from potential harms.

While ENDS do not contain tobacco and may or may not contain nicotine depending on their type, they pose serious threats to the global fight against smoking and may have long-term health impacts.

Most concerning, ENDS may renormalise smoking cigarettes in younger generations, as the WHO report found children and adolescents who use the products can double their risk of smoking cigarettes.

In the US, high school students increased their e-cigarettes usage from 1.5 percent in 2011 to 19.6 percent in 2020, according to the WHO.

The devices are marketed in thousands of flavours, with some candy flavours appealing to children and young adults. There are an estimated 16,000 flavours available.

70 percent of current US youth aged 12–17 say they use e-cigarettes “because they come in flavours I like.”

For these reasons and more, the WHO says “ENDS should be strictly regulated for maximum protection of public health.”

“As cigarette sales have fallen, tobacco companies have been aggressively marketing new products – like e-cigarettes – and lobby governments to limit their regulation,” said Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries.

“Their goal is simple: to hook another generation on nicotine. We cannot let that happen.” added Bloomberg.