Reducing global tobacco use

Although global efforts to cut tobacco use have had some success, more can be done to reduce the number of deaths from smoking, according to a commentary published in CMAJ (Canadian Medical Association Journal).

More than 170 countries have signed the World Health Organization's (WHO) Framework Convention on Tobacco Control agreement since it was adopted in 2005. However, smoking rates are still high in many low- and middle-income countries compared with Canada and other high-income countries where efforts to curb smoking have been more successful.

Regular smokers have a threefold higher risk of dying from smoking than nonsmokers. Quitting by age 40 will substantially reduce the risk.

To meet the WHO's recommended 30% reduction in smoking by 2025, countries need to triple tobacco taxes. If this reduction is achieved, it would save an estimated 200 million lives by the end of the 21st century.

"The only plausible way to reduce smoking to this extent would be to triple tobacco excise taxes in most low- and middle-income countries," writes Dr. Prabhat Jha, Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, with coauthor Sir George Alleyne, Pan American Health Organization, Washington, DC. "Estimates suggest that tripling excise tax would double the retail price of tobacco products and reduce consumption by about 40% in these nations."

Annual global sales of tobacco have risen over the last 25 years, from 5 million cigarettes to 6 trillion according to WHO estimates. One tonne of tobacco produces 1 million cigarettes and causes 1 death. Global tobacco industry profits equal about $10 000 per death.

Global efforts to reduce smoking must counter the tactics and large budgets of tobacco companies that allow them to use lobbying and marketing to ensure that cigarettes are affordable.

"The Framework Convention on Tobacco Control is a great achievement in global health. Now is the time to take stronger steps to implement its important provisions. If we do, we might expect to achieve unprecedented numbers of lives saved in the next few decades of the 21st century," the authors conclude.