Smoking: men are still the

(1)

22 World Health • SlstYear, No. 5, September-October 1998

Smoking: men are still the

• • •

main v1ct1ms

Barbara Zolty

E

ach year about 2.8 million men around the world die from smoking. This translates to almost 8000 deaths each and every day. As startling as these figures are, current trends indicate that the number of deaths worldwide will actually escalate, and by the year 2020 tobacco use will be killing more people than any single disease.

For the individual, the risks of smoking are just as real. Half of those regular smokers who start smoking during adolescence will eventually be killed by tobacco; half of them in middle age and half in old age.

At present, 80% of tobacco deaths occur among men. This does not mean that tobacco is not a prob- lem among women, but simply reflects the fact that, in most countries, men have been smoking in large numbers for longer than women. Where reliable data are available to assess trends, the epidemic of tobacco use among men has usually been followed, some decades later, by a similar epidemic among women. This pattern has been repeated in the industrialized world throughout the century, and there is every reason to believe that the same will eventually hold true in the developing world as well.

With the development of the manufactured cigarette, men in developed countries first started smoking regularly in the 1920s, with per capita consumption rising steadily to its peak in the 1970s. As consumption levels rose, smoking- related deaths followed, allowing for the 30-40-year delay that typically occurs between smoking initiation and the resulting health

consequences. Although the increase in smoking-related deaths is

Eight thousand individuals die every day as a result of smoking - and 80% of them are men.

Nevertheless, anti-tobacco measures do work and - if adopted worldwide - could save millions of lives. Photo)&P Hubley

slowing among men in developed countries, smoking rates among men in developing countries have increased rapidly, and it is likely that smoking-related deaths will increase too. Increased smoking among women is also a cause for concern. Unless tobacco use among women and girls can be reduced in developed countries and prevented from becoming established in developing countries, women could well form the second wave of the tobacco epidemic.

From rich to poor countries

There are around 1100 million smokers in the world today. Some 900 million (82%) are men and, of these, 700 million - more than two- thirds - live in the developing world. By the mid-2020s, the transfer of the tobacco epidemic from rich to poor countries will be well advanced, with only 15% of the world's smokers living in rich countries. It is feared that health care facilities in developing countries will be hope- lessly unable to cope with the results of this epidemic.

It is estimated that, on average, 47% of men around the world smoke, compared with 12% of women. In the 87 countries for which data are available, smoking rates among men range from around 25% or less in countries such as Bahamas, New Zealand and Sweden to over 65% in the Dominican Republic, Latvia, the Republic of Korea, and the Russian Federation.

In countries around the world, tobacco use is rising among young people. At the same time, the age at which people start smoking is going down. If people do not begin to use tobacco before the age of 20, they are unlikely to start smoking as adults. The tobacco industry knows this, and even though it may publicly claim that it does not want young people to smoke, their own docu- ments show a long-standing interest in young people. For its very sur- vival, the tobacco industry needs to recruit new smokers every year to replace those who die from tobacco- related diseases. Those new smokers are most often teenagers.

(2)

World Health • SlstYeor, No. 5, September--October 1998

Gender issues . ,j~~-

~~·

Health risks

Tobacco is a known or probable cause of about 25 diseases, yet the sheer scale of its impact on the global disease burden is still not. . fully appreciated. For example, 1t 1s known to be the most important cause of lung cancer. Less known is the fact that tobacco kills more people through many other diseases, including cancers in other parts of the body, heart disease, stroke, emphysema and other chronic diseases. Evidence is also mounting about the serious health consequences of environmental tobacco smoke, both for adults and children.

Research shows that the risks from smoking are substantially higher than was previously thought.

With prolonged smoking, smokers have a death rate three times higher than nonsmokers at all ages, starting from young adulthood; and smokers in their 30s and 40s are five times more likely to have a heart attack than nonsmokers.

In the mid-1990s in developed countries, about 25% of all deaths among men, and more than one-third of deaths among middle-aged men (age 35-69), were caused by smoking. In 1990, it was estimated that smoking caused 42% of all cancer deaths among men in developed countries and 21 % in developing countries.

Although life expectancy for both sexes is predicted to rise in many countries, the gap between.

men and women is widening, mainly due to the large numbers of men who smoke and die of tobacco-related diseases. However, the number of women and girls who smoke is also rising, and this will lead to an increase in the number of tobacco- related deaths among women.

Tobacco is one of the greatest public health challenges facing countries of central and eastern Europe. In 1995, there were about 700 OOO deaths in these countries, or about 25% of the world total. In marked contrast to countries of western Europe, where half or less of smoking-related deaths occur in people under age 70, in central and eastern Europe about three-quarters of such deaths occur in middle age (35-69 years).

In China, about three-quarters of a million deaths each year are caused by smoking, and most of these are among men. About 63% of Chinese men smoke, compared with only 4%

of Chinese women. The most com- mon causes of death in China are already stroke, heart disease, cancer and respiratory diseases.

If current rates of smoking per- sist, tobacco will kill a third of all young men alive today in China. Of the 300 million males in China under the age of 30, about 200 million will become smokers. If they continue to

Young people ore a favourite target for the tobacco industry. Mad of those who start smoking in their teens will become lifelong smokers. Photo WHO/H. Anen en

23

smoke throughout their lives, 100 million will eventually be killed by tobacco and half of these deaths will occur before the age of 70. More- over, more girls will probably start to smoke following the invasion of Western-style advertising which portrays smoking as glamorous, modern, and "liberating".

Economic costs

Tobacco is detrimental to the economic health of countries. To the direct health care costs of tobacco- caused illnesses must be added such costs as disability, reduced produc- tivity and income lost due to early morbidity. According to a World Bank study, tobacco use causes a net global loss of US$ 200 billion per year, and half of those losses occur in developing countries. Other costs resulting from tobacco use are more difficult to quantify, such as a reduced quality of life for smokers and those exposed to environmental tobacco smoke, and the suffering caused by the loss of a loved one.

Drastic measures are needed at once to reverse the tobacco epidemic and avert millions of preventable deaths. There is some reason for optimism. International experience shows that comprehensive tobacco control policies and programmes work. They include such legislative and fiscal measures as complete bans on tobacco advertising and sponsorship, restrictions on smoking in public places, and higher taxes on tobacco products. These must be complemented by widely available smoking cessation courses and strong anti-tobacco educational programmes. Countries that have adopted such policies and programmes have seen tobacco consumption fall. If such measures were adopted on a large scale by countries around the world, millions of lives and billions of dollars would be saved. •

Ms Barbaro Zolty is Technical Officer with the Tobacco-Free Initiative, World Health Organization, 1 2 1 1 Geneva 27, Switzerland