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Despite decades of awareness, tobacco use continues to claim millions of lives annually, with women facing unique health challenges
A Lancet review calls for focused research and policy interventions to curb tobacco use, especially among women
It highlights the need for comprehensive tobacco control measures to protect vulnerable populations from the industry's influence
The dangers of tobacco use have been well-known since the 1950s but the industry continues to push its products and add to the global disease burden.
In 2021 alone, 7.3 million people lost their lives to ailments related to tobacco-use. Over the last three decades, the number of deaths were a staggering 200 million.
A new policy review by the journal Lancet Respiratory Medicine highlights the health burden of the global commercial tobacco epidemic, despite many of the ailments, especially the respiratory diseases, being largely preventable.
Smoking is the primary reason for the around 30 per cent chronic obstructive pulmonary disease deaths and half of all lung cancer deaths, it noted.
The impact is particularly dire and complex for women. While tobacco use among women has been on a decline and is expected to reduce further by 2030, new policy intervention in countries with high tobacco use prevalence among men can avert a rise in tobacco use by women, the authors wrote.
The health consequences of smoking often take years to manifest. Thus, a higher tobacco use in the past, may result in a large number of women with related diseases. One sign of this is that more women are dying of lung cancer than breast cancer in many countries, the document showed.
Further, women are more vulnerable to second-hand smoking, with more than 64 per cent of second-hand smoke-related deaths occur among women.
The review also trained the spotlight on new nicotine and tobacco products that have flooded the markets, such as e-cigarettes and heated tobacco products. There are multiple problems with the proliferation of these products. First, their health impacts remain unknown as the products are not well-researched.
Second, they're targeted at young people, which can lead to high population-level nicotine use, the authors wrote. The electronic nicotine delivery systems can be a way the youth are introduced to tobacco use, reversing gains made in many countries in reducing the use of the substance.
Paucity of funds and the imposition of the tobacco industry have often hindered adoption of tested measures to cut tobacco use, the document highlighted. As a result, some 2.3 billion people are without protection from even one measure at a best-practice level of implementation.
However, solutions exist and have also been successful at some levels. The health and economic impact of WHO’s tobacco control tools, particularly the MPOWER package, is likely underestimated. Many studies fail to account for indirect benefits like the denormalisation of tobacco use or reductions in exposure to second-hand smoke, which are crucial for non-smokers, including children.
Other overlooked outcomes include fewer adverse birth effects from maternal smoking, lower healthcare costs, and improved quality of life. Reductions in smokeless tobacco use, another area often neglected in assessments, also offer additional public health gains.
Among all measures, raising tobacco taxes is the most effective single policy, the authors observed. A $1 increase in excise tax per cigarette pack could raise prices by 42 per cent, reduce consumption by 18 per cent and generate $190 billion in global revenue.
Yet only 1.2 billion people live in countries that have adopted best-practice tax levels. Smoke-free laws also deliver clear health benefits, reducing hospitalisations from cardiovascular disease and respiratory deaths by up to 17 per cent. Currently, 2.6 billion people are covered under such laws.
Graphic health warnings, adopted by 110 countries, protect over 5.1 billion people, while bans on tobacco advertising and promotion are more common in low-income countries than in high-income ones. Implementing all MPOWER strategies together can lower adult smoking rates by over 7 per cent, highlighting their collective power.
Final summary: The global tobacco epidemic remains a significant health burden, claiming millions of lives each year, particularly affecting women. A Lancet review stresses the need for targeted research and policy changes to address tobacco use among women, who are increasingly vulnerable to second-hand smoke and related diseases. Effective measures like raising tobacco taxes and enforcing smoke-free laws are crucial to reducing tobacco-related deaths and improving public health.