The war on tobacco is far from over, with control policies needing renewal, warn experts

The latest estimates on smoking prevalence from the Global Burden of Disease collaboration show that although tobacco control programmes have been effective, the ever increasing population has meant worldwide smoking prevalence is still on the increase.

Between 1990 and 2015, global smoking prevalence has decreased by almost one third, from 29.4% to 15.3%, yet the overall number of smokers over this period has risen from 870.4 million to 933.1 million, owing to an increasing and aging population.

The study looked at 195 countries and territories between 1990 and 2015 and found that smoking still seems to be a leading risk factor for death and disability. Compared with 2005, the number of deaths caused by smoking increased by 4.7% in 2015 and smoking is now the second rather than third leading cause of disability.

Since the WHO Framework Convention on Tobacco Control was introduced in 2005, the implementation of tobacco policies in many countries has led to reductions in smoking prevalence.

However, lead author of the study, Dr Emmanuela Gakidou (University of Washington, USA) says: “Despite progress in some settings, the war against tobacco is far from won, especially in countries with the highest numbers of smokers.”

The 10 countries with the highest smoking prevalence were China, India, Indonesia, USA, Russia, Bangladesh, Japan, Brazil, Germany and the Philippines, across which the number of smokers made up two thirds (63.6%) of smokers worldwide.

The researchers also linked increases in the number of women smoking in Eastern Europe since 1990, with the tobacco industry’s targeting of that area in the 1990’s. For example, in Russia, the number of female smokers rose by 56.2% between 1990 and 2015. This targeting was also linked to the persistently high levels of male smokers in the area. In Latvia, for instance, male smoking prevalence remained at a similarly high level between 1990 and 2015, at 37.3% versus 38.3%.

The authors anticipate that this could also happen in sub-Saharan Africa, where the tobacco industry has plans to exploit the slack tobacco control policies in this region.

In an associated commentary, Professor John Britton (University of Nottingham, UK,) warned: "Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources.”

With this in mind, Gakidou and colleagues advise that individual countries make sure that tobacco control is tailored to their own context and needs and that compliance and enforcement work together.