Deaths From Smoking Will Increase Dramatically in the Next Quarter-Century

In the countries and areas of the Western Pacific Region (WPRO) of the World Health Organization (WHO)*, about as many people die each year from smoking as from alcohol, murder, suicide, drug abuse, drowning, traffic accidents, industrial accidents and AIDS combined.

* In the region as a whole, an estimated 60% of men and 8% of women smoke. In absolute figures, there are at present some 340 million men and 45 million women who smoke.

* However, there are wide variations between countries and there may be some under-reporting of the female smoking rates in countries where it is culturally less acceptable for women to smoke.

* On average, lifetime smokers have a 50% chance of dying from tobacco. And half of these will die in middle age (age 35-69), losing more than 20 years of normal life expectancy.

* Tobacco is a known or probable cause of about 25 diseases.

In the past 20 years, tobacco use has been increasing in nearly all of the countries and areas of WPRO. Due to this rise in cigarette consumption and the population growth, deaths from smoking are rising and are expected to escalate dramatically in the next century.

* In these countries and areas, per capita consumption of cigarettes has nearly doubled from the early 1970s to the early 1990s from 1100 cigarettes to 2010 cigarettes per adult per year. This is the largest increase in any of the six WHO regions*.

* The population in the Western Pacific region will increase by about 500 million from the current 1.5 billion to 2.0 billion in 2025. Even if the smoking rates remain unchanged, the total number of smokers will increase and so, eventually, will the number of deaths caused by tobacco.

* Worldwide, smoking kills 3 million people a year. Unless current trends are reversed, by the year 2025 this figure will rise to 10 million. The developing world will account for 7 million of these deaths, with 2 million in China alone. Of all the children alive in China now, on current smoking patterns, about 50 million will eventually die from smoking.

Increased buying power of the population coupled with such activities as advertising, sponsorship and targeting of specific groups are among the factors contributing to the expansion of tobacco markets in the Western Pacific region.

* The growing affluence of many countries in the region means among other things that cigarettes are becoming more affordable, especially to young people.

* Tobacco advertising and sponsorship of sports and the arts is widespread and, as in the West, the industry seduces its market by the use of tobacco product placement in films and cigarette names in conjunction with clothes, sports equipment and holidays.

* Women and young people are being targeted in particular with tobacco companies selling the message that smoking is glamorous, modern, and sophisticated.

* The specific marketing techniques aimed at women include the introduction and advertising of women’s brands of cigarettes. In some countries, smoking among young women is now more common than among young men. Smoking among girls is increasing throughout the Western Pacific region.

* Environmental tobacco smoke causes ill-health in childhood. The impact of smoking in pregnancy is greater in countries where nutrition and health care are still poor.

Tobacco is an economic drain. The net costs are profoundly negative, representing a significant burden on individuals, families and societies - from direct medical costs as well as lost productivity from increased illness and early death.

* Worldwide, the costs of treatment, mortality and disability exceed estimates of the economic benefit by at least US$200 billion annually. In the Western Pacific region, a substantial and increasing amount will be borne by the region’s developing countries.

However, there is some positive news from countries of the WHO Western Pacific region.

* A few countries, such as Australia, New Zealand and Singapore, have a long history of action against tobacco use and have seen a decline in smoking. Less than 30% of men in New Zealand now smoke compared with 60% for the region as a whole.

* Singapore’s first ban on advertising was in 1971.

* China made the historic decision to ban smoking on all domestic flights as long ago as 1983.

* Most countries have introduced smoke-free areas in public places and several have lowered tar levels in cigarettes.

* Countries as far apart as Mongolia and Viet Nam have held major meetings on tobacco or health, illustrating the awareness shown by the region overall of the impact of smoking on its economic and social structures and providing a focus for health research and tobacco control.

There are also positive examples from Asian countries outside the WHO Western Pacific region:

* In the 1980s, several Asian countries were threatened with trade sanctions if the domestic market was not opened up to the import of American cigarettes. Thailand resisted this threat, and the matter was eventually resolved by a GATT panel which ruled that the market must be opened to imports, but that in the interests of protecting public health, a number of tobacco control measures could be undertaken. This lead to strong comprehensive national tobacco control policies and programmes in Thailand. With its expanding economy and the perception of cigarettes as a luxury product, this should logically have meant a rise in tobacco use in Thailand. However, smoking rates have actually dropped.

But the challenge to control tobacco continues and action must be stepped up. Sophisticated advertising and promotion is still seen throughout the region. Millions of people lack awareness of the health risks of cigarettes. Government leaders may not be fully aware yet of the degree of harm done by smoking or are preoccupied by other urgent problems. They may lack experience in dealing with the tactics of the international tobacco industry.

Funds for tobacco control measures are limited and imposing measures is difficult, particularly in remote or rural areas. But comprehensive tobacco control is essential - countries in the region that have relied principally on health education have not been as successful in reducing smoking as those that utilize a combination of health education, tobacco control legislation and price policies.

WHO’s Regional Office for the Western Pacific instituted the Action Plan on Tobacco or Health for 1995-1999. It’s main objectives are to develop, implement and strengthen comprehensive national policies and programmes on tobacco control; to collect data on use; to support health advocacy, education and information; to support implementation of appropriate legislation; and to achieve pricing policies that deter tobacco use.

Specifically, the regional plan has called for: a tobacco-advertising free region by the year 2000; a percentage of tobacco tax to be allocated to fund sports, arts and health promotion; all airlines to be smoke-free; all countries with long-established tobacco or health action to cut consumption by at least 1%-2% annually; countries with no long-term history of tobacco or health programmes to reduce consumption during the 2000-2004 period; and all countries and areas to prevent a rise in smoking among women.

* The Western Pacific region of the World Health Organization includes 28 countries: Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People’s Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federal States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Viet Nam.

*African Region (AFRO), Region of the Americas (AMRO), Eastern Mediterranean Region (EMRO), European Region (EURO), South-East Asia Region (SEARO) and Western Pacific Region (WPRO).