Deaths From Smoking Slated to Jump Globally Without Major Interventions

A new review describes how increasing prices on cigarettes could be one of the most effective methods in the coming decades for reducing tobacco-related mortality.

Tobacco killed approximately 100 million people in the 20th century from lung cancer and other diseases, and it will kill 1 billion in the 21st century unless concerted efforts are made to reduce smoking habits around the world. A review article in the New England Journal of Medicine described the effects of smoking, of quitting, and how simply increasing prices on cigarettes could be one of the most effective methods in the coming decades for reducing tobacco-related mortality.

“Tobacco is the biggest external cause of noncommunicable disease and is responsible for even more deaths than adiposity both in high-income countries such as the United States and globally,” wrote Prabhat Jha, MD, DPhil, of the University of Toronto, and Richard Peto, FRS, of Oxford University in the United Kingdom. The World Health Organization has called for a reduction in smoking prevalence by one third by 2025; if achieved, it is estimated that this would avoid upwards of 200 million deaths from tobacco over the rest of the 21st century.

Though smoking rates have dropped in developed countries, there is still significant uptake of smoking around the world. Globally, about 50% of young men and 10% of young women become smokers, with relatively small numbers who quit. Thus, the 5 million tobacco-related deaths in 2010 are slated to jump to more than 10 million within a few decades.

Increasing prices and excise taxes on cigarettes has been deemed the best method to reduce smoking rates. A review by the International Agency for Research on Cancer found that a 50% increase in tobacco prices results in a 20% drop in consumption, in both the developed and developing worlds. “Higher taxes are particularly effective in poorer or less educated groups and help prevent young people who are experimenting with smoking from becoming regular smokers,” the authors wrote.

Large tax increases can produce exceptionally rapid results. The United States and the United Kingdom took more than 30 years to achieve a halving of cigarette consumption per adult. France and South Africa, meanwhile, needed half that time to achieve the same result thanks to those big tax hikes. “Without large price increases, a reduction in smoking by a third would be difficult to achieve,” the authors wrote.

Among the other effective interventions that could help achieve major smoking reductions are advertising bans, brand-free packaging, and quitting cessation programs and aids. Bans on television advertising in the United States and the United Kingdom corresponded with big drops in sales of cigarettes, but tobacco marketing is still an $8.6 billion per year enterprise in the United States alone.

Australia introduced plain packaging for cigarettes in 2011, with only a small mention of a brand name on each pack. There is evidence that this increases cessation attempts, and New Zealand will soon follow suit with other countries considering the move.

And encouraging smoking cessation is, clearly, an important piece. Among individuals who smoked beginning in early adulthood but stopped at age 30, 40, or 50, life expectancy increases by 10, 9 and 6 years, respectively.