Tobacco kills nearly 6 million people each year,

Key facts

• Tobacco kills up to half of its users.
• Tobacco kills nearly 6 million people each year, of whom more than 5 million are from direct tobacco use and more than 600 000 are nonsmokers exposed to second-hand smoke. Unless urgent action is taken, the annual death toll could rise to more than eight million by 2030.
• Nearly 80% of the world's one billion smokers live in low- and middle-income countries.
• Consumption of tobacco products is increasing globally, though it is decreasing in some high-income and upper middle-income countries.

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Leading cause of death, illness and impoverishment

The tobacco epidemic is one of the biggest public health threats the world has ever faced. It kills nearly 6 million people a year of whom more than 5 million are from direct tobacco use and more than 600 000 are nonsmokers exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco and this accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease.
Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.
Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.
In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to "green tobacco sickness", which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.

Gradual killer

Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of tobacco-related disease and death has just begun.

• Tobacco caused 100 million deaths in the 20th century. If current trends continue, it may cause about one billion deaths in the 21st century.
• Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. More than 80% of those deaths will be in low- and middle-income countries.

Surveillance is key

Good monitoring tracks the extent and character of the tobacco epidemic and indicates how best to tailor policies. Only fifty-nine countries, representing under half of the world's population, monitor tobacco use by repeating nationally representative youth and adult surveys at least once every five years.

Second-hand smoke kills

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water pipes. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.
There is no safe level of exposure to second-hand tobacco smoke.

• In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it causes sudden death. In pregnant women, it causes low birth weight.
• Almost half of children regularly breathe air polluted by tobacco smoke in public places.
• Over 40% of children have at least one smoking parent.
• Second-hand smoke causes more than 600 000 premature deaths per year.
• In 2004, children accounted for 28% of the deaths attributable to second-hand smoke.

Every person should be able to breathe smoke-free air. Smoke-free laws protect the health of non-smokers, are popular, do not harm business and encourage smokers to quit.

• Under 11% of the world's population are protected by comprehensive national smoke-free laws.
• The number of people protected from second-hand smoke more than doubled to 739 million in 2010 from 354 million in 2008.

Tobacco users need help to quit

Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey in China revealed that only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it causes stroke.
Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed.

• National comprehensive health-care services supporting cessation are available in only 19 countries, representing 14% of the world's population.
• There is no cessation assistance in 28% of low-income countries and 7% of middle-income countries.

Picture warnings work

Hard-hitting anti-tobacco advertisements and graphic pack warnings – especially those that include pictures – reduce the number of children who begin smoking and increase the number of smokers who quit.
Graphic warnings can persuade smokers to protect the health of non-smokers by smoking less inside the home and avoiding smoking near children. Studies carried out after the implementation of pictorial package warnings in Brazil, Canada, Singapore and Thailand consistently show that pictorial warnings significantly increase people's awareness of the harms of tobacco use.
Mass media campaigns can also reduce tobacco consumption, by influencing people to protect non-smokers and convincing youths to stop using tobacco.

• Just 19 countries, representing 15% of the world's population, meet the best practice for pictorial warnings, which includes the warnings in the local language and cover an average of at least half of the front and back of cigarette packs. No low-income country meets this best-practice level. Forty-two countries, representing 42% of the world’s population, mandate pictorial warnings.
• More than 1.9 billion people, representing 28% of the world's population, live in the 23 countries that have implemented at least one strong anti-tobacco mass media campaign within the last two years.

Ad bans lower consumption

Bans on tobacco advertising, promotion and sponsorship can reduce tobacco consumption.

• A comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7%, with some countries experiencing a decline in consumption of up to 16%.
• Only 19 countries, representing 6% of the world’s population, have comprehensive national bans on tobacco advertising, promotion and sponsorship.
• Around 38% of countries have minimal or no restrictions at all on tobacco advertising, promotion and sponsorship.

Taxes discourage tobacco use

Tobacco taxes are the most effective way to reduce tobacco use, especially among young people and poor people. A tax increase that increases tobacco prices by 10% decreases tobacco consumption by about 4% in high-income countries and by up to 8% in low- and middle-income countries.

• Only 27 countries, representing less than 8% of the world's population, have tobacco tax rates greater than 75% of the retail price.
• Tobacco tax revenues are on average 154 times higher than spending on tobacco control, based on available data.

WHO response

WHO is committed to fight the global tobacco epidemic. The WHO Framework Convention on Tobacco Control entered into force in February 2005. Since then, it has become one of the most widely embraced treaties in the history of the United Nations with 176 Parties covering 88% of the world's population. The WHO Framework Convention is WHO's most important tobacco control tool and a milestone in the promotion of public health. It is an evidence-based treaty that reaffirms the right of people to the highest standard of health, provides legal dimensions for international health cooperation and sets high standards for compliance.
In 2008, WHO introduced a practical, cost-effective way to scale up implementation of provisions of the WHO Framework Convention on the ground. That is, the best-buy and good-buy measures for reducing tobacco use set out in MPOWER. Each MPOWER measure corresponds to at least one provision of the WHO Framework Convention on Tobacco Control.
The six MPOWER measures are:

• Monitor tobacco use and prevention policies
• Protect people from tobacco use
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion and sponsorship
• Raise taxes on tobacco.

For more details on progress made for tobacco control at global, regional and country level, please refer to the series of WHO reports on the global tobacco epidemic.