Print

Mail

wiki links

Smoking kills both the rich and poor

About as many people are now dying from smoking in the developing world as in the industrialized nations, according to the most thorough estimate to date of global deaths caused by tobacco.

The research, published this week in The Lancet medical journal, concludes that 4.84 million people died from smoking worldwide in 2000 -- 2.41 million in the developing countries and 2.43 million in rich nations.

Experts say the study will likely be used by governments -- especially those in developing countries -- to build anti-smoking health policies.

"The policies and legislative activities within countries frequently only happen when it becomes obvious that the epidemic is actually happening in that country," said Dr. Michael Thun, head of epidemiology at the American Cancer Society, who was not involved in the study.

"Things which happen elsewhere are easily dismissed ... This is an important early effort to develop these estimates," he said.

Experts have previously estimated trends in deaths from tobacco in the industrialized world, where smoking first became prevalent, but evidence from poorer countries has been thin.

The World Health Organization (WHO) estimated in 1990 that about 3 million people die every year from smoking worldwide, but that was a crude extrapolation of trends in the Western world. Much more has been learned since then about how smoking affects different populations.

A major study in 2001 of smoking patterns in China showed that, unlike in the West, tobacco causes many more deaths there from chronic lung disease than lung cancer.

A study last month found that in India, smoking mainly kills through tuberculosis rather than through lung cancer as in the West.

"Smoking kills people in different ways in different countries but what is common is this very high toll from smoking, wherever it becomes prevalent," Thun said.

The latest study, conducted by Alan Lopez at the University of Queensland in Brisbane, Australia, and Majid Ezzati of the Harvard School of Public Health, used findings from the more recent studies to build a global picture.

"Tobacco, which we have traditionally thought of as a Western risk, is really in developing countries now," Ezzati said. "This is the first time, according to these estimates, that there are literally identical numbers of deaths in developing and industrialized countries."

"Much of the increase in smoking in the last few decades has been in developing countries, so we really have shifted tobacco from a Western risk to a global risk and more so a developing country risk. That's where a lot of tobacco control should be moving," Ezzati said.

In an unprecedented global push, the WHO adopted a sweeping anti-tobacco treaty in May.

The so-called Framework Convention on Tobacco Control provides for a general ban on tobacco advertising and promotion -- or simply restrictions in countries as in the US, where a total prohibition would violate the constitution.

The treaty says that health warnings -- including pictures such as diseased gums and lungs -- should cover at least half the package. In particular it aims to stop hard-sell tactics aimed at adolescents and strip tobacco of its image as being glamorous and cool.

The accord takes effect after 40 countries have ratified it. Much work lies ahead in trying to put the terms of the convention into practice, especially in the developing countries where 70 percent of the 10 million deaths forecast in 2030 will occur.

Developing countries, already grappling with a heavy burden from infectious diseases, have been at the fore in pushing for the convention, saying they need protection from tobacco multinationals who have switched their sales drives from saturated Western markets to Asia and Africa. There are about 1 billion smokers worldwide.

Sir Richard Peto, an Oxford University epidemiologist who conducted the studies in India and China but was not involved in the latest global estimate, said he believes that deaths in the developing world have probably already outstripped those in the rich countries.

"It's difficult because until the studies are done in particular countries, you can't really know," he said.
This story has been viewed 1992 times.