The tobacco epidemic is one of the
biggest public health threats the world has ever faced, killing more than 8
million people a year around the world. More than 7 million of those deaths are
the result of direct tobacco use while around 1.2 million are the result of
non-smokers being exposed to second-hand smoke.(1)
All forms of tobacco are harmful, and there is no safe level of
exposure to tobacco. Cigarette smoking is the most common form of tobacco use
worldwide. Other tobacco products include waterpipe tobacco, various smokeless
tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco,
bidis and kreteks.
Waterpipe tobacco use is damaging to health in similar ways to
cigarette tobacco use. However, the health dangers of waterpipe tobacco use are
often little understood by users.
Smokeless tobacco use is highly addictive and damaging to
health. Smokeless tobacco contains many cancer-causing toxins and its use
increases the risk of cancers of the head, neck, throat, oesophagus and oral
cavity (including cancer of the mouth, tongue, lip and gums) as well as various
Over 80% of the 1.3 billion tobacco users worldwide live in low-
and middle-income countries, where the burden of tobacco-related illness and
death is heaviest. Tobacco use contributes to poverty by diverting household
spending from basic needs such as food and shelter to tobacco.
The economic costs of tobacco use are substantial and include
significant health care costs for treating the diseases caused by tobacco use
as well as the lost human capital that results from tobacco-attributable
morbidity and mortality.
In some countries children from poor households are employed in
tobacco farming to boost family income. Tobacco growing farmers are also
exposed to a number of health risks, including the "green tobacco
Key measures to reduce the demand for tobacco
- Second-hand smoke is the smoke that fills
enclosed spaces when people burn tobacco products such as
cigarettes, bidis and water-pipes.
- There is no safe level of exposure to second-hand
tobacco smoke, which causes more than 1.2 million premature deaths per
year and serious cardiovascular and respiratory diseases.
- Almost half of children regularly breathe air
polluted by tobacco smoke in public places, and 65 000 die each year from
illnesses attributable to second-hand smoke.
- In infants, it raises the risk of sudden
infant death syndrome. In pregnant women, it causes pregnancy
complications and low birth weight.
- Smoke-free laws protect the health of
non-smokers and are popular, as they do not harm business and they
encourage smokers to quit.
health warnings work
pictorial or graphic health warnings, including plain packaging, with hard
hitting messages can persuade smokers to protect the health of non-smokers
by not smoking inside the home, increase compliance with smoke-free laws
and encourage more people to quit tobacco use.
- Studies show that pictorial warnings
significantly increase people's awareness of the harms from tobacco use.
- Mass media campaigns can also reduce demand
for tobacco by promoting the protection of non-smokers and by convincing
people to stop using tobacco.
Bans on tobacco advertising lower
- Comprehensive bans on tobacco advertising,
promotion and sponsorship can reduce tobacco consumption.
- A comprehensive ban covers both direct and
indirect varieties of promotion.
- Direct forms include,
among others, advertising on television, radio, print publications,
billboards and more recently in various social media platforms.
- Indirect forms include,
among others, brand sharing, brand stretching, free distribution, price
discounts, point of sale product displays, sponsorships and promotional
activities masquerading as corporate social responsibility
Taxes are effective in reducing tobacco use
- Tobacco taxes
are the most cost-effective way to reduce tobacco use and health care
costs, especially among youth and low-income people, while increasing
revenue in many countries.
- The tax increases need to be high enough to
push prices up above income growth. An increase of tobacco prices by 10%
decreases tobacco consumption by about 4% in high-income countries and
about 5% in low- and middle-income countries.
- Despite this, introducing high tobacco taxes
is a measure that is least implemented among the set of available tobacco
Tobacco users need help to quit
- Studies show that few people understand the
specific health risks of tobacco use. However, when smokers become aware
of the dangers of tobacco, most want to quit.
- Without cessation support only 4% of attempts
to quit tobacco will succeed.
- Professional support and proven cessation
medications can more than double a tobacco user's chance of successful
Illicit trade of tobacco products
must be stopped
The illicit trade in tobacco products poses major health,
economic and security concerns around the world. It is estimated that 1 in
every 10 cigarettes and tobacco products consumed globally is illicit. The
illicit market is supported by various players, ranging from petty traders to
big tobacco companies, and in some instances even organized criminal networks
involved in arms and human trafficking.
Tax avoidance (licit) and tax evasion (illicit) undermine the
effectiveness of tobacco control policies, particularly higher tobacco taxes.
The tobacco industry and others often argue that high tobacco
product taxes lead to tax evasion. However, experience from many countries
demonstrate that illicit trade can be successfully addressed even when tobacco
taxes and prices are raised.
Stopping illicit trade in tobacco products is a health priority
and is achievable. But to do so requires improvement of national and
sub-national tax administration systems and international collaboration. The
WHO FCTC Protocol to Eliminate the Illicit Trade of Tobacco Products (ITP) sets out a range of important measures and interventions to reduce tobacco use and its health and economic consequences.
and emerging nicotine and tobacco products
Heated tobacco products (HTPs)
HTPs are like all other tobacco products, inherently toxic
and contain carcinogens. They should be treated like any other tobacco product
when it comes to setting policies on HTPs. HTPs produce aerosols containing
nicotine and toxic chemicals upon heating of the tobacco, or activation of a
device containing the tobacco. Examples include iQOS, Ploom, glo and PAX
vaporizers. The aerosols are inhaled by users during a process of sucking or
smoking involving a device. They contain the highly addictive substance
nicotine, non-tobacco additives and are often flavoured.
In recent years, HTPs have been promoted as ‘reduced harm’
products and/or products that can help people quit conventional tobacco
smoking. HTPs expose users to toxic emissions, many of which cause cancer and
currently there is not enough evidence to suggest that they are less harmful
than conventional cigarettes. There is also insufficient evidence at present on
the effects of second-hand emissions produced by HTPs, though the emissions
from these products contain harmful and potentially harmful chemicals (2).
Electronic nicotine delivery systems (ENDS) and electronic
non-nicotine delivery systems (ENNDS), commonly referred to as e-cigarettes,
are devices which heat a liquid to create an aerosol which is then inhaled by
the user, these may or may not contain nicotine. The main constituents of the
solution by volume are propylene glycol, with or without glycerol, and
flavouring agents. E-cigarettes do not contain tobacco but are harmful to
health and are not safe. However, it is too early to provide a clear answer on
the long-term impacts of using them or being exposed to them.
E-cigarettes are particularly risky when used by children and
adolescents. Nicotine is highly addictive and young people’s brains develop up
to their mid-twenties.
ENDS use increases the risk of heart disease and lung
disorders. They also pose significant risks to pregnant women who use
them, as they can damage the growing fetus.
Advertising, marketing and promotion of ENDS has grown rapidly,
through channels which rely heavily on internet and social media (3). Much of the marketing around these products gives rise to concern about deceptive health claims, deceptive claims on cessation efficacy, and targeting towards youth (especially with the use of flavours).
ENDS/ENNDS should not be promoted as a cessation aid until
adequate evidence is available and the public health community can agree upon
the effectiveness of those specific products. Where ENDS and ENNDS are not
banned, WHO recommends that the products be regulated in accordance with four
initiation of ENDS/ENNDS by non-smokers, minors and vulnerable groups;
- Minimize health risks for ENDS/ENNDS users and
protect non-users from exposure to their emissions;
- Prevent unproven health claims being made
about ENDS/ENNDS; and
- Protect tobacco control from all commercial
and other vested interests related to ENDS/ENNDS, including interests of
the tobacco industry