Global Hazards of Tobacco and the Benefits of Smoking Cessation and Tobacco Taxes

Tobacco use kills approximately five million people annually worldwide, accounting for over 20 percent of all deaths of adult men and 5 percent of deaths of adult women. As death rates from causes not attributed to tobacco are falling, the proportion of all adult deaths due to smoking will rise. In the 20th century, 100 million tobacco deaths occurred; nearly 70 percent were in high-income countries (HICs) and the former socialist economies of Europe. In contrast, in the 21st century, tobacco is expected to kill about one billion people, mostly in low- and middle-income countries (LMICs). Widespread use of a few powerful interventions affecting tobacco price, information, and regulations could prevent tens of millions of premature deaths over the next few decades. This chapter starts with the epidemiology of smoking-related diseases, focusing on contemporary estimates of the hazards of smoking and the benefits of cessation, and then describes current and future smoking patterns, including the rapid emergence of electronic cigarettes. We next turn to interventions to rapidly raise cessation rates in LMICs, in particular, higher excise taxes on tobacco products. We discuss the cost-effectiveness, cost-benefit, and poverty considerations of tobacco control and conclude by reviewing the current state of global tobacco control implementation.