posts: 44085

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id	title	slug	type	status	content	archieml	archieml_update_statistics	published_at	updated_at	gdocSuccessorId	authors	excerpt	created_at_in_wordpress	updated_at_in_wordpress	featured_image	formattingOptions	markdown	wpApiSnapshot
44085	Smoking: How large of a global problem is it? And how can we make progress against it?	smoking-big-problem-in-brief	post	publish	<!-- wp:html --> <div class="blog-info"> <p>Our World in Data presents the data and research to make progress against the world’s largest problems.<br>This post draws on data and research discussed in our entry on <strong><a href="https://ourworldindata.org/smoking" target="_blank" rel="noopener">Smoking</a></strong>.</p> </div> <!-- /wp:html --> <!-- wp:paragraph --> <p>Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use – published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation – agree that around 8 million people die prematurely every year from smoking. More details in <a href="https://ourworldindata.org/smoking">our Our World in Data entry on smoking</a>.{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About <a href="https://ourworldindata.org/births-and-deaths">58 million people</a> die every year.{/ref} Millions more live in poor health because of it.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, <a href="https://ourworldindata.org/smoking#smoking-and-cancer">more than one in five</a> cancer deaths are attributed to smoking.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.<br>Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: <a href="https://ourworldindata.org/terrorism">https://ourworldindata.org/terrorism</a> {/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world – we visualized their estimates <a href="https://ourworldindata.org/grapher/share-deaths-smoking">here</a>. In many high-income countries smoking causes between 15% to 20% of all deaths.<br>According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm">the US CDC on Smoking & Tobacco Use</a>.{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority – 6.2 million corresponding to 71% of the total – are men.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about <em>10 years</em> lower than that of non-smokers.{ref}Banks et al (2015) find that “Current smokers are estimated to die an average of 10 years earlier than non-smokers.”</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Pirie et al (2013) estimate a loss of 11 life years.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext">The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK</a>. Lancet. 2013;381:133–41.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) – <a href="https://www.ncbi.nlm.nih.gov/books/NBK179276/">The Health Consequences of Smoking – 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>It’s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) – <a href="https://doi.org/10.1016/S0140-6736(21)01169-7">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337–2360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that "If current smoking patterns persist, tobacco will kill about 1 billion people this century."{ref}Prabhat Jha and Richard Peto (2014) – <a href="https://www.nejm.org/doi/10.1056/NEJMra1308383">Global Effects of Smoking, of Quitting, and of Taxing Tobacco</a>. N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>It is on us to prevent this.</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":3} --> <h3>How to make progress against the millions of deaths from smoking?</h3> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills </h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The most fundamental work to prevent millions of deaths is already done. We know that smoking kills. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General’s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers – like Pearl in Baltimore – presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>People who do not think well about the work of statisticians sometimes <a href="http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html">fall</a> for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true – for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it “opens up the lungs.” The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn’t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene – it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.<br>See my article on Ignaz Semmelweis and the history of maternal mortality – Roser (2017) <a href="https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality">Measurement Matters – The decline of maternal mortality</a> on Our World in Data.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Smoking seemed inevitable until it didn’t</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The chart summarizes the history of smoking in the US (the development in other high-income countries <a href="https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day">was similar</a>). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then – decade after decade – it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) – <a href="https://www.ncbi.nlm.nih.gov/books/NBK179276/">The Health Consequences of Smoking – 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Once people learned that smoking kills, they could act on it. It took some time, but they did.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>I wasn’t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different – for a long time smoking kept on increasing and it looked as if it would never change. But then it did.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Nearly half of all former smokers have quit,{ref}According to CDC – <a href="https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm">History of the Surgeon General's Reports on Smoking and Health</a>{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.</p> <!-- /wp:paragraph --> <!-- wp:image {"id":44088,"sizeSlug":"full","linkDestination":"none"} --> <figure class="wp-block-image size-full"><img src="https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png" alt="" class="wp-image-44088"/></figure> <!-- /wp:image --> <!-- wp:heading {"level":4} --> <h4>The global perspective: people in poor countries are not following the path</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich<em> </em>and<em> </em>poorer countries. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world – all the countries above the grey line – the death rate from smoking is now lower than back in 1990.</p> <!-- /wp:paragraph --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp:paragraph --> <p></p> <!-- /wp:paragraph --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:heading {"level":4} --> <h4><a href="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017"></a>A global public health campaign that is winning over big business by making use of a wide range of measures</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see ‘The Economics of Tobacco and Tobacco Control’:<br><br>U.S. National Cancer Institute and World Health Organization (2016) – <a href="https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21">The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control</a>. Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>See also: Frank J. Chaloupka & Michael Grossman (1996) – <a href="https://www.nber.org/papers/w5740">Price, Tobacco Control Policies and Youth Smoking</a>{/ref} A number of factors mattered – all of them clear reminders that good public policy can oppose the interests of big business when it really matters:</p> <!-- /wp:paragraph --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:paragraph --> <p>By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important – and cost-effective ways – to reduce smoking and increase public health.</p> <!-- /wp:paragraph --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:paragraph --> <p>Tobacco advertisement – once omnipresent – was restricted or banned in many countries.</p> <!-- /wp:paragraph --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:paragraph --> <p>Many countries also offered smokers support to help them quit smoking.</p> <!-- /wp:paragraph --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:paragraph --> <p>Smoking was also banned in public places where it was once common – in restaurants, bars, planes, and talk-shows.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do.</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4><strong>Conclusion:</strong> the benefits from stopping to smoke are very large</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it <em>a lot</em> to justify it. About <em>two-thirds</em> of those who were still smokers when they died, died <em>because</em> of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Reitsma et al. (2021) – <a href="https://doi.org/10.1016/S0140-6736(21)01169-7">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337–2360.{/ref} </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that’s nothing compared to what smokers are willing to do.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref} </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about <a href="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL">one-in-five</a> adults in the world smokes, and, as we’ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write "Among past smokers, mortality diminished gradually … and did not differ significantly from never-smokers in those quitting prior to age 45.”</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Pirie et al (2013) find “Smokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.”</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>But smoking cessation at any age – not just at a young – dramatically reduces death rates. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) – <a href="https://pubmed.ncbi.nlm.nih.gov/23343064/">50-year trends in smoking-related mortality in the United States</a>. N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples’ self-interest to not shorten their lifespan by 10 years.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Or more positively, we can appeal to peoples’ self-interest to live 10 more years of their life!</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.</p> <!-- /wp:paragraph -->	{ "id": "wp-44085", "slug": "smoking-big-problem-in-brief", "content": { "toc": [], "body": [ { "type": "text", "value": [ { "text": "Our World in Data presents the data and research to make progress against the world\u2019s largest problems.", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "This post draws on data and research discussed in our entry on ", "spanType": "span-simple-text" }, { "children": [ { "url": "https://ourworldindata.org/smoking", "children": [ { "text": "Smoking", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "spanType": "span-bold" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use \u2013 published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation \u2013 agree that around 8 million people die prematurely every year from smoking. More details in ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/smoking", "children": [ { "text": "our Our World in Data entry on smoking", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/births-and-deaths", "children": [ { "text": "58 million people", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " die every year.{/ref} Millions more live in poor health because of it.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/smoking#smoking-and-cancer", "children": [ { "text": "more than one in five", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " cancer deaths are attributed to smoking.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/terrorism", "children": [ { "text": "https://ourworldindata.org/terrorism", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " {/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world \u2013 we visualized their estimates ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/share-deaths-smoking", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". In many high-income countries smoking causes between 15% to 20% of all deaths.", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See ", "spanType": "span-simple-text" }, { "url": "https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm", "children": [ { "text": "the US CDC on Smoking & Tobacco Use", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority \u2013 6.2 million corresponding to 71% of the total \u2013 are men.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about ", "spanType": "span-simple-text" }, { "children": [ { "text": "10 years", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " lower than that of non-smokers.{ref}Banks et al (2015) find that \u201cCurrent smokers are estimated to die an average of 10 years earlier than non-smokers.\u201d", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). ", "spanType": "span-simple-text" }, { "url": "https://doi.org/10.1186/s12916-015-0281-z", "children": [ { "text": "https://doi.org/10.1186/s12916-015-0281-z", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Pirie et al (2013) estimate a loss of 11 life years.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext", "children": [ { "text": "The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". Lancet. 2013;381:133\u201341.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://www.ncbi.nlm.nih.gov/books/NBK179276/", "children": [ { "text": "The Health Consequences of Smoking \u2013 50 Years of Progress", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "It\u2019s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://doi.org/10.1016/S0140-6736(21)01169-7", "children": [ { "text": "Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". In ", "spanType": "span-simple-text" }, { "children": [ { "text": "The Lancet", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": ", 397(10292), 2337\u20132360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that \"If current smoking patterns persist, tobacco will kill about 1 billion people this century.\"{ref}Prabhat Jha and Richard Peto (2014) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://www.nejm.org/doi/10.1056/NEJMra1308383", "children": [ { "text": "Global Effects of Smoking, of Quitting, and of Taxing Tobacco", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "It is on us to prevent this.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "How to make progress against the millions of deaths from smoking?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "text": [ { "text": "The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills\u00a0", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The most fundamental work to prevent millions of deaths is already done. We know that smoking kills.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General\u2019s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers \u2013 like Pearl in Baltimore \u2013 presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "People who do not think well about the work of statisticians sometimes ", "spanType": "span-simple-text" }, { "url": "http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html", "children": [ { "text": "fall", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true \u2013 for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it \u201copens up the lungs.\u201d The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn\u2019t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene \u2013 it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "See my article on Ignaz Semmelweis and the history of maternal mortality \u2013 Roser (2017) ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality", "children": [ { "text": "Measurement Matters \u2013 The decline of maternal mortality", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " on Our World in Data.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Smoking seemed inevitable until it didn\u2019t", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The chart summarizes the history of smoking in the US (the development in other high-income countries ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day", "children": [ { "text": "was similar", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then \u2013 decade after decade \u2013 it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://www.ncbi.nlm.nih.gov/books/NBK179276/", "children": [ { "text": "The Health Consequences of Smoking \u2013 50 Years of Progress", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Once people learned that smoking kills, they could act on it. It took some time, but they did.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "I wasn\u2019t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different \u2013\u00a0for a long time smoking kept on increasing and it looked as if it would never change. But then it did.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Nearly half of all former smokers have quit,{ref}According to CDC \u2013 ", "spanType": "span-simple-text" }, { "url": "https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm", "children": [ { "text": "History of the Surgeon General's Reports on Smoking and Health", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "alt": "", "size": "wide", "type": "image", "filename": "Smoking-and-lung-cancer-mortality-US-only.png", "parseErrors": [] }, { "text": [ { "text": "The global perspective: people in poor countries are not following the path", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich", "spanType": "span-simple-text" }, { "children": [ { "text": " ", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": "and", "spanType": "span-simple-text" }, { "children": [ { "text": " ", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": "poorer countries.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world \u2013 all the countries above the grey line \u2013 the death rate from smoking is now lower than back in 1990.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "left": [ { "url": "https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL", "type": "chart", "parseErrors": [] } ], "type": "sticky-right", "right": [ { "url": "https://ourworldindata.org/grapher/smoking-death-rate-1990-2017", "type": "chart", "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "url": "https://ourworldindata.org/grapher/smoking-death-rate-1990-2017", "children": [], "spanType": "span-link" }, { "text": "A global public health campaign that is winning over big business by making use of a wide range of measures", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see \u2018The Economics of Tobacco and Tobacco Control\u2019:", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "spanType": "span-newline" }, { "text": "U.S. National Cancer Institute and World Health Organization (2016) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21", "children": [ { "text": "The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "See also: Frank J. Chaloupka & Michael Grossman (1996) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://www.nber.org/papers/w5740", "children": [ { "text": "Price, Tobacco Control Policies and Youth Smoking", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref} A number of factors mattered \u2013 all of them clear reminders that good public policy can oppose the interests of big business when it really matters:", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "left": [ { "type": "text", "value": [ { "text": "By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important \u2013\u00a0and cost-effective ways \u2013 to reduce smoking and increase public health.", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "type": "sticky-right", "right": [ { "url": "https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax", "type": "chart", "parseErrors": [] } ], "parseErrors": [] }, { "left": [ { "type": "text", "value": [ { "text": "Tobacco advertisement \u2013 once omnipresent \u2013 was restricted or banned in many countries.", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "type": "sticky-right", "right": [ { "url": "https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising", "type": "chart", "parseErrors": [] } ], "parseErrors": [] }, { "left": [ { "type": "text", "value": [ { "text": "Many countries also offered smokers support to help them quit smoking.", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "type": "sticky-right", "right": [ { "url": "https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use", "type": "chart", "parseErrors": [] } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Smoking was also banned in public places where it was once common \u2013 in restaurants, bars, planes, and talk-shows.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "children": [ { "text": "Conclusion:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " the benefits from stopping to smoke are very large", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it ", "spanType": "span-simple-text" }, { "children": [ { "text": "a lot", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " to justify it. About ", "spanType": "span-simple-text" }, { "children": [ { "text": "two-thirds", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " of those who were still smokers when they died, died ", "spanType": "span-simple-text" }, { "children": [ { "text": "because", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). ", "spanType": "span-simple-text" }, { "url": "https://doi.org/10.1186/s12916-015-0281-z", "children": [ { "text": "https://doi.org/10.1186/s12916-015-0281-z", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Reitsma et al. (2021) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://doi.org/10.1016/S0140-6736(21)01169-7", "children": [ { "text": "Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". In ", "spanType": "span-simple-text" }, { "children": [ { "text": "The Lancet", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": ", 397(10292), 2337\u20132360.{/ref}\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that\u2019s nothing compared to what smokers are willing to do.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref}\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL", "children": [ { "text": "one-in-five", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " adults in the world smokes, and, as we\u2019ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write \"Among past smokers, mortality diminished gradually \u2026 and did not differ significantly from never-smokers in those quitting prior to age 45.\u201d", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). ", "spanType": "span-simple-text" }, { "url": "https://doi.org/10.1186/s12916-015-0281-z", "children": [ { "text": "https://doi.org/10.1186/s12916-015-0281-z", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Pirie et al (2013) find \u201cSmokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.\u201d", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133\u201341.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "But smoking cessation at any age \u2013 not just at a young \u2013 dramatically reduces death rates.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) \u2013 ", "spanType": "span-simple-text" }, { "url": "https://pubmed.ncbi.nlm.nih.gov/23343064/", "children": [ { "text": "50-year trends in smoking-related mortality in the United States", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples\u2019 self-interest to not shorten their lifespan by 10 years.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Or more positively, we can appeal to peoples\u2019 self-interest to live 10 more years of their life!", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "type": "article", "title": "Smoking: How large of a global problem is it? And how can we make progress against it?", "authors": [ "Max Roser" ], "excerpt": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.", "dateline": "July 14, 2021", "subtitle": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.", "sidebar-toc": false, "featured-image": "Screen-Shot-2021-07-07-at-17.08.06.png" }, "createdAt": "2021-07-07T15:52:24.000Z", "published": false, "updatedAt": "2023-02-14T19:37:57.000Z", "revisionId": null, "publishedAt": "2021-07-14T10:00:00.000Z", "relatedCharts": [], "publicationContext": "listed" }	{ "errors": [ { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag image" } ], "numBlocks": 55, "numErrors": 1, "wpTagCounts": { "html": 6, "image": 1, "column": 8, "columns": 4, "heading": 6, "paragraph": 47 }, "htmlTagCounts": { "p": 48, "h3": 1, "h4": 5, "div": 13, "figure": 1, "iframe": 5 } }	2021-07-14 10:00:00	2024-02-16 14:22:51	1ZaRD3XCH3rRG3Ito8QpCqmBQ2AakmmwNAapGvYpq_jM	[ "Max Roser" ]	Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.	2021-07-07 15:52:24	2023-02-14 19:37:57	https://ourworldindata.org/wp-content/uploads/2021/07/Screen-Shot-2021-07-07-at-17.08.06.png	{}	Our World in Data presents the data and research to make progress against the world’s largest problems. This post draws on data and research discussed in our entry on [Smoking](https://ourworldindata.org/smoking). Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use – published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation – agree that around 8 million people die prematurely every year from smoking. More details in [our Our World in Data entry on smoking](https://ourworldindata.org/smoking).{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About [58 million people](https://ourworldindata.org/births-and-deaths) die every year.{/ref} Millions more live in poor health because of it. Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, [more than one in five](https://ourworldindata.org/smoking#smoking-and-cancer) cancer deaths are attributed to smoking. This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: [https://ourworldindata.org/terrorism](https://ourworldindata.org/terrorism) {/ref} Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world – we visualized their estimates [here](https://ourworldindata.org/grapher/share-deaths-smoking). In many high-income countries smoking causes between 15% to 20% of all deaths. According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See [the US CDC on Smoking & Tobacco Use](https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm).{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority – 6.2 million corresponding to 71% of the total – are men.{/ref} The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about _10 years_ lower than that of non-smokers.{ref}Banks et al (2015) find that “Current smokers are estimated to die an average of 10 years earlier than non-smokers.” Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Pirie et al (2013) estimate a loss of 11 life years. Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – [The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext). Lancet. 2013;381:133–41. For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) – [The Health Consequences of Smoking – 50 Years of Progress](https://www.ncbi.nlm.nih.gov/books/NBK179276/). A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref} It’s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) – [Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019](https://doi.org/10.1016/S0140-6736(21)01169-7). In _The Lancet_, 397(10292), 2337–2360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that "If current smoking patterns persist, tobacco will kill about 1 billion people this century."{ref}Prabhat Jha and Richard Peto (2014) – [Global Effects of Smoking, of Quitting, and of Taxing Tobacco](https://www.nejm.org/doi/10.1056/NEJMra1308383). N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref} It is on us to prevent this. ## How to make progress against the millions of deaths from smoking? ### The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills The most fundamental work to prevent millions of deaths is already done. We know that smoking kills. This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General’s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers – like Pearl in Baltimore – presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref} People who do not think well about the work of statisticians sometimes [fall](http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html) for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true – for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it “opens up the lungs.” The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis. Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn’t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene – it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them. See my article on Ignaz Semmelweis and the history of maternal mortality – Roser (2017) [Measurement Matters – The decline of maternal mortality](https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality) on Our World in Data.{/ref} ### Smoking seemed inevitable until it didn’t The chart summarizes the history of smoking in the US (the development in other high-income countries [was similar](https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day)). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right. Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then – decade after decade – it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day. The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) – [The Health Consequences of Smoking – 50 Years of Progress](https://www.ncbi.nlm.nih.gov/books/NBK179276/). A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref} Once people learned that smoking kills, they could act on it. It took some time, but they did. I wasn’t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different – for a long time smoking kept on increasing and it looked as if it would never change. But then it did. Nearly half of all former smokers have quit,{ref}According to CDC – [History of the Surgeon General's Reports on Smoking and Health](https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm){/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined. <Image filename="Smoking-and-lung-cancer-mortality-US-only.png" alt=""/> ### The global perspective: people in poor countries are not following the path For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more. But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich_ _and_ _poorer countries. The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world – all the countries above the grey line – the death rate from smoking is now lower than back in 1990. <Chart url="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL"/> <Chart url="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017"/> ### [](https://ourworldindata.org/grapher/smoking-death-rate-1990-2017)A global public health campaign that is winning over big business by making use of a wide range of measures The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see ‘The Economics of Tobacco and Tobacco Control’: U.S. National Cancer Institute and World Health Organization (2016) – [The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control](https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21). Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. See also: Frank J. Chaloupka & Michael Grossman (1996) – [Price, Tobacco Control Policies and Youth Smoking](https://www.nber.org/papers/w5740){/ref} A number of factors mattered – all of them clear reminders that good public policy can oppose the interests of big business when it really matters: By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important – and cost-effective ways – to reduce smoking and increase public health. <Chart url="https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax"/> Tobacco advertisement – once omnipresent – was restricted or banned in many countries. <Chart url="https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising"/> Many countries also offered smokers support to help them quit smoking. <Chart url="https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use"/> Smoking was also banned in public places where it was once common – in restaurants, bars, planes, and talk-shows. One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref} The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do. ### Conclusion: the benefits from stopping to smoke are very large The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it _a lot_ to justify it. About _two-thirds_ of those who were still smokers when they died, died _because_ of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Reitsma et al. (2021) – [Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019](https://doi.org/10.1016/S0140-6736(21)01169-7). In _The Lancet_, 397(10292), 2337–2360.{/ref} Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that’s nothing compared to what smokers are willing to do. The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref} It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about [one-in-five](https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL) adults in the world smokes, and, as we’ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate. It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write "Among past smokers, mortality diminished gradually … and did not differ significantly from never-smokers in those quitting prior to age 45.” Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Pirie et al (2013) find “Smokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.” Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41. But smoking cessation at any age – not just at a young – dramatically reduces death rates. See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) – [50-year trends in smoking-related mortality in the United States](https://pubmed.ncbi.nlm.nih.gov/23343064/). N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age. We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples’ self-interest to not shorten their lifespan by 10 years. Or more positively, we can appeal to peoples’ self-interest to live 10 more years of their life! The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.	{ "id": 44085, "date": "2021-07-14T11:00:00", "guid": { "rendered": "https://owid.cloud/?p=44085" }, "link": "https://owid.cloud/smoking-big-problem-in-brief", "meta": { "owid_publication_context_meta_field": { "latest": true, "homepage": true, "immediate_newsletter": true } }, "slug": "smoking-big-problem-in-brief", "tags": [], "type": "post", "title": { "rendered": "Smoking: How large of a global problem is it? And how can we make progress against it?" }, "_links": { "self": [ { "href": "https://owid.cloud/wp-json/wp/v2/posts/44085" } ], "about": [ { "href": "https://owid.cloud/wp-json/wp/v2/types/post" } ], "author": [ { "href": "https://owid.cloud/wp-json/wp/v2/users/2", "embeddable": true } ], "curies": [ { "href": "https://api.w.org/{rel}", "name": "wp", "templated": true } ], "replies": [ { "href": "https://owid.cloud/wp-json/wp/v2/comments?post=44085", "embeddable": true } ], "wp:term": [ { "href": "https://owid.cloud/wp-json/wp/v2/categories?post=44085", "taxonomy": "category", "embeddable": true }, { "href": "https://owid.cloud/wp-json/wp/v2/tags?post=44085", "taxonomy": "post_tag", "embeddable": true } ], "collection": [ { "href": "https://owid.cloud/wp-json/wp/v2/posts" } ], "wp:attachment": [ { "href": "https://owid.cloud/wp-json/wp/v2/media?parent=44085" } ], "version-history": [ { "href": "https://owid.cloud/wp-json/wp/v2/posts/44085/revisions", "count": 17 } ], "wp:featuredmedia": [ { "href": "https://owid.cloud/wp-json/wp/v2/media/44090", "embeddable": true } ], "predecessor-version": [ { "id": 55914, "href": "https://owid.cloud/wp-json/wp/v2/posts/44085/revisions/55914" } ] }, "author": 2, "format": "standard", "status": "publish", "sticky": false, "content": { "rendered": "\n<div class=\"blog-info\">\n<p>Our World in Data presents the data and research to make progress against the world\u2019s largest problems.<br>This post draws on data and research discussed in our entry on <strong><a href=\"https://ourworldindata.org/smoking\" target=\"_blank\" rel=\"noopener\">Smoking</a></strong>.</p>\n</div>\n\n\n\n<p>Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use \u2013 published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation \u2013 agree that around 8 million people die prematurely every year from smoking. More details in <a href=\"https://ourworldindata.org/smoking\">our Our World in Data entry on smoking</a>.{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About <a href=\"https://ourworldindata.org/births-and-deaths\">58 million people</a> die every year.{/ref} Millions more live in poor health because of it.</p>\n\n\n\n<p>Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, <a href=\"https://ourworldindata.org/smoking#smoking-and-cancer\">more than one in five</a> cancer deaths are attributed to smoking.</p>\n\n\n\n<p>This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.<br>Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: <a href=\"https://ourworldindata.org/terrorism\">https://ourworldindata.org/terrorism</a> {/ref}</p>\n\n\n\n<p>Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world \u2013 we visualized their estimates <a href=\"https://ourworldindata.org/grapher/share-deaths-smoking\">here</a>. In many high-income countries smoking causes between 15% to 20% of all deaths.<br>According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See <a href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm\">the US CDC on Smoking & Tobacco Use</a>.{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority \u2013 6.2 million corresponding to 71% of the total \u2013 are men.{/ref}</p>\n\n\n\n<p>The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about <em>10 years</em> lower than that of non-smokers.{ref}Banks et al (2015) find that \u201cCurrent smokers are estimated to die an average of 10 years earlier than non-smokers.\u201d</p>\n\n\n\n<p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a> </p>\n\n\n\n<p>Pirie et al (2013) estimate a loss of 11 life years.</p>\n\n\n\n<p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext\">The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK</a>. Lancet. 2013;381:133\u201341.</p>\n\n\n\n<p>For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) \u2013 <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK179276/\">The Health Consequences of Smoking \u2013 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>\n\n\n\n<p>It\u2019s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) \u2013 <a href=\"https://doi.org/10.1016/S0140-6736(21)01169-7\">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337\u20132360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that “If current smoking patterns persist, tobacco will kill about 1 billion people this century.”{ref}Prabhat Jha and Richard Peto (2014) \u2013 <a href=\"https://www.nejm.org/doi/10.1056/NEJMra1308383\">Global Effects of Smoking, of Quitting, and of Taxing Tobacco</a>. N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}</p>\n\n\n\n<p>It is on us to prevent this.</p>\n\n\n\n<h3>How to make progress against the millions of deaths from smoking?</h3>\n\n\n\n<h4>The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills </h4>\n\n\n\n<p>The most fundamental work to prevent millions of deaths is already done. We know that smoking kills. </p>\n\n\n\n<p>This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General\u2019s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers \u2013 like Pearl in Baltimore \u2013 presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}</p>\n\n\n\n<p>People who do not think well about the work of statisticians sometimes <a href=\"http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html\">fall</a> for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true \u2013 for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it \u201copens up the lungs.\u201d The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.</p>\n\n\n\n<p>Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn\u2019t the only case where the negative impact of a practice wasn’t seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene \u2013 it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.<br>See my article on Ignaz Semmelweis and the history of maternal mortality \u2013 Roser (2017) <a href=\"https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality\">Measurement Matters \u2013 The decline of maternal mortality</a> on Our World in Data.{/ref}</p>\n\n\n\n<h4>Smoking seemed inevitable until it didn\u2019t</h4>\n\n\n\n<p>The chart summarizes the history of smoking in the US (the development in other high-income countries <a href=\"https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day\">was similar</a>). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.</p>\n\n\n\n<p>Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then \u2013 decade after decade \u2013 it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.</p>\n\n\n\n<p>The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) \u2013 <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK179276/\">The Health Consequences of Smoking \u2013 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>\n\n\n\n<p>Once people learned that smoking kills, they could act on it. It took some time, but they did.</p>\n\n\n\n<p>I wasn\u2019t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different \u2013\u00a0for a long time smoking kept on increasing and it looked as if it would never change. But then it did.</p>\n\n\n\n<p>Nearly half of all former smokers have quit,{ref}According to CDC \u2013 <a href=\"https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm\">History of the Surgeon General’s Reports on Smoking and Health</a>{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.</p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" width=\"3048\" height=\"2130\" src=\"https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png\" alt=\"\" class=\"wp-image-44088\" srcset=\"https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png 3048w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-400x280.png 400w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-787x550.png 787w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-150x105.png 150w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-768x537.png 768w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-1536x1073.png 1536w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-2048x1431.png 2048w\" sizes=\"(max-width: 3048px) 100vw, 3048px\" /></figure>\n\n\n\n<h4>The global perspective: people in poor countries are not following the path</h4>\n\n\n\n<p>For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more. </p>\n\n\n\n<p>But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich<em> </em>and<em> </em>poorer countries. </p>\n\n\n\n<p>The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world \u2013 all the countries above the grey line \u2013 the death rate from smoking is now lower than back in 1990.</p>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/smoking-death-rate-1990-2017\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<h4><a href=\"https://ourworldindata.org/grapher/smoking-death-rate-1990-2017\"></a>A global public health campaign that is winning over big business by making use of a wide range of measures</h4>\n\n\n\n<p>The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see \u2018The Economics of Tobacco and Tobacco Control\u2019:<br><br>U.S. National Cancer Institute and World Health Organization (2016) \u2013 <a href=\"https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21\">The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control</a>. Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. </p>\n\n\n\n<p>See also: Frank J. Chaloupka & Michael Grossman (1996) \u2013 <a href=\"https://www.nber.org/papers/w5740\">Price, Tobacco Control Policies and Youth Smoking</a>{/ref} A number of factors mattered \u2013 all of them clear reminders that good public policy can oppose the interests of big business when it really matters:</p>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important \u2013 and cost-effective ways \u2013 to reduce smoking and increase public health.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Tobacco advertisement \u2013 once omnipresent \u2013 was restricted or banned in many countries.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Many countries also offered smokers support to help them quit smoking.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<p>Smoking was also banned in public places where it was once common \u2013 in restaurants, bars, planes, and talk-shows.</p>\n\n\n\n<p>One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}</p>\n\n\n\n<p>The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do.</p>\n\n\n\n<h4><strong>Conclusion:</strong> the benefits from stopping to smoke are very large</h4>\n\n\n\n<p>The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it <em>a lot</em> to justify it. About <em>two-thirds</em> of those who were still smokers when they died, died <em>because</em> of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a> </p>\n\n\n\n<p>Reitsma et al. (2021) \u2013 <a href=\"https://doi.org/10.1016/S0140-6736(21)01169-7\">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337\u20132360.{/ref} </p>\n\n\n\n<p>Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that\u2019s nothing compared to what smokers are willing to do.</p>\n\n\n\n<p>The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref} </p>\n\n\n\n<p>It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about <a href=\"https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL\">one-in-five</a> adults in the world smokes, and, as we\u2019ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate. </p>\n\n\n\n<p>It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write “Among past smokers, mortality diminished gradually \u2026 and did not differ significantly from never-smokers in those quitting prior to age 45.\u201d</p>\n\n\n\n<p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a> </p>\n\n\n\n<p>Pirie et al (2013) find \u201cSmokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.\u201d</p>\n\n\n\n<p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133\u201341.</p>\n\n\n\n<p>But smoking cessation at any age \u2013 not just at a young \u2013 dramatically reduces death rates. </p>\n\n\n\n<p>See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) \u2013 <a href=\"https://pubmed.ncbi.nlm.nih.gov/23343064/\">50-year trends in smoking-related mortality in the United States</a>. N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.</p>\n\n\n\n<p>We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples\u2019 self-interest to not shorten their lifespan by 10 years.</p>\n\n\n\n<p>Or more positively, we can appeal to peoples\u2019 self-interest to live 10 more years of their life!</p>\n\n\n\n<p>The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.</p>\n", "protected": false }, "excerpt": { "rendered": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.", "protected": false }, "date_gmt": "2021-07-14T10:00:00", "modified": "2023-02-14T19:37:57", "template": "", "categories": [ 1 ], "ping_status": "closed", "authors_name": [ "Max Roser" ], "modified_gmt": "2023-02-14T19:37:57", "comment_status": "closed", "featured_media": 44090, "featured_media_paths": { "thumbnail": "/app/uploads/2021/07/Screen-Shot-2021-07-07-at-17.08.06-150x87.png", "medium_large": "/app/uploads/2021/07/Screen-Shot-2021-07-07-at-17.08.06-768x444.png" } }

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Smoking: How large of a global problem is it? And how can we make progress against it?

smoking-big-problem-in-brief

post

publish

<div class="blog-info"> <p>Our World in Data presents the data and research to make progress against the world’s largest problems.<br>This post draws on data and research discussed in our entry on <strong><a href="https://ourworldindata.org/smoking" target="_blank" rel="noopener">Smoking</a></strong>.</p> </div>   <p>Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use – published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation – agree that around 8 million people die prematurely every year from smoking. More details in <a href="https://ourworldindata.org/smoking">our Our World in Data entry on smoking</a>.{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About <a href="https://ourworldindata.org/births-and-deaths">58 million people</a> die every year.{/ref} Millions more live in poor health because of it.</p>   <p>Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, <a href="https://ourworldindata.org/smoking#smoking-and-cancer">more than one in five</a> cancer deaths are attributed to smoking.</p>   <p>This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.<br>Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: <a href="https://ourworldindata.org/terrorism">https://ourworldindata.org/terrorism</a> {/ref}</p>   <p>Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world – we visualized their estimates <a href="https://ourworldindata.org/grapher/share-deaths-smoking">here</a>. In many high-income countries smoking causes between 15% to 20% of all deaths.<br>According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm">the US CDC on Smoking & Tobacco Use</a>.{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority – 6.2 million corresponding to 71% of the total – are men.{/ref}</p>   <p>The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about <em>10 years</em> lower than that of non-smokers.{ref}Banks et al (2015) find that “Current smokers are estimated to die an average of 10 years earlier than non-smokers.”</p>   <p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p>   <p>Pirie et al (2013) estimate a loss of 11 life years.</p>   <p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext">The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK</a>. Lancet. 2013;381:133–41.</p>   <p>For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) – <a href="https://www.ncbi.nlm.nih.gov/books/NBK179276/">The Health Consequences of Smoking – 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>   <p>It’s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) – <a href="https://doi.org/10.1016/S0140-6736(21)01169-7">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337–2360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that "If current smoking patterns persist, tobacco will kill about 1 billion people this century."{ref}Prabhat Jha and Richard Peto (2014) – <a href="https://www.nejm.org/doi/10.1056/NEJMra1308383">Global Effects of Smoking, of Quitting, and of Taxing Tobacco</a>. N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}</p>   <p>It is on us to prevent this.</p>   <h3>How to make progress against the millions of deaths from smoking?</h3>   <h4>The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills </h4>   <p>The most fundamental work to prevent millions of deaths is already done. We know that smoking kills. </p>   <p>This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General’s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers – like Pearl in Baltimore – presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}</p>   <p>People who do not think well about the work of statisticians sometimes <a href="http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html">fall</a> for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true – for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it “opens up the lungs.” The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.</p>   <p>Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn’t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene – it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.<br>See my article on Ignaz Semmelweis and the history of maternal mortality – Roser (2017) <a href="https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality">Measurement Matters – The decline of maternal mortality</a> on Our World in Data.{/ref}</p>   <h4>Smoking seemed inevitable until it didn’t</h4>   <p>The chart summarizes the history of smoking in the US (the development in other high-income countries <a href="https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day">was similar</a>). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.</p>   <p>Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then – decade after decade – it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.</p>   <p>The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) – <a href="https://www.ncbi.nlm.nih.gov/books/NBK179276/">The Health Consequences of Smoking – 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>   <p>Once people learned that smoking kills, they could act on it. It took some time, but they did.</p>   <p>I wasn’t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different – for a long time smoking kept on increasing and it looked as if it would never change. But then it did.</p>   <p>Nearly half of all former smokers have quit,{ref}According to CDC – <a href="https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm">History of the Surgeon General's Reports on Smoking and Health</a>{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.</p>   <figure class="wp-block-image size-full"><img src="https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png" alt="" class="wp-image-44088"/></figure>   <h4>The global perspective: people in poor countries are not following the path</h4>   <p>For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more. </p>   <p>But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich<em> </em>and<em> </em>poorer countries. </p>   <p>The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world – all the countries above the grey line – the death rate from smoking is now lower than back in 1990.</p>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div>   <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe>   <p></p> </div> </div>   <h4><a href="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017"></a>A global public health campaign that is winning over big business by making use of a wide range of measures</h4>   <p>The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see ‘The Economics of Tobacco and Tobacco Control’:<br><br>U.S. National Cancer Institute and World Health Organization (2016) – <a href="https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21">The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control</a>. Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. </p>   <p>See also: Frank J. Chaloupka & Michael Grossman (1996) – <a href="https://www.nber.org/papers/w5740">Price, Tobacco Control Policies and Youth Smoking</a>{/ref} A number of factors mattered – all of them clear reminders that good public policy can oppose the interests of big business when it really matters:</p>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <p>By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important – and cost-effective ways – to reduce smoking and increase public health.</p> </div>   <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div> </div>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <p>Tobacco advertisement – once omnipresent – was restricted or banned in many countries.</p> </div>   <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div> </div>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <p>Many countries also offered smokers support to help them quit smoking.</p> </div>   <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div> </div>   <p>Smoking was also banned in public places where it was once common – in restaurants, bars, planes, and talk-shows.</p>   <p>One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}</p>   <p>The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do.</p>   <h4><strong>Conclusion:</strong> the benefits from stopping to smoke are very large</h4>   <p>The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it <em>a lot</em> to justify it. About <em>two-thirds</em> of those who were still smokers when they died, died <em>because</em> of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p>   <p>Reitsma et al. (2021) – <a href="https://doi.org/10.1016/S0140-6736(21)01169-7">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337–2360.{/ref} </p>   <p>Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that’s nothing compared to what smokers are willing to do.</p>   <p>The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref} </p>   <p>It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about <a href="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL">one-in-five</a> adults in the world smokes, and, as we’ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate. </p>   <p>It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write "Among past smokers, mortality diminished gradually … and did not differ significantly from never-smokers in those quitting prior to age 45.”</p>   <p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href="https://doi.org/10.1186/s12916-015-0281-z">https://doi.org/10.1186/s12916-015-0281-z</a> </p>   <p>Pirie et al (2013) find “Smokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.”</p>   <p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41.</p>   <p>But smoking cessation at any age – not just at a young – dramatically reduces death rates. </p>   <p>See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) – <a href="https://pubmed.ncbi.nlm.nih.gov/23343064/">50-year trends in smoking-related mortality in the United States</a>. N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.</p>   <p>We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples’ self-interest to not shorten their lifespan by 10 years.</p>   <p>Or more positively, we can appeal to peoples’ self-interest to live 10 more years of their life!</p>   <p>The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.</p>

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                        "text": "Our World in Data presents the data and research to make progress against the world\u2019s largest problems.",
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                        "text": "This post draws on data and research discussed in our entry on ",
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                        "text": "Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use \u2013 published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation \u2013 agree that around 8 million people die prematurely every year from smoking. More details in ",
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                        "text": ".{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About ",
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                                "text": "58 million people",
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                        "text": " die every year.{/ref} Millions more live in poor health because of it.",
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                        "text": "Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, ",
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                                "text": "more than one in five",
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                        "text": " cancer deaths are attributed to smoking.",
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                        "text": "This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.",
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                        "text": "Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: ",
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                        "text": "Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world \u2013 we visualized their estimates ",
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                        "text": ". In many high-income countries smoking causes between 15% to 20% of all deaths.",
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                        "text": "According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See ",
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                        "url": "https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm",
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                                "text": "the US CDC on Smoking & Tobacco Use",
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                        "text": ".{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority \u2013 6.2 million corresponding to 71% of the total \u2013 are men.{/ref}",
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                        "text": "The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about ",
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                                "text": "10 years",
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                        "text": " lower than that of non-smokers.{ref}Banks et al (2015) find that \u201cCurrent smokers are estimated to die an average of 10 years earlier than non-smokers.\u201d",
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                        "text": "Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). ",
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                    {
                        "url": "https://doi.org/10.1186/s12916-015-0281-z",
                        "children": [
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                                "text": "https://doi.org/10.1186/s12916-015-0281-z",
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                        "text": "Pirie et al (2013) estimate a loss of 11 life years.",
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                "value": [
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                        "text": "Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 ",
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                    },
                    {
                        "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext",
                        "children": [
                            {
                                "text": "The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK",
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                        ],
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                    },
                    {
                        "text": ". Lancet. 2013;381:133\u201341.",
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                        "text": "For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) \u2013 ",
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                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/books/NBK179276/",
                        "children": [
                            {
                                "text": "The Health Consequences of Smoking \u2013 50 Years of Progress",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": ". A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}",
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                        "text": "It\u2019s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) \u2013 ",
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                    },
                    {
                        "url": "https://doi.org/10.1016/S0140-6736(21)01169-7",
                        "children": [
                            {
                                "text": "Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". In ",
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                    {
                        "children": [
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                                "text": "The Lancet",
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                        "text": ", 397(10292), 2337\u20132360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that \"If current smoking patterns persist, tobacco will kill about 1 billion people this century.\"{ref}Prabhat Jha and Richard Peto (2014) \u2013 ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.nejm.org/doi/10.1056/NEJMra1308383",
                        "children": [
                            {
                                "text": "Global Effects of Smoking, of Quitting, and of Taxing Tobacco",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}",
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                        "text": "It is on us to prevent this.",
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                "text": [
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                        "text": "How to make progress against the millions of deaths from smoking?",
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                        "text": "The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills\u00a0",
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                        "text": "The most fundamental work to prevent millions of deaths is already done. We know that smoking kills.\u00a0",
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                        "text": "This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General\u2019s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers \u2013 like Pearl in Baltimore \u2013 presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}",
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                        "text": "People who do not think well about the work of statisticians sometimes ",
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                    {
                        "url": "http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html",
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                                "text": "fall",
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                        "text": " for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true \u2013 for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it \u201copens up the lungs.\u201d The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.",
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                        "text": "Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn\u2019t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene \u2013 it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.",
                        "spanType": "span-simple-text"
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                        "text": "See my article on Ignaz Semmelweis and the history of maternal mortality \u2013 Roser (2017) ",
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                    },
                    {
                        "url": "https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality",
                        "children": [
                            {
                                "text": "Measurement Matters \u2013 The decline of maternal mortality",
                                "spanType": "span-simple-text"
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                        "spanType": "span-link"
                    },
                    {
                        "text": " on Our World in Data.{/ref}",
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                "text": [
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                        "text": "Smoking seemed inevitable until it didn\u2019t",
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                        "text": "The chart summarizes the history of smoking in the US (the development in other high-income countries ",
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                        "url": "https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day",
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                                "text": "was similar",
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                        "text": "). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.",
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                        "text": "Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then \u2013 decade after decade \u2013 it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.",
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                        "text": "The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) \u2013 ",
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                        "url": "https://www.ncbi.nlm.nih.gov/books/NBK179276/",
                        "children": [
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                                "text": "The Health Consequences of Smoking \u2013 50 Years of Progress",
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                        "text": ". A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}",
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                        "text": "I wasn\u2019t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different \u2013\u00a0for a long time smoking kept on increasing and it looked as if it would never change. But then it did.",
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                        "text": "Nearly half of all former smokers have quit,{ref}According to CDC \u2013 ",
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                        "text": "{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.",
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                        "text": "The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world \u2013 all the countries above the grey line \u2013 the death rate from smoking is now lower than back in 1990.",
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                        "text": "A global public health campaign that is winning over big business by making use of a wide range of measures",
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                        "text": "The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see \u2018The Economics of Tobacco and Tobacco Control\u2019:",
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                        "text": ". Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.\u00a0",
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                        "text": "See also: Frank J. Chaloupka & Michael Grossman (1996) \u2013 ",
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                                "text": "Price, Tobacco Control Policies and Youth Smoking",
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                        "text": "{/ref} A number of factors mattered \u2013 all of them clear reminders that good public policy can oppose the interests of big business when it really matters:",
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                        "text": "One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}",
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                        "text": " of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). ",
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                        "children": [
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                                "text": "Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019",
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                        "text": ". In ",
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                        "text": "Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that\u2019s nothing compared to what smokers are willing to do.",
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                        "text": "The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref}\u00a0",
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                        "text": "It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about ",
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                        "text": " adults in the world smokes, and, as we\u2019ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate.\u00a0",
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                        "text": "Pirie et al (2013) find \u201cSmokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.\u201d",
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                        "text": "Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133\u201341.",
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                        "text": "See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) \u2013 ",
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                                "text": "50-year trends in smoking-related mortality in the United States",
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                        "text": ". N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.",
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                        "text": "We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples\u2019 self-interest to not shorten their lifespan by 10 years.",
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                        "text": "The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.",
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        "excerpt": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.",
        "dateline": "July 14, 2021",
        "subtitle": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.",
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2021-07-14 10:00:00

2024-02-16 14:22:51

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[
    "Max Roser"
]

Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.

2021-07-07 15:52:24

2023-02-14 19:37:57

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{}

Our World in Data presents the data and research to make progress against the world’s largest problems. This post draws on data and research discussed in our entry on **[Smoking](https://ourworldindata.org/smoking)**. Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use – published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation – agree that around 8 million people die prematurely every year from smoking. More details in [our Our World in Data entry on smoking](https://ourworldindata.org/smoking).{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About [58 million people](https://ourworldindata.org/births-and-deaths) die every year.{/ref} Millions more live in poor health because of it. Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, [more than one in five](https://ourworldindata.org/smoking#smoking-and-cancer) cancer deaths are attributed to smoking. This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: [https://ourworldindata.org/terrorism](https://ourworldindata.org/terrorism) {/ref} Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world – we visualized their estimates [here](https://ourworldindata.org/grapher/share-deaths-smoking). In many high-income countries smoking causes between 15% to 20% of all deaths. According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See [the US CDC on Smoking & Tobacco Use](https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm).{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority – 6.2 million corresponding to 71% of the total – are men.{/ref} The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about _10 years_ lower than that of non-smokers.{ref}Banks et al (2015) find that “Current smokers are estimated to die an average of 10 years earlier than non-smokers.” Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Pirie et al (2013) estimate a loss of 11 life years. Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – [The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext). Lancet. 2013;381:133–41. For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) – [The Health Consequences of Smoking – 50 Years of Progress](https://www.ncbi.nlm.nih.gov/books/NBK179276/). A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref} It’s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) – [Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019](https://doi.org/10.1016/S0140-6736(21)01169-7). In _The Lancet_, 397(10292), 2337–2360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that "If current smoking patterns persist, tobacco will kill about 1 billion people this century."{ref}Prabhat Jha and Richard Peto (2014) – [Global Effects of Smoking, of Quitting, and of Taxing Tobacco](https://www.nejm.org/doi/10.1056/NEJMra1308383). N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref} It is on us to prevent this. ## How to make progress against the millions of deaths from smoking? ### The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills The most fundamental work to prevent millions of deaths is already done. We know that smoking kills. This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General’s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers – like Pearl in Baltimore – presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref} People who do not think well about the work of statisticians sometimes [fall](http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html) for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true – for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it “opens up the lungs.” The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis. Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn’t the only case where the negative impact of a practice wasn't seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene – it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them. See my article on Ignaz Semmelweis and the history of maternal mortality – Roser (2017) [Measurement Matters – The decline of maternal mortality](https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality) on Our World in Data.{/ref} ### Smoking seemed inevitable until it didn’t The chart summarizes the history of smoking in the US (the development in other high-income countries [was similar](https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day)). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right. Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then – decade after decade – it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day. The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) – [The Health Consequences of Smoking – 50 Years of Progress](https://www.ncbi.nlm.nih.gov/books/NBK179276/). A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref} Once people learned that smoking kills, they could act on it. It took some time, but they did. I wasn’t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different – for a long time smoking kept on increasing and it looked as if it would never change. But then it did. Nearly half of all former smokers have quit,{ref}According to CDC – [History of the Surgeon General's Reports on Smoking and Health](https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm){/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined. <Image filename="Smoking-and-lung-cancer-mortality-US-only.png" alt=""/> ### The global perspective: people in poor countries are not following the path For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more. But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich_ _and_ _poorer countries. The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world – all the countries above the grey line – the death rate from smoking is now lower than back in 1990. <Chart url="https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL"/> <Chart url="https://ourworldindata.org/grapher/smoking-death-rate-1990-2017"/> ### [](https://ourworldindata.org/grapher/smoking-death-rate-1990-2017)A global public health campaign that is winning over big business by making use of a wide range of measures The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see ‘The Economics of Tobacco and Tobacco Control’: U.S. National Cancer Institute and World Health Organization (2016) – [The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control](https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21). Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. See also: Frank J. Chaloupka & Michael Grossman (1996) – [Price, Tobacco Control Policies and Youth Smoking](https://www.nber.org/papers/w5740){/ref} A number of factors mattered – all of them clear reminders that good public policy can oppose the interests of big business when it really matters: By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important – and cost-effective ways – to reduce smoking and increase public health. <Chart url="https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax"/> Tobacco advertisement – once omnipresent – was restricted or banned in many countries. <Chart url="https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising"/> Many countries also offered smokers support to help them quit smoking. <Chart url="https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use"/> Smoking was also banned in public places where it was once common – in restaurants, bars, planes, and talk-shows. One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref} The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do. ### **Conclusion:** the benefits from stopping to smoke are very large The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it _a lot_ to justify it. About _two-thirds_ of those who were still smokers when they died, died _because_ of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Reitsma et al. (2021) – [Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019](https://doi.org/10.1016/S0140-6736(21)01169-7). In _The Lancet_, 397(10292), 2337–2360.{/ref} Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that’s nothing compared to what smokers are willing to do. The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref} It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about [one-in-five](https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL) adults in the world smokes, and, as we’ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate. It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write "Among past smokers, mortality diminished gradually … and did not differ significantly from never-smokers in those quitting prior to age 45.” Banks, E., Joshy, G., Weber, M.F. et al. (2015) – Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). [https://doi.org/10.1186/s12916-015-0281-z](https://doi.org/10.1186/s12916-015-0281-z) Pirie et al (2013) find “Smokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.” Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) – The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41. But smoking cessation at any age – not just at a young – dramatically reduces death rates. See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) – [50-year trends in smoking-related mortality in the United States](https://pubmed.ncbi.nlm.nih.gov/23343064/). N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age. We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples’ self-interest to not shorten their lifespan by 10 years. Or more positively, we can appeal to peoples’ self-interest to live 10 more years of their life! The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.

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        "rendered": "\n<div class=\"blog-info\">\n<p>Our World in Data presents the data and research to make progress against the world\u2019s largest problems.<br>This post draws on data and research discussed in our entry on <strong><a href=\"https://ourworldindata.org/smoking\" target=\"_blank\" rel=\"noopener\">Smoking</a></strong>.</p>\n</div>\n\n\n\n<p>Smoking is so common, and feels so familiar, that it can be hard to grasp just how large the impact is. Every year, around 8 million people die prematurely as a result of smoking.{ref}The two regularly updated studies on the global death toll from tobacco use \u2013 published respectively by the World Health Organization and the Institute for Health Metrics and Evaluation \u2013 agree that around 8 million people die prematurely every year from smoking. More details in <a href=\"https://ourworldindata.org/smoking\">our Our World in Data entry on smoking</a>.{/ref} This means that about one in seven deaths worldwide are due to smoking.{ref}About <a href=\"https://ourworldindata.org/births-and-deaths\">58 million people</a> die every year.{/ref} Millions more live in poor health because of it.</p>\n\n\n\n<p>Smoking primarily contributes to early deaths through heart diseases and cancers. Globally, <a href=\"https://ourworldindata.org/smoking#smoking-and-cancer\">more than one in five</a> cancer deaths are attributed to smoking.</p>\n\n\n\n<p>This means tobacco kills more people every day than terrorism kills in a year.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day.<br>Over the past decade, terrorists killed an average of 21,000 people worldwide each year. See our entry on terrorism: <a href=\"https://ourworldindata.org/terrorism\">https://ourworldindata.org/terrorism</a> {/ref}</p>\n\n\n\n<p>Smoking is a particularly large problem in high-income countries. There, cigarette smoking is the most important cause of preventable disease and death.{ref}The Global Burden of Disease publishes estimates for countries around the world \u2013 we visualized their estimates <a href=\"https://ourworldindata.org/grapher/share-deaths-smoking\">here</a>. In many high-income countries smoking causes between 15% to 20% of all deaths.<br>According to the US CDC smoking causes an even higher share of deaths in the US than what the GBD estimates suggest; the CDC estimates that it leads to the premature death of about 20% of Americans (1,300 deaths every day). See <a href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm\">the US CDC on Smoking &amp; Tobacco Use</a>.{/ref} This is especially true for men: they account for almost three-quarters of deaths from smoking.{ref}According to the latest Global Burden of Disease study 8.7 million die prematurely from smoking. The huge majority \u2013 6.2 million corresponding to 71% of the total \u2013 are men.{/ref}</p>\n\n\n\n<p>The impact of smoking is devastating on the individual level. In case you need some motivation to stop smoking: The life expectancy of those who smoke regularly is about <em>10 years</em> lower than that of non-smokers.{ref}Banks et al (2015) find that \u201cCurrent smokers are estimated to die an average of 10 years earlier than non-smokers.\u201d</p>\n\n\n\n<p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a>&nbsp;</p>\n\n\n\n<p>Pirie et al (2013) estimate a loss of 11 life years.</p>\n\n\n\n<p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext\">The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK</a>. Lancet. 2013;381:133\u201341.</p>\n\n\n\n<p>For many additional references that suggest a similar loss of life years see U.S. Department of Health and Human Services (2014) \u2013 <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK179276/\">The Health Consequences of Smoking \u2013 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>\n\n\n\n<p>It\u2019s also devastating on the aggregate level. In the past 30 years more than 200 million have died from smoking.{ref}Reitsma et al. (2021) \u2013 <a href=\"https://doi.org/10.1016/S0140-6736(21)01169-7\">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337\u20132360.{/ref} Looking into the future, epidemiologists Prabhat Jha and Richard Peto estimate that &#8220;If current smoking patterns persist, tobacco will kill about 1 billion people this century.&#8221;{ref}Prabhat Jha and Richard Peto (2014) \u2013 <a href=\"https://www.nejm.org/doi/10.1056/NEJMra1308383\">Global Effects of Smoking, of Quitting, and of Taxing Tobacco</a>. N Engl J Med 2014; 370:60-68 DOI: 10.1056/NEJMra1308383{/ref}</p>\n\n\n\n<p>It is on us to prevent this.</p>\n\n\n\n<h3>How to make progress against the millions of deaths from smoking?</h3>\n\n\n\n<h4>The most fundamental step is taken: Thanks to the work of statisticians we know that smoking kills&nbsp;</h4>\n\n\n\n<p>The most fundamental work to prevent millions of deaths is already done. We know that smoking kills.&nbsp;</p>\n\n\n\n<p>This fact is so widely known today that it is hard to imagine that until the middle of the last century nobody was aware of it.{ref}British epidemiologists Richard Doll and Austin Bradford Hill began suspecting the link in the late 1940s, but it took them a long time to convince first themselves, then other health professionals, and finally the public. The report of the US Surgeon General\u2019s first Smoking and Health in 1964 is seen as the landmark report that made it known to a wide public that smoking cigarettes has dangerous health effects, including lung cancer and heart disease. Some other pioneers \u2013 like Pearl in Baltimore \u2013 presented evidence even earlier (late 30s), but a consensus was only established much later.{/ref}</p>\n\n\n\n<p>People who do not think well about the work of statisticians sometimes <a href=\"http://notthetreasuryview.blogspot.com/2017/04/spreadsheets-are-people-too-statistics.html\">fall</a> for the idea that statistics are incapable of seeing and understanding the reality that is right in front of our eyes. The impact of smoking is a clear example where the opposite is true \u2013 for many decades smokers themselves were entirely blind to the fact that their habit was poisoning and eventually killing them. I have an old mountaineering guide that gives climbers the advice that they should take a pause every now and then during the climb so that they can smoke a cigarette as it \u201copens up the lungs.\u201d The reality that smoking causes cancer and heart disease became only visible through careful statistical analysis.</p>\n\n\n\n<p>Many of the most important facts are not even visible to those who are impacted by them. Often you need statistics to see what your world actually looks like.{ref}Smoking isn\u2019t the only case where the negative impact of a practice wasn&#8217;t seen until statisticians made them visible. It also feels obvious to us today that basic hygiene is key to staying healthy, but until the late 19th century even doctors were entirely unaware of the importance of hygiene \u2013 it was common practice to deliver babies right after performing autopsies without the doctors washing their hands in between. The widespread lack of hygiene was one of the main causes of maternal mortality and countless children lost their mother right in the moment she gave birth to them.<br>See my article on Ignaz Semmelweis and the history of maternal mortality \u2013 Roser (2017) <a href=\"https://ourworldindata.org/measurement-matters-the-decline-of-maternal-mortality\">Measurement Matters \u2013 The decline of maternal mortality</a> on Our World in Data.{/ref}</p>\n\n\n\n<h4>Smoking seemed inevitable until it didn\u2019t</h4>\n\n\n\n<p>The chart summarizes the history of smoking in the US (the development in other high-income countries <a href=\"https://ourworldindata.org/grapher/sales-of-cigarettes-per-adult-per-day\">was similar</a>). I plotted two different metrics: in purple you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.</p>\n\n\n\n<p>Smoking was very much a 20th century problem. It was rare at the beginning of the century, but then \u2013 decade after decade \u2013 it became steadily more common. By the 1960s it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.</p>\n\n\n\n<p>The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.{ref}See U.S. Department of Health and Human Services (2014) \u2013 <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK179276/\">The Health Consequences of Smoking \u2013 50 Years of Progress</a>. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.{/ref}</p>\n\n\n\n<p>Once people learned that smoking kills, they could act on it. It took some time, but they did.</p>\n\n\n\n<p>I wasn\u2019t alive during peak-smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different \u2013\u00a0for a long time smoking kept on increasing and it looked as if it would never change. But then it did.</p>\n\n\n\n<p>Nearly half of all former smokers have quit,{ref}According to CDC \u2013 <a href=\"https://web.archive.org/web/20221003063925/https://www.cdc.gov/tobacco/sgr/history/index.htm\">History of the Surgeon General&#8217;s Reports on Smoking and Health</a>{/ref} cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.</p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" width=\"3048\" height=\"2130\" src=\"https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png\" alt=\"\" class=\"wp-image-44088\" srcset=\"https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only.png 3048w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-400x280.png 400w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-787x550.png 787w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-150x105.png 150w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-768x537.png 768w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-1536x1073.png 1536w, https://owid.cloud/app/uploads/2021/07/Smoking-and-lung-cancer-mortality-US-only-2048x1431.png 2048w\" sizes=\"(max-width: 3048px) 100vw, 3048px\" /></figure>\n\n\n\n<h4>The global perspective: people in poor countries are not following the path</h4>\n\n\n\n<p>For some time it looked as if people in poorer countries followed the path of people in richer countries. As they became richer they started to smoke more.&nbsp;</p>\n\n\n\n<p>But more recently this has changed, as the line chart shows: the share of people who smoke is declining in rich<em> </em>and<em> </em>poorer countries.&nbsp;</p>\n\n\n\n<p>The fact that poorer countries are not following the stupidity of the early industrializers is a very positive development. This is good news for global health, as we see in the scatterplot. In most countries in the world \u2013 all the countries above the grey line \u2013 the death rate from smoking is now lower than back in 1990.</p>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&amp;country=High+income~Lower+middle+income~Middle+income~Sub-Saharan+Africa+%28excluding+high+income%29~Upper+middle+income~OWID_WRL\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/smoking-death-rate-1990-2017\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<h4><a href=\"https://ourworldindata.org/grapher/smoking-death-rate-1990-2017\"></a>A global public health campaign that is winning over big business by making use of a wide range of measures</h4>\n\n\n\n<p>The decline of smoking is achieved through a successful global health campaign.{ref}On the following section and the big question of what is increasing and decreasing smoking see \u2018The Economics of Tobacco and Tobacco Control\u2019:<br><br>U.S. National Cancer Institute and World Health Organization (2016) \u2013 <a href=\"https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21\">The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control</a>. Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.&nbsp;</p>\n\n\n\n<p>See also: Frank J. Chaloupka &amp; Michael Grossman (1996) \u2013 <a href=\"https://www.nber.org/papers/w5740\">Price, Tobacco Control Policies and Youth Smoking</a>{/ref} A number of factors mattered \u2013 all of them clear reminders that good public policy can oppose the interests of big business when it really matters:</p>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>By taxing cigarettes very heavily, many governments made cigarettes much more expensive. Reducing the affordability of cigarettes is one of the most important \u2013&nbsp;and cost-effective ways \u2013 to reduce smoking and increase public health.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-tobacco-retail-price-that-is-tax\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Tobacco advertisement \u2013 once omnipresent \u2013 was restricted or banned in many countries.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/enforcement-of-bans-on-tobacco-advertising\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Many countries also offered smokers support to help them quit smoking.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/support-to-help-to-quit-tobacco-use\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<p>Smoking was also banned in public places where it was once common \u2013 in restaurants, bars, planes, and talk-shows.</p>\n\n\n\n<p>One argument for government intervention is the fact that a large number of people die from smoking who are not smokers themselves. About 1.2 million people die every year from passive secondhand-smoke: exposure from the smoke of others.{ref}The latest estimates on the death toll from secondhand smoking from the WHO and the IHME are similar. As of June 2021 the IHME estimates 1.3 million deaths and the WHO estimates 1.2 million deaths.{/ref}</p>\n\n\n\n<p>The various health campaigns reinforce each other in a virtuous cycle: once smoking becomes less common the peer pressure to smoke disappears. Instead, the pressure from peers turns against cigarettes and it becomes an increasingly unpopular thing to do.</p>\n\n\n\n<h4><strong>Conclusion:</strong> the benefits from stopping to smoke are very large</h4>\n\n\n\n<p>The argument in favour of smoking is that many people enjoy it; that is, of course, an important argument. But you should be clear to yourself that you have to enjoy it <em>a lot</em> to justify it. About <em>two-thirds</em> of those who were still smokers when they died, died <em>because</em> of their smoking.{ref}Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a>&nbsp;</p>\n\n\n\n<p>Reitsma et al. (2021) \u2013 <a href=\"https://doi.org/10.1016/S0140-6736(21)01169-7\">Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019</a>. In <em>The Lancet</em>, 397(10292), 2337\u20132360.{/ref}&nbsp;</p>\n\n\n\n<p>Even decades after we learned that smoking kills it is hard to understand just how damaging smoking really is. Imagine how we would think of an extreme sport in which two-thirds of those who practice it die. If you are fascinated by the risk-taking of climbers like Reinhold Messner or Alex Honnold, that\u2019s nothing compared to what smokers are willing to do.</p>\n\n\n\n<p>The devastation caused by smoking today is still terrible. On any average day it kills more than 20,000 people.{ref}The annual death toll from tobacco use estimated in the Global Burden of Disease study is 8.7 million, as cited above. This corresponds to 23,836 deaths on any average day. Some of these deaths are due to other forms of tobacco use, but the large majority are due to smoking.{/ref}&nbsp;</p>\n\n\n\n<p>It will remain one of the largest health problems in the world for many years to come. Even after a long decline, about <a href=\"https://ourworldindata.org/grapher/share-of-adults-who-smoke?tab=chart&amp;country=High%20income~Lower%20middle%20income~Middle%20income~Sub-Saharan%20Africa%20(excluding%20high%20income)~Upper%20middle%20income~OWID_WRL\">one-in-five</a> adults in the world smokes, and, as we\u2019ve seen above, it takes decades for a reduction in smoking to translate into a reduction of the death rate.&nbsp;</p>\n\n\n\n<p>It is difficult to overcome an addiction, but the benefits from stopping are huge. Studies show that those who stop smoking in the first four or five decades of their life do not suffer from elevated mortality risks.{ref}Banks et al (2015) write &#8220;Among past smokers, mortality diminished gradually \u2026 and did not differ significantly from never-smokers in those quitting prior to age 45.\u201d</p>\n\n\n\n<p>Banks, E., Joshy, G., Weber, M.F. et al. (2015) \u2013 Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015). <a href=\"https://doi.org/10.1186/s12916-015-0281-z\">https://doi.org/10.1186/s12916-015-0281-z</a>&nbsp;</p>\n\n\n\n<p>Pirie et al (2013) find \u201cSmokers who stop at about 40 years of age avoid about 90% of the excess hazard among continuing smokers, whereas those who stop at about 30 years of age avoid about 97% of it. Hence, stopping well before age 40 years would avoid well over 90% of the excess hazard in continuing smokers, and stopping well before age 30 years would avoid well over 97% of it.\u201d</p>\n\n\n\n<p>Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators (2013) \u2013 The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133\u201341.</p>\n\n\n\n<p>But smoking cessation at any age \u2013 not just at a young \u2013 dramatically reduces death rates.&nbsp;</p>\n\n\n\n<p>See alsoThun M, Carter B, Feskanich D, Freedman N, Prentice R, Lopez A, et al. (2013) \u2013 <a href=\"https://pubmed.ncbi.nlm.nih.gov/23343064/\">50-year trends in smoking-related mortality in the United States</a>. N Eng J Med.2013 Jan 24;368(4):351-64. doi: 10.1056/NEJMsa1211127.{/ref} But the benefits from smoking cessation are large at any age.</p>\n\n\n\n<p>We can win the fight against smoking. Among the largest problems in the world it is one where I feel most certain that we can achieve a lot of progress. Thanks to the statisticians we have the scientific knowledge to know about its consequences; we know that the public health campaigns work; and we can appeal to peoples\u2019 self-interest to not shorten their lifespan by 10 years.</p>\n\n\n\n<p>Or more positively, we can appeal to peoples\u2019 self-interest to live 10 more years of their life!</p>\n\n\n\n<p>The share of the world population that is following this crippling path is falling. The world is breaking patterns of the past. If we continue making progress we will not have to see a billion smokers die an early death this century.</p>\n",
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        "rendered": "Every year, around 8 million people die prematurely as a result of smoking. But there are things we can do to prevent this.",
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    "date_gmt": "2021-07-14T10:00:00",
    "modified": "2023-02-14T19:37:57",
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    "authors_name": [
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