Currently, smoking causes approximately 5–6 million deaths per year, including 31% and 6% of all cancer deaths in middle-aged men and women, respectively. The proportions of male cancer and total deaths due to smoking are falling in high-income countries but rising in low- and middle-income countries.
Cessation by current smokers is the only practical way to avoid a substantial proportion of tobacco deaths worldwide before 2050.
Cessation before middle age avoids more than 90% of the lung cancer mortality attributable to smoking and markedly reduces the risks of death from other diseases. Although cessation has become common in high-income countries, it is still rare in most low- and middle-income countries.
Countries such as France that have aggressively used higher taxes to curb smoking have reduced consumption much faster than countries that have not aggressively increased tobacco taxation.
In low- and middle-income countries, a 10% higher tobacco price reduces consumption by around 8%, which is twice the effect seen in high-income countries. Health information, counter-advertising, restrictions on smoking and cessation therapies are also highly effective at reducing smoking.
A 70% higher street price of cigarettes (corresponding to around a 2–3-fold higher tax) would avoid 115 million deaths or one-quarter of expected tobacco deaths over the next few decades. Of the avoided deaths, approximately 25 million would be from cancer and 50 million from vascular disease.
On the basis of current consumption patterns, approximately 450 million adults will be killed by smoking between 2000 and 2050. At least half of these adults will die between 30 and 69 years of age, losing decades of productive life. Cancer and the total deaths due to smoking have fallen sharply in men in high-income countries but will rise globally unless current smokers, most of whom live in low- and middle-income countries, stop smoking before or during middle age. Tripling the taxes on tobacco could rapidly raise cessation rates and deter the initiation of smoking. Higher taxes, regulations on smoking and information for consumers could avoid at least 115 million smoking-associated deaths in the next few decades, including around 25 million cancer deaths.
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I thank F. J. Chaloupka for helpful comments, J. Boreham, M. Ezzati, C. Hill, R. Peto and M. Thun for providing access to various mortality data and smoking estimates, L. Aleksandrowicz for help with graphics and O. P. Malhotra and L. Corson for editing support. The author is supported by the Fogarty International Centre (grant R01 TW007939-01), the Li Ka Shing Knowledge Institute and Keenan Research Centre, St. Michael's Hospital and the Canada Research Chair programme.
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