The global combustible tobacco epidemic remains a formidable public health challenge, with devastating disparities in smoking rates across nations. As we reflect on the progress made in countries like the United Kingdom, it becomes evident that a one-size-fits-all approach is inadequate and unacceptable.
Instead, we must prioritize countries grappling with alarmingly high smoking rates, particularly those at the early stages of their tobacco control journey. On World No Tobacco Day 2024, we must rally together to address this urgent crisis with renewed vigor and ingenuity.
The statistics paint a sobering picture. Smoking rates among men in Indonesia and Jordan today stand at about 60 percent—a grim reflection of the UK’s rate in 1978, the year the first baby was born through in vitro fertilization. This historical parallel underscores the stagnation in tobacco control efforts in certain regions where advances in health technologies have not been matched by progress on smoking prevalence.
Similarly, men in countries like Armenia, China, Egypt and Kiribati today have smoking rates of around 50 percent—reminiscent of the UK’s rate in 1985, the year the ozone hole over Antarctica was discovered. This period marked a significant environmental wake-up call; in many countries, urgency around smoking has not reached a comparable tipping point.
It is unconscionable that as some countries approach the endgame by embracing effective harm reduction options, others are still at the starting line.
Countries such as Lebanon, Lesotho, the Philippines, Tunisia and Türkiye are currently contending with smoking rates of about 40 percent among men—akin to the UK in 1990, the year the Hubble Space Telescope was launched into orbit, revolutionizing our understanding of the cosmos. Despite leaps in scientific understanding and technological advances around nicotine since then, these countries continue to suffer the health impacts of high smoking rates.
Among women, meanwhile, smoking rates in Bulgaria, Croatia and Hungary today stand at about 30 percent—reminiscent of the UK in 2000, the year the first map of the human genome marked a significant milestone in scientific progress. The persistent high smoking rates among women in these countries highlight continuing gender disparities in tobacco control efforts.
It is hardly less alarming that countries like Argentina, Austria, Chile, Lebanon, the Solomon Islands and Türkiye are today grappling with smoking rates of about 20 percent among women—equivalent to the UK in 2010, the year the Arab Spring protests swept across the Middle East, and the Affordable Care Act (Obamacare) was signed into law in the United States.
Transformative events can shape public health landscapes. We’ve seen this happen with smoking, particularly in a number of wealthier countries. Yet across much of the world, progress has been inexcusably slow.
One beacon of hope in this landscape is Sweden, which has achieved remarkable success through tobacco harm reduction. Sweden’s use of snus, a smokeless tobacco product, has contributed to one of the lowest smoking rates in Europe. By providing an alternative to combustible tobacco, Sweden has demonstrated that harm reduction can be an effective tool.
Countries like Japan and, as we’ve seen, the UK, have taken their own, quite different pathways to tobacco harm reduction successes. The wider world must learn from their experiences by incorporating harm reduction into tobacco control strategies, offering safer alternatives to people who smoke and are unable or unwilling to quit nicotine.
Acceleration can be achieved by making a range of different product types simultaneously available.
But even in the UK, it has taken far too long for smoking rates to reach their current level of around 10 percent. In 2024, with an unprecedented range of tools, experiences and knowledge at our disposal, we must aim higher.
Current strategies must be reviewed, and effective cessation and tobacco harm reduction measures must be made available to facilitate rapid progress. These measures should draw on the scientific and technological innovations of the last few decades—despite the failure of the World Health Organization (WHO) to embrace them.
We cannot afford to deny countries in dire need the chance to leapfrog over the slow pace of change characterized by the WHO’s MPOWER programs. It is unconscionable that as some countries approach the endgame by embracing effective harm reduction options, others are still at the starting line.
We need to promote harm reduction tools such as vapes, pouches and heated tobacco products, all of which have helped many people transition away from combustible tobacco. Acceleration can be achieved by making a range of different product types simultaneously available, rather than limiting people to one or two categories, as even some of the most successful countries have done.
While these products are not without controversy, evidence demonstrates that they can all play a valuable role in the broader strategy to reduce tobacco-related harm, especially in countries where smoking rates remain stubbornly high.
By prioritizing countries with the highest smoking rates, we can speed up progress and save countless lives.
We cannot expect governments of lower-and-middle-income countries to do this by themselves, however. International collaboration and support are crucial. Wealthier nations with advanced tobacco control programs have a moral obligation to assist lower-income countries in developing and implementing effective strategies. This assistance could take the form of financial aid, technical expertise and sharing best practices.
World No Tobacco Day should serve as a clarion call for urgent and decisive action against a global toll of over 8 million preventable smoking-related deaths each year. By prioritizing countries with the highest smoking rates and adopting a comprehensive, innovative harm reduction approach, we can speed up progress and save countless lives.
On World No Tobacco Day 2024, let us be inspired by the remarkable scientific and social achievements of the past. If we channel that spirit of innovation and determination, we can win the fight for a healthier future for all.
This article was coauthored by Yusuff Adebayo Adebisi and Sahan Lungu.
Yusuff Adebayo Adebisi
Yusuff is a qualified pharmacist and an Oxford University-trained epidemiologist, with core interests in advancing equity and innovation in global public health research, policy and practice. He has authored over 100 academic papers on various population health issues, including tobacco harm reduction. Yusuff is an inaugural recipient of the Kevin Molloy Fellowship for Tobacco Harm Reduction, awarded by Knowledge-Action-Change, and he leads the African Tobacco Harm Reduction Research Hub. He currently lives in Glasgow, United Kingdom. @prof_rx
Sahan Lungu
Sahan is a media, health communications and project management practitioner with THR Malawi. He is active in promoting tobacco harm reduction practice in his country through information dissemination, enabling access to interventions and community collaboration. His interests have extended to public health research, and he is being trained in health and behavior change at the Malawi University of Business and Applied Sciences. Sahan is an inaugural recipient of the Kevin Molloy Fellowship, awarded by Knowledge-Action-Change. He lives in Lilongwe, Malawi. @SahanLungu
Top photograph by Reza Mehrad on Unsplash
The Influence Foundation, which operates Filter, has received grants from Derek Yach’s former employer, the Foundation for a Smoke-Free World (now renamed Global Action to End Smoking); and from Knowledge-Action-Change, which has provided scholarships to Yusuff Adebayo Adebisi and Sahan Lungu. Filter‘s Editorial Independence Policy applies.
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