(2003; 211 pages)
1. The burden of tobacco smoking
The health risks of tobacco use, particularly cigarette smoking, are well-recognized. Tobacco smoke is the single most important factor contributing to poor health, and it is widely believed that a reduction in the prevalence of tobacco smoking would be the single most effective preventive health measure (1). An estimated 70 - 90% of lung cancer, 56 - 80% of chronic respiratory diseases and 22% of cardiovascular diseases are attributable to tobacco smoking (2).
Cigarette smoking remains the most important preventable cause of premature death and disability worldwide (3). Each year, tobacco use causes some 4.9 million premature deaths (2,4).Whereas until recently this epidemic of chronic disease affected the wealthy countries, it is now rapidly becoming a problem in the developing world (5). About 80% of the world's 1.1 billion smokers live in low-income and middle-income countries. By 2030, seven out of every 10 deaths from smoking will occur in low-income countries (6).
The available evidence suggests that free trade in tobacco products has led to increases in tobacco smoking and other types of tobacco use, but measures to reduce its supply are difficult to implement. However, interventions to reduce the demand for tobacco are likely to succeed. These include higher tobacco taxes, antismoking education, bans on tobacco advertising and promotion, policies designed to prevent smoking in public spaces or workplaces, and pharmacological therapies to help smokers to quit (5,6).
Hundreds of controlled scientific studies have demonstrated that appropriate treatment can help tobacco users to achieve permanent abstinence. Millions of lives could therefore be saved with effective treatment for tobacco dependence.