Tobacco and Public Health - TCSC Indonesia

Chapter 16
The future worldwide health effects
of current smoking patterns
Richard Peto and Alan D Lopez
Worldwide, there are only two or three major causes of death whose effects are now
increasing rapidly: tobacco and HIV (and, perhaps, obesity). If current smoking patterns
persist, there will be about 1 billion deaths from tobacco during the twenty-first
century, as against ‘only’ about 0.1 billion (100 million) during the whole of the twentieth
century. About half of these deaths will be in middle age (35–69) rather than old
age—and, those killed by tobacco in middle age lose, on average, more than 20 years of
non-smoker life expectancy (Box A).
There are two main reasons for this large increase in tobacco deaths. First, the world
population in middle and old age will increase. Second, the proportion of the deaths in
middle and old age that is caused by tobacco will increase substantially over the next
few decades, due to the delayed effects of the large increase in cigarette smoking among
young adults over the past few decades (Doll et al. 1994; Peto et al. 1994, 1999; Murray
and Lopez 1996; World Health Organization 1996, 1997). Among cigarette smokers,
Box A: Hazards for the persistent cigarette smoker:
1990s British and American evidence
(Doll et al. 1994, 2004; Peto et al. 1994, 2000)
◆ HALF are killed: Among persistent cigarette smokers (those who start in
early adult life and do not give up), about 50% will eventually be killed by
tobacco.
◆ A quarter killed in MIDDLE age (35–69): Half those killed by tobacco are still in
middle age, losing on average about 20–25 years of life.
◆ Stopping smoking works: Even in middle age, smokers who stop before they
have developed some serious disease avoid MOST of their subsequent risk of
death from tobacco: smokers who stop before middle age avoid almost all their
risk.