Tobacco and Public Health - TCSC Indonesia

RICHARD PETO AND ALAN D LOPEZ 283
already suffers almost a million deaths a year from tobacco, a figure that is likely to at
least double by 2025. The Chinese study consisted of two parts, one retrospective (Liu
et al. 1998) (ascertaining the smoking habits of adults who had recently died) and one
prospective (Niu et al. 1998) (which will continue for decades, monitoring the longterm
growth of the epidemic). In recent years large retrospective and prospective studies
have been, or are being, established in China, India, Latin America, and elsewhere,
to monitor the current and future hazards not only in developed but also in various
developing populations: results from China (Liu et al. 1998; Niu et al. 1998), and
from India (Gupta and Mehta 2000; Gajalakshmi et al. 2003), show that the hazards in
some developing countries are already substantial.
Worldwide, there are now about 4–5 million deaths a year caused by tobacco, 2 million
in developed and 2–3 million in developing countries. But, these numbers reflect smoking
patterns several decades ago, and worldwide cigarette consumption has increased
substantially over the past half century (World Health Organization 1997). On current
smoking patterns, about 30% of young adults become persistent smokers and relatively
few give up (except in selected populations, such as educated adults in parts of western
Europe and North America).
The main diseases by which smoking kills people are substantially different in America
(where vascular disease and lung cancer predominate) (Peto et al. 1994), in China
(where chronic obstructive pulmonary disease predominates, causing even more
tobacco deaths than lung cancer) (Liu et al. 1998; Niu et al. 1998), and in India (where
half the world’s tuberculosis deaths take place, and the ability of smoking to increase the
risk of death from TB may well be of particular importance) (Gupta and Mehta 2000;
Gajalakshmi et al. 2003). But, there is no good reason to expect the overall 50% risk of
death from persistent cigarette smoking to be very different in different populations.
There are already a billion smokers, and by 2030 about another billion young adults
will have started to smoke. On current smoking patterns, worldwide mortality from
tobacco is likely to rise from about 4–5 million deaths a year around AD 2000 to about
10 million a year around 2030 (i.e. 100 million per decade) (Peto et al. 1994), and will
rise somewhat further in later decades. So, tobacco will cause about 150 million deaths
in the first quarter of the century and 300 million in the second quarter. Predictions for
the third and, particularly, the fourth quarter of the next century are inevitably somewhat
speculative, but if over the next few decades about 30% of the young adults
become persistent smokers and about half are eventually killed by their habit, then
about 15% of adult mortality in the second half of the century will be due to tobacco
(implying more than half a billion tobacco deaths in 2050–2099).
These numbers of tobacco deaths before 2050 cannot be greatly reduced unless a
substantial proportion of the adults who have already been smoking for some time
give up the habit. For, a decrease over the next decade or two in the proportion of children
who become smokers will not have its main effects on mortality until the third
quarter of the century (Box B).