Tobacco and Public Health - TCSC Indonesia

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THE FUTURE WORLDWIDE HEALTH EFFECTS OF CURRENT SMOKING PATTERNS
Box B: Effects of adult smokers quitting on tobacco deaths
before 2050, and of young people not starting on tobacco
deaths after 2050 (Doll et al. 1994, 2004; Peto et al. 1994,
2000)
◆ Quitting: If many of the adults who now smoke were to give up over the next
decade or two, halving global cigarette consumption per adult by the year 2020,
then this would prevent about one-third of the tobacco deaths in 2020 and
would almost halve tobacco deaths in the second quarter of the century. Such
changes would avoid about 20 or 30 million tobacco deaths in the first quarter of
the century and would avoid about 150 million in the second quarter.
◆ Not starting: If, by progressive reduction over the next decade or two in the
global uptake rate of smoking by young people, the proportion of young adults
who become smokers were to be halved by 2020, then this would avoid hundreds
of millions of the deaths from tobacco after 2050. It would, however, avoid almost
none of the 150 million deaths from tobacco in the first quarter of the century,
and would probably avoid “only” about 10 or 20 million of the 300 million deaths
from tobacco in the second quarter of the century.
The calculations in Box B show that quitting by adult smokers offers the only realistic
way in which widespread changes in smoking status can prevent large numbers of
tobacco deaths over the next half century. Widely practicable ways of helping large
numbers of young people not to become smokers could avoid hundreds of millions of
tobacco deaths in the middle and second half of the century, but not before, whereas
widely practicable ways of helping large numbers of adult smokers to quit (preferably
before middle age, but also in middle age: Box A) might well avoid one or two hundred
million tobacco deaths in the first half of the century. The strategies that are relevant to
young people may well be of little relevance to adults, and vice versa, so over-emphasis
on either at the expense of the other would be inappropriate. In particular, it is often
wrongly supposed that it is impossible to get large numbers of adult smokers to quit, but
the experience of several countries over the past few decades shows that decreases can
occur both in the proportion who start and in the proportion who continue to smoke.
Britain, which is now experiencing the most rapid decrease in the world in premature
deaths from tobacco, shows that quite large improvements are possible (Peto et al.
1994, 2000). From 1965 to 1995 annual UK cigarette sales fell by half, and there was a
threefold reduction in the machine-measured tar delivery per cigarette (and hence a
moderate reduction in the hazard per smoker: Doll and Peto 1981; Peto 1986). Over
the same period, annual UK tobacco deaths in middle age decreased from 80 000 to
30 000, and they are still falling rapidly (Peto et al. 1994, 2000). (For lung cancer, the