The number of cigarettes smoked worldwide is finally decreasing. Many of the tobacco industry’s largest markets are highly populous countries across Asia, and the fastest growth is largely in Africa and the Eastern Mediterranean.
About 5.7 trillion (5,700,000,000,000) cigarettes were smoked worldwide in 2016. Although overall consumption has declined slightly over the past few years, the future path of global tobacco control is still uncertain. Despite the rhetorical commitment of some in the tobacco industry toward a smoke-free world, all major tobacco companies continue to aggressively advertise cigarettes and vigorously fight tobacco control efforts around the world. The significant reductions in smoking rates in the United Kingdom, Australia, Brazil, and other countries that have implemented the most advanced tobacco control laws globally are almost entirely offset by the increasing consumption in many countries with weaker tobacco control regulations.
Cigarette consumption is predicted to increase in many low- and medium-HDI countries due to dynamic economic development and continued population growth. For example, the number of tobacco smokers is set to increase by 24 million in Indonesia and by 7 million in Nigeria from 2015 to 2025. China, whose people smoke more than 40% of all cigarettes globally, remains a challenge. Although cigarette use in China has begun to decline, half of Chinese adult males continue to smoke cigarettes. Without appropriate prevention policies, the world will lose a billion lives this century due to tobacco smoking.
Number of cigarettes smoked per person per year: age ≥ 15, 2016; estimates are of legally-sold machine-made and roll-your-own cigarette consumption
Euromonitor International. “Passport Database.” London, UK, 2017.
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2016 (GBD 2016) Population Estimates 1950-2016. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2017.
Another challenge is addressing cigarette smoking among specific sub-populations within countries. Cigarette consumption is associated with lower socioeconomic status, even in low- and medium-HDI countries. Other vulnerable populations with high smoking prevalence include individuals from certain racial/ethnic groups, the mentally ill (see Comorbidities), and, in some countries, in the LGBT community. These inequalities in tobacco smoking can be reduced using targeted tobacco control measures. For example, revenue from cigarette tax increases could be directed to fund tobacco prevention and cessation programs for disadvantaged groups.
Rigorous monitoring of tobacco use is critical for the implementation of effective tobacco control strategies. Although many countries are making a good progress in surveying the rates of cigarette smoking, estimates of the number of cigarettes smoked are typically absent. Often, the only available estimates of cigarette consumption come from market research companies, which track cigarette sales. The United Kingdom’s efforts to estimate cigarette consumption are exceptional: the annual cigarette use estimates by Her Majesty’s Revenue and Customs not only provide valuable information on trends in the tobacco epidemic in the UK, but are also part of a larger government effort to understand the scope of the illicit cigarette trade problem in the country (see Illicit Trade). More counties should attempt to follow the UK’s best practices.
Smoking and Wealth
Disparities in cigarette consumption in selected Global Adult Tobacco Survey countries by wealth group
Lower socioeconomic groups tend to smoke more
Kostova D, Tesche J, Perucic A-M, Yurekli A, Asma S. Exploring the Relationship Between Cigarette Prices and Smoking Among Adults: A Cross-Country Study of Low- and Middle-Income Nations. Nicotine Tob Res. 2014 Jan 1;16(Suppl 1):S10-5.
“The market competes on addiction—the most addictive products win out. With research, they [firms], like the cigarette companies, may find out which of their ingredients is most effective in increasing sales/addiction. […]they are loath to give up these profit opportunities, no matter the costs to society.”
– Joseph E. Stiglitz, Recipient of the Nobel Memorial Prize in Economic Sciences, 2008
Stiglitz JE. Toward a general theory of consumerism: Reflections on Keynes’s Economic possibilities for our grandchildren. Pecchi L, Piga G (Red) Revisiting Keynes Econ Possibilities Our Gd. 2008;41–86. DOI:10.7551/mitpress/9780262162494.003.0004