Global Tobacco Use Is Steadily Declining

More than 60 years ago, on January 11, 1964, the Surgeon General of the U.S. Public Health Service, Luther L. Terry, M.D., published the first comprehensive report on the effects of smoking on health. A committee was appointed to review and evaluate existing research on the topic in order to “reach some definitive conclusions on the relationship between smoking and health in general.” And while it may seem absurd from today’s point of view that the adverse effects of smoking were ever in doubt, 60 years ago the “tobacco-health controversy” was exactly that: a controversy. After consulting more than 7,000 articles about the relationship between smoking and disease, the committee did come to a definite conclusion, however, making its report “Smoking and Health” a landmark study in the fight against smoking.

“On the basis of prolonged study and evaluation of many lines of converging evidence, the Committee makes the following judgement: Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” (Smoking and Health, 1964)

The report found that smoking is a cause of lung cancer and laryngeal cancer in men, a probable cause of lung cancer in women, the most important cause of chronic bronchitis and a contributing factor to cardiovascular diseases, resulting in a higher death rate from coronary artery disease among male cigarette smokers. After its release, it dominated newspaper headlines for days and was later ranked among the top news stories of 1964.

And while some tobacco control measures, such as warning labels on cigarette packs, were implemented promptly, cigarette sales in the U.S. continued to rise until the early 1980s, which is when they peaked at more than 630 billion cigarettes per year. Over the past four decades, measures to discourage smoking and protect the public from second-hand smoke have become more and more strict and wide-ranging, resulting in falling tobacco use prevalence in the United States and large parts of the world. Looking at the U.S., the CDC considers the antismoking campaign a “public health success with few parallels in history”, as it achieved its goal despite “the addictive nature of tobacco and the powerful economic forces promoting its use.”

According to WHO estimates, 21.7 percent of all people aged 15 and older used tobacco in 2020, down from 32.7 percent at the turn of the millennium. As the following chart nicely illustrates, the tobacco use rate is highest among 45- to 54-year-olds at 27.5 percent, while it’s just 13.8 percent among 15- to 24-year-olds and 13.5 percent among those aged 85 and older.