Deaths from tobacco in Europe

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Compared to the rest of the world, the WHO European Region has one of the highest proportions of deaths attributable to tobacco. Before the WHO Framework Convention on Tobacco Control (WHO FCTC) came into force in 2005, 16% of all deaths in adults aged over 30 years in the WHO European Region were due to tobacco. This is in contrast to the African or the Eastern Mediterranean regions, with 3% and 7% of deaths attributable to tobacco respectively, and a global average of 12%.

In every region, more men than women die from tobacco, but this difference is very pronounced in the WHO European Region, with a male to female mortality ratio of 5:1. Of the premature deaths in the Region in 2004, almost 1 in every 5 in the 30–44 age group was attributable to tobacco use, and 1 in every 3 among those aged 45–59 years.

These findings, and others, are contained in the WHO global report: mortality attributable to tobacco. The information provided in this report focuses on the year 2004, a year chosen to provide baseline data for the year immediately before the WHO FCTC came into force. The data are conservative, focusing on adults aged 30 years and over, and not including deaths from second-hand smoke, which has been shown to cause about 600 000 deaths annually worldwide.

A follow-up report, reviewing mortality data since the introduction of the WHO FCTC, is being prepared, and due to be released next year. Smoking prevalence has fallen in many countries in the WHO European Region, particularly in the western part, since the WHO FCTC was introduced. The accelerating rates of tobacco use among women, primarily in the eastern part of the Region, however, are of grave concern and will have devastating consequences for women in the future. The proportion of female smokers is estimated to rise from about 12% in the first decade of this century to 20% by 2025, globally.

Effect of tobacco on health

Tobacco use or exposure to tobacco smoking has a negative impact on health across the life-course. During fetal development, tobacco can increase rates of stillbirth and selected congenital malformations. In infancy, it can cause sudden infant death syndrome. In childhood and adolescence, tobacco can cause disability from respiratory diseases. The negative impact of tobacco use becomes particularly visible, however, from about the age of 30 years. In relatively young middle-aged adults, it can include increased rates of cardiovascular disease and, later in life, higher rates of cancer (especially lung cancer), as well as death associated with diseases of the respiratory system.

Although tobacco is usually associated with noncommunicable diseases (NCDs), such as cancers and heart and respiratory diseases, tobacco is also a major factor in deaths from communicable diseases. For example, tuberculosis can at times be latent or dormant, until activated by tobacco use.

Within NCDs, 85% of the deaths caused by cancer of the trachea, bronchus and lung are attributed to tobacco, and 16% of the deaths caused by ischaemic heart disease are tobacco-attributed. For communicable diseases, 26% of tuberculosis deaths are attributed to tobacco, as are 24% of all lower respiratory infection deaths.

The WHO FCTC

To address the global burden of tobacco, the WHO FCTC was adopted in 2003 and came into force in 2005. In the WHO European Region, 47 countries have ratified it, committing themselves to developing and implementing a series of evidence-based tobacco control measures to regulate the devastating health, social, environmental and economic consequences of tobacco consumption and exposure.

WHO calls on all countries not only to ratify but also to fully implement the evidence-based measures included in the treaty. But legislation is only the first step; enforcement is vital to ensure effectiveness.