Key Facts
- Tobacco kills up to half of its users who don’t quit (1–3).
- Tobacco kills more than 7 million people each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke (4).
- Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries.
- To address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently, 183 countries are Parties to this treaty.
- The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure.
Overview
The tobacco epidemic is one of the biggest public health threats the world has ever faced, accounting for over 7 million deaths annually, alongside disability and long-term suffering from tobacco-related diseases (4). Tobacco use is harmful in all forms, and there is no safe level of exposure. Among these forms, cigarette smoking remains the most prevalent worldwide. Other tobacco products include waterpipe tobacco, cigars, smokeless tobacco, and more.
About 80% of the 1.3 billion tobacco users globally live in low- and middle-income countries. In these regions, the burdens of tobacco-related illness and death are especially severe. Tobacco use exacerbates poverty by diverting household budgets away from essential needs such as food and shelter—behavior hard to change due to the addictive nature of tobacco.
The economic costs related to tobacco use are staggering, covering health care expenses for treating tobacco-induced diseases and the lost workforce productivity stemming from morbidity and mortality.
Key Measures to Reduce the Demand for Tobacco
Surveillance is Key
Effective monitoring is crucial for tracking the scope of the tobacco epidemic. Almost half of the global population participates in nationally representative surveys assessing tobacco use among adults and adolescents. These insights help tailor public health policies effectively.
More on monitoring tobacco use
Second-Hand Smoke Kills
Second-hand smoke fills spaces like restaurants and offices when individuals smoke tobacco products. Notably, there’s no safe level of exposure to this type of smoke. It contributes significantly to conditions such as cardiovascular disease and lung cancer, resulting in approximately 1.6 million premature deaths yearly.
Currently, over a third of the world’s population in 79 countries enjoys comprehensive protection under national smoke-free laws.
Tobacco Users Need Help to Quit
Most smokers know the dangers associated with tobacco use and wish to quit. Supportive measures, such as counseling and medications, can significantly enhance the chances of quitting. However, currently, comprehensive cessation services are only available in 31 countries, covering merely a third of the global population.
Pictorial Health Warnings Work
Robust anti-tobacco campaigns and pictorial health warnings are crucial in preventing children and vulnerable groups from starting to use tobacco, while also increasing quitting rates among existing users. Today, 62% of the global population lives in 110 countries that have implemented best practice graphic health warnings.
Moreover, 2.9 billion individuals live in 36 countries where at least one strong anti-tobacco mass media campaign has been aired within the last two years.
More on tobacco health warnings
Bans on Tobacco Advertising Lower Consumption
Tobacco advertising, promotion, and sponsorship (TAPS) play a substantial role in sustaining tobacco use. Banning all forms of TAPS can significantly reduce tobacco consumption. Over a third of countries (68), representing more than a quarter of the global population, have enacted complete bans on TAPS.
More on tobacco advertising bans
Taxes Are Effective in Reducing Tobacco Use
Implementing taxes on tobacco products is the most effective way to deter usage, especially among youth and low-income demographics. A 10% increase in tobacco prices can lead to a 4% decrease in tobacco consumption in high-income nations, while the decrease can be around 5% in low- and middle-income countries. Unfortunately, high tobacco taxes are seldom seen, with only 41 countries imposing taxes high enough to account for at least 75% of retail prices.
Illicit Trade of Tobacco Products Must Be Stopped
The illicit trade in tobacco presents significant health, economic, and security challenges globally. An estimated one in every ten tobacco products consumed globally is illicit. Many countries show that addressing illicit trade is possible even while increasing tobacco taxes and prices, leading to higher tax revenues and reduced usage.
The WHO FCTC Protocol to Eliminate the Illicit Trade of Tobacco Products (ITP) serves as a key policy to tackle this issue.
More on eliminating the illicit trade of tobacco products
Newer Nicotine and Tobacco Products
Heated tobacco products (HTPs) generate aerosols containing nicotine and harmful chemicals through the heating of tobacco. Despite claims of reduced risk, evidence indicates no conclusive benefits compared to traditional tobacco. HTPs present new hazards, containing additional toxicants that could pose greater health risks.
More on heated tobacco products
Additionally, electronic cigarettes, often termed vaping, emerge as commonly used electronic nicotine delivery systems. Although they may seem less harmful, emissions from these products still pose health risks to users and bystanders, since they contain nicotine and other toxic substances. Some ‘nicotine-free’ claims have even been found misleading.
Research indicates that use of electronic cigarettes can increase heart disease and lung disorder risks, while also posing dangers to fetal health during pregnancy.
Finally, nicotine pouches are new products that contain nicotine and resemble traditional smokeless tobacco. They are often marketed as “tobacco-free” and are seen as accessible alternatives, but they still carry their own risks.
WHO Response
The conflict between the tobacco industry’s interests and public health cannot be overstated. The industry’s operations are fundamentally at odds with the imperative to promote health, as they manufacture products that are addictive and harmful. The scope of tobacco’s impact is staggering, yet preventable.
The WHO FCTC represents a landmark achievement in endorsing public health. This treaty not only establishes high standards for health cooperation internationally but also strengthens the legal framework for compliance. Since its initiation in 2005, 182 Parties have signed, accounting for over 90% of the global population.
In 2007, WHO introduced the MPOWER initiative, designed to enhance the implementation of the demand reduction facets of the WHO FCTC. The six MPOWER measures are:
- Monitor tobacco use and prevention policies.
- Protect people from tobacco use.
- Offer help to quit tobacco use.
- Warn about the dangers of tobacco.
- Enforce bans on tobacco advertising, promotion, and sponsorship.
- Raise taxes on tobacco.
WHO has actively monitored these MPOWER measures since their introduction. For further insights into the advancements made in global tobacco control, consult the series of WHO reports on the global tobacco epidemic.
References
(1) Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004 Jun 26;328(7455):1519.
(2) Banks, E., Joshy, G., Weber, M.F. et al. Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence. BMC Med 13, 38 (2015).
(3) Siddiqi, K., Husain, S., Vidyasagaran, A. et al. Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries. BMC Med 18, 222 (2020).
(4) Global Burden of Disease 2023. [online application]. Seattle: Institute for Health Metrics and Evaluation; 2025 (https://vizhub.healthdata.org/gbd-compare/). [to be published July 2025]
(5) WHO global report on trends in prevalence of tobacco use 2000-2030. WHO, Geneva, 2024.
