WHO deplores insufficient decline in smoking in Europe

18% of noncommunicable disease (NCD) deaths in Europe are caused by tobacco use, and nearly one in five premature deaths from noncommunicable diseases could be avoided if tobacco use were eliminated in the region. However, even though smoking is declining in Europe, continued action and efforts are needed to achieve the World Health Organization (WHO) target.

A greater reduction in men

In the WHO European Region, adult smoking prevalence decreased from 34.2% in 2000 to 26.3% in 2018, or approximately 227 million people in 2000 compared to approximately 186 million in 2018. This significant decline, however, is still insufficient. Models predict that the European Region is heading towards a reduction in smoking of 18% between 2010 and 2025, while the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 targeted a reduction of 30% worldwide.

WHO estimates that about one-third of men (34%) in the European region used tobacco in 2018, or about 119 million people, compared to 150 million (46%) in 2000. This number is expected to continue to decline to approximately 107 million (30%) by 2025.

The scourge of smoking among women in the European region

The European Region is the only WHO region that is not expected to meet the 30 % reduction target among women by 2025. Indeed, according to WHO, about one-fifth of women (19 %) in the European Region used tobacco in 2018, or about 67 million people, compared to about 77 million (23 %) in 2000 and reaching only about 63 million (18 % decline) by 2025.

Disparities according to geographical areas

The average smoking rate among men in Northern Europe in 2010 was the lowest of the four defined subregions. It is also the one projected to experience the largest decline by 2025 (from 30 % to 17 %). The average rate in Western Europe was slightly higher and projected to experience the slowest decline of the four subregions (from 32 % to 26 %). The average rate in Southern Europe was even higher (from 38 % to 30 %), while the highest smoking rate among men is in Eastern Europe. It is projected to remain the highest of the four subregions (from 44 % to 34 %).

The average smoking rate among women in 2010 in Eastern European countries was the lowest of the four subregions and is projected to decline slightly by 2025 (from 14 % to 12 %). This rate is higher for Southern Europe, which is projected to experience the smallest decline of the four subregions (from 21 % to 19 %). The average rate for Western Europe is projected to decrease from 25 to 22 % by 2025. The highest average rate among women was in Northern Europe, but this subregion is projected to experience a very sharp decline by 2025, from 28 % to 17 %.

The impact of education level

Confirming several previous studies, the WHO's work shows that in almost all countries and for both sexes, the prevalence of smoking is higher among people with little education and lower among those with several years of education. This data must therefore be taken into account when developing prevention and information actions.

Men's health more affected

The proportion of deaths from NCDs (non-communicable diseases) attributable to smoking is four times higher in men (28 %) than in women (7 %). Thus, the proportion of deaths from cardiovascular diseases (heart disease, stroke and others) attributable to smoking is 25 % in men and 6% in women. The overall proportion of cancer deaths attributed to smoking is 27 % in men and 10% in women. Finally, in men, 9 out of 10 lung cancers are due to smoking.

WHO recommendations

• More countries need to monitor all forms of tobacco use, including the use of new tobacco products, such as e-cigarettes with nicotine (ENDS) or without nicotine (ENNDS) and heated tobacco;
• Countries are encouraged to use scientific and evidence-based standards and protocols for tobacco surveys;
• Countries' capacities to conduct, disseminate and use their results should be strengthened;
• Countries should integrate tobacco surveillance programs into national, regional and global health surveillance programs so that comparable data can be analyzed at regional and international levels.