The effects of tobacco control policies on global smoking prevalence

A recent study[1] simulated the impact of tobacco control policies on smoking prevalence worldwide. It was found that if all countries had adopted comprehensive tobacco control policies by 2009, there would have been approximately 100 million fewer smokers worldwide by 2017.

Significant global efforts have been devoted to reducing the tobacco epidemic over the past two decades, particularly since the adoption of the Framework Convention on Tobacco Control by the World Health Organization in 2003, but tobacco use remains widespread with 1.1 billion smokers worldwide.

This study examines the effect of tobacco control policies on smoking rates with the aim of providing indications of the importance of different policies. The study simulated the smoking prevalence reached in 2017 in countries under two different scenarios: if there had been no change in tobacco control policies since 2008 and if comprehensive and effective policies had been implemented. To maintain consistency of results across scenarios, the analysis was limited to 155 countries for which data related to policies implemented between 2008 and 2016 were available.

Strong evidence for the effectiveness of tobacco control policies

The study highlights four proven measures that should be prioritized in comprehensive tobacco control programs, including tax increases, smoking bans in public and communal places, advertising bans, and health warnings. The analysis indicates that high levels of implementation of all key measures were significantly associated with a reduction in smoking prevalence from 2009 to 2017. During this period, overall smoking prevalence declined worldwide by 7.7% for men aged 15 and older and by 15.2% for women, also aged 15 and older. The largest relative declines were observed among young people aged 15 to 29, with a decline of 15% for both sexes. Conversely, prevalence declined less sharply among those over 50, with a decline of just over 6% for both sexes. While the study does not detail the impact of each measure on global prevalence, it does mention that tax and price increases are recognized as the most effective tobacco control policy measure, particularly among adolescents and young adults.

Without the strengthening or introduction of tobacco control measures since 2008, it was estimated that smoking prevalence would have been higher than the rates observed in 2017, with an increase in the number of smokers worldwide: 31 million more smokers among people aged 15 and over.

Progress made but considerable room for improvement

Significantly greater progress in reducing smoking prevalence would have been observed if a combination of higher prices—resulting in reduced affordability levels—and a robust policy package had been implemented by all countries. This option would have led to lower smoking rates among men and women in all age groups and around 100 million fewer smokers. Under this scenario, the largest relative decline in prevalence would have been observed among people aged 15–29 for both sexes, with 33 million fewer smokers in 2017.

These results reaffirm that the best results are achieved when a comprehensive tobacco control policy is implemented. The study thus highlights that despite much progress, much remains to be done and that efforts must be strengthened and accelerated to achieve health benefits and reduce the costs of smoking. A significant portion of the world's population is still not covered by comprehensive laws. For example, more than 2 billion people still live in countries where no or very few tobacco control policies are in place.