Germany on alert over increased smoking

While the overall number of smokers is declining, Germany is seeing a significant increase in tobacco consumption among smokers. According to data from the KKH health insurance fund, the number of people smoking more than 20 cigarettes per day has increased by 50% in ten years. This trend is accompanied by a marked increase in chronic respiratory diseases such as COPD, the number of cases of which increased by 30% between 2013 and 2023.[1].

The German Tobacco Survey (Debra Study) indicates that the number of smokers in Germany will be around 32,000 in the general population in 2023.

An increase in smoking and associated pathologies

According to an analysis by the health insurance fund - Kaufmannische Krankenkasse KKH, the number of people smoking more than 20 cigarettes a day has increased by 50% in ten years in Germany. This trend mainly affects men aged 40 to 59, but also affects younger age groups. While overall smoking is declining slightly in certain population groups, this increase in consumption is raising concerns among health professionals due to the further worsening of associated pathologies.

KKH data reveals a notable increase in chronic tobacco-related pathologies, particularly chronic obstructive pulmonary disease (COPD). Between 2013 and 2023, the number of people with COPD monitored by the insurance fund increased by 30%, and nearly a quarter (22.8%) of smokers who smoked more than 20 cigarettes a day had COPD, compared to 19.5% ten years earlier. This serious respiratory disease, which causes progressive obstruction of the airways, is strongly linked to prolonged and heavy tobacco use. Women now represent 40% of affected patients, a figure that is on the rise, reflecting the changing smoking behaviors among the female population.

COPD often remains underdiagnosed due to subtle symptoms at the onset of the disease (shortness of breath, chronic cough, fatigue). However, once established, it is irreversible and could become the third leading cause of death in the world by 2030 according to theWHOIn Germany, pulmonologists are also warning of a rise in cases among people who are still working, highlighting the growing impact of tobacco on the quality of life and productivity of middle-aged adults.

The KKH study also highlights significant regional disparities. In the state of Thuringia, the number of smokers has doubled in ten years, rising from 3.5 % in 2013 to 7 % in 2023. Berlin has the highest rates nationally, with 9 % of insured persons affected in 2023 compared to 6.4 % ten years earlier. Conversely, the states of Baden-Württemberg (4.3 %) and Hesse (4.7 %) have the lowest rates of tobacco dependence in 2023. These differences reflect the unequal exposure to tobacco across regions, and call for more targeted prevention policies.

In addition to COPD, experts also point to an increase in chronic respiratory infections, severe asthma attacks, and an increased risk of cardiovascular disease, particularly in this category of smokers.

Germany's tobacco control policy is lagging behind

Despite ratifying the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC), Germany is among the least advanced countries in Europe when it comes to tobacco regulation and prevention. Unlike many neighboring countries that have adopted comprehensive tobacco control policies—including tax incentives, strict advertising bans, plain packaging, and enhanced support for quitting—Germany remains behind in most of these areas.

In 2023, the WHO highlighted this situation in its ninth annual report on global tobacco consumption, explicitly condemning Germany's inaction over the past fifteen years. Rüdiger Krech, director of health promotion at the WHO, declared that current German tobacco policy was "very worrying," highlighting the lack of effective measures to prevent initiation or support cessation.

Among the main flaws in the German system is the relative affordability of tobacco products. According to data from the German Cigarette Manufacturers Association (German Cigarette Association, DZV), the average price of a pack of 20 cigarettes was €8.70 in 2024 – a price much lower than that charged in other Western European countries with more aggressive tax policies. This relatively low price is not effective in deterring young people or low-income populations from smoking.

Tobacco advertising is still widely permitted in public spaces, particularly on billboards, in cinemas, and on the fronts of certain points of sale. Regulatory measures for marketing new nicotine products (such as e-cigarettes, heated tobacco, or nicotine pouches) are also considered insufficient.

Finally, the strong presence of tobacco industry lobbies constitutes a major obstacle to any structural progress. Several NGOs and public health experts regularly denounce the influence of manufacturers in legislative processes, which contributes to maintaining a permissive regulatory framework, out of step with the gravity of the situation and international recommendations.

©Generation Without Tobacco

AE

[1] Press release, Bald atemlos? Zahl der Tabaksüchtigen stark gestures, KKH, published May 26, 2025, accessed June 16, 2025