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Starting with epidemiology
The causal relationship between tobacco use and death and disease has been demonstrated in countless epidemiological studies since the pioneering work of Doll 50 years ago. Initial studies in the UK and the USA have been followed in recent years by research in China, India, South Africa, and many other countries. All reinforce and strengthen the arguments for urgent action if the public health impact of tobacco is to be reduced and ultimately stopped.
It was epidemiologists, cancer specialists, and pulmonologists who first led the waves of advocacy that have taken tobacco from being regarded as a desirable social behaviour to being seen for what it is—the most preventable cause of death in the world. Globally, 4 million people die annually from tobacco, a figure that will increase to 10 million annually within 25 years. By that time 70% of deaths will be reported from developing countries.1
As the years pass the death toll rises and the relationships between tobacco and health outcomes grow. The relationship between passive smoking and many causes of ill health in children as well as lung cancer in adults is regarded as causal2; the long neglected relationship between major assaults on tuberculosis of the lung3 and tobacco is being acknowledged and programmes to address both together are being planned; and the complex relationship between tobacco use and several forms of mental disorder are receiving attention.
The public health evidence is well beyond dispute, even by most tobacco companies. But, while the impact of tobacco is well understood, the death toll will rise for decades. The prevalence of smoking in many countries continues to grow, especially among the young and in women. The current smoking rates in 13–15 year old subjects in many countries suggest that, unless vigorous action is taken, the …
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