Tobacco use killed 100 million people worldwide in the 20th century and could kill one billion people in the 21st unless governments act now to dramatically reduce it, the World Health Organization said in a report Thursday.
Governments around the world collect more than $200 billion in tobacco taxes every year but spend less than one fifth of 1 percent of that revenue on tobacco control, it said.
"We hold in our hands the solution to the global tobacco epidemic that threatens the lives of one billion men, women and children during this century," WHO Director-General Dr. Margaret Chan said in an introduction to the report.
The WHO Report on the Global Tobacco Epidemic, 2008 calls on all countries to dramatically increase efforts to prevent young people from beginning to smoke, help smokers quit, and protect nonsmokers from exposure to second hand smoke.
It urges governments to adopt six "tobacco control policies" — raise taxes and prices of tobacco; ban tobacco advertising, promotion and sponsorship; protect people from second hand smoke; warn people about the dangers of tobacco; help those who want to quit smoking; and monitor tobacco use to understand and reverse the epidemic.
"The tobacco epidemic already kills 5.4 million people a year from lung cancer, heart disease and other illnesses," Chan said. "Unchecked, that number will increase to more than 8 million a year by 2030."
Chan was launching the report with New York Mayor Michael Bloomberg, whose foundation, Bloomberg Philanthropies, helped fund it.
According to the report, nearly two thirds of the world's smokers live in 10 countries — China, which accounts for nearly 30 percent, India for about 10 percent, Indonesia, Russia, the United States, Japan, Brazil, Bangladesh, Germany and Turkey.
It forecast that more than 80 percent of tobacco-related deaths will be in low- and middle-income countries by 2030.
Tobacco use is growing fastest in low-income countries, the report said, "due to steady population growth coupled with tobacco industry targeting, ensuring that millions of people become fatally addicted each year."
While standard cigarettes are most common, WHO said other types of smoked tobacco are also "lethal," including small hand-rolled cigarettes called bidis which are smoked in India and other Southeast Asian nations, clove and tobacco cigarettes called Kreteks smoked in Indonesia, and tobacco cured with flavorings known as shisha smoked from water pipes.
It warned that "the shift of the tobacco epidemic to the developing world will lead to unprecedented levels of disease and early death in countries where population growth and the potential for increased tobacco use are highest and where health care services are least available."
"In the 20th century, the tobacco epidemic killed 100 million people worldwide," the report said. "Unless urgent action is taken, more than one billion people could be killed by tobacco during this century."
WHO called the rise in tobacco use by younger women "one of the most ominous potential developments of the epidemic's growth."
Only 86 of 193 countries surveyed have recent data on tobacco use for both adults and youths. Seventy-four countries still allow smoking in health care institutions and about the same number allow smoking in schools. And more than half the countries, with two-thirds of the world's population, allow smoking in government offices and workplaces, the report said.
Only two countries — Uruguay and New Zealand — had both comprehensive smoke-free laws and high enforcement, it said.
For the tobacco industry to survive, and keep existing customers hooked and attract new customers, "it spends tens of billions of dollars a year on advertising, promotion and sponsorship," WHO said.
One of the most effective ways to curb tobacco use is to ban all forms of tobacco advertising, promotion and sponsorship, but it said only 20 of 179 countries that responded have complete bans.
While many tobacco users want to quit, they are unable to because of their addiction to nicotine, and "the vast majority of countries" provide no help, the report said. Only nine countries, accounting for 5 percent of the world's population, offer a full range of treatment and at least partial financial subsidies to help people trying to quit, it said.
"Weak health warnings on tobacco packs — or no warnings at all — continue to be the global norm," the report added, noting that only 15 of 176 countries surveyed required picture warnings which are most effective.