Tobacco is responsible for about one-in-ten adult
deaths worldwide, equating to about 6 million deaths each year. It is a major risk
factor for at least two of the leading causes of premature mortality - circulatory
disease and cancer, increasing the risk of heart attack, stroke, lung cancer, cancers
of the larynx and mouth, and pancreatic cancer. It also causes peripheral vascular
disease and hypertension. In addition, it is an important contributory factor for
respiratory diseases such as chronic obstructive pulmonary disease (COPD), while
smoking among pregnant women can lead to low birth weight and illnesses among infants.
It remains the largest avoidable risk to health in OECD countries.
Several studies provide strong evidence of
socio-economic differences in smoking and related mortality. People in lower social
groups have a greater prevalence and intensity of smoking. The influence of smoking as
a determinant of overall health inequalities is such that, in a non-smoking
population, mortality differences between social groups would be halved.
In the post-war period, most OECD countries tended to
follow a general pattern marked by very high smoking rates among men (50% or more)
through to the 1960s and 1970s, while the 1980s and the 1990s were characterised by a
marked downturn in tobacco consumption. Much of this decline can be attributed to
policies aimed at reducing tobacco consumption through public awareness campaigns,
advertising bans and increased taxation, in response to rising rates of
tobacco-related diseases. In addition to government policies, actions by anti-smoking
interest groups were very effective in reducing smoking rates by changing beliefs
about the health effects of smoking, particularly in North America.
The proportion of daily smokers is defined as the
percentage of the population aged 15 years and over reporting smoking every day.
International comparability is limited due to the lack
of standardisation in the measurement of smoking habits in health interview surveys
across OECD countries. Variations remain in the age groups surveyed, wording of
questions, response categories and survey methodologies. For example in a number of
countries, respondents are asked if they smoke regularly, rather than daily.
The proportion of daily smokers among the adult
population varies greatly across countries, even between neighbouring countries.
Thirteen of 34 OECD countries had less than 20% of the adult population smoking
daily in 2009. Rates among OECD countries were lowest in Mexico, Sweden, Iceland,
the United States, Canada and Australia. Although large disparities remain,
smoking rates across most OECD countries have shown a marked decline. On average,
smoking rates have decreased by about one-fifth over the past ten years, with a
higher decline for men than for women. Large declines occurred in Denmark (from
31% to 19%), Iceland (from 25% to 16%), Norway (from 32% to 21%), Canada (from 24%
to 16%) and New Zealand (from 26% to 18%). Greece maintains the highest level of
smoking (40%), along with Chile and Ireland among OECD countries, with around 30%
or more of the adult population smoking daily. Smoking rates are also high in the
Russian Federation. Greece and the Czech Republic are the only two OECD countries
where smoking rates have increased over the past ten years.
Smoking prevalence among men is higher in all OECD
countries except Sweden. Rates for men and women are nearly equal in Iceland,
Norway and the United Kingdom. Smoking rates for women continue to decline in most
OECD countries, and in a number of cases (Canada, Ireland, the Netherlands, New
Zealand and the United States) at an even faster pace than rates for men. However,
in three countries for women smoking rates have been increasing over the last ten
years (the Czech Republic, Greece and Korea), but even in these countries women
are still less likely to smoke than men. In 2009, the gender gap in smoking rates
was particularly large in Korea, Japan and Turkey, as well as in the
Russian Federation, Indonesia and China.