Tobacco is responsible for about one-in-ten adult
deaths worldwide, equating to about 5 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 – as it increases the risk of heart attack, stroke, lung cancer,
cancers of the larynx and mouth, and pancreatic cancer. Smoking 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.
Fifteen of the 34 OECD countries had less than 20% of the adult population smoking
daily in 2010. Rates among OECD countries were lowest in Mexico, Sweden, Iceland,
Australia and the United States. Although large disparities remain, smoking rates
across most OECD countries have shown a marked decline. On average, smoking rates
have decreased by about one-third over the past twenty years, with a higher
decline for men than for women. Large declines occurred in Nordic countries, in
Denmark (from 45% in 1990 to 20% in 2010), Iceland (from 30% to 14%), Sweden (from
26% to 14%), Norway (from 32% to 21%), and in the Netherlands (from 37% to 21%).
Greece maintains the highest level of smoking among OECD countries, along with
Chile and Ireland, with around 30% of the adult population smoking daily. Smoking
rates are even higher in the Russian Federation.
Smoking prevalence among men is higher in all OECD
countries except Sweden. Rates for men and women are equal or nearly equal in
Denmark, Iceland, Norway and the United Kingdom. In 2010, the gender gap in
smoking was particularly large in Japan, Korea and Turkey, as well as in the
Russian Federation, Indonesia and China. Female smoking rates continue to decline
in most OECD countries, and in several at a faster pace than rates for men.
However, female smoking rates have shown little or no decline since 2000 in the
Czech Republic, France and Italy.