Tobacco consumption worldwide

• Over 1.1 billion people around the world are smokers.
• It is estimated that, in 2019, smoking caused 7.7 million deaths globally.
• Switzerland has a higher proportion of smokers than other developed countries, while these same countries already have higher smoking rates than other parts of the world.
• Compared with countries that are the most advanced in their fight against smoking, Switzerland, with its elevated proportion of smokers, lags behind.

In the absence of data that are strictly comparable, we must be cautious about trying to compare the extent of tobacco use in Switzerland with that of other countries. On the one hand, the necessity of conducting epidemiological studies which are specific to the socio-economic, linguistic, and legal context of a country, and even more the need for figures to be comparable over time (meaning the ability to follow up and therefore a preference for studies already underway at a national level), reduces the validity of such comparisons. On the other hand, the pertinence of international comparisons can be compromised by the fundamentally sociocultural – and even historical – nature of tobacco consumption, and by legal contexts which can be very different from one country to another. Together, these elements can have important consequences for our observations (for example, at the national level, significant advances in the effort to reduce smoking can take a long time to demonstrate their effectiveness and thus their usefulness for international comparison). Nevertheless, when interpreted carefully, certain attempts at standardising prevalence measures internationally, such as those reported in the Global Burden of Disease project,[1] [2] [3] and the estimations produced by the study Health Behavior in School-aged Children[4] (which was conducted in no fewer than 45 countries in 2017/2018), give us information about the changes in tobacco use worldwide and about how Switzerland ranks in this matter.

It should be noted that there are a variety of initiatives regarding Switzerland’s position with respect to other countries – for example, in the area of measures for combatting tobacco use (see our page Tobacco Control Scale) or of the potential for interference by tobacco industry in political and legislative processes (see our page Global Tobacco Industry Interference Index).

Smoking worldwide

The collaborative work Global Burden of Disease[5] [6] [7] is the most complete effort to date to measure the level and the epidemiological tendencies of tobacco use worldwide. It furnishes estimates of the global prevalence of tobacco use based on data from 3,625 representative studies, conducted in no fewer than 204 countries. According to these figures, it is estimated that worldwide, 32.7% of men and 6.6% of women age 15 and up smoked tobacco products in 2019 (Figure D1), which represents more than 1.1 billion people (GBD 2019 Tobacco Collaborators, 2021[8]). Also, it is estimated that for the same year, smoking caused 7.7 million deaths. It is notable that according to these estimates, in spite of the fact that global tobacco use has diminished since the 1990s, the total number of smokers 15 and up has grown in the last few decades because of overall population growth. The World Health Organization (WHO) estimates that, worldwide, more than 1.3 billion people use tobacco products, whether by smoking or in some other form (World Health Organization, 2021[9]).

Figure D1 - Standardised prevalence of tobacco use worldwide (smoking) in wealthy countries and in Switzerland in 2019 (source: Global Burden of Disease 2019).

Estimates from Global Burden of Disease of the prevalence of tobacco use in Switzerland, standardised for international comparison, are 29.3% for men and 23.4% for women (Figure D1; GBD 2019 Tobacco Collaborators, 2021[10]). Compared to estimates of use worldwide, the standardised prevalence for Switzerland is thus slightly lower for men (32.7%), but significantly higher for women (6.6%). It should also be noted that compared to the average of other relatively wealthy countries, Switzerland has a significantly higher rate of tobacco use for both men (26.9%) and women (17.6%). The WHO, in its 2021 report on the worldwide epidemic of tobacco use, underlines the fact that while the prevalence of smoking is diminishing faster in the most developed countries in recent years, these same countries still have the highest rate of tobacco use when compared to all other countries (WHO, 2021[11]). The prevalence of daily smoking has been modeled for 2019 in this report. Compared to its geographic neighbors, Switzerland finds itself, with 21% of the population smoking daily, in the middle of the pack on this measure (18% in Germany, 21% in Austria, 20% in Italy and 28% in France).

Tobacco use in 11- to 15-year-olds in Europe and Canada

At the international level, the HBSC study was conducted in 2017/2018 in 45 countries in Europe and Canada (Inchley et al. 2020a[12]). The data from all the countries participating in this project showed that 2% of girls and 5% of 11-year-old boys, 10% (girls) and 12% (boys) of 13-year-olds, and 27% (girls) and 29% (boys) of 15-year-olds had already experimented with smoking cigarettes at these ages (i.e. tried it at least once; Inchley et al., 2020b[13]). As was described in our presentation about the extent of smoking in this age group in Switzerland, a similar prevalence was observed at 11 and 13 years of age (see our page Consumption of tobacco among young people). However, by the age of 15, Swiss students showed rates of experimentation with tobacco higher than the average of the countries participating in the HBSC study (with 29% of Swiss girls and 36% of Swiss boys having tried smoking, these estimates being standardised for international comparison). The international average for cigarette use over the preceding 30 days was 1% for all 11-year-olds, 5% for 13-year-olds, and 15% for 15-year-olds. For the three age groups in question, Swiss youths had a prevalence comparable to the estimated averages over the group of countries participating in the HBSC study.

Other estimates and comparisons relating to tobacco use among young people

In the publication of its projections for 2020 to 2025, the WHO notes – on the basis of the data coming from its HBSC studies, the Global Youth Tobacco Survey[14] (GYTS), and the Global School-based Student Health Survey[15] (GSHS) – that worldwide, 12% of youths ages 13 to 15, or more than 43 million young people, smoke tobacco products in one form or another (WHO, 2021[16]). Incidentally, around 3.6% of youths in this age group – 4.5% of boys and 2.5% of girls – are thought to use smokeless tobacco products. This represents over 13 million young people ages 13 – 15 around the world.

Comparisons with other countries that are successfully combatting smoking

Finally, while the European Parliament committed in early 2022 to produce a non-smoking generation in Europe by 2040, countries such as Australia, New Zealand, Ireland, England, Finland and the Netherlands have in the last few years (or decades) developed exemplary policies regarding the prevention of tobacco use. They thus represent interesting points of comparison with Switzerland, which is one of the countries with the worst records internationally on measures of smoking prevention (see our page Tobacco Control Scale).

By the standardised estimates of the Global Burden of Disease (GBD 2019 Tobacco Collaborators, 2021[17]), Switzerland, with its prevalence of smoking at 23.4% for women and 29.3% for men, clearly performs worse than Finland (women 18.1%; men 24.8%), the Netherlands (women 20.4%; men 25.0%), Ireland (women 22.8%; men 21.9%), or Great Britain (women 18.1%; men 21.7%). New Zealand (women 15.2%; men 18.4%) and Australia (women 14.4%; men 16.4%) show still lower prevalences.

Based on the data from HBSC 2017/2018 (Inchley et al., 2020b[18]), with its 29% of girls and 36% of boys having already experimented with cigarettes by age 15 (defined as having smoked at least once in their life), Switzerland appears to be close to the rates of Finland (girls 32%, boys 34%; although these figures represent a significant reduction by 2018 in Finland since the previous study). Switzerland, however, clearly did less well than Ireland (girls 19%; boys 19%), England (girls 20%; boys 25%) and the Netherlands (girls 24%, boys 22%).

[1] https://www.healthdata.org/gbd/2019; accessed 23.02.2022.

[2] https://www.thelancet.com/gbd; accessed 23.02.2022.

[3] https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates; accessed 23.02.2022.

[4] https://www.hbsc.ch; accessed 23.02.2022.

[5] https://www.healthdata.org/gbd/2019; accessed 23.02.2022.

[6] https://www.thelancet.com/gbd; accessed 23.02.2022.

[7] https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates; accessed 23.02.2022.

[8] GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021 397: 2337-2360.

[9] World Health Organization (2021). WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition. Geneva: World Health Organization. Download

[10] GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021 397: 2337-2360.

[11] OMS (2021). WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2021 - Addressing new and emerging products. Geneva: World Health Organization. Download

[12] Inchley, Jo; Currie, Dorothy; Budisavljevic, Sanja; Torsheim, Torsheim; Jåstad, Atle; Cosma, Alina; Kelly, Colette; Arnasson, Arsael M. (2020a). Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 1. Key findings. Copenhagen: WHO Regional Office for Europe; 2020. World Health Organization. Geneva. Download

[13] Inchley J, Currie D, Budisavljevic S, Torsheim T, Ja?stad A, Cosma A et al., editors. (2020b). Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data. Copenhagen: WHO Regional Office for Europe; 2020. Download

[14] WHO. Global Youth Tobacco Survey. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-youth-tobacco-survey; accessed 23.02.2022.

[15] WHO. Global School-based Student Health Survey. https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-school-based-student-health-survey; accessed 23.02.2022.

[16] WHO (2021). WHO global report on trends in prevalence of tobacco use 2000-2025. fourth edition. Geneva: World Health Organization. Download

[17] GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021 Volume 397: 2337-2360.

[18] Inchley J, Currie D, Budisavljevic S, Torsheim T, Ja?stad A, Cosma A et al., editors. (2020b). Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data. Copenhagen: WHO Regional Office for Europe; 2020. Download

AT Schweiz, September 2022