Over the past 60 years smoking rates have plummeted in Britain, America, Australia and other countries that have cracked down on the habit. But in some others they have changed little, and in nearly 40 countries the number of smokers is actually increasing.
The risks are well documented and smoking is the leading preventable cause of death around the world. So why aren't smoking rates dropping everywhere?
First, governments aren't doing enough. The best ways to stop people smoking are well known: publicise the health risks, raise taxes, ban smoking indoors and advertising, and provide support for those trying to quit. In countries that follow these steps, the results are clear: The percentage of Turkish men who smoke fell 11% in eight years. Despite this just one country, Turkey, has imposed and properly enforces all the recommended measures at the highest level, a study found. And only 33 countries have fixed cigarette taxes at the level recommended by the WHO: more than three quarters of the retail price. This means cigarettes are still affordable for many.
Second, pressure from tobacco companies. Companies exert pressure wherever possible. Because many taxes vary based on factors like length, companies can adapt their products to keep some brands cheaper. And they have a long history of marketing 'light' or 'slim' brands as healthier, which they aren't. Tobacco lobbyists have been known to encourage finance ministers in developing countries to keep taxes low to discourage black-market cigarettes. But higher taxes, coupled with tighter border controls, are an effective way to reduce consumption.
It's also often easy to find loopholes in advertising bans. In some places, salespeople wear branded clothing in nightclubs and cafes. In others, billboards of point-of-sale advertising behind the counter slips through.
Lastly, reluctance from smokers to quit or abide by anti-smoking regulation. In some countries, smokers have simply failed to accept the evidence: more than four-fifths of smokers in Denmark and the Netherlands say they have tried to quit, compared with just a third in Bulgaria and Portugal. And while many more countries are introducing smoking bans, these can be got around: in France and Ireland, people smoke in covered outdoor patio areas. In Greece and Portugal, locals simply ignore the rules altogether. Some smokers also get around the taxes by buying counterfeit or smuggled cigarettes; these make up around tenth of global sales.
Smoking now kills 6m people every year. That number is projected to rise to 8m by 2030, with the majority of cases moving from rich to poor countries. There is some hope: China, home to a third of the world's smokers, has at last started to get serious about smoking. It banned smoking in public places from June 1st of this year, and government officials can no longer smoke at official functions. If governments fail to follow its example and crack down on smoking now, by introducing the necessary measures and properly enforcing those already in place, a global health catastrophe looms.