नो स्मोकिंग प्लीज

Tobacco is the second major cause of death in the world। It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year)। If current smoking patterns continue, it will cause some 10 million deaths each year by 2020। Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco।

Tobacco is the fourth most common risk factor for disease worldwide. The economic costs of tobacco use are equally devastating. In addition to the high public health costs of treating tobacco-caused diseases, tobacco kills people at the height of their productivity, depriving families of breadwinners and nations of a healthy workforce. Tobacco users are also less productive while they are alive due to increased sickness. A 1994 report estimated that the use of tobacco resulted in an annual global net loss of US$ 200 thousand million, a third of this loss being in developing countries.
Tobacco and poverty are inextricably linked. Many studies have shown that in the poorest households in some low-income countries as much as 10% of total household expenditure is on tobacco. This means that these families have less money to spend on basic items such as food, education and health care. In addition to its direct health effects, tobacco leads to malnutrition, increased health care costs and premature death. It also contributes to a higher illiteracy rate, since money that could have been used for education is spent on tobacco instead. Tobacco's role in exacerbating poverty has been largely ignored by researchers in both fields.
Experience has shown that there are many cost-effective tobacco control measures that can be used in different settings and that can have a significant impact on tobacco consumption। The most cost-effective strategies are population-wide public policies, like bans on direct and indirect tobacco advertising, tobacco tax and price increases, smoke-free environments in all public and workplaces, and large clear graphic health messages on tobacco packaging. All these measures are discussed on the provisions of the WHO Framework Convention on Tobacco Control.

Major causes of death: A primer
Q: How many people die every year?
During 2002, an estimated 57 million people died.
Q: What is the number one cause of death throughout the world?
Cardiovascular diseases kill more people each year--in high, middle- and low-income countries alike--than any others. In 2002, 7.2 million people died of coronary heart disease, 5.5 million from stroke or another form of cerebrovascular disease.
Q: Isn't smoking a top cause of death?
Because it is a major cause of many of the world's top killer diseases-including cardiovascular disease, chronic obstructive lung disease and lung cancer--tobacco use is responsible for the death of one in 10 adults worldwide. Smoking is often the hidden cause of the disease recorded as responsible for a death.
Q: What are the main differences between rich and poor countries with respect to causes of death?
In high-income countries more than two-thirds of all people live beyond the age of 70 and die of chronic diseases: cardiovascular disease, chronic obstructive lung disease, cancers, diabetes or dementia. Lung infection remains the only leading infectious cause of death.
In middle-income countries, nearly half of all people live to the age of 70 and chronic diseases are the major killers, just as they are in high-income countries. Unlike in high-income countries, however, HIV/AIDS, complications of pregnancy and childbirth and road traffic accidents also are leading causes of death.
In low-income countries less than a quarter of all people reach the age of 70, and nearly a third of all deaths are among children under 14. Although cardiovascular diseases together represent the leading cause of death in these countries, infectious diseases (above all HIV/AIDS, lung infections, tuberculosis, diarrhoeal diseases and malaria) together claim more lives. Complications of pregnancy and childbirth together continue to be a leading cause of death, claiming the lives of both infants and mothers.
Q: How many young children die each year?
Nearly 11 million deaths in 2002 were among children under five years of age, and 98% of them were in low- and middle-income countries.
Q: Is there relatively a lower proportion of deaths overall in rich countries than in poor countries?
Yes। About one out of six people in the world, or about 15%, live in high-income countries (chiefly in North America and Europe)। But only 7% of all deaths annually occur in those countries.

Deaths across the globe: An overview
Imagine a diverse international group of 1000 individuals representative of the women, men and children from all over the globe who died in 2002। One hundred thirty-eight of those people would have come from high-income countries, 362 from middle-income countries and 501 from low-income countries।

What will be the top 10 causes of their deaths?
Among the 138 people from high-income countries, 24 would have died from coronary heart disease, 13 from stroke or other cerebrovascular diseases, eight from lung cancer, five from a lower respiratory infection, five from chronic obstructive pulmonary disease, mostly caused by smoking, five from colon or rectal cancer, four each from dementia or diabetes and three each from breast cancer or stomach cancer.

Of the 362 people from middle-income countries, 54 people would have died from stroke or other cerebrovascular diseases, 49 from coronary heart disease, 27 from chronic obstructive pulmonary disease. Twelve people each would have died from lower respiratory infection and HIV/AIDS. Eleven infants would have died from perinatal complications--conditions arising during pregnancy and childbirth, mainly low birth weight and birth trauma. Ten people would have died from stomach cancer, lung cancer or a road traffic injury. And nine would have died from hypertensive heart disease.

Of the 501 people from low-income countries, 54 people would have died from coronary heart disease. Fifty people, 31 of them under the age of 14, would have died from a lower respiratory infection. HIV/AIDS would have carried off 38 people. Thirty-two infants would have died from perinatal conditions. Thirty people would have died of stroke or other cerebrovascular diseases. Twenty-seven people, 24 of them under the age of 14, would have died of diarrhoea. Twenty-two would have died from malaria, 19 from tuberculosis, 15 because of chronic obstructive pulmonary disease and nine because of a road traffic injury.

Why counting the dead matters
Measuring how many people die each year and why they have died is one of the most important means--along with gauging how various diseases and injuries are affecting the living--at assessing the effectiveness of a country's health system. Having those numbers helps health authorities determine whether they are focussing on the right kinds of public health actions. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years, for example, has a strong interest in starting a vigorous programme to encourage lifestyles that will help prevent these illnesses. Similarly, if a country recognizes that many children are dying of malaria, but only a small portion of the health budget is dedicated to providing effective treatment, an adjustment can be made.
Industrialized countries have systems in place for assessing causes of death in the population। Most developing countries do not have such systems, and the numbers of deaths from specific causes have to be estimated from incomplete data. It is widely acknowledged that progress in this realm is crucial for improving health and reducing preventable deaths in the developing world.

The 10 leading causes of death by broad income group (2005 projections)

High-income countries

Coronary heart disease
1.38 Deaths in millions
16.9% of deaths
Stroke and other cerebrovascular diseases
0.77 Deaths in millions
9.5 % of deaths
Trachea, bronchus, lung cancers
0.47 Deaths in millions
5.8 % of deaths
Lower respiratory infections
0.34 Deaths in millions
4.2 % of deaths
Chronic obstructive pulmonary disease
0.32 Deaths in millions
3.9 % of deaths
Colon and rectum cancers
0.27 Deaths in millions
3.3 % of deaths
Diabetes mellitus
0.24 Deaths in millions
2.9 % of deaths
Alzheimer and other dementias
0.23 Deaths in millions
2.8 % of deaths
Breast cancer
0.15 Deaths in millions
1.8 % of deaths
Stomach cancer
0.15 Deaths in millions
1.8 % of deaths

Middle-income countries

Stroke and other cerebrovascular diseases
3.14Deaths in millions
14.8 % of deaths
Coronary heart disease
2.9 Deaths in millions
13.7 % of deaths
Chronic obstructive pulmonary disease
1.72Deaths in millions
8.1 % of deaths
HIV/AIDS
0.75 Deaths in millions
3.5 % of deaths
Trachea, bronchus, lung cancers
0.62Deaths in millions
2.9 % of deaths
Stomach cancer
0.62 Deaths in millions
2.9 % of deaths
Lower respiratory infection
0.62Deaths in millions
2.9 % of deaths
Road traffic accidents
0.6 Deaths in millions
2.8 % of deaths
Hypertensive heart disease
0.55Deaths in millions
2.6
% of deaths
Perinatal conditions
0.52Deaths in millions
2.5% of deaths

Low-income countries

Coronary heart disease
3.29 Deaths in millions
11.4 % of deaths
Lower respiratory infections
2.72 Deaths in millions
9.5 % of deaths
HIV/AIDS
2.06Deaths in millions
7.2 % of deaths
Stroke and other cerebrovascular diseases
1.83 Deaths in millions
6.4 % of deaths
Perinatal conditions
1.78Deaths in millions
6.2 % of deaths
Diarrhoeal diseases
1.48Deaths in millions
5.2 % of deaths
Tuberculosis
1.01 Deaths in millions
3.5 % of deaths
Chronic obstructive pulmonary disease
0.97 Deaths in millions
3.4% of deaths
Malaria
0.87 Deaths in millions
3 % of deaths
Road traffic accidents
0.6 Deaths in millions
2.1 % of deaths

For more information contact:
WHO Media centreTelephone: +41 22 791 2222E-mail: mediainquiries@who.int