Date: 10/15/2025
Source: World Health Organization. WHO Global Report on Trends in Prevalence of Tobacco Use, 2000–2024 and Projections, 2025–2030 (6th ed., 2025).
The Essentials
Global monitoring report synthesizing 2,034 national surveys covering 97% of the world’s population; trend analysis 2000–2024 with projections to 2030.
Tobacco users fell from 1.38B (2000) to 1.2B (2024); ~120M fewer since 2010; still ~1 in 5 adults use tobacco. Regional highlights: men in South/Southeast Asia down 70% → 37%; Europe now highest regional prevalence (24.1%); global women 11% → 6.6%, men 41.4% → 32.5%.
Economic stakes: shifting even 1% of smokers to cessation or non-combustibles saves thousands of lives and large healthcare costs; excise design must avoid illicit markets and fund cessation, surveillance, and education.
Impact/cost-effectiveness: Cochrane reviews indicate nicotine e-cigs increase quit rates vs. NRT; real-world signals from Sweden/Japan suggest population-level harm reduction when non-combustibles displace smoke.
Equity & policy: ~80% of users live in LMICs; Africa shows declining prevalence but rising absolute numbers; Europe’s female prevalence (17.4%) is the world’s highest—underscoring gender and regional inequities
Why It Matters
The report confirms a real win—less smoking—while exposing a harder truth: progress is uneven, language is political, and policy often lags behind evidence. The word “epidemic” is more political than technical. Calling smoking an “epidemic” mobilizes action, but when advocacy blurs prevalence with “addiction,” nuance—and people—get lost.
Public health works when it balances protection of youth, support for adults who smoke, and clarity about relative risks. Behind every percentage is a biography: a body that coughs in the morning and reaches for relief at night. Evidence must meet that body with proportion, not purity.
What Changes in Practice
Health/Regulation – Separate nicotine from smoke in all guidance; integrate e-cigs, pouches, heated tobacco, and NRT into stepped cessation for highly dependent adults; protect minors with strict age-gating, marketing limits, product standards; improve surveillance (daily vs. experimental use; cessation trajectories).
Industry/Innovation – Incentivize low-toxicant, non-combustible designs; mandate independent emissions testing, tamper-resistant packaging, and robust age verification; channel data-sharing to public registries to accelerate safety science.
Society/Environment – Treat determinants of health (income, housing, work, education, gender burden) as tobacco policy; invest tobacco tax revenue in free cessation, mental-health support, leisure/community spaces, and clear, non-moralistic education.
Scenarios and Next Steps
Short term (1–2 years): Update clinical pathways to include harm-reduction options; redesign excise to maintain the highest prices on combustibles and a clear differential for non-combustibles; enforce youth protections; upgrade surveys to capture use intensity and quit trajectories.
Medium term (3–5 years): Scale biomarker-based cessation programs; fund independent long-term studies (respiratory/cardiovascular endpoints) with open data; expand licensing and retailer audits; integrate determinants (cash transfers, housing, flexible work) into tobacco strategies.
Long term (5–10 years): Normalize “smoke-free nicotine” as cessation/maintenance for the hardest-to-quit; drive structural declines in combustion to rarity; close gender gaps in care; embed proportionate risk communication into school curricula and primary care.
The Takeaway
Winning means less fire, fewer coughs, protected kids—and policies sized to people, not ideals.
For Further Reading:
Part I — The Smoke We Still Breathe
From rise to decline, smoking has ceased to be just a public health problem: it has become a mirror of inequality, morality, and fear.
Part II — The Moral Geography of Smoke
Nicotine is a psychoactive stimulant. It is not synonymous with “tobacco,” nor with “cigarettes.” And certainly not with “cancer.”
Part III — What To Do With the Smoke (or With Ourselves)
From a realistic, bioethical standpoint, there are at least six moves that can help nations and health systems confront nicotine without reproducing moral panic. This is not about absolving a molecule, but about reducing harm while preserving autonomy, equity, and truth.
Am I reading this right? Does this mean the WHO FCTC might be finally accepting smokeless alternatives?