The study, “,” was published January 8 in the Journal of the American Medical Association in a special issue devoted to tobacco.

Overall, age-standardized smoking prevalence decreased by 42% for women and 25% for men between 1980 and 2012. Four countries—Canada, Iceland, Mexico, and Norway—have reduced smoking by more than half in both men and women since 1980.

But substantial population growth between 1980 and 2012 contributed to a 41% increase in the number of male daily smokers and a 7% increase for females. In 2012, smoking prevalence among men was higher than for women in all countries except Sweden. More than 50% of men smoke every day in several countries, including Russia, Indonesia, Armenia, and Timor Leste. Smoking prevalence for women was above 25% in Austria, Chile, and France and higher than 30% in Greece, among the highest percentages in the world. The lowest smoking rates for men can be found in Antigua and Barbuda, Sao Tome and Principe, and Nigeria. For women, smoking rates are lowest in Eritrea, Cameroon, and Morocco.

These differences persist despite decades of strong tobacco control measures globally. Fifty years ago, the first U.S. Surgeon General’s report was issued on the health impact of smoking, The report spurred research on tobacco and investments by governments and nonprofit agencies to reduce tobacco prevalence and cigarette consumption. In 2003, the Framework Convention on Tobacco Control was adopted by the World Health Assembly and has since been ratified by 177 countries.

“Despite the tremendous progress made on tobacco control, much more remains to be done,” said Dr. Christopher Murray, 91̽��professor of global health and director of the Institute for Health Metrics and Evaluation. “We have the legal means to support tobacco control. Where we see progress being made we need to look for ways to accelerate that progress. Where we see stagnation, we need to find out what’s going wrong.”

According to the most recent figures from the , coordinated by the Institute for Health Metrics and Evaluation, tobacco use led to 5.7 million deaths, 6.9% of years of life lost, and 5.5% of total health loss around the world. These estimates exclude health effects from secondhand smoke.

The Institute based its estimates on a wide range of data sources, including in-country surveys, government statistics, and World Health Organization data. Previous estimates typically have used fewer data sources.

The greatest health risks for both men and women are likely to occur in countries where smoking is pervasive and where smokers consume a large quantity of cigarettes. These countries include China, Ireland, Italy, Japan, Kuwait, South Korea, the Philippines, Uruguay, Switzerland, and several countries in Eastern Europe. The number of cigarettes smoked around the world has grown to more than 6 trillion. In 75 countries, smokers consumed an average of more than 20 cigarettes per day in 2012.

“Tobacco control is particularly urgent in countries where the number of smokers is increasing,” said Alan Lopez, Laureate Professor at the University of Melbourne. “Because we know that half of all smokers will eventually be killed by tobacco, greater numbers of smokers will mean a massive increase in premature deaths in our lifetime.”

There have been three phases of global progress in reducing the age-standardized prevalence of smokers: modest progress from 1980 to 1996, followed by a decade of more rapid global progress, then a slowdown in reductions from 2006 to 2012. This was in part due to increases in the number of smokers since 2006 in several large countries, including Bangladesh, China, Indonesia, and Russia.

Annualized rate of change captures the relative reduction in smoking prevalence, and several countries had notable declines of 2% or more between 1980 and 2012. For men, annualized rates of decline of 2% or more occurred in 17 countries, with the greatest rates of decline observed in Canada, Iceland, Mexico, Norway, and Sweden. For women, annualized rates of decline greater than 2% were achieved in 22 countries. Bolivia, Canada, Denmark, Iceland, Israel, Norway, Sweden, and the United States all had prevalence rates in 1980 higher than 20%, but achieved annualized rates of decline of greater than 2%. In a disturbing trend, Austria, Bulgaria, and Greece all had prevalence rates greater than 20% in 1980 and have shown statistically significant increases since then.

“Change in tobacco prevalence typically has been slow, underscoring what a hard habit it is to break,” said Emmanuela Gakidou, 91̽��professor of global health and director of education and training at the Institute for Health Metrics and Evaluation. “But we know from these global trends that rapid progress is possible. If more countries were able to repeat the success we have seen in Norway, Mexico, and the United States, we would see much less health loss from smoking.”

Which countries had the highest and lowest smoking prevalence for men in 2012?

Which countries had the highest and lowest smoking prevalence for women in 2012?

Which countries where smoking prevalence was greater than 20% in 1980 had the fastest declines and the biggest annual increases between 1980 and 2012?

In terms of number of cigarettes, which countries with populations greater than 1 million had the highest and lowest average consumption per smoker per day in 2012?

“Globally, there has been significant progress in combating the deadly toll of tobacco use,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids in response to the paper. “These findings demonstrate both that where countries take strong action, tobacco use can be dramatically reduced and the devastating consequences when countries do not fully adopt and implement effective tobacco control measures.”

Download the JAMA  article: 

Download the JAMA supplement: 

An online visualization tool showing data for each country is available at:

Watch a training tutorial of the visualization tool at: 

These are some of the findings from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study, a collaborative project led by the Institute for Health Metrics and Evaluation at the UW. Country-specific findings, including those  for the United States, will be announced March 5 at the Bill & Melinda Gates Foundation in Seattle by Institute for Health Metrics and Evaluation Director Dr. Christopher Murray and Gates Foundation Co-chair and Trustee Bill Gates.

The findings detail the causes of death and disability – across age groups and sexes – for 187 countries around the world. The Global Burden of Diseases 2010 study encompasses researchers from 303 institutions and 50 countries, and the work, which generated 1 billion estimates for health challenges large and small, was funded by the Bill & Melinda Gates Foundation.

A full range of dynamic visualizations of the findings for the United States and other countries can be found at the Institute for Health Metrics and Evaluation .These tools allow people everywhere to see the progress being made in health and the challenges that remain.

“We know that the world’s health can only improve if we are measuring the right problems and evaluating the right solutions,” Murray said. “That’s why we are working hard to gather more and better data constantly and are challenging ourselves to improve our analytical methods. We also are expanding our network of collaborators. This extended network will improve the quality of the assessment but also provide a forum for ongoing reflection, learning, interpretation, and action based on the Globan Burden of Diseae results and future revisions.”

Much of the illness and death in the United States is caused by a short list of ailments. The researchers found that just 17 distinct causes account for more than half of the American disease burden, measured as the number of years lost to disability and premature death. The top cause is ischemic heart disease, followed by chronic obstructive pulmonary disease, low back pain, lung cancer, and major depressive disorders.

In critical ways, the United States is lagging behind many wealthy and middle-income countries in terms of health. Americans live shorter lives, and shorter healthy lives, than do many other people. For example, men in 39 other countries – including Greece, Lebanon, and South Korea – live longer, and men in 30 other countries – such as Costa Rica, New Zealand, and Portugal – enjoy more years of good health.

Health is being largely eroded because Americans make poor lifestyle choices that cause lung ailments, musculoskeletal stress, and obesity-related illnesses such as heart disease and diabetes. Obesity’s impact is especially troubling. High body mass index as a risk factor rose by 45 percent between 1990 and 2010, and is now the third largest risk factor in the United States. Obesity accounts for more than one-tenth of total disease burden in 2010.

Like many countries in the world, the United States is struggling with a growing burden of disability. Almost all of the top causes of disability – back and neck pains, depression, anxiety, migraine headaches – grew as health threats from 1990 to 2010. These causes of disability are often not causes of death but their toll on health is dramatic.

The Washington Post wrote of the study, “The health of most of the planet’s population is rapidly coming to resemble that of the United States, where death in childhood is rare, too much food is a bigger problem than too little, and life is long and often darkened by disability.”

“We are in transition to a world where disability is the dominant concern as opposed to premature death,” Murray told the Post.

A public symposium on the study will be held on campus at 4 p.m., Monday,  March 11 to discuss the major findings and how the study provides a platform for collaboration across research centers on campus and worldwide. Murray will give a lecture “Findings of the Global Burden of Diseases, Injuries and Risk Factors 2010” in Hogness Auditorium at the 91̽��Health Sciences Center. 91̽��President Young, 91̽��Provost Ana Mari Cauce, 91̽��Medicine CEO Paul G. Ramsey, and 91̽��School of Public Health Dean Howard Frumkin will discuss the implications of the study.

A Q&A session will follow and a reception will be held in the Health Sciences lobby. To register for the event, please go to  .