In the quest to curb tobacco use, Southeast Asia is leading the world – it has massively reduced tobacco consumption since 2010. Earlier per capita tobacco use was the highest, but in the World Health Organization (WHO) league table it has come down to second place. Europe now takes the top spot.
Why is this important? About a quarter of the world’s population lives in Southeast Asia. At the turn of the century, more than 50% of the region’s population (1 in 2 people), aged 15 or older, used tobacco. By 2030, it is expected that less than 1 in 5 people in Southeast Asia will use tobacco.
“The decline is notable, but it is in line with declines seen in the rest of the world,” said Kamran Siddiqui, a professor of public health at the University of York, UK.
The population around the world has been turning away from tobacco since the year 2000. This is primarily driven by government regulations on cigarette sales and advertising and public health awareness campaigns.
In 2010, WHO set its goal to reduce tobacco use by 30% within 15 years. Only South East Asia, Africa and America will be able to achieve this.
Direct use of tobacco and exposure to secondhand smoke can lead to serious diseases including lung cancer, heart disease, stroke and asthma.
What does the data show?
WHO’s latest data Show an overall decline in tobacco consumption: There are 120 million fewer smokers worldwide today than in 2010. This is a 27% decrease over a 15-year period.
In Southeast Asia, more than 50% of smokers have given up the habit. This is good news because physical improvements begin almost immediately when users stop using tobacco.
But one fifth of the world’s population still uses tobacco – and it’s not just cigarettes; Products include chewing tobacco, sachets and e-cigarettes.
And while data shows declines in use in highly populated areas, progress has been slower in high-income countries.
Tobacco kills approximately seven million people per year, and an additional 1.6 million non-smokers who are exposed to secondhand smoke also die as a result of tobacco.
Most tobacco users are men, so most public health interventions target men. But it appears to be effective only in Southeast Asia and the Americas.
How has Southeast Asia managed to cut down on its tobacco?
It is estimated that tobacco use has declined by 40% in Southeast Asia since 2010. This is mainly due to men quitting smoking. In 2000, 70% of men in Southeast Asia were tobacco users. Now, that figure is almost half.
So, how was this achieved? Ravi Mehrotra, assistant professor at Emory University in the US and founder of the Center for Health Innovation and Policy Foundation, India, said the society-wide effort has led to the decline in smoking.
“The giants in this field have done a lot of work on this,” Mehrotra told DW. These “giants” include researchers and others in the health field, politicians, and law enforcement.
This has led to a change in active public policy. Countries have introduced measures such as health labeling and messaging on products, smoking bans, in-school education, and using actors and athletes as positive role-models.
These interventions have also curbed tobacco use, thereby reducing the number of young, first-time consumers.
Such measures can be found in other countries and regions, but Asian countries have also taken unique approaches to curbing tobacco use. For example, India mandates that health warnings must be displayed wherever tobacco use is shown in public. This includes when people who smoke appear in movies, TV shows, and streaming media.
Smokeless tobacco is the next challenge
Southeast Asia is still home to a quarter of the world’s tobacco users. Despite the decline in the number of cigarette smokers, the decline in widespread use of smokeless products is still hidden.
More than a quarter of men in the region use such products, and a lower, but still substantial, 1 in 7 women use them.
Additionally, approximately 1 in 7 teens aged 13–15 use electronic cigarettes. This compares to 1 in every 1,000 people across all age groups.
Siddiqui said Southeast Asia has a unique context in the global tobacco epidemic – the WHO classifies tobacco use as an epidemic.
Unlike other regions where cigarettes predominate, smokeless products are used by just as many people in Southeast Asia.
But monitoring the use of smokeless products is difficult and not held to the same standard as cigarettes.
“We haven’t got as strong data from Southeast Asia on all forms of tobacco as we have for cigarettes,” Siddiqui said. “Illegal tobacco is still very common, most smokeless tobacco is illegal. We would love to see big progress, much more significant improvements.”
In 2023, Siddiqui and his colleagues called for a nuanced approach to tobacco control in Southeast Asia, including measures to reduce exposure to secondhand smoke, a better understanding of the region’s tobacco supply chain, and increased understanding of the impact of smokeless products. Siddiqui told DW that these challenges still need attention.
“Reductions are happening all over the world and I think they would be even greater in Southeast Asia if we were more aware of the contextual factors.” [like] Smokeless tobacco,” Siddiqui said.
Solutions lie in taxation and packaging regulation
If Southeast Asia is to further reduce its tobacco use, it will depend on both targeted measures to address its unique challenges and measures that have seen widespread success around the world.
Siddiqui and Mehrotra both point to higher levels of taxation as a promising measure: the WHO recommends that 70% of the purchase price should be taxed. Siddiqui and Mehrotra also recommend plain packaging, which has helped curb tobacco use in other areas.
Tighter controls on what Mehrotra calls “surrogate advertising” could also help.
Edited by: Zulfikar Abbani
Editor’s note: Please note that WHO groups countries and territories according to its own statistical and administrative criteria. For example: while India may usually be considered part of South Asia, WHO groups it with Southeast Asia, and Indonesia, which is often considered part of Southeast Asia, is, for the purpose of WHO statistics, grouped in the Western Pacific region.