The study on smoking prevalence in 187 countries published in this month's edition of the Journal of the American Medical Asociation shows Indonesia, Timor Leste, Papua New Guinea, Tonga and Kiribati among others, have extremely high rates of smoking.
The study tracked changes between 1980 and 2012.
Alan Lopez, one of the study's authors, says the health toll of smoking in the Pacific and Asia is great, and going to get a lot greater in the next 10 or 20 years as current smokers start to die prematurely.
Presenter: Jemima Garrett
Speaker: Dr Alan Lopez, Laureate Professor, School of Population and Global Health, Melbourne University
LOPEZ: The Pacific is particularly bad. Countries like Tonga, PNG, Kiribati all have smoking prevalence in males above 50 per cent, and very high in females. That is unusual. What we tend to see in the developing countries in the region here, say in Asia, is comparatively high and disturbingly high in fact, prevalence for males, around 40 to 50 per cent but much lower prevalence for females. We don't tend to see that in the Pacific where women are smoking almost as much as men.
GARRETT: Why do we often see men smoking more than women and why are we finding in the Pacific that women are smoking as much as their male counterparts?
LOPEZ: Well, the male female differential is well studied and well established and in countries like Australia it was much more common for men, presumably because of social norms prohibiting females from smoking in large numbers in the first half of the twentieth century. That changed in the second half of the twentieth century and women began to smoke in large numbers in Australia, and began to die in large numbers in Australia about two to three decades later. What we are seeing in many of the developing countries of the region is that that social taboo about female smoking in most countries, more or less, has not been lifted and is still there. So you have only two or three per cent of women smoking in Indonesia, for example, whereas you have 55 per cent of men smoking. Now in the Pacific that social taboo does not seem to be near as strong.
GARRETT: The other dark side of this survey is that not one country in the Pacific or Asia is on the list of countries that have seen a significant reduction in smoking. Why is that?
LOPEZ: That is right and that is absolutely alarming. In countries like Australia, United States, UK, much of Europe, particularly northern Europe we have seen fabulous commitment; bold commitment to tobacco control, bold public policy by governments, persistent in the face of severe attacks by the tobacco industry, the right public policy. We don't see that, near as much in countries in Asia, although to their credit, countries like China are now beginning to show the benefits of persistent tobacco control programs, particularly for males.
GARRETT: Governments in developing countries have many funding priorities including many major health priorities such as tackling malaria and child health. Are there low cost initiatives that governments can use to reduce the number of people who smoke?
LOPEZ: Oh, absolutely! There are established methods such as just simply raising the price, raising taxes on tobacco. Raising the price will restrict access greatly. It will lead to a massive drop in consumption and it has done so in virtually every country where it has been tried, including Australia. But that is not all. You can ban advertising and promotion so you don't see the Marlboro Man the moment you get off the plane in Jakarta, on a billboard somewhere. You can ban advertising in television and in newspapers. Any form of public promotion of a substance that will kill one in two of its regular users has got to be good public health practice and countries around the region ought to be adopting it rigorously.
GARRETT: You say that tobacco control is particularly important in these countries where smoking prevalence is increasing. Why? What impact will it have on the country as well as the health of the individuals?
LOPEZ: Well, it has a massive effect at the population level. In Australia, for example, the peak of the effects of the epidemic were only seen in the 1980's when tobacco was killing one in three adult Australian males in middle age. These are not old aged Australian males, these were middle aged adult Australian deaths! One in three of those was caused by tobacco but Australian males have started to reduce tobacco consumption two to three decades earlier. So what we are seeing and are going to see increasingly in the Asia Pacific region, is not so much the impact on the individual, that is tragic for the individual who dies of a heart attack, or a stroke or lung cancer or chronic lung disease because he is a smoker, but the population level effects that will have huge impact on health services cost in these countries.
GARRETT: What other initiatives can countries take to reduce the impact of smoking?
LOPEZ: I think the main thing is that they have a comprehensive approach: that they take the recommendations of the United Nations Framework Convention on Tobacco Control seriously. Most of the countries in the region have signed up but they are doing very little or they are doing not enough, fast enough. And so, this cocktail of established interventions, raising prices, raising taxes, banning all forms of advertising and promotion and restricting access to tobacco, use of tobacco, in public places, like we have in Australia, plain packaging eventually, although it is too early to tell about the population level effects of the plain packing regulations in Australia, they must have an impact in combination with these other measures.