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Smokers consumed more than 5 trillion (5,000,000,000,000) cigarettes worldwide in 2019. Although global cigarette consumption appears to be continuing its slow decline since its peak in 2012, consumption in approximately 40% of countries has either increased or leveled off, making the future path of global tobacco control uncertain. Though major tobacco companies claim a commitment to shifting toward non-combustible products (e.g., e-cigarettes)—and sales of these products are rapidly growing in some countries—every company continues to aggressively market cigarettes, and cigarettes still comprise more than 90% of the global tobacco marketplace. Moreover, tobacco companies have not ceased in devoting their enormous resources to fight nearly every kind of tobacco control effort around the world.

Though cigarette consumption is declining in many higher-HDI countries, it is predicted to increase in some low- and medium-HDI countries. This is due not only to economic and population growth but to the relentless and aggressive marketing and pricing of the industry. The latest WHO projections predict that at least five countries in the Eastern Mediterranean Region will experience smoking prevalence increases by 2025. Around the world, in some countries the predicted small declines in prevalence will be overwhelmed by population growth and the absolute number of smokers in these countries will increase.

A major challenge for tobacco control is the high rates of smoking prevalence among specific marginalized subpopulations within countries. For example, higher cigarette prevalence and consumption are typically associated with lower socioeconomic status, even in low- and medium-HDI countries. These marginalized populations include individuals from certain racial/ethnic groups, persons with mental illness, and, in some countries, the LGBTQ+ community. Targeted tobacco control measures can address these inequities directly. Certain broader measures are also effective—for example, research consistently shows that tobacco taxes reduce consumption in most marginalized groups.

FDA’s successful anti-smoking campaign to reach the US’s LGBTQ+ community.

To maximize profits, tobacco manufacturers make products that are addictive and attractive. To counter these strategies, governments must implement product standards to make products less addictive and attractive. Strategies include banning characterizing flavors that enhance attractiveness and additives that quicken the body’s nicotine absorption. There is also mounting evidence that limiting nicotine to non-addictive levels may show significant promise. Beyond products standards, market-based policies are also effective, including prohibiting the introduction of new brands and restricting a brand to a single presentation to prevent implicit suggestions of a sub-brand’s reduced harm (e.g., “blue” is somehow less harmful than “red”).

The global tobacco industry continues to consolidate through privatization, acquisitions, and mergers: five firms control more than 80% of the global cigarette market. These companies have modernized production and, as a result, factories are employing fewer and fewer workers, decreasing costs, and increasing profitability. When tobacco companies argue that tobacco control policies threaten many manufacturing jobs, it is largely a myth. Most research on tobacco taxes demonstrates that, while the decreased consumption from higher taxes might affect a small number of tobacco manufacturing jobs, the overall effect on employment in the broader economy is typically positive as spending shifts from tobacco to other sectors. This positive effect can be heightened by governments’ wise spending in sectors such as health (e.g., Argentina, Mexico, and Pakistan).