A century of smoke

Tobacco kills 5 million people annually. By the mid 2020s, that figure will increase to about 10 million a year, with most of the deaths occurring in developing countries. This review explains how early technological and regulatory developments contributed to the epidemic, reveals the efforts of the tobacco industry to conceal its products' harmfulness, and stresses the role of the globalization of trade and marketing as a means of increasing consumption world-wide. The results of tens of thousands of studies published globally over the past 50 years point to an association between smoking and lung cancer and other adverse health effects, and the non-smoker's rights movement has exposed the wide-spread perils of 'secondhand' smoke. Yet, the tobacco industry continues its global expansion, and consumers in low- and middle-income countries are especially susceptible to its marketing tactics. This review ends by emphasising the need for a global public-health response, and identifies the Framework Convention on Tobacco Control as a significant effort. It stresses the need for accelerated action and innovative tobacco-control efforts, if the projected death toll is to be reduced in this century.