Dr. Philippe Presles Head of R&D Health, AXA France

Towards a tobacco-free world

Imagine a world without tobacco. What would it look like? What would it change? Discover a world that exists only in the imagination, though it is well within our reach. Protecting People
May 31, 2018

A tobacco-free world is most importantly one with fewer wasted lives. It’s a world without the end-of-life suffering experienced by smokers. It’s a world with fewer grieving families: their tears, their distress and, very often, their failure to comprehend.

It’s a world in which no one would need an oxygen tank to make the arduous journey to the corner store for a few groceries. It’s a world in which no one would need an electrolarynx to read their child a bedtime story. It’s a world in which doctors would no longer need to deliver so many bleak prognoses to their patients.

A world without tobacco means eradicating the leading cause of preventable death in the world. It’s one billion lives saved throughout the 21st century worldwide - 10% of the total world population. For the average smoker, that means adding 11 years to their life expectancy. Who could possibly see that as a negligible benefit? Certainly not anyone who has witnessed the ravages of tobacco first-hand or lost a loved one far too early…  

A world without tobacco is also 4.3 million hectares of the planet’s farmland made available for more meaningful purposes. It’s also 2-4% of global deforestation avoided every year. Not to mention cleaner air, of course.

$1 trillion
The annual cost of smoking worldwide

according to the WHO and the US National Cancer Institute

$269 million
Global tax revenue generated by tobacco

according to the WHO (2013-2014)

The list goes on. These are just a few examples, but I think they are enough to get a general idea of what a tobacco-free world might look like.

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Unfortunately, this is not the world we live in. Smoking still kills today. It increases cancer risk by astronomic rates (90% of all lung cancer deaths are linked to tobacco), as well as cardiovascular disease and other respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD). It also intensifies the risk of several chronic diseases. Not to mention its broader impact on healthcare systems.

3 essential levers for fighting tobacco

I am convinced of one thing: the world with tobacco we live in today is not the only possible world. And I’m not just saying that because I’m an optimist. But because my experience, as a tobacco treatment specialist, as a member of the scientific board of SOS Addictions and in my work with AXA, has showed me an important truth: little by little, mindsets are changing. 

But that is not enough. To continue to fight against tobacco, we need to keep taking action on several levers, which will produce tangible results in the immediate and foreseeable future, as well as more long-term benefits:

  • Price: according to the WHO, a 10% increase in tobacco prices would cut tobacco use by 4% in high-income countries and up to 5% in low- and middle-income countries. For the World Bank, raising tobacco prices by 50% could lead to a 20% decline in tobacco use.
  • Denormalizing tobacco use: fighting against tobacco also means denormalizing tobacco use. A total ban on all forms of tobacco advertising notably helps to reduce tobacco consumption by 7% on average. Some countries have even cut tobacco by up to 16%, according to the WHO. Not only does banning smoking from public areas make for cleaner environments, it also changes people’s attitudes towards smoking. And even though smokers have a rough time adapting to these bans, the vast majority later agree that it is a positive measure and say they would not want to go back! Finally, whether through media campaigns or efforts on the ground, raising awareness remains a powerful way to denormalize tobacco use, especially among young people. 
  • Reducing risk: reducing risk is a fundamental component of the global fight against tobacco. It notably encompasses tobacco harm reduction programs and programs to limit or stop smoking. Of course, it also includes personalized health monitoring. Britain’s National Institute for Health & Care Excellence (NICE) offers several detailed guidelines aimed at health professionals. We can only hope that these efforts will catch on and become the standard in other countries…
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In my view, Great Britain provides the best example of how to use all 3 of these levers simultaneously: it charges a high tax on tobacco sales, prohibited smoking in public places, banned all tobacco advertising, introduced plain tobacco packaging and conducted substantial media campaigns against the dangers of tobacco. Only in terms of reducing risk, especially in terms of tobacco replacements, does it show room for improvement. But that point should not overshadow the country’s remarkable results:

50 %
In 1974, half of adult men

and 40% of adult women smoked in Britain

19 %
Today, the rate has fallen to 16.9% of the population

respectively 19.1% for men and 14.9% for women

Other countries like Sweden and Australia are also pointing the way forward by enacting proactive policies identical to those in place in Great Britain. Their efforts have achieved equally encouraging results, made possible by activating all three levers mentioned above. More countries should follow their lead.

It is time to accelerate the movement

In 1962, the Royal College of Physicians, a leading institution on this topic, recommended 10 key measures to fight against tobacco use:  

  • More education of the public concerning the hazards of smoking
  • Prohibit the sale of tobacco to minors
  • Restrict tobacco advertising
  • Tax tobacco sales
  • Carry out scientific research on cigarette smoking
  • Open anti-smoking clinics
  • Develop nicotine substitutes (nicotine injections)
  • Encourage smokers who cough to quit smoking
  • Urge doctors to avoid smoking in front of patients 

It took 30 years – and the discovery of second-hand smoke, which kills nearly 900,000 people every year! – for most of these measures to be put in place. It takes time for policies to enact change… Often, too much time: especially when it comes to smoking.

But today, we can rest assured that we are now on the right path. We have identified and defined the proper levers. They are within our reach and have already yielded results. Now it is time to implement these levers everywhere, simultaneously and in the strongest possible way. 

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It is also time to accelerate the changes underway. For example, I think we need to increase the number of lung cancer screenings: if we catch this cancer at an early stage, the patient’s survival rate is 15 times higher. We need to educate people even more on this topic: not only among smokers, but also within the medical community.

Further accelerating this change are the initiatives led by companies that are divesting from the tobacco industry, as we are doing at AXA along with companies like Scor, Calpers, AMP Capital and other corporate groups. Going forward, it is my sincerest hope that many other companies will follow suit.

Because a tobacco-free world is certainly attainable. And we are getting closer and closer to that goal. Perhaps one day, while flipping through their history books, schoolchildren will ask their teachers: “Why? How was it possible?” And their elders, with the perspective afforded by time, will simply reply: “It was time”. On that day, we will have finally turned one of the most baffling pages in the history of human health.