1.  2012 Johns Hopkins Bloomberg School of Public Health Joanna Cohen, PhD Director, Institute for Global Tobacco Control Bloomberg Professor of Disease Prevention Johns Hopkins Bloomberg School of Public Health Learning from the Experts: A Course for Healthcare Providers

2.  2012 Johns Hopkins Bloomberg School of Public Health 2 Tobacco and Smokeless Tobacco Come in Many Forms Images source: iStockphoto.com

3.  2012 Johns Hopkins Bloomberg School of Public Health Increase in Global Cigarette Consumption Global cigarette consumption in one century increased over a hundredfold 3

4.  2012 Johns Hopkins Bloomberg School of Public Health The World’s Smokers Nearly two-thirds of the world’s smokers live in just ten countries 4

5.  2012 Johns Hopkins Bloomberg School of Public Health Male Smoking Prevalence 5

6.  2012 Johns Hopkins Bloomberg School of Public Health Female Smoking Prevalence 6

7.  2012 Johns Hopkins Bloomberg School of Public Health Tobacco as a Risk Factor Tobacco—the only risk factor shared by four major non- communicable diseases 7 Tobacco use Unhealthy diets Lack of physical activity Use of alcohol Cardiovascular Diabetes Cancer Chronic respiratory Source: Tobacco Atlas. (2012). www.tobaccoatlas.org

8.  2012 Johns Hopkins Bloomberg School of Public Health Global Burden of Tobacco Past and Present Tobacco killed 100 million people in the twentieth century Tobacco use is now the world’s single leading preventable cause of death  Kills more people than HIV/AIDS, TB, and malaria combined  Responsible for >15 percent of deaths among men and 7 percent among women  Almost 6 million tobacco-caused deaths in 2011  Tobacco kills up to half of lifetime smokers  Smokers die an average of 14 years earlier than nonsmokers 8 Sources: World Health Organization. (2008). WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva. http://www.who.int/tobacco/mpower/gtcr_download/en/index.html; Centers for Disease Control and Prevention (CDC). (2002). Annual smoking-attributable mortality, years of potential life lost, and economic costs-- United States, 1995-1999. MMWR, 51(14), 300-3. www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm

9.  2012 Johns Hopkins Bloomberg School of Public Health Future Global Burden of Tobacco Without urgent action, 1 billion people will die from tobacco in the twenty-first century  500 million deaths among persons alive today  Unchecked, worldwide deaths from tobacco products will exceed 8 million a year by 2030 Every death from tobacco products is preventable! 9 Source: World Health Organization. (2008). WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER package. Geneva. http://www.who.int/tobacco/mpower/gtcr_download/en/index.html

10.  2012 Johns Hopkins Bloomberg School of Public Health Vector of Disease 10 Source: Cohen et al. (2010). AJPM, 39: 352-6.

11.  2012 Johns Hopkins Bloomberg School of Public Health Trend in Tobacco Production 11

12.  2012 Johns Hopkins Bloomberg School of Public Health Global Cigarette Market Share, 2008 12 Company Cigarettes (billions) Share of global market China National Tobacco Company2,14338.3% Philip Morris International86915.5% British American Tobacco83014.8% Japan Tobacco61210.9% Imperial (UK)3295.9% Altria/Philip Morris USA1693.0% Korea Tobacco & Ginseng (S. Korea)1021.8% RJ Reynolds901.6% Source: Callard. (2010). Tob Control, 19(4): 285-90.

13.  2012 Johns Hopkins Bloomberg School of Public Health Tobacco Company Revenue & Profits: Top 6 Companies 13

14.  2012 Johns Hopkins Bloomberg School of Public Health Change in Affordability of Tobacco Products 14

15.  2012 Johns Hopkins Bloomberg School of Public Health MPOWER 15 Image source: World Health Organization. (2008). WHO Report on the Global Tobacco Epidemic, 2008. www.who.int/tobacco/mpower/2008/en/index.html

16.  2012 Johns Hopkins Bloomberg School of Public Health WHO Framework Convention on Tobacco Control 16

17.  2012 Johns Hopkins Bloomberg School of Public Health Closing Remarks The tobacco epidemic will cause the most harm to low- and middle-income countries  Tobacco use is growing fastest in these countries, fueled by steady population growth  The tobacco industry is expanding its advertising, marketing, and promotion to the developing world  Many of these countries have fewer resources to respond to the health, social, and economic problems caused by tobacco use, which will exacerbate the tobacco epidemic’s impacts  This will create a “perfect storm” of future tobacco-caused disease and death, unless there is a strong response from the public health community 17