Long-term trends in the prevalence of daily smoking in European countries where such data are available are illustrated in chapter 1. Overall, smoking is still a massive problem in Europe and there are large regional differences in smoking prevalence.
Figure 1 shows national smoking rates in Europe in 2010, based on data from the World Health Organization (WHO). It should be noted that the definition of smoking prevalence varies between countries: for many countries, the data are based on ‘daily smoking of any tobacco product’, while in others the definition ‘current smoking of any tobacco product’ is used. Subject to these caveats, average prevalence of daily or any current smoking in the 28 countries of the European Union (EU) in 2010 was 27.8% in females and 41.4% in males, while overall in the WHO European region, the averages were 24.1% in females and 47.3% in males.
The most recent data on smoking prevalence come from the European Commission’s (EC’s) Eurobarometer survey, and are based on 26 751 interviews carried out in 2012 in 27 EU countries. Overall smoking prevalence was 28% (32% in males and 24% in females) and varied considerably with age (29% among 15–24-year-olds; 37% among 25–39-year-olds; 34% among 40–54-year-olds, and 17% among those aged 55 years or over.
Tobacco use is not high everywhere: according to 2011 data from the Organisation for Economic Co-operation and Development (OECD), Iceland has a notably low smoking prevalence of 14% in both sexes. Further afield, in California, comprehensive community legislation against smoking has contributed to a prevalence of less than 10% and to considerable savings in healthcare expenditure – an illustration of what can be achieved with the right political will.
The fight against tobacco use is making progress. The 2011 OECD data, from 26 European countries, show that between 1979 and 2010 the prevalence of smoking declined by an average of 36% in females and 32% in males, but with wide variation between countries from 0% to 71% (see chapter 1, figure 10). Among men, the overall tendency in European countries is for a gradual decline in smoking prevalence, which has levelled off in the past decade. Among women there has also been an overall decline, but in a minority of countries smoking prevalence has remained stubbornly constant for the past 30–40 years.
Reducing the health burden of tobacco smoking involves both treatment and prevention. In order to affect morbidity and mortality due to smoking during the next 20 years, the most powerful intervention is to persuade today’s smokers to quit. Because it takes 20 years or more for most smoking-related disease to develop, the most effective means of reducing morbidity and mortality beyond that time is legislation now to reduce uptake of smoking among young people. In practice, we need to focus on both cessation and prevention.