Tobacco (17) Do people understand the health, socio-economic and environmental harms of using tobacco products?

26 February, 2023

Dear HIFA colleagues,

For the first week of our 5-week deep-dive discussion on Tobacco, I invite you to consider Question 1:


Is it important that people understand the harms of tobacco? I think/hope everyone will agree this is a rhetorical question. It is clear that many smokers quit primarily because of concerns over their current health, or concerns about the increased risk of future disease such as lung cancer.

Do people understand the health risks? What about young people? Most people worldwide start using tobacco before the age of 18. In the USA and Europe people typically start at the age of 15 or 16. I myself started smoking at the age of 15 (I quit many years later). I was aware that 'smoking causes lung cancer' but I had no clue about its impact on other areas of health. As a teenager, this health risk that would probably not emerge for decades was of little consequence to me. Teenagers tend not to worry about what might happen 20 years in the future. As part of this discussion, I invite you to consider the drivers and barriers to communicating the health risks of tobacco to young people.

I cannot claim to be fully aware of the health risks of tobacco. Very, very few people are. The UK NHS website notes that 'Smoking increases your risk of developing more than 50 serious health conditions'. Hardly anyone could recite these from memory.

I was also unaware until just a few weeks ago (at the age of 62, preparing for this discussion) about the full extent of the environmental harms of tobacco. Until I saw this 1-minute video from WHO:

What matters to teenagers? They want to fit in with their peers who had already started smoking (why I and so many others started to smoke). They want money to spend with their friends (this has become an increasingly important deterrent in the 2020s as compared with the 1970s when a pack of 20 cigarettes cost 40 pence (in the UK). Many teenagers worldwide are becoming very aware about climate change and the environment. If they were to be fully aware of the environmental harms of tobacco, would this persuade them not to take up smoking, or even make smoking socially less acceptable?

I have introduced this discussion with a few random thoughts and personal experience about teenagers. I invite your own thoughts not only on teenagers, but also in relation to older persons. Do people fully understand the health, socio-economic and environmental harms of tobacco? What matters to them? How can they be better informed?

Best wishes, Neil

Co-chair, HIFA project on Mental health: meeting information needs for substance use disorders - Tobacco, Alcohol, Opiates

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: