Tobacco (18) Do people understand the health, socio-economic and environmental harms of using tobacco products? (2)

27 February, 2023

Dear Neil thanks for your question Do people understand the health, socio-economic and environmental harms of using tobacco products?

In our experience in terms of primary respiratory care, in many countries there is a strong awareness about tobacco smoking and lung cancer but less awareness about tobacco smoking and asthma (the most common chronic disease in childhood) or tobacco smoking and chronic obstructive lung disease (COPD), the third leading cause of death worldwide. Data suggest people with asthma are more not less likely to smoke tobacco than those without asthma, which suggests scope for more research about why. Eg from

South Korea

Meanwhile there is significant under reporting and under diagnosis of COPD.

not all is caused by tobacco smoking but it is the most modifiable risk factor. Treating tobacco dependence is not only prevention but also first line treatment for COPD where tobacco smoking is the cause.

We still see high rates of tobacco smoking amongst medical students in some countries which suggests a lack of commitment to include tobacco as a mandatory element of medical curricula. Our colleagues in North Macedonia are taking action on this presently.

The key message to HCPs must be that tobacco dependence is a treatable long term relapsing condition that often begins in childhood. That is, it is a health professional responsibility to diagnose and treat it.

The personal economic harm of tobacco smoking has been well explained by ASH UK but is probably underused: this seems a very teachable moment with global economic crises to explain this harm.

The health harms of other forms of tobacco eg shisha (and it’s many other names) and chewed tobacco are less well known and less well regulated. Work is ongoing to establish the size of the problem and solutions

The knowledge of the environmental harms of tobacco are surely insufficiently known and deserve much more attention. This slide set from IPCRG’s associate member Prof Nick Hopkinson backs up the points made in the WHO film with data.

Finally, for those who want to know more about primary care and framing tobacco use as a treatable dependency please see our resources here:



Siân Williams +44 (0)7980 541664

HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. AT