BACKGROUND: Four industries producing unhealthy commodities, namely, tobacco, ultra-processed food, fossil fuel, and alcohol, account for at least a third of global annual deaths that are avoidable. The aim of this research is to delineate the global health equation focusing on the tobacco industry.
METHODS: We use country-level estimates of the years of life lost due to tobacco-attributable diseases and deaths in 2021 from the Global Burden of Disease study to measure the annual cost-of-illnesses attributable to smoking and exposure to secondhand smoke. Then, based on existing estimates from a U.S. study of the elasticity of per capita income with respect to the smoking status of the population and the coefficient of lagged income representing the effect of past income on future income trajectory, we generate country-level estimates of the cumulative aggregate economic loss attributable to smoking. Finally, we construct a global health equation by presenting the above estimates against the market value generated by the tobacco industry globally.
RESULTS: The global estimate of the annual cost-of-illnesses attributable to smoking and exposure to secondhand smoke is USD 1.7 trillion in 2021 (2.4 trillion in international purchasing power parity dollars, PPP$)—USD 656.5 billion due to excess healthcare expenses to treat the illnesses and USD 1.1 trillion from productivity losses due to smoking-related morbidity and premature mortality—equivalent to 1.7% of global Gross Domestic Product of USD 100.6 trillion. The cumulative aggregate economic loss is estimated at USD 18.5 trillion in 2022. The global tobacco industry generated a total market value of USD 886.1 billion in 2023, which can barely compensate 5% of the loss they cause to the global economies.
CONCLUSIONS: It is not enough to balance the lopsided global health equation by making the tobacco industry pay for the excess cost. The way forward is to eliminate the industry through end game strategies.