Q&A: The burden of smoking in the ASEAN region

According to new research, smoking caused more than 10% of all deaths in the Association of Southeast Asian Nations (ASEAN) region in 2021. The number of smokers has increased by 63% in the region from 1990 to 2021, according to new research published in The Lancet Public Health.

Dr. Xiaochen Dai, a first author and Lead Research Scientist at IHME, presents the findings from the burden of smoking paper, what we can learn from the results, and what we can do to improve health incomes in the future.

This study is one in a series of four that examined the burden of mental health disorders, cardiovascular disorders, smoking, and injuries in ASEAN.

Video transcript

This transcript has been lightly edited for clarity

How important is smoking as a health issue in the ASEAN region?

Smoking is a huge public health issue in the ASEAN region. We’re talking about over 137 million current smokers. That’s nearly 1 in 2 adult men. and smoking isn’t just a habit. It is responsible for more than 10% of all deaths in the region.

So that isn’t a small issue. It causes massive burden of diseases, especially in non-communicable diseases like cancers, cardiovascular diseases, and chronic lung diseases. What’s really concerning is that despite some progress, the absolute number of smokers is still going up, especially among young people in several countries.

Why was this research undertaken, and what is its purpose?

This study was done because there was no single consistent and reliable source tracking how smoking affects all 10 ASEAN countries over time.

Most past research focused on individual countries or were small snapshots in time. So we wanted to pull together a comprehensive view, using the best available data, to really understand how smoking prevalence and the related health burdens have changed over the last 30 years. The goal is to inform better policies and help governments see what’s working and what’s not, so they can make smarter decisions.

What were the key findings of the research?

The key takeaway from this research is that while smoking rates have gone down in most ASEAN countries, the total number of smokers has actually increased by over 50 million since 1990. Smoking still causes more than half a million deaths a year in the region. We also found huge differences between countries.

As this map shows, smoking is very common among men in the ASEAN region. In 2021, most countries had male smoking prevalence between 30% and 60%, with Indonesia, Laos, and the Philippines at the high end. Female smoking prevalence is much lower, generally below 6% across the region and often under 2%.

However, a few countries like Vietnam and the Philippines show slightly higher rates compared to their neighbors.

Most countries saw modest declines in age-standardized smoking prevalence among men, though the progress is uneven. Countries like Singapore and the Philippines achieved significant reductions. Indonesia, however, actually saw an increase in male smoking prevalence, which is one of the few countries globally to do so.

There were larger percentage declines in smoking among women in many ASEAN countries. For example, Myanmar and Thailand have notable reductions, but since female smoking prevalence was already low, the larger percentage change does not translate to huge decreases in female smokers or disease burdens.

Singapore has made amazing progress, but countries like Indonesia and Laos have seen smoking rates increase. We also saw that youth smoking is a rising issue in some countries, like Malaysia and Indonesia, which is super concerning.

As the line graph shows, over the last 30 years, for men, the overall regional prevalence has declined slightly. But the total number of male smokers continues to rise, which is driven by population growth and slower than needed reductions in smoking prevalence.

For women, in the past 30 years, the prevalence stayed relatively flat in many places, with small dips in a few countries. The concern here is more about uptake among young women, which is rising in some countries.

What are successful countries doing well, and what can others learn from them?

Singapore and the Philippines stand out for doing really well. They’ve implemented strong tobacco taxes, public smoking bans, and anti-smoking campaigns, and they’ve seen real declines in smoking rates.

On the flip side, Indonesia has one of the highest smoking rates in the world, especially among men. And it’s still going up. One big difference is that Indonesia hasn’t signed the World Health Organization’s Framework Convention on Tobacco Control, and their tobacco taxes are relatively low. So there’s a lot to learn from the higher-performing countries, like how to tighten policies, raise taxes, and fight tobacco industry influence.

What needs to be done to improve the situation?

We need stronger action, plain and simple. That includes raising tobacco taxes, banning tobacco advertising, and enforcing public smoking bans.

Right now, only a few ASEAN countries are doing all of that. Another key issue is protecting young people, because we’re seeing more and more kids picking up smoking or vaping. So we need better educational campaigns and tighter regulation of newer products like e-cigarettes. But, maybe most importantly, ASEAN countries need to work together. The tobacco industry operates regionally, so the response has to be regional too.