Conclusion

Tobacco owes much of its destructive power to the fact that its lethal effects are not immediately dis­cernible. Initial reactions to smoking like nausea and respiratory distress usually subside, and many persons continue smoking, chewing, or snuffing to­bacco for several decades without apparent serious injury or death.

Only recently, during the fifth century of post­Columbian tobacco experience, has medical and epidemiological science advanced sufficiently that the diffuse nature and great magnitude of tobacco’s depredations have become fully evident. In the twen­tieth century alone, we tally these numbers:

In the United States the smoking of 26 trillion cigarettes and 556 billion cigars and the consump­tion of 25 billion pounds of “manufactured to­bacco” (pipe tobacco, chewing tobacco, and snuff) have produced: more than 2.9 million deaths from lung cancer, more than 7 million deaths from cardiovascular dis­

ease, and more than 14 million deaths from all forms of

tobaccosis.

During the 1980s, the U.S. tobaccosis death toll was roughly 500,000 annually, for a total of 5 million deaths in the decade. Moreover, even if all tobacco use ceased immediately, many millions would still die of tobaccosis in ensuing decades.

In 1989 the world’s inhabitants were smoking 5 trillion cigarettes annually and consuming millions of tons of tobacco as cigars, bidis, chewing tobacco, and snuff, as well as in pipes and hookas. The tobac­cosis death toll was more than 2.5 million, and that in the twentieth century more than 50 million.

Considered a global entity with an extraordi­narily diffuse, subtle nature and with lifetime laten­cies, tobaccosis poses the ultimate challenge to epi­demiology and to world public health and political leadership.

R. T. Rauenholt

Excerpted and reprinted with the permission of the Population Council from R.T. Ravenholt. 1990. Tobacco’s global death march. Population and Development Review 16(2):213-40.