photo credit: photo courtesy Tomasz Sienicki/Wiki Commons
It is a truth universally acknowledged that … tobacco prematurely kills about half of those who use it. That amounts to 6 million people, or one of every ten deaths worldwide, each year. This, in and of itself, may not make tobacco a global development issue. However, the fact that tobacco use in most middle-income and low-income countries runs against otherwise generally positive global development trends related to poverty, hunger and most of the MDGs, should give us pause, particularly on World No Tobacco Day  (May 31).
Most health improvements move in sequence, starting in rich countries and then following in developing countries (e.g. vaccination, disease eradication, life expectancy). Tobacco use threatens to become a grievous exception—just as rates are plummeting in wealthy countries, they threaten to explode in emerging economies.
In the coming generation, most developing countries will enjoy a once-in-a-lifetime-of-the-species opportunity, in which the working-age population will briefly outnumber both young and old. Tobacco threatens to impinge on their efforts to make this the healthiest, best-nourished, best-trained generation in history and exploit the full potential of this “demographic dividend.”
But wait: Isn’t tobacco use a matter of rational choice by informed individuals who, despite being aware of their deleterious health effects, want to continue enjoying their smokes? Enough with the nanny state already!!!
The short answers are NO, NO, and NO.
The myth of “rational choice” is particularly egregious in the matter of tobacco. Depending on which statistics one reviews, between 80 to 90 percent of tobacco users start smoking or chewing before they are 18 years old. As any parent knows, the brain of a teenager is still a “work in progress ,” and nearly every society has found it both necessary and appropriate to limit access of the young to noxious substances. In economic parlance, adolescents, even more than adults, apply hyperbolic discount to the potential future consequences of today’s actions.
Fair enough, skeptics say, but once an individual becomes an adult, he or she surely knows of the health dangers of tobacco use and can stop smoking.
The reality is that despite the deluge of information in wealthy countries, tobacco users—particularly the poor-- in middle- and low-income countries are often not aware of the danger that consuming tobacco in its different forms represents.
Just as tobacco companies in affluent countries once depicted smoking as glamorous—or even healthy (!)—in today’s emerging economies, reliable information on smoking is often not available. Moreover, by now we know that the capacity of information to change behavior is limited in the best of the cases, and even more so in the case of addictive behavior.
This last point addresses the “Doubting Thomases” who ask, “Don’t fully informed tobacco users choose to persist despite knowing their risks?” Again no, it is not so simple. A number of surveys across the world suggest that roughly 80 percent of smokers want to quit, and most have tried more than once. Unfortunately, more than 85 percent of those who try to quit on their own, relapse -- most within a week. The reason is simple: tobacco is a highly addictive  substance. Biomedical literature compares tobacco’s addictive capacity to that of illicit drugs such as cocaine and heroin.
Increasing tobacco prices sufficiently and progressively reducing its affordability is the fastest way to reduce the number of adolescents who start smoking. Yes, there are issues to consider when increasing tobacco prices, which I will address in another blog post. In the meantime, remember that today, like every day this year, between 82,000 and 99,000 young people around the world, most of them in middle- and low-income countries, will start smoking, and half of them will die prematurely because of it. Anything that so affects the future is a development problem of the first order.
Follow the World Bank health team on Twitter at: @worldbankhealth 
World Bank and Tobacco Control: The Facts 
Blog: Latin America: Making Sure Anti-Tobacco Efforts Don’t Go Up in Smoke 
World No Tobacco Day (WHO) 
Video - The Truth About Tobacco: How Much is a Life Worth? 
- Health