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By 2030, the number of deaths resulting from tobacco use will reach 7 million a year in the developing world, the authors of a review in Thorax have estimated (2004;59:623-30).

International support is essential to reverse the rise, say the authors, but they cite a range of obstacles, including high smoking rates among doctors and other health professionals, lack of awareness of the dangers of tobacco, economic dependence on tobacco, poor healthcare systems, and the tactics of the tobacco industry.

The report says that the developing world is facing a rapidly growing epidemic of tobacco use. Rates began rising in the early 1970s, and by 1995 about 82% of the world’s smokers were in the developing world. In 2000, there were 2.41 million deaths in developing countries were related to smoking.

"Tobacco control, particularly cessation interventions, will need to be a priority for policy makers in developing countries if a substantial impact is to be made within the next few decades on the morbidity and mortality caused by tobacco," write the authors, from the department of community medicine, University of Hong Kong,

They add: "Unfortunately, many barriers must be overcome for cessation strategies to be implemented broadly and successfully. Interventions through the healthcare system may be limited by high smoking rates among healthcare providers, competing health priorities, and lack of awareness of the adverse health and economic costs of tobacco use."

The report says that rates of smoking among health professionals in the developing world seem high. In 1999, 37% of Algerian medical students smoked, as did 61% of physicians from a hospital in China in 1996, and 54% of hospital workers in Nairobi, Kenya.

Awareness of the health hazards of tobacco is also low. In 1996 two thirds of adult Chinese smokers believed that cigarettes did little or no harm. Low levels of education in many developing countries also make it harder for people to understand the hazards.

The authors say that while the public health community is busy trying to reduce tobacco use, the tobacco industry continues to market its products aggressively.

"The industry also minimises the health impacts of tobacco, even in developed countries where the problem has been well documented. Tobacco companies are also investing in developing countries by building manufacturing plants. Industry lobbying can also impede action on tobacco prevention and control policies," they write.

Some immediate actions are possible, say the authors, including increasing taxes on tobacco products, implementing or strengthening warning labels, and getting doctors and teachers to stop smoking.

"Global support and strong commitment, especially from international organisations and donor agencies, will be crucial," say the authors.