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Air pollution is not ‘the new smoking’: comparing the disease burden of air pollution and smoking across the globe, 1990–2017
  1. Wayne Gao1,
  2. Mattia Sanna1,
  3. Marita Hefler2,
  4. Chi Pang Wen3,4
  1. 1Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
  2. 2Tobacco Control Research Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
  3. 3Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
  4. 4China Medical University, Taichung, Taiwan
  1. Correspondence to Dr Wayne Gao, Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan; waynegao{at}; Dr Chi Pang Wen, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; cwengood{at}


Air pollution has been labelled the ‘new smoking’, with news articles bearing titles such as ‘If You Live in a Big City You Already Smoke Every Day’ and ‘The Air Is So Bad in These Cities, You May As Well Be Smoking’. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, highlighted this attention-catching comparison, saying, ‘The world has turned the corner on tobacco. Now it must do the same for the ‘new tobacco’ – the toxic air that billions breathe every day’ and ‘Globally, with smoking on the decline, air pollution now causes more deaths annually than tobacco’ at the First Global Conference on Air Pollution and Health in 2018. The suggestion that the world has turned the corner on tobacco control and the reference to air pollution as the ‘new smoking’ raise a number of concerns. We generate outputs from GBD Compare (the online data visualisation tool of the Global Burden of Diseases and Injuries (GBD) Study) to demonstrate historical disease burden trends in terms of disability-adjusted life years and age-standardised mortality attributable to air pollution and tobacco use from 1990 to 2017 across the globe. We find that the disease burden caused by ambient air pollution declined significantly faster than the burden caused by tobacco use. We conclude that the world is still far from turning the corner on the tobacco endemic. Further, the suggestion that air pollution is as bad as actual smoking is not only inaccurate but also potentially dangerous to public health.

  • new smoking
  • attributable deaths
  • tobacco control
  • ambient air pollution

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  • Contributors WG conceived the idea and drafted the manuscript. CPW conceived the idea and critically reviewed and revised the manuscript. MS re-organised the data, and critically reviewed and revised the manuscript. MH was involved in the early drafts, and critically reviewed and revised the manuscript. MH and MS helped with new revisions in response to referees’ comments and questions. All the authors approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work.

  • Funding MH is supported by a National Heart Foundation Australia Postdoctoral Fellowship, award number 101938. CPW is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 108-2321-B-039-003-), Tseng-Lien Lin Foundation, Taichung, Taiwan and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

  • Disclaimer The funding source had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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