Martin Broughton was not correct in telling the Health Committee last week that the WHO projections of about 10 million deaths a year from tobacco were based only on evidence from white American males. It is true that when in the late 1980s we first produced such estimated we were chiefly using studies from the UK and US, but since then there have been large studies in developing countries that confirm that these projections are appropriate.

  Indeed, the largest study of tobacco deaths ever undertaken was done in China: a brief report of it from Nature Medicine (1999; 5: 15-17) is enclosed,[18]and the full report may be found in British Medical Journal 1998; 317: 1411-1422 and 1423-1424. Those reports, which include data from a retrospective study of one million deaths and a prospective study of 200,000 adults, concluded that in China alone there would be an average of about one million deaths a year from tobacco during the first decade of the 21st century, and about two million a year during the third decade.

  Likewise, recent large retrospective and prospective studies in India (a retrospective study of 50,000 deaths and a prospective study of 100,000 adults), results from which were presented by me and others at the Asian-Pacific Cancer Congress in December 1999, found that at ages 25-69 the age-standardised death rate of Indian men who smoke is double that of Indian men who have never smoked. Taking smokers and non-smokers together, this indicates that among Indian men about 30 per cent of all deaths at ages 25-69 (plus a smaller percentage of those at older ages) would not have happened if smokers had had the same age-specific death rates as non-smokers. If so, then tobacco is already, in the year 2000, causing about 0.7 million of the current annual total of 2.3 million Indian male deaths at ages 25-69, plus a smaller fraction of the 1.4 million at older ages (and a very small fraction of the three million adult female deaths per year in India).

  With population growth, therefore, tobacco will cause about as many deaths in India as in China over the next few decades, ie an average of about a million a year in the first decade of the 21st century and about two million a year in the third decade. (Interestingly, Indian smokers have substantially higher rates of premature death than non-smokers not only for neoplastic, vascular and chronic respiratory disease, but also for tuberculosis; TB is still a major cause of death in India.)

1 February 1999