Why tobacco on World Mental Health Day?

By Kazuyuki Uji and Cecilia Oh, HIV and Health Group, UNDP Bangkok Regional Hub

October 10, 2023

With approximately 1 billion people affected by mental health conditions and 1.3 billion using tobacco, the global costs are staggering.

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The interconnectedness between mental health and tobacco use has come to the forefront of public health discussions in recent years. Although not yet conclusive, a growing body of evidence suggests a causal relationship between the two, where tobacco use can serve as both a cause and consequence of mental health challenges.

On the one hand, smoking can act as a catalyst for conditions such as depression, while on the other, people with mental health conditions may find themselves drawn to tobacco useHowever, there is hope – quitting tobacco can improve mental well-being. Compelling research has shown that quitting smoking can be as effective, if not more so, than traditional antidepressants in alleviating the burden of depression and anxiety.

The costs of mental health conditions and tobacco use are staggering. Globally, 1 billion people are affected by mental health conditions, incurring an estimated annual cost of US$1 trillion. Depression, representing over 4 percent of the global disease burden, is projected to become the leading cause of disability worldwide by 2030. Similarly, 1.3 billion people use tobacco, resulting in a yearly cost of US$1.4 trillion, and claiming the lives of over 8 million people annually. 

Low- and middle-income countries (LMICs) account for 80 percent of cases of mental health conditions and tobacco use

The poor and marginalized populations are more likely to suffer from both mental health conditions and tobacco use, often concurrently. 

Data from a household survey in the United Kingdom illustrates this. It found that men in the lowest income quintile, or the poorest 20 percent, were 2.7 times more likely to experience mental health conditions than those in the highest income quintile. Likewise, people in the lowest income sextile, or the bottom 17 percent, were twice as likely to smoke cigarettes as those in the highest income sextile. 

Another UK study revealed that the prevalence of smoking among lesbian, gay and bisexual (LGB) adults was 27 percent, while it was 18 percent in heterosexual adults. LGB adults also presented a significantly higher presence of long-term mental health conditions (16 percent) than heterosexual adults (6 percent).

Too often, access to treatment is limited for both mental health conditions and tobacco use disorder, especially in LMICs, further compounding the problem. According to the WHO, only 23 countries (including 7 LMICs) offered comprehensive tobacco cessation services in 2018. Furthermore, many countries do not cover these services through their national health insurance schemes, making it costly for people to seek treatment. 

Across LMICs, only 15 to 24 percent of people with severe mental health conditions receive treatment. Globally, the average allocation of government health budgets for mental health stands at just 2 percent, dwindling to less than 1 percent in low-income countries. 

The escalating and interconnected risks posed by mental health conditions and tobacco use and their significant economic and developmental consequences demand urgent policy attention and proactive measures. 

To raise awareness on these critical issues, UNDP published an issue brief that outlines recommendations for action by governments and other essential stakeholders, including the following: 

Implement integrated responsesThe strong link between mental health conditions and tobacco use underscores the need for an integrated approach that prioritizes prevention at the primary health care level. For example, tobacco prevention education in schools, policy advocacy and health warnings on cigarette packs typically focus only on the physical health risks of tobacco use. These efforts should also incorporate lesser-known mental health risks associated with tobacco use.

Increase tobacco taxes - Evidence indicates that a significant increase in tobacco excise tax is the most effective measure for reducing tobacco use. Given the positive relationship between tobacco cessation and improved mental health, increasing tobacco excise tax is likely to benefit not only tobacco users with mental health conditions but also their families, friends and co-workers exposed to second-hand smoke.

Engage with affected communities - The design and implementation of interventions should involve active participation from tobacco users with mental health conditions and marginalized communities impacted by both challenges. To ensure that interventions are tailored to each community’s specific needs and cultural contexts, community-specific initiatives should be spearheaded by members directly impacted by these challenges.

Provide comprehensive coverage - Providing free or affordable mental health and tobacco cessation treatments as part of basic universal health coverage benefit packages would benefit millions. The strategic use of increased government revenues from increased tobacco taxes could provide sustainable financing for mental health and tobacco cessation treatments.

Prevent tobacco industry interferenceCountries need robust governance systems to prevent tobacco industry interference. To address this issue, the WHO Framework Convention on Tobacco Control mandates the protection of tobacco control policies from industry interference (Article 5.3).

Reduce stigma - Individuals with mental health conditions and tobacco use, particularly those in marginalized communities, often encounter pervasive stigma, which prevents them from seeking help. Thus, offering care and support that empower these individuals is vital. A good starting point is to use appropriate language in policy and public discussions, including on social and news media, to demonstrate respect and recognize individuals as rights-holders and agents of change. For instance, terms like “people with mental health conditions” should be used rather than stigmatizing language such as “mentally ill,” “mental,” or “psycho.” Likewise, terms like “cigarette smokers” or “tobacco users” should be used instead of derogatory terms such as “nicotine addicts.”

On this World Mental Health Day, it is crucial that we recognize and take action to address the interconnected double burden of mental health conditions and tobacco use.