Lives Cut Short, Billions Lost: The Growing Toll of Smoking in the MENA Region

A study across 24 MENA countries found that smoking caused over 465,000 premature deaths and $29.7 billion in economic losses. The findings highlight an urgent need for stronger tobacco control policies to reduce the region's health and financial burdens.

A landmark study by researchers Mouaddh Nagi, Arthorn Riewpaiboon, and Montarat Thavorncharoensap, affiliated with Mahidol University’s Faculty of Pharmacy in Bangkok and Aljanad University in Taiz, Yemen, has brought into sharp focus the devastating consequences of tobacco use in the Middle East and North Africa (MENA). Published in the Eastern Mediterranean Health Journal, the study meticulously analyzes the human and economic cost of smoking across 24 MENA countries. The findings are alarming: 465,285 premature deaths were attributed to tobacco smoking that year, translating into over 7.1 million years of potential life lost (YPLL). Each smoking-related death led to an average of 15.23 years lost. The economic cost of this premature mortality was estimated at US$29.7 billion, amounting to 0.76% of the region’s total gross domestic product.

Men Bear the Brunt, Economies Feel the Strain

The burden of smoking-related deaths fell disproportionately on men, who accounted for a staggering 88.6% of the total deaths. This gender imbalance reflects broader cultural trends in the region, where smoking among men remains prevalent while rates among women are significantly lower. In countries such as Jordan, Tunisia, and Turkey, male smoking prevalence surpassed 60%, and even exceeded 40% in many others. As men typically represent the primary earners in most MENA households, their premature deaths result in a heavier economic blow to national productivity.

Cardiovascular diseases emerged as the leading culprits behind smoking-attributable mortality. Ischemic heart disease (IHD) alone claimed over 193,000 lives and was responsible for $11.4 billion in economic losses. Stroke, chronic obstructive pulmonary disease (COPD), and lung cancer also contributed significantly to the mortality and financial burden. Notably, lung, trachea, and bronchus cancers were among the most strongly associated with smoking, with more than 70% of such cases linked directly to tobacco use.

The Worst-Hit Countries: Turkey, Egypt, Saudi Arabia

Among the 24 nations analyzed, Turkey stood out as the most affected by the smoking epidemic. The country alone accounted for 41% of the region’s total smoking-related mortality cost, amounting to over $12.2 billion. Saudi Arabia followed with $2.6 billion, trailed closely by Egypt and Pakistan. These five countries, like Turkey, Saudi Arabia, Egypt, Pakistan, and the United Arab Emirates, jointly absorbed 71% of the entire MENA region’s economic losses due to tobacco-related premature mortality.

In proportional terms, Lebanon suffered the highest GDP impact, losing 1.85% of its national output to smoking-related deaths. Tunisia (1.32%) and Turkey (1.68%) were not far behind. Such statistics underscore the steep cost of inaction and the urgent need for reform in countries where public health systems and economic resilience are already under stress.

More Than a Health Issue: Smoking’s Widespread Impact

The research included 24 diseases linked to smoking, encompassing 16 types of cancer, four cardiovascular illnesses, three respiratory conditions, and diabetes. While the spotlight often shines on lung cancer and heart disease, smoking was also found to contribute to less-publicized but equally fatal conditions such as colorectal cancer, liver cancer, and myeloid leukemia. The study calculated Smoking-Attributable Fractions (SAFs) for each condition, revealing particularly high SAFs in Lebanon and Turkey at 33%, and similarly elevated figures in Jordan, Syria, and the UAE.

The study’s economic analysis relied on the Human Capital Method, estimating productivity losses based on the present value of future earnings. While this method offers valuable insight, it likely underestimates true costs in regions with large informal economies. It doesn’t capture losses from unpaid labor, secondhand smoke exposure, long-term disability, or treatment costs all of which would only raise the total burden further.

A Call to Action: Curbing the Epidemic Before It Grows

Perhaps most disturbing is the revelation that more than half of smokers in the region begin the habit before the age of 10. This early initiation is fueled by poor regulation, widespread availability of tobacco products, and minimal enforcement of age restrictions. Despite global progress in tobacco control, several MENA countries continue to report rising smoking rates, particularly among youth. The report suggests that without immediate intervention, the death toll and economic damage will only escalate.

The authors argue that comprehensive tobacco control strategies must become a policy priority. These include raising tobacco taxes, enforcing bans on advertising and smoking in public places, implementing large health warnings on packaging, and launching sustained public awareness campaigns. Political will and commitment to implementing the World Health Organization’s Framework Convention on Tobacco Control are crucial for change.

The study serves as both a sobering diagnosis and a potential blueprint for saving lives and money. Smoking is not just a health risk, it is an economic liability, a development barrier, and a silent epidemic claiming hundreds of thousands of lives across the region. With decisive action, MENA countries have the opportunity to reverse this trend, reclaim years of life, and redirect billions toward a healthier, more productive future.