Thanks to celebrity activism and widespread media attention, HIV, malaria and starvation are well-known diseases of the third world. But there's another resource-draining plague afflicting these countries, one hiding in plain sight: smoking.
While the smoking population is half what it was a generation ago in the U.S. and other industrialized nations, with only one in five using tobacco, it's different in Africa and East Asia, where time stands still when it comes to cigarettes.
Smoking rates of 40% or more of the population are common in these regions, making for an extra-tough health hazard when medical services are as limited as filterless, hand rolled smokes are plentiful.
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We assembled a list of the countries where the highest percentage of citizens smoke according to the most recent public health data available and ranked them based on that figure. But we also took it further, estimating the potential drain on each nation's potential income opportunity due to smoking deaths as compared to the nation's gross domestic product.
Societal costs in those countries can't be calculated the same way they would be in the U.S., where most studies measure how much smokers burden taxpayers with extra Medicare and Medicaid payments. For poor countries, there is no Medicare-like program to fund. Nor is there enough data about the economic impact of other diseases to make real comparisons.
"In Africa, these health care systems don't exist, at least not in the form we're used to," says Tom Glynn, Director of International Care Control for the American Cancer Society. Only Kenya, he says of Africa's low income nations, has a medical care system that reasonably resembles that of the western world.
What you can try to sum up is how much economic potential is lost due to deaths from smoking through some back of the envelope calculations. Most studies conclude a cigarette costs 10 minutes of life, so a pack-a-day smoker (20 cigarettes a day) loses 13.9% of a year to the habit over the long haul.
In Namibia, where half of the country's two million citizens smoke, the average income is about $3,230 a year, according to the World Bank. How much does the habit drain that? About $448.61 per year in lost income. Multiplied by just over 1 million smokers, it adds up to $461 million in income losses nationwide, or 6.9% of the country's $6.6 million total.
The average lifespan in Namibia is 47, meaning that many people are losing a lot of prime earning years. And while smoking is hardly the only reason--low income nations have many variables affecting life expectancy--the habit has always been picked up most heavily by the less well-to-do, exacerbating the health and earning problems even more.
Guinea, Kenya, Namibia and Yemen, which together average $1,245 in gross national income per capita (U.S. dollars), are all among the 10 heaviest smoking countries in the world.
The Gross National Income in Nauru, which tops our list, is $5,000 per capita, of which a smoker can expect to lose an average of $694 over his working life. Over the full population, the national annual income of $67.6 million would be $5.1 million, or 7.5% higher if the 54% of the citizens who smoke didn't lose a portion of their earning years.
Glynn, who has done a lot of work in Africa among his many travels, says even those most in the know can't be counted on to set much of an example.
"Physicians smoke even more than the general population," he says.