Between 1990 and 2009, cigarette consumption in regions of the world like Western Europe dropped by more than 25% - but that is only one side of the coin. Historically, cigarette consumption has been a privilege to the rich and high-income countries. Now, with those countries understanding the risks of cancer and the dangers of smoking, the number of smokers decline. But in the past twenty years, for example, the use of cigarettes in the Middle East and Africe has increased by 60%: "Among the 14 countries where 50% or more of men smoke all but one country (Greece) are classified as low- or middle-income."
"As consumption rates continue to increase in low- and middle-income countries," the ACS report reads, "these countries will experience a disproportionate amount of tobacco-related illness and death." In 2009, China consumed 40% of the world's cigarettes.