Preventive Medicine 70 (2015) 76–77
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Letter to the Editor Long live the Italians! Keywords: Tobacco smoking Alcohol drinking Obesity prevalence Temporal trends Italy
As Italian scientists working in the epidemiology and public health fields, we have often criticized the Italian population for their unhealthy lifestyle habits. For once, we want to applaud them for just the opposite. Tobacco, alcohol, and obesity are three leading determinants of disease burden in high-income countries, with smoking clearly ranking first in most countries (Lim et al., 2012). According to the WHO Global Health Observatory most recent data, Italy ranks among the top highincome countries with the most favorable patterns for those major risk factors (Table 1; WHO, 2014a). Tobacco smoking falls to lowest levels in Italy since recording started in the 1950s. Two thirds of Italian men in the 50's, and a quarter of women in the 90's, were smokers; over the most recent calendar years, these rates decreased to 25% for men and 18% for women (Gallus et al., 2013). In 1960, only France exceeded Italy in terms of per capita alcohol consumption. Over the last five decades, countries of the Mediterranean area showed a consistent and substantial fall in wine – and consequently total alcohol – consumption. The fall was more pronounced in Italy, where per capita alcohol consumption decreased from 19 l in 1973 to 6 l in 2010. The real reduction is indeed greater, since available data are based on alcohol entering the market, ignoring home-grown alcohol production and direct local selling, which decreased substantially over the last decades (La Vecchia et al., 2014). Dramatic increases in obesity prevalence have been observed in most high-income as well as several middle-income countries. A recent review of the literature on obesity concluded that “no national success stories have been reported in the past 33 years” (Ng et al., 2014). However, representative surveys on adults demonstrated that over the last two decades overweight remained stable in Italy, and obesity prevalence only increased negligibly, failing to exceed 10% in both sexes (Gallus et al., 2014a). Thus, Italy is now one of the high-income countries with the lowest levels of alcohol drinking (La Vecchia et al., 2014) and obesity prevalence, possibly due to a favorable impact of the Mediterranean diet (Gallus et al., 2014a; Giacosa et al, 2013). Also smoking prevalence in Italy is rather low, considering the relatively limited adoption of national-level tobacco control strategies (Joossens and Raw, 2014; Gallus et al., 2014b). Given these favorable patterns, it is not by chance that Italy is one of the countries with the highest global life expectancy (83 years; WHO, 2014b).
http://dx.doi.org/10.1016/j.ypmed.2014.11.015 0091-7435/© 2014 Elsevier Inc. All rights reserved.
Table 1 High-income countries with more than 10 million inhabitants (according to the World Bank, 2014), ranked by the latest adult smoking prevalence, per capita alcohol consumption, adult obesity prevalence, and life expectancy at birth. Countries sorted by life expectancy. High-income countries
Smoking prevalence°, (2009)a
Per capita alcohol consumption (2010)a
Obesity prevalence°, (2008)a
Life expectancy (2012)b
Japan Australia Italy Canada France Spain Germany Greece Republic of Korea Netherlands Portugal United Kingdom Belgium Chile United States Czech Republic Poland Saudi Arabia Russian Federation
IIIIIIII III IIIIII II IIIIIIIIIIIII IIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIII IIIIIIIII IIIIIIIIII IIII IIII IIIIII IIIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIII IIIIIIIIIIIII I (lowest) IIIIIIIIIIIIIIIIII
III IIIIIIIIIIII II IIIIIII IIIIIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIII IIII IIIIII IIIIIIIII IIIIIIIIIIIIIII IIIIIIIIIII IIIIIIIIIIIII IIIII IIIIIIII IIIIIIIIIIIIIIIIIII IIIIIIIIIIIIII I (lowest) IIIIIIIIIIIIIIII
I (lowest) IIIIIIIIIIIIIII IIIII IIIIIIIIIIII III IIIIIIIIIII IIIIIIII IIIIII II IIII IIIIIIIII IIIIIIIIIIIIII IIIIIII IIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIIIIII IIIIIIIIIIIII
I (highest) II II IIII IIII IIII IIIIIII IIIIIII IIIIIII IIIIIII IIIIIII IIIIIII IIIIIIIIIIIII IIIIIIIIIIIII IIIIIIIIIIIIIII IIIIIIIIIIIIIIII IIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIII
° Age- and sex-standardized estimates (world population). a Ascending order; data retrieved and elaborated from the WHO databases (WHO, 2014a). b Descending order; data retrieved and elaborated from the WHO databases (WHO, 2014b).
There is still a lot to be done in Italy, particularly in controlling tobacco, but today we just want to celebrate the progresses made in disease prevention and control in this wonderful country: long lives the Italians, keep it up! Conflict of interest statement SG, CB, and CLV declare to be Italian Nationals; LC enthusiastically declares to be an Italian resident.
References Gallus, S., Lugo, A., Colombo, P., Pacifici, R., La Vecchia, C., 2013. Smoking prevalence in Italy 2011 and 2012, with a focus on hand-rolled cigarettes. Prev. Med. 56, 314–318. Gallus, S., Lugo, A., Murisic, B., Bosetti, C., Boffetta, P., La Vecchia, C., 2014a. Overweight and obesity in 16 European countries. Eur. J. Nutr. http://dx.doi.org/10.1007/ s00394-014-0746-4 ([Aug 5, [Epub ahead of print]]). Gallus, S., Lugo, A., La Vecchia, C., et al., 2014b. Pricing policies and control of tobacco in Europe (PPACTE) project: cross-national comparison of smoking prevalence in 18 European countries. Eur. J. Cancer Prev. 23, 177–1785. Giacosa, A., Barale, R., Bavaresco, L., et al., 2013. Cancer prevention in Europe: the Mediterranean diet as a protective choice. Eur. J. Cancer Prev. 22, 90–95.
Letter to the Editor Joossens, L., Raw, M., 2014. The Tobacco Control Scale 2013 in Europe. Association of European Cancer leagues, Brussels, Belgium (http://www.europeancancerleagues. org/images/TobaccoControl/TCS_2013_in_Europe_13-03-14_final_1.pdf (accessed Nov 3, 2014)). La Vecchia, C., Bosetti, C., Bertuccio, P., Castro, C., Pelucchi, C., Negri, E., 2014. Trends in alcohol consumption in Europe and their impact on major alcohol-related cancers. Eur. J. Cancer Prev. 23, 319–322. Lim, S.S., Vos, T., Flaxman, A.D., et al., 2012. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224–2260. Ng, M., Fleming, T., Robinson, M., et al., 2014. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766–781. WHO, 2014a. Global health observatory (GHO): risk factors. http://www.who.int/gho/ ncd/risk_factors/en/ (accessed Nov 3, 2014). WHO, 2014b. Global health observatory data repository: life expectancy; data by country. http://apps.who.int/gho/data/node.main.688?lang=en (accessed Nov 3, 2014). World Bank, 2014. Data: High income. http://data.worldbank.org/income-level/HIC (accessed Dec 4, 2014).
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Silvano Gallus ⁎ Cristina Bosetti Liliane Chatenoud Department of Epidemiology, IRCCS — Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy ⁎ Corresponding author. E-mail address:
[email protected] (S. Gallus). Carlo La Vecchia Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
Available online 28 November 2014