International comparisons of preventable risk factors

We evaluate how rates of smoking, obesity and alcohol consumption compare internationally.



Last updated: 20/10/2023


Preventable risk factors such as smoking tobacco, being overweight, physical inactivity and harmful use of alcohol contribute to the global burden of non-communicable diseases. These risk factors can be influenced by effective policies (e.g. the smoking ban) and public health campaigns. Here we compare the prevalence of tobacco smoking, obesity and alcohol consumption internationally over time.

Adult smokers by country

Smoking tobacco is a risk factor for cancer, stroke, coronary heart disease and respiratory diseases such as chronic obstructive pulmonary disease (COPD). Smoking while pregnant can lead to low birth weight and illnesses among infants. The World Health Organization (WHO) has estimated that tobacco smoking kills more than 8 million people each year worldwide, of which around 1.2 million deaths are the result of second-hand smoke.

Daily smoking has decreased in most OECD countries since 2006. In Great Britain, the proportion of the population aged 15+ who are daily smokers decreased from 22% in 2006 to 13% in 2021. Between 2006 and 2019, the largest decreases among the comparator countries were in Greece (from 40% to 25%) and The Netherlands (from 25% to 15%). In 2021, France had the highest rate of tobacco smoking out of the countries for which there was data, with 25% of the country’s adult population classified as daily smokers. Canada, Sweden, and the United States had the lowest proportion of daily smokers, ranging between 9–10%.

Many OECD countries have introduced policies to reduce tobacco use, such as raising taxes on tobacco products, banning advertising and providing support for smokers to quit.

Obesity by country

Obesity and being overweight are major risk factors for several chronic diseases, including diabetes, cardiovascular diseases and cancer. In 2021, the OECD reported that overweight-related diseases can cause life expectancy to decrease by 2.7 years and obesity puts people at increased risk of developing severe symptoms or dying of Covid-19.  

Obesity has been rising in most OECD countries over the past two decades. In England, this trend has accelerated during the Covid-19 pandemic: in the 2021/22 school year, over 23% of Year 6 children were either obese or severely obese. Further, the prevalence of obesity in those aged 15 and over increased from 21% in 2000 to 28% in 2019. Japan has consistently had very low rates of obesity; however, the proportion has still risen over the same period, from 3% to 5%. Among the comparator countries, the United States has the highest proportion of the total population who are obese, at 43% in 2019.

OECD countries have implemented a range of public health policies in recent years to try to slow the obesity epidemic. These include food labelling measures, using social media and new technologies for public health promotion, and taxation policies to raise the price of foods that are high in salt, fat or sugar.

Alcohol consumption by country

Harmful alcohol use is a leading cause of death and disability worldwide, particularly in adults of working age. Globally, 3 million deaths result from harmful alcohol use each year, representing 5.3% of all deaths. There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, non-communicable diseases and injuries.

Recorded alcohol consumption has decreased in many OECD countries since 2000. However, the extent of the decrease varies by country, and consumption has in fact increased in 3 of the 19 countries included here (Canada, Sweden and the United States). Between 2000 and 2010, annual alcohol consumption in the United Kingdom was 10.8 litres per capita on average. Over the next ten years, average consumption decreased to 10 litres per capita in 2021. In 2021, alcohol consumption in the UK was higher than the average of the comparator countries (9.2 litres). In the same year, Japan had the lowest alcohol consumption at 6.6 litres per capita, and Austria had the highest at 11.1 litres per capita.

There are already many policies that target harmful use of alcohol. Some target heavy drinkers, while others cover whole populations. All OECD countries apply taxes to alcoholic beverages, but the level of tax varies across countries. New forms of fiscal policy are being implemented, such as minimum pricing of one unit of alcohol in Scotland. Other commonly used policies are regulations on advertising alcoholic products, legal limits for driving under the influence of alcohol, and controls on drinking age and hours of sale.

About this data

Definitions and comparability for the indicators are taken directly from the OECD report Health at a Glance 2021: OECD Indicators. Detailed information about the definitions and the source and methods for each country can be found here.

Tobacco consumption:
The proportion of daily smokers is defined as the percentage of the population aged 15 years and over who report smoking tobacco every day. Other forms of smokeless tobacco products, such as snuff in Sweden, are not considered. This indicator is more representative of the smoking population than the average number of cigarettes smoked per day, as the act of smoking is more determining of regular smoking than the quantity. Most countries report data for the population aged 15+, but there are some exceptions. International comparability may be affected by a lack of standardisation in the measurement of smoking habits in health interview surveys across OECD countries.

Obese population:
Overweight and obesity are defined as excessive weight presenting health risks because of the high proportion of body fat. The most frequently used measure is based on the body mass index (BMI), which is a single number that evaluates an individual's weight in relation to height (weight/height², with weight in kilograms and height in metres). Based on the WHO classification, adults over the age of 18 with a BMI greater than or equal to 25 are defined as overweight, and those with a BMI greater than or equal to 30 as obese. Most countries report data for the population aged 15+, but there are some exceptions. Rates of overweight and obesity can be assessed through self-reported estimates of height and weight derived from population-based health interview surveys, or measured estimates derived from health examinations (which we have used here). Estimates from health examinations are generally higher and more reliable than those from health interviews.

Alcohol consumption:
Recorded alcohol consumption is defined as annual sales of pure alcohol in litres per person aged 15 years and over. Most countries report data for the population aged 15+, but there are some exceptions. The methodology to convert alcoholic drinks to pure alcohol may differ across countries. Official statistics do not include unrecorded alcohol consumption, such as home production. In some countries, national sales do not accurately reflect actual consumption by residents, since purchases by non-residents may create a significant gap between national sales and consumption.