The environment decides.
Brazil apresenta ao mundo uma contradição reveladora: décadas de políticas públicas antitabagismo produziram uma das maiores vitórias de saúde pública do hemisfério sul, mas o mesmo Estado que venceu essa batalha parece incapaz de enfrentar o álcool, a obesidade e o diabetes com igual determinação. Um estudo publicado no The Lancet projeta o horizonte de 2030 como um espelho dividido — de um lado, o fruto da vontade política sustentada; do outro, o custo do abandono. A saúde de uma nação, sugere a pesquisa, não é apenas uma questão de escolha individual, mas de arquitetura social.
- O Brasil está prestes a superar em mais de 30 pontos percentuais sua própria meta de redução do tabagismo — uma vitória rara em saúde pública global.
- Mas o consumo excessivo de álcool, a obesidade, o diabetes e a hipertensão avançam sem freio, ignorados por uma estrutura regulatória fraca e por políticas que perderam fôlego desde 2016.
- Mulheres enfrentam aumento desproporcional no consumo episódico de álcool, e populações de baixa renda são as mais expostas ao peso do ambiente — sem parques, sem alimentos saudáveis acessíveis, sem escolha real.
- Os pesquisadores alertam: as projeções não são destino, mas aviso — se o Brasil retomar a pressão política sobre álcool, alimentação e espaços públicos, a curva pode mudar.
Uma equipe da Universidade Federal de São Paulo mapeou o futuro da saúde brasileira até 2030 com base em quase 650 mil respostas coletadas pelo Vigitel entre 2009 e 2023. O retrato é profundamente dividido.
No tabaco, o Brasil está vencendo com folga. A taxa de fumantes deve cair de 9,8% para 4,7%, superando a meta governamental de redução de 40% em mais de 30 pontos percentuais. O consumo de bebidas açucaradas também despenca, de 15% para 3,2% — resultado de décadas de proibições publicitárias, impostos, ambientes livres de fumo e advertências gráficas. A infraestrutura de controle funcionou.
Mas os pesquisadores identificaram uma desaceleração preocupante a partir de 2015. Sem ajuste nos impostos sobre cigarros desde 2016, os dados mais recentes já mostram uma leve reversão. A mesma inércia ameaça os avanços com bebidas açucaradas.
No restante, a direção é oposta. O consumo excessivo de álcool subirá de 18,8% para 21,3%, com aumentos mais acentuados entre mulheres. A obesidade atingirá 28,3% — mais de um em cada quatro brasileiros —, enquanto o diabetes crescerá 47,3%, chegando a 10,9% da população. A hipertensão também avançará.
A pesquisadora Jacqueline Wahrhaftig enquadra o problema como uma questão de vontade política e desigualdade. O tabaco foi vencido porque havia pressão contínua e tributação consistente. O álcool não tem esse arcabouço. E para frutas, vegetais e atividade física, a legislação não basta: quem trabalha longas horas em bairros sem parques, com salário que torna o alimento fresco um luxo, não pode simplesmente escolher saúde. O ambiente decide.
As projeções não são inevitáveis. Se o Brasil fortalecer a regulação do álcool, retomar os ajustes tributários sobre o tabaco, tornar a alimentação saudável acessível e ampliar espaços públicos de exercício, a trajetória pode mudar. O estudo é, acima de tudo, um aviso: as políticas que funcionaram estão perdendo impulso, e os problemas que crescem mal foram enfrentados.
A research team at the Federal University of São Paulo has mapped out Brazil's health future through 2030, and the picture is starkly divided. The good news arrives first: smoking will plummet. The bad news follows close behind: everything else is about to get worse.
The study, published this month in The Lancet Regional Health, draws on nearly 650,000 survey responses collected between 2009 and 2023 through Vigitel, an annual telephone survey of health risk factors conducted across Brazil's state capitals. Researchers from the university's Chronic Disease Epidemiology Research Center and the Health Ministry used this data to project how Brazilians will fare against the country's own health targets for the coming decade.
On tobacco, Brazil is winning. Smoking rates are expected to fall from 9.8 percent in 2019 to 4.7 percent by 2030—not just meeting the government's 40 percent reduction goal, but crushing it by more than 30 percentage points. Sugary beverages tell a similar story. Consumption is projected to collapse from 15 percent to 3.2 percent, exceeding the 30 percent reduction target by 162 percent. These victories reflect decades of policy work: advertising bans, taxes, smoke-free spaces, graphic health warnings on cigarette packs. The infrastructure of tobacco control, built over years, is working.
But the researchers found something troubling lurking in the recent data. Between 2015 and 2023, the rate of improvement began to flatten. For tobacco, the stagnation is especially visible: there has been no adjustment to cigarette taxes since 2016, and the most recent Vigitel survey from 2024 already shows smoking rates ticking back up. The same hesitation appears with sugary drinks. Without continued policy pressure, these gains could evaporate.
Everything else is moving in the wrong direction. Excessive episodic alcohol consumption—binge drinking—will rise from 18.8 percent to 21.3 percent, with sharper increases among women. The researchers cite weak enforcement of alcohol pricing and marketing rules as culprits. Obesity will surge to 28.3 percent, meaning more than one in four Brazilians will be obese, a 29.4 percent increase when the government's goal is to stop growth entirely. Diabetes prevalence will jump 47.3 percent to 10.9 percent. High blood pressure will climb from 24.5 percent to 27.3 percent.
The modest gains in fruit and vegetable consumption—rising from 22.9 percent to 24.5 percent—will still fall far short of targets, reaching only 23 percent of the goal. Leisure-time physical activity will inch up from 39 percent to 45.3 percent, still leaving the country at barely half its target.
Jacqueline Wahrhaftig, a doctoral researcher and author of the study, frames the problem as one of policy momentum and inequality. Tobacco control succeeded because it had sustained political will and consistent taxation. Alcohol reduction has no such framework. Fruit and vegetable consumption, physical activity—these depend on something harder to legislate: access. A person working long hours in a neighborhood without parks, earning a wage that makes fresh food a luxury, cannot simply choose health. The environment decides.
This is not a prediction set in stone. Wahrhaftig emphasizes that the projections assume current trends continue. If Brazil strengthens alcohol regulation, adjusts tobacco taxes again, makes healthy food affordable, and builds public spaces for exercise, the trajectory could shift. But the study is also a warning: the policies that worked are losing momentum, and the problems that are growing have barely been addressed.
Notable Quotes
Recent data shows signs of stagnation in tobacco and sugary drink improvements, closely tied to policy stagnation. Tobacco tax rates haven't been adjusted since 2016, and the most recent survey already detected a rise in smoking.— Jacqueline Wahrhaftig, study author and doctoral researcher at Federal University of São Paulo
This is a complex, multifactorial scenario involving access. When we talk about fruit and vegetable consumption and physical activity, the environment matters greatly. A person working fewer hours, living in areas with more exercise spaces, with higher purchasing power, will be able to acquire healthier foods and exercise more.— Jacqueline Wahrhaftig
The Hearth Conversation Another angle on the story
Why does Brazil seem to be winning on smoking but losing on everything else?
Because tobacco control had a long political runway. Decades of consistent policy—taxes, advertising bans, graphic warnings—created a system that works. But that system is now coasting. There's been no tax increase since 2016, and you're already seeing smoking rates creep back up.
And alcohol? Why is that harder to tackle?
There's no equivalent infrastructure. Pricing rules exist on paper but aren't enforced. Marketing restrictions have gaps. It's almost like the country built a fortress around cigarettes but left the door open for beer and spirits.
What about the obesity and diabetes numbers? Those are alarming.
They are. And they're connected to the same root problem—access. Healthy food costs more. Safe places to exercise are scarce in poor neighborhoods. A person working two jobs can't afford the time or the money for the life the health targets assume.
So this is really a story about inequality?
It's a story about what policy can and cannot do. Tobacco control worked because it taxed a product and restricted its marketing. You don't need to be rich to quit smoking. But telling someone to eat more vegetables when vegetables cost three times what processed food costs—that's a different kind of problem.
The study says these are projections, not certainties. What would have to change?
Everything. Stronger alcohol regulation. Tobacco taxes adjusted again. Subsidies for healthy food. Public investment in parks and gyms in poor neighborhoods. The study is saying: if you keep doing what you're doing, this is where you'll end up. But you don't have to keep doing what you're doing.