[Health transition in Tunisia over the past 50 years]

We describe the dramatic demographic, socioeconomic and health changes witnessed in Tunisia over the past 50 years. Demographically, the gross mortality rate and the infant mortality rate have gone from 19 per 1000 and 150 per 1000 respectively in 1956 to 5.7 per 1000 and 26.2 per 1000 now, and life expectancy at birth going from 50 to 72 years for the same period. Socioeconomically, the urban population has risen from 25% to 62%, the literacy rate from 15% to 73%, and the per capita income has increased 5-fold in real terms. Epidemiologically, the infectious and perinatal diseases prevailing in the 1960s have decreased whereas chronic and degenerative diseases have risen. The proportion of the GNP related to health expenditure has risen from 3.8% to 6.2%. The implication of these changes on the Tunisian health system and the need to adapt in terms of curative care and prevention of risks are discussed

[Trends in tobacco consumption in Tunisia]

Because tobacco-related diseases are a growing health problem, we assessed tobacco smoking in Tunisia since 1970 using different sources. The average consumption of tobacco calculated over the period of 10 years [1981-90] was 1493 g per person and per year; equivalent of 75 packets of cigarettes. Cigarettes are the most popular form of tobacco smoking. Cigarette smoking increased from 1981 to 1993 but since has decreased slightly. According to a national study of respiratory diseases conducted in 1996, the current prevalence of tobacco smoking is 30.4% for both sexes: around 52% for males and 6% for females. Average consumption is 17.7 cigarettes/day, irrespective of sex. For young people, the prevalence is 29.21%: 50% for males and 3.9% for females. Young people who attend school smoke less than those who do not [18.1% versus 38.4%]. Most started smoking between 14 years and 18 year