FIFTY YEARS on, the war on smoking can look back and claim a huge victory. Nearly half of the country used to smoke. Now less than a fifth of the country does. Some say that public health advocates have done enough; let those who still choose to light up, disproportionately from poor and vulnerable communities, smoke away their lives in peace. We disagree. It’s time for more taxes, more regulation and more outreach.
“Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking outweighs all other factors; and the risk of developing lung cancer increases with the duration of smoking and number of cigarettes smoked per day, and diminishes by discontinuing smoking.”
Today, these lines seem obvious. Fifty years ago, when they appeared in the surgeon general’s first report on smoking’s health effects, they were revolutionary.
Today, we know that smoking and secondhand smoke cause so many health problems across so much of the body that the benefits from the drop in use, accumulated across so many lives, are incalculable. Millions who quit or never started smoking breathe easier, suffer fewer strokes, get fewer cases of lung cancer, pass on fewer birth defects and take fewer sick days.
A new study in the Journal of the American Medical Association attempts at least to calculate the number of premature deaths prevented since 1964 by changing the public’s view of the habit. Based on the assumption that smoking patterns would have continued without a decades-long public health push, the researchers estimated that tobacco-control programs have saved 8 million lives in the past five decades. Should the country forgo the opportunity to save millions more?
Of course not. Plenty of sensible measures that stop short of banning cigarettes but effectively discourage their use are not consistently applied in the United States. The most obvious is taxing cigarettes. Rates vary drastically by state , leading to interstate smuggling. The federal government should raise its excise tax, bringing laggard states closer to those that do the right thing, reducing the opportunity for criminals and increasing incentives not to smoke. If Congress doesn’t act, individual states with low taxes, such as Virginia, should. Similarly, states and localities without strong indoor smoking restrictions should bring them in line with others’ stronger rules.
The Food and Drug Administration, meanwhile, has a range of authorities over tobacco products that it should exercise with ambition. Perhaps the most promising is the possibility that requiring tobacco companies to reduce the amount of nicotine in their products will usefully cut their addictive quality.
Consumer choice might help, too. Electronic cigarettes appear to offer the hopelessly addicted a safer alternative to combustible tobacco products, and smokers’ increasing use of these indicates significant demand for this sort of product. If federal regulation, public education and other efforts combine smartly with smokers’ desire to stop lighting up, e-cigarettes might be a useful tool to reduce harm rather than a gateway to a life of smoking.