Tobacco At A Crossroads: Opportunity to Translate Progress into Fundamental Change

 Matthew L. Myers
President
Campaign for Tobacco-Free Kids

Forty-two years after the Surgeon General’s first report conclusively linking tobacco to lung cancer and other serious diseases, tobacco remains the number one preventable cause of premature death and disease in the United States.  Last year, tobacco killed over 400,000 Americans and close to 5 million people worldwide.  If current trends continue, the American Cancer Society projects that one billion people worldwide will die from tobacco this century. 

Today, we are at a crossroads.  Despite the magnitude of the problem, we have made progress.  In the United States, youth smoking rates have plummeted from 36.4 percent in 1997 to 23 percent in 2005.  Over the same period, adult smoking rates have declined from 24.7 percent to 20.9 percent.   These successes have caused some to think the tobacco problem has been solved.  There are others who believe that the programs to complete the job are in place and that it is time to turn their attention to other problems.  The progress that has been made in the United States and elsewhere has been the result of a sustained, substantial, multifaceted approach, and future progress will take place only if there is no reduction in our effort and focus.  

Following the release of the first Surgeon General's report in 1964, many Americans quit smoking because of increased awareness of the health effects of tobacco.  However, the public health community’s increased level of activism in the promotion of scientifically-proven, population-based approaches is primarily responsible for reduced tobacco use over the last decade. 

Whether progress continues, stalls or regresses depends on whether individuals, communities and organizations strongly support the tactics that work to reduce smoking in the coming years.    

There is no faster, more efficient or more effective way to reduce tobacco use than to substantially raise the price of tobacco products through increased tobacco tax.   A ten percent increase in the price of tobacco products results in a three to five percent decline in adult tobacco consumption and has a greater impact on children.   In the last four years, 43 states and the District of Columbia have implemented or passed 64 separate cigarette tax increases increasing the average state tax rate from 43.4 cents to 96.1 cents per pack.  Some tobacco tax increases fund tobacco prevention and cessation activities, expand health insurance for children and provide funds for the prevention and treatment of chronic diseases.  Unfortunately, the revenue generated from tobacco tax increases more frequently has been used to fill budget holes and not address health problems.  While tobacco taxes remain popular, the pace of increases has been slowing.  In 2006, only four states increased their tax on tobacco products so far with tobacco tax increases on the ballot in two other states.  Equally importantly the tobacco industry has often countered the impact of tobacco tax increases through major discounting of the most popular cigarette brands. 

State and community enactment of strong smoke-free laws has also impacted tobacco use.  These efforts received a powerful boost by the 2006 Surgeon General’s report conclusive findings that secondhand smoke causes serious diseases.  Today, 14 states have passed smoke-free laws that include restaurants and bars, two states have smoke-free laws that exempt stand-alone bars only and hundreds of cities and counties have strong smoke-free laws.   Smoke-free laws both protect nonsmokers from the risks of secondhand smoke and prompt many smokers to quit, however, the majority of Americans still do not live in jurisdictions with smoke-free laws.   While smoke-free laws are widely popular, the tobacco industry and its allies continue to resist their enactment. 

Public education and marketing efforts integrated with community-based programs can quickly and substantially reduce tobacco use.  Programs in Washington, Minnesota, Ohio, Indiana, Florida, Mississippi, Maine, Massachusetts, California, Oregon, Arizona and New York have all reduced tobacco use rates and increased cessation rates, as has  the American Legacy Foundation's hard-hitting mass media campaign,  Truth©.   However, only fifteen states currently fund tobacco prevention at half the minimum levels recommended by the CDC,  five states allocate no significant state funds to tobacco prevention and cessation, and funding for the Truth© campaign has been cut.   Funding for Truth© needs to be restored, and states need to increase funding for such effective programs and make a long term financial commitment to them.

Unless addressed globally, the public health toll from tobacco cannot be conquered.  If action is not taken to alter current tobacco use trends, tobacco will eventually kill about 650 million smokers alive today.  Progress globally will take place only if the 140 nations that have ratified the World Health Organization Framework Convention on Tobacco Control implement it fully and aggressively.  There is much the United States can do in this effort.    While the United States is a world leader in public health, it is also a large exporter of tobacco and tobacco products.   Ratification of the Framework Convention on Tobacco Control by the U.S., while providing funding for poorer nations to help implement the treaty, would be an important step in the right direction, as would U.S. support for efforts  to curtail the tobacco industry's continued marketing practices to promote tobacco use, particularly among children.   Our country could also serve as a role model by providing the U.S. Food and Drug Administration with authority over tobacco products comparable to the authority it exercises over food and drugs. 

To meet our Healthy People 2010 goals, we must continue to tackle the problem of tobacco. While changes in public attitudes about tobacco and the declines in tobacco use over the last 10 years have reduced tobacco use, fundamental change is not assured.  Continued success depends upon insuring that our governmental leaders adopt the policies and fund the programs that have been proven to save lives. The question is – will the public health community and its supporters continue to push for these changes, so we as a nation translate the solutions we now know work into action.  Literally, millions of lives are at stake.

For more information about how you can take action against tobacco use, go to www.tobaccofreekids.org.