Ever since school started, I’ve been bombarded with emails about various talks happening around campus. The University has high-profile speakers visiting campus on a regular basis, such as the EPA Administrator. Sometimes, we’re lucky enough to call them our own. On Monday, October 7, I attended a talk at the Ford School of Public Policy by Professor Ken Warner, hosted by CLOSUP, the Center for Local, State, and Urban Policy. Not only has he been a professor for over 40 years, he was also dean of the School of Public Health from 2005 to 2010 and calling him an expert in tobacco control policy and economics doesn’t even begin to describe his work in the field. He’s also a really funny guy.
Dr. Warner taught the first public health class that I took as an undergraduate, Introduction to Public Health (HMP 200). The class was as interesting as the talk he gave on Monday, which was about the history and future of tobacco control in the United States. Several takeaways from the talk:
The anti-smoking campaign has been arguably the most successful public health initiative in the United States in recent history. Since the first Surgeon General’s report about the risks of smoking was released in 1964, tobacco control has prevented an estimated 10 million premature deaths, and life expectancy was increased by an average of 20 years for each of these lives saved. These figures are from a paper that Dr. Warner will be submitting for review very soon. Dr. Warner told the crowd that when he started in 1972, about half of SPH faculty smoked in their offices!
Smoking is still a huge problem. Despite the successes of tobacco control, it is the greatest remaining burden of preventable death and illness–obesity doesn’t even come close. Even at current rates of smoking, there are hundreds of thousands of premature deaths every year.
There are many approaches to prevent initiation and induce cessation of smoking. Some work, some don’t. Techniques used over the past 50 years include advertisements and media campaigns, steep cigarette taxes, smoke-free laws, and warning labels on cigarette boxes. The Truth Campaign (which is returning) was the second most effective tool to prevent smoking. Many people my age will remember seeing these ads on TV as kids and teens. The most effective tool? Increasing the price of cigarettes with ever-higher taxes. Current warning labels haven’t proven to be effective.
Tobacco control is at a standstill… According to a model by Dr. Warner and Dr. David Mendez, smoking rates will decrease to and remain at about 14% in the United States (from 18% in 2012) by 2050 if nothing changes–that is, people will continue to start and quit smoking at about the same rate that they do today, due to tobacco control efforts. We must increase our efforts if we want this number to keep declining.
…but there is hope. More and more states, municipalities, and universities are going smoke-free. Media campaigns have returned, a new design for cigarette boxes is in the works, and we can always keep increasing the taxes on cigarettes. There’s a flood of new products on the horizon–e-cigarettes, nicotine inhalers, and snus, a tobacco product that has been used for decades in Sweden. The health risks from snus are significantly lower than those from cigarettes. Funny enough, snus became the preferred form of tobacco in Sweden several decades ago due to a lower tax rate than cigarettes.
There are ideas about tobacco control from home and abroad. In other countries, the government regulates the cigarette supply (Australia, Canada, New Zealand) or bans the possession of cigarettes by people born after a certain year (Singapore) to create a “smoke-free generation”. Some ideas bouncing around in the United States include reducing nicotine to non-addictive levels and even “prohibition lite”, or banning combustible tobacco products (when tobacco is burned, it exposes users to a lot more dangerous chemicals), with an eventual, “complete” prohibition.
Success is not clearly defined. When can we declare ourselves victorious? When the smoking rate reaches 10%? 5%? 0% (not exactly possible, according to Dr. Warner)? When we eliminate nicotine addiction? When we minimize harm and tobacco use?
We can’t predict the future, but we know what we need maintain a successful tobacco control system. We don’t know when we will achieve any of the goals above. But to even have a shot at being successful, we need creativity, energy, and resources. What we may lack in the future is leadership and public interest. The generation that is to take the reins of tobacco control may not view tobacco control as a pressing issue because smoking isn’t everywhere.