It’s probably my earliest public health memory — the image of Surgeon General C. Everett Koop and his grandfatherly beard on the television warning my elementary school self about the dangers of smoking. He was the first doctor I knew by name.
But while Koop may be the surgeon general that people of my generation most likely associate with the public health movement to reduce smoking, he wasn’t the first to speak out against tobacco. Koop was carrying on a legacy that began decades before with the nation’s ninth surgeon general, Luther Terry, who on Jan. 11, 1964, released the first surgeon general’s report on smoking and health and said unequivocally: “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” On the 50th anniversary of that declaration, public health advocates are celebrating hard-fought declines in the smoking rate and warning that it’s no time to retreat.
“We have made enormous progress in the past 50 years, preventing millions of deaths and tens of millions of illnesses,” said Centers for Disease Control and Prevention Director Tom Frieden. “But we have much further to go — tobacco remains, by far, the single leading preventable cause of death in the United States and the world.”
In that first surgeon general’s report, the authors wrote:
In the early part of the 16th century, soon after the introduction of tobacco into Spain and England by explorers returning from the New World, controversy developed from the differing opinions as to the effects of the human use of the leaf and the products derived from it by combustion or other means. Pipe-smoking, chewing and snuffing of tobacco were praised for pleasurable and reputed medicinal actions. At the same time, smoking was condemned as a foul-smelling, loathsome custom, harmful to the brain and lungs. The chief question was then as it is now: is the use of tobacco bad or good for health or devoid of effects on health? Parallel with the increasing production and use of tobacco, especially with the constantly increasing smoking of cigarettes, the controversy has become more and more intense. Scientific attack upon the problems has increased proportionately. The design, scope and penetration of studies have improved and the yield of significant results has been abundant.
Considering that this report is just 50 years old, it’s amazing how much public health has achieved (and keep in mind how enormously difficult it is to change people’s behavior, especially when public health has been continuously and enormously outspent by tobacco marketers). In fact in 1999, CDC ranked the declines in smoking and the lives saved as one of the greatest public health achievements of the 20th century. According to the agency, smoking rates declined from more than 42 percent in 1965 to less than 25 percent in 1997, and the percentage of adults who never smoked went up from 44 percent to 55 percent. About half the country is now protected by smoke-free workplace laws.
A more recent study published Jan. 8 in the Journal of the American Medical Association found that tobacco control efforts (education, cigarette taxes, smoke-free laws, media campaigns, sales and marketing restrictions, and cessation programs) have saved 8 million lives in the last five decades, with more than half of the lives saved younger than 65. In all, a gain of 157 million years of life is associated with tobacco control efforts. Without tobacco control, the study found that life expectancy among both men and women would be shorter by two to four years.
Still, more than 40 million adults and 3 million youth smoke in the U.S., and tobacco use results in hundreds of billions of dollars in medical costs and lost productivity. Worldwide, it’s estimated that 1.3 billion people smoke and 4.9 million people die every year from tobacco-related disease. On top of that, tobacco companies still spend billions on advertising every year — $8.37 billion on cigarette marketing in 2011 in the U.S. alone. At the same time, state spending on tobacco prevention doesn’t meet CDC recommendations. For example, officials estimated that although states collected more than $25 billion in tobacco taxes and legal settlements in 2013, lawmakers spent less than 2 percent of that on cessation and prevention. Plus, public health agencies continue to struggle with tight budgets and service cuts (see our previous coverage of how budget cuts are affecting health department tobacco efforts here).
In other words, there’s no doubt that continued tobacco use prevention is a steep climb. Luckily, public health folks aren’t used to easy victories.
“We still have an industry that continues to sell a product that we know is harmful and from which children are at enormous risk,” said Georges Benjamin, executive director of the American Public Health Association. “This anniversary marks an important public health success, yet we need to make sure the victory we celebrate today is not hollow.”
Since that first surgeon general’s report in 1964, 30 additional surgeon general reports have been released on the dangers of tobacco and secondhand smoke, and another is expected this year.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.