By Ronald Dunlap, M.D., President, Massachusetts Medical Society
Fifty years ago this month, Luther Terry, M.D. issued the U.S. Surgeon General’s first report on smoking and health, marking the start of the nation’s campaign against tobacco. It is arguably the most important public health document ever published: it called attention to the destructive nature of a product that nearly half of the U.S. population at the time used routinely and without fear.
Since 1964, 36 additional reports on the subject have followed, many establishing clear and convincing connections between tobacco, diseases such as cancer and heart disease, and nicotine addiction.
On Friday of this week, the Surgeon General will issue a 37th report: 50 Years of Progress; it will highlight the successes of anti-tobacco efforts over five decades, present new data on tobacco’s health impact, and suggest ways to end the tobacco epidemic in the U.S.
The anniversary of the first report has attracted great attention, as it should. Newspapers large and small, from The Washington Post to the Cape Cod Times, have published editorials on its meaning, and the Associated Press has even returned to its archives, distributing its first account of the event from 1964.
The anniversary reminds us that we have much to celebrate. We have cut the adult smoking rate from 43 percent in 1964 to 18 percent today. Per capita consumption of cigarettes has dropped by 70 percent. The incidence of lung cancer has declined, as have deaths from heart disease and stroke.
Many elements have led to this stunning reduction in tobacco use. Prevention and treatment strategies, such as approved medications for tobacco addiction and toll-free quit lines, have proved fruitful. So, too, have warnings on cigarette packages, limits on advertising, higher tobacco taxes, and laws restricting tobacco use in public venues. And new efforts are occurring: communities are raising the age to buy tobacco and prohibiting health facilities like pharmacies from selling tobacco products.
This latest Surgeon General’s report, however, also serves as a warning.
Tobacco in 2014 is still the leading cause of preventable disease and premature death in the U.S. The Centers for Disease Control estimates that nearly 44 million American adults still smoke, and each year, tobacco use accounts for some 443,000 deaths. It also claims a huge part of our nation’s annual health care expense – at $96 billion in direct medical costs. Globally, according to the World Health Organization, tobacco accounts for some five million deaths a year, and kills more people than tuberculosis, HIV/AIDS, and malaria combined.
Today’s concern is greatest with youth, as nearly all tobacco use begins in childhood and adolescence. Every day, more than 1,000 youth under 18 become daily cigarette smokers. Adolescents and young adults are susceptible to social influences to use tobacco, and the targeted marketing techniques by tobacco companies appeal to them. The young are also more likely to use multiple tobacco products, and smokeless tobacco and new products such as flavored cigars and electronic present additional challenges. Indeed, the Surgeon General’s 2012 report – the first to explore tobacco data on young adults as a discrete population – has described tobacco use as a “pediatric epidemic, around the world as well as in the United States.”
Other vulnerable populations with high rates of tobacco addiction demand our attention as well: recent immigrants, the LBGT community, and individuals with mental illness, the last of whom, remarkably, consume about 44 percent of all cigarettes in the U.S.
To help draw attention to the topic locally, MMS has produced Smoking, Tobacco, and Health, the January episode of our patient education television program, Physician Focus.
Featuring Alan Woodward, M.D., MMS past president and current chair of Tobacco Free Mass, and Douglas Ziedonis, M.D., M.P.H., professor and chair of the Psychiatry Department at UMass Memorial Health Care and UMass Medical School, and hosted by James Kenealy, M.D., the program has been widely distributed across the Commonwealth and is available online. It examines the impact of tobacco on personal and public health, looks at what can be done to further reduce the use of tobacco, discusses new challenges such as e-cigarettes, and offers ways for people to quit smoking.
The program also includes a one-minute public service announcement on youth and tobacco recorded especially for MMS by Howard Koh, M.D., Assistant Secretary for Health in the U.S. Department of Health and Human Services and former Massachusetts Commissioner of Public Health.
I thank these physicians for their efforts and invite you to view their presentations at www.physicianfocus.org/tobacco, not so much as a reminder of the success we’ve achieved, but more as a notice of the work we have yet to do.
The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.
Editor’s note: The U.S. Surgeon General’s latest report, The Health Consequences of Smoking: 50 Years of Progress, was issued Friday, January 17, and the full report is available here. An Executive Summary is located here. The Surgeon General has also produced a Consumer Booklet, available here.