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US is marking 50th anniversary of surgeon general report that turned the tide against smoking

Article by: MIKE STOBBE , Associated Press
ATLANTA — Fifty years ago, ashtrays seemed to be on every table and desk. Athletes and even Fred Flintstone endorsed cigarettes in TV commercials. Smoke hung in the air in restaurants, offices and airplane cabins. More than 42 percent of U.S. adults smoked, and there was a good chance your doctor was among them.
The turning point came on Jan. 11, 1964. It was on that Saturday morning that U.S. Surgeon General Luther Terry released an emphatic and authoritative report that said smoking causes illness and death — and the government should do something about it.
In the decades that followed, warning labels were put on cigarette packs, cigarette commercials were banned, taxes were raised and new restrictions were placed on where people could light up.
“It was the beginning,” said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.
It was not the end. While the U.S. smoking rate has fallen by more than half to 18 percent, that still translates to more than 43 million smokers. Smoking is still far and away the leading preventable cause of death in the U.S. Some experts predict large numbers of Americans will puff away for decades to come.
Nevertheless, the Terry report has been called one of the most important documents in U.S. public health history, and on its 50th anniversary, officials are not only rolling out new anti-smoking campaigns but reflecting on what the nation did right that day.
The report’s bottom-line message was hardly revolutionary. Since 1950, head-turning studies that found higher rates of lung cancer in heavy smokers had been appearing in medical journals. A widely read article in Reader’s Digest in 1952, “Cancer by the Carton,” contributed to the largest drop in cigarette consumption since the Depression. In 1954, the American Cancer Society announced that smokers had a higher cancer risk.
But the tobacco industry fought back. Manufacturers came out with cigarettes with filters that they claimed would trap toxins before they settled into smokers’ lungs. And in 1954, they placed a full-page ad in hundreds of newspapers in which they argued that research linking their products and cancer was inconclusive.
It was a brilliant counter-offensive that left physicians and the public unsure how dangerous smoking really was. Cigarette sales rebounded.
In 1957 and 1959, Surgeon General Leroy Burney issued statements that heavy smoking causes lung cancer. But they had little impact.
Amid pressure from health advocates, President John F. Kennedy’s surgeon general, Dr. Luther Terry, announced in 1962 that he was convening an expert panel to examine all the evidence and issue a comprehensive, debate-settling report. To ensure the panel was unimpeachable, he let the tobacco industry veto any proposed members it regarded as biased.
Surveys indicated a third to a half of all physicians smoked tobacco products at the time, and the committee reflected the culture: Half its 10 members were smokers, who puffed away during committee meetings. Terry himself was a cigarette smoker.
Dr. Eugene Guthrie, an assistant surgeon general, helped persuade Terry to kick the habit a few months before the press conference releasing the report.
“I told him, ‘You gotta quit that. I think you can get away with a pipe — if you don’t do it openly.’ He said, ‘You gotta be kidding!’ I said, ‘No, I’m not. It just wouldn’t do. If you smoke any cigarettes, you better do it in a closet,'” Guthrie recalled in a recent interview with The Associated Press.
The press conference was held on a Saturday partly out of concern about its effect on the stock market. About 200 reporters attended.
The committee said cigarette smoking clearly did cause lung cancer and was responsible for the nation’s escalating male cancer death rate. It also said there was no valid evidence filters were reducing the danger. The committee also said — more vaguely — that the government should address the problem.
“This was front-page news, and every American knew it,” said Robin Koval, president of Legacy, an anti-smoking organization.
Cigarette consumption dropped a whopping 15 percent over the next three months but then began to rebound. Health officials realized it would take more than one report.
In 1965, Congress required cigarette packs to carry warning labels. Two years later, the Federal Communications Commission ordered TV and radio stations to provide free air time for anti-smoking public service announcements. Cigarette commercials were banned in 1971.
Still, progress was slow. Warner recalled teaching at the University of Michigan in 1972, when nearly half the faculty members at the school of public health were smokers. He was one of them.
“I felt like a hypocrite and an idiot,” he said. But smoking was still the norm, and it was difficult to quit, he said.
The 1970s also saw the birth of a movement to protect nonsmokers from cigarette fumes, with no-smoking sections on airplanes, in restaurants and in other places. Those eventually gave way to complete smoking bans. Cigarette machines disappeared, cigarette taxes rose, and restrictions on the sale of cigarettes to minors got tougher.
Tobacco companies also came under increasing legal attack. In the biggest case of them all, more than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths.
In 1998, while the settlement was being completed, tobacco executives appeared before Congress and publicly acknowledged for the first time that their products can cause lung cancer and be addictive.
Experts agree the Terry report clearly triggered decades of changes that whittled the smoking rate down. But it was based on data that was already out there. Why, then, did it make such a difference?
For one thing, the drumbeat about the dangers of smoking was getting louder in 1964, experts said. But the way the committee was assembled and the carefully neutral manner in which it reached its conclusion were at least as important, said Dr. Tim McAfee, director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.
At the same time, he and others said any celebration of the anniversary must be tempered by the size of the problem that still exists.
Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and 8.6 million live with a serious illness caused by smoking, according to the CDC.
Donald Shopland finds that depressing.
Fifty years ago, he was a 19-year-old who smoked two packs a day while working as a clerk for the surgeon general’s committee. He quit cigarettes right after the 1964 report came out, and went on to a long and distinguished public health career in which he wrote or edited scores of books and reports on smoking’s effects.
“We should be much further along than we are,” the Georgia retiree lamented.
http://www.startribune.com/lifestyle/health/238716101.html?page=all&prepage=1&c=y#continue

Triple tobacco taxes? Researchers say yes to save 200M lives

By Cheryl K. Chumley – The Washington Times
Tripling tobacco taxes would save 200 million smokers around the world from premature deaths over the course of the next century, researchers say.
That’s because the higher costs would make it nearly impossible for many to afford the habit and at the same time serve as a deterrent to youth from taking their first puffs, scientists said, AOL Money reported.
The scientists said they reviewed 63 different studies about the causes and effects of tobacco smoking around the world — and discovered a link between lower smoking statistics and higher priced product. Raising the price of cigarettes by 50 percent lowers the rate of smoking by about a fifth, the scientists found.
So now study authors suggest that prices of tobacco should be raised significantly, by boosting taxes of the product by three times the present amount.
“The two certainties in life are death and taxes,” said study co-author Professor Sir Richard Peto, from the nonprofit Cancer Research UK, in the AOL Money report. “We want higher tobacco taxes and fewer tobacco deaths. It would help children not to start, and it would help many adults to stop while there’s still time.”
They estimate the death rate could be cut by almost half if the tax rate increase is accepted.
“Globally, about half of all young men and one in 10 of all young women become smokers and, particularly in developing countries, relatively few quit,” Mr. Peto said, in AOL Money. “If they keep smoking, about half will be killed by it. But if they stop before 40, they’ll reduce their risk of dying form tobacco by 90 percent.”
The researchers say that in the European Union alone, 100,000 lives per year of those under the age of 70 could be saved by doubling the cost of cigarettes.
http://www.washingtontimes.com/news/2014/jan/2/triple-tobacco-taxes-researchers-say-save-lives/

Trebling [tripling] tobacco tax 'could prevent 200 million early deaths'

By: Kate Kelland, Reuters
LONDON (Reuters) – Trebling [tripling] tobacco tax globally would cut smoking by a third and prevent 200 million premature deaths this century from lung cancer and other diseases, researchers said on Wednesday.
In a review in the New England Journal of Medicine, scientists from the charity Cancer Research UK (CRUK) said hiking taxes by a large amount per cigarette would encourage people to quit smoking altogether rather than switch to cheaper brands, and help stop young people from taking up the habit.
As well as causing lung cancer, which is often fatal, smoking is the largest cause of premature death from chronic conditions like heart disease, stroke and high blood pressure.
Tobacco kills around 6 million people a year now, according to the World Health Organization (WHO), and that toll is expected to rise above 8 million a year by 2030 if nothing is done to curb smoking rates.
Richard Peto, an epidemiologist at CRUK who led the study, said aggressively increasing tobacco taxes would be especially effective in poorer and middle-income countries where the cheapest cigarettes are relatively affordable.
Of the 1.3 billion people around the world who smoke, most live in poorer countries where often governments have also not yet introduced smoke-free legislation.
But increasing tobacco tax would also be effective in richer countries, Peto said, citing evidence from France, which he said halved cigarette consumption from 1990 to 2005 by raising taxes well above inflation.
“The two certainties in life are death and taxes. We want higher tobacco taxes and fewer tobacco deaths,” he said in a statement. “It would help children not to start, and it would help many adults to stop while there’s still time.”
While smokers lose at least 10 years of life, quitting before age 40 avoids more than 90 percent of the increased health risk run by people who continue smoking. Stopping before age 30 avoids more than 97 percent of the risk.
Governments around the world have agreed to prioritize reducing premature deaths from cancer and other chronic diseases in the United Nations General Assembly and in the WHO’s World Health Assembly in 2013. They also agreed to a target of reducing smoking by a third by 2025.
The CRUK analysis found that doubling the price of cigarettes in the next decade through increased taxes would cut worldwide consumption by about a third by that target, and at the same time increase annual government revenues from tobacco by a third from around $300 billion to $400 billion.
This extra income, the researchers suggested, could be spent on boosting health care budgets.
Peto noted that the international tobacco industry makes about $50 billion in profits each year, saying this equated to “approximately $10,000 per death from smoking”.
“Worldwide, around half a billion children and adults under the age of 35 are already – or soon will be – smokers, and many will be hooked on tobacco for life. So there’s an urgent need for governments to find ways to stop people starting and to help smokers give up,” said Harpal Kumar, CRUK’s chief executive.
He said the study, which examined 63 research papers on the causes and consequences of tobacco use in many different countries, showed tobacco taxes are “a hugely powerful lever”.
They are also potentially a triple win, Kumar said, cutting the number of people who smoke and die from their addiction, reducing the health care burden and costs linked to smoking and at the same time increasing government income.
(Reporting by Kate Kelland; Editing by Janet Lawrence)
http://www.grandforksherald.com/event/article/id/281348/

Oregon cigarette tax goes up Jan. 1

Written by Peter Wong

Oregon’s cigarette tax will go up Jan. 1.
The actual tax is applied on individual cigarettes. The tax will go up from $1.18 to $1.31 on a standard pack of 20 cigarettes. It will be the first increase since 2004, when it actually dropped from $1.28 to $1.18 as the result of voter rejection of a ballot measure for a budget-balancing tax increase. It had been at $1.28 for a decade, but a 10-cent increment had to be renewed every two years, and expired in 2004.
Proceeds from cigarette taxes go to the Oregon Health Plan, the state general fund, and a special account for tobacco-use reduction. There are earmarked shares for cities, counties, special transportation for older people and people with disabilities, and now, mental health programs. Lawmakers added the latter category in a special session this year.
“Ordinarily, the consumer pays the tax as a part of the price when purchasing cigarettes from an Oregon retailer. Consumers must remember that they are responsible for filing and paying the tax on cigarettes purchased on-line or otherwise brought in from outside the state,” said Chris Wytoski, manager of Oregon’s tobacco tax program in the Department of Revenue.
There is also a $1.01 federal tax.
pwong@StatesmanJournal.com or (503) 399-6745 or twitter.com/capitolwong 
http://www.statesmanjournal.com/article/20131226/UPDATE/131226021/Oregon-cigarette-tax-goes-up-Jan-1

CHART OF THE DAY: How Cigarettes Became Bigger Than Spitting Tobacco 100 Years Ago

, Business Insider
These days, you can’t talk about tobacco without talking about the rise of e-cigarettes.
“By year-end 2013, the e-cigarette category is expected to have doubled to over $1B from $500MM in 2012, according to various industry sources,” noted RBC Capital analyst Nik Modi.
Still, e-cigarettes represent a very tiny fraction of the tobacco business.  Tobacco giant Lorillard recently said that e-cigarettes may have taken 1% of the U.S. cigarette volume.
However, there was once a time when the cigarette wasn’t the dominant product in the tobacco business.
“We point out that it took 45 years for tobacco consumers to transition from smokeless to cigarettes during the late 1800s and early 1900s,” added Modi. “The cigarette’s popularity among tobacco consumers as we know it today was helped by two key catalysts: 1) spitting tobacco was declared unsanitary and disease spreading, leading to spittoons being removed from public places in 1915; and 2) during the Second World War, soldiers were given cigarettes as part of their rations.”
The removal of spittoons a hundred years ago isn’t unlike the bans on smoking we see today.
Who knows where we’ll be 45 years from now?

cotd tobaccoRBC Capital Markets

http://www.businessinsider.com/historical-share-of-tobacco-2013-12#ixzz2nekV5FUw

Hike in city cigarette tax will cut smoking, save lives, health chief says

BY FRAN SPIELMAN, City Hall Reporter, Chicago Sun-Times
Mayor Rahm Emanuel’s controversial plan to raise the city’s cigarette tax by 75-cents-a-pack will persuade 5,500 adults to quit smoking and 6,400 kids not to take their first puff, a top mayoral aide claimed Tuesday.
Health Commissioner Dr. Bechara Choucair went on the offensive for the most controversial element of Emanuel’s 2014 budget, armed with what he called an “independent analysis” conducted by the Campaign for Tobacco-Free Kids.
It concluded that the 75-cents-a-pack tax that would leave Chicago with the nation’s highest combined state and local tax rate would persuade 6,400 kids “not to light up their first cigarette” and 5,500 adults to quit smoking.
The study further concluded that the tax would “save 3,500 lives long-term from premature death related to tobacco” and save the city $235 million in long-term health care costs.
Choucair and the Campaign for Tobacco-Free Kids are hardly unbiased observers.
But the commissioner’s impassioned defense of the $10 million-a-year sin tax that Emanuel wants to use to expand health care for kids was aimed at persuading aldermen to think twice before attempting to snuff out the tax.
“The cigarette tax is a proven public policy approach to save lives, to save health care dollars and add revenue,” Choucair said Tuesday during testimony at City Council budget hearings.
A veteran family physician, Choucair added, “I saw a lot of patients here in Chicago. I also saw patients in Houston. I saw patients in Rockford, Lebanon, Iraq Guatemala and Mexico. And the No. 1 reason as to why people are dying in all of these places is related to smoking. So we have the responsibility to act.”
South Side Ald. Toni Foulkes (15th) said she’s concerned that the added 75-cents-a-pack will drive up the use of unfiltered, roll-up cigarettes.
“A lot of seniors—mostly male—[who] can’t afford cigarettes and wouldn’t go out and purchase loose cigarettes go for the roll-ups,” Foulkes said.
“They’re already at high-risk. They already have pre-existing issues. What are some of the health risks because I think more people, now younger, would probably go to the roll-ups because it’s much cheaper to buy the tobacco.”
Choucair noted that people who live in low-income communities are four times more likely to quit because of higher taxes.
He added, “When it comes to tobacco—whether it’s with filter or without filter—poison is poison. … We really need to be aggressively addressing this. Big Tobacco tries to give us the impression that, if we have a filter, that it’s safer. The reality is, tobacco is tobacco and people will die from smoking tobacco.”
http://www.suntimes.com/news/metro/23553833-418/hike-in-city-cigarette-tax-will-cut-smoking-save-lives-health-chief-says.html
 
 
 
 
 
 
 
Downtown Ald. Brendan Reilly (42nd), a smoker, said expanding the eye-care program for kids is a “noble cause” he wholeheartedly supports.
 
But Reilly said he remains concerned about the “potential unintended negative consequences” for Chicago retailers.
 
“I wouldn’t encourage anyone to pick up smoking. It’s a stupid thing to do. I’m just concerned this could pose a potential boon for suburban retailers who are literally across the street from the city of Chicago and put some of our, especially gas station owners, at a competitive disadvantage,” Reilly said.
 
Reilly noted that politicians at all levels love to link an unpopular tax to a feel-good program to make the bitter pill easier to swallow.
 
But he noted that the eye-care program is likely to “grow over time” while the cigarette tax has a history of going in the opposite direction.
 
“The higher the tax, the expectation is fewer people will purchase cigarettes. My concern is that we may not have a stable revenue source to support a very good program that helps lots and lots of kids,” the alderman said.
 
Choucair replied, “Keep in mind that we’re investing $2 million for this vision program. Expected revenue from the cigarette tax is around $10 million. So, we’ll keep an eye definitely on the expected revenue from the cigarette tax.”
 
Emanuel’s plan to raise the city’s cigarette tax by 75-cents-a-pack remains a key sticking point in a relatively non-controversial budget.
 
Critics contend it will encourage people to stand on street corners hawking loose cigarettes, exacerbating a black market that’s already worse than the ones for marijuana, cocaine and heroin.
 
“The human costs are devastating. It creates an underground economy,” Ald. Roderick Sawyer (6th) said when City Council budget hearings opened last week.
 
Ald. Leslie Hairston (5th) warned that the nation’s highest combined state and local tax would “disproportionately impact communities of color” by “creating a very large black market” for smokes.
 
“The loose sale of single cigarettes. The sale of cigarettes without tax stamps, which leads to increased loitering. Which means people who might be involved in illegal activity are visible and on the street. If I’m in a rival gang, then I’m going to come by and then we have another shooting,” she said.
 
Emanuel has a history of tinkering at the margins of his budgets to appease aldermen. But if the $10 million cigarette tax hike was thrown in as a bargaining chip to be dealt away, the mayor has not yet tipped his hand.
 
“Two years ago, the state increased the cigarette tax by $1. Last year, the county increased it by $1. We’ve increased it 75 cents and we’re putting it towards improving the health care of our children. That’s the right type of investment. And I think it’s the right step, because it also reduces health care costs for those associated with smoking,” the mayor said last week.

Maryland should hike tobacco taxes again

By , Washington Post

BOOSTING TAXES on cigarettes is an effective way to cut smoking rates among adults and, even more, among those college-age and younger, along with tobacco-related disease and death. A case in point is Maryland, where the incidence of smoking fell by a third from 1998 to 2010, a period during which the state more than quintupled its cigarette tax.
By the same token, states that have allowed cigarette levies to remain low, under the sway of Big Tobacco or anti-tax sentiment, generally suffer from higher smoking rates and the resulting impact on public health. Virginia’s cigarette tax is second-lowest in the nation, after Missouri’s; it is an example of a state that extends its smokers a license to kill — themselves.
Pleased with the results in Maryland, anti-
tobacco advocates want to build on their success. On the merits, they have an easy case to make. After the state doubled its levy in 2008, to $2 per pack, cigarette sales dropped sharply. Now advocates want to raise the per pack tax again, to $3. Lawmakers should take note.
Higher taxes are particularly effective in cutting tobacco use among younger smokers, whose habits are less entrenched and who are more sensitive to price. As a direct result of the 2008 tax increase, youth smoking rates plummeted by almost a third in two years. In 2009, just 12 percent of Maryland youths were smokers, compared with a national rate of almost 20 percent.
And while adult smokers are somewhat less sensitive to price increases, Maryland’s 2008 tax hike helped cut the number of adult smokers by about 13 percent.
Complacency is the wrong course of action. Anti-tobacco advocates point out that following the big drop after 2008, smoking rates in Maryland have started to inch up again over the past few years. That coincides with an 80 percent cut in spending on the state’s main anti-smoking program, which aims to help people to quit or not start in the first place. Despite its relatively high tax rate on cigarettes, Maryland ranks just 34th nationally among the states in spending on its anti-smoking program.
Each of the three increases in Maryland’s cigarette tax over the past dozen years has been followed immediately by a sharp drop in sales. True, some Maryland smokers may simply cross the border to buy their cartons in low-tax Virginia. But more have quit or cut back, as state-by-state smoking rates suggest.
The tobacco lobby remains strong enough to push back against further increases. In Annapolis, a bill this year to raise the state’s per-pack tax to $3 died in committee. A similar effort in the legislative session starting in January may suffer the same fate. Anti-smoking advocates are focusing their efforts on the next year or two in the legislative calendar. They should be helped both by the counter-example of Virginia — and by the facts.
Washington Post Editorials –  Editorials represent the views of The Washington Post as an institution, as determined through debate among members of the editorial board. News reporters and editors never contribute to editorial board discussions, and editorial board members don’t have any role in news coverage.
http://www.washingtonpost.com/opinions/maryland-should-hike-tobacco-taxes-again/2013/11/03/820e5ffc-433b-11e3-a624-41d661b0bb78_story.html

Maryland cigarette sales down 17% since tobacco tax hike, report says

, Reporter-Baltimore Business Journal
The number of cigarette packs sold in Maryland has declined 17 percent since 2008, according to a new report released Wednesday by a health care advocacy group.
A total of 200 million packs of cigarettes were sold in Maryland in fiscal 2012, down from 243 million in 2008, according to data compiled by Maryland Citizens’ Health Initiative that analyzes data from the national Campaign for Tobacco-Free Kids. The report is intended to highlight improvements in combatting smoking among teens and adults since Maryland raised a tax on cigarette packs in 2008 to $2.
The report comes as the Citizens’ Health Initiative and other health care organizations prepare to lobby for another $1 increase on the cigarette tax. If successful in the Maryland General Assembly, the tax would rise to $3 a pack.
The total number of cigarette packs sold in Maryland has been declining for more than a decade, according to the report. Back in 1995, 389 million packs of cigarettes were sold in the state.
Maryland’s General Assembly in 2012 increased the tax on mini cigars (which come in fruit flavors and have become popular among teenagers) to 70 percent of wholesale price, up from 15 percent. The assembly also increased the tax on smokeless tobacco to 30 percent of wholesale price, up from 15 percent.
In the assembly’s next session, which starts in January, health advocates will also be seeking another increase to the tax on smokeless tobacco and mini cigars.

City Council to Vote on Raising Cigarette Purchase Age

In the latest move to snuff out smoking in New York, the City Council could vote Wednesday to bar anyone under the age of 21 from buying cigarettes and e-cigarettes.

Under federal law, no one under 18 can buy tobacco anywhere in the country, but some states and localities have raised it to 19.

Public health advocates say a higher minimum age discourages, or at least delays, young people from starting smoking and thereby limits their health risks. But opponents of such measures have said 18-year-olds, legally considered adults, should be able to make their own decisions about whether or not to smoke.

Some communities, including Needham, Mass., have raised the minimum age to 21, but New York would be the biggest city to do so.

Officials say 80 percent of NYC smokers started before age 21, and an estimated 20,000 New York City public high school students now smoke. While it’s already illegal for many of them to buy cigarettes, officials say this measure would play a key role by making it illegal for them to turn to slightly older friends to buy smokes for them. The vast majority of people who get asked to do that favor are between 18 and 21 themselves, city officials say.

Under Mayor Bloomberg and the health commissioners he has appointed, including Farley, New York has rolled out a slate of anti-smoking initiatives.

Bloomberg, a billionaire who has given $600 million of his own money to anti-smoking efforts around the world, began taking on tobacco use in the city shortly after he became mayor in 2002.

Over his years in office, the city — at times with the council’s involvement — helped impose the highest cigarette taxes in the country, barred smoking at parks and on beaches and conducted sometimes graphic advertising campaigns about the hazards of smoking.

Earlier this year, the Bloomberg administration unveiled a proposal to keep cigarettes out of sight in stores until an adult customer asks for a pack, as well as stopping shops from taking cigarette coupons and honoring discounts, but the proposal was dropped earlier this week, according to the New York Times.

Bloomberg’s administration and public health advocates praise the initiatives as bold moves to help people live better. Adult smoking rates in the city have fallen from 21.5 percent in 2002 to 14.8 percent in 2011, Farley has said.

http://www.nbcnewyork.com/news/local/Cigarettes-Vote-New-York-Wednesday-229822281.html

Latest Research on Tobacco Use and Health Care Cost Has Global Implications

By Derek Yach, Executive Director, The Vitality Institute, and a former executive director of the World Health Organization (WHO), and Katie Tryon, M.D., Clinical Director, The Vitality Institute.
This month’s articles on health care costs and tobacco control in the South African Medical Journal (SAMJ) have far reaching implications beyond the shores of South Africa. The latest Global Burden of Disease data (Lancet, 2012) show that two of the top three risk factors that contribute to the highest burden of disease in Western Europe and the U.S. are tobacco and high Body Mass Index (BMI). This not only has serious health consequences, it has significant financial implications for governments, businesses and individuals — both in terms of direct health care costs and indirect costs such as work productivity.
One of the papers, published by RAND Corporation and Vitality, looks at the direct health care cost impact of these two risk factors. They show that severely obese individuals have a 23 percent higher health expenditure than those at a healthy weight, and moderately obese individuals have an 11 percent higher health cost. Furthermore, current or past smokers have an 11 percent higher health expenditure. The research was carried out on an insured South African population with similar demographic and health care profiles to counterparts in Western Europe and the US. It supports recent research carried out by Pandya et al. in the U.S. (Health Affairs, 2013) which predicted a significant increase in healthcare costs in the U.S. from cardiovascular disease due to the aging population, declining mortality and ever increasing obesity rates.
While Pandya et al. research highlighted declining smoking rates in the U.S. as positively influencing cardiovascular disease cost projections, they were not outweighed by the other pressures increasing the costs. An additional paper published by Reddy et al. also adds caution to the enthusiasm over declining smoking rates. It shows that while there has been a significant decline in smoking in school age children in South Africa between 1999 and 2008, there has been a marginal increase between 2008 and 2011 (to 16.9 percent in 2011). This has been mirrored in the U.S. by the CDC Youth Risks Behavior Surveillance that showed a significant decline in youth smoking rates between 1997 and 2009, but no significant decline between 2009 and 2011 (remaining at 18.1 percent in 2011). As today’s young smokers are our tomorrow’s smoking adults, a leveling of the decline, or even a potential increase could have significant impact on future health care costs.
Continued cigarette consumption worldwide, despite all interventions that have been tried, argues for a look at new breakthrough interventions to prevent the inevitable future costs.The editorial co-authored by David Sweanor of the University of Ottawa highlights the need to provide smokers with alternative viable options, rather than continuing along the same lines of controlling combustion cigarette supply and demand. Taxes have played a key role in getting smoking rates down across the world but an improved approach, complimentary to accepted policies in place, is needed to better tackle addiction. E-cigarettes have been a consumer breakthrough that should be embraced by public health personnel and governments rather than vilified. As they state, “We can still strive for complete nicotine cessation… but we are currently presented with the very real prospect of massively reducing the individual and population risks of smoking by something in the range of two orders of magnitude.”
High BMI and smoking remain among the top three risk factors that contribute to the highest burden of disease in Western Europe and the U.S., and the research mentioned above highlights this issue and discusses potential solutions, with implications far beyond South Africa.
The Vitality Institute is a global health think tank with the mission to advance knowledge about the evolving science and art of prevention and health promotion in order to build healthier societies. To join the conversation, follow us on Twitter at The Vitality Institute @VitalityInst.
http://www.huffingtonpost.com/dr-derek-yach/tobacco-use-research_b_4164593.html