“[Brown’s] ability to make a complicated subject accessible to the general reader is remarkable...” –Katherine Salant, Washington Post
After a century-long buildup in cigarette smoking, the world is turning away from cigarettes (see chart below), following the U.S. lead. In 1999 cigarettes smoked per person in the United States fell by a staggering 8 percent and for the world as a whole by more than 3 percent.
The U.S. trend is driven by a deepening awareness of the health-damaging effects of smoking, rising cigarette prices, rising cigarette taxes, aggressive antismoking campaigns in several states, and a decline in the social acceptability of smoking. Ironically, the land that gave the world tobacco is now leading it away from tobacco.
In the United States, the number of cigarettes smoked per person has been falling for two decades, dropping from 2,810 in 1980 to 1,633 in 1999, a decline of 42 percent. Worldwide, where the downturn lags that of the United States by roughly a decade, usage has dropped from the historical high of 1,027 cigarettes smoked per person in 1990 to 915 in 1999, a fall of 11 percent.
Indeed, smoking is on the decline in nearly all the major cigarette consuming countries, including such bastions of smoking as France, China, and Japan. The number of cigarettes smoked per person has dropped 19 percent in France since peaking in 1985, 8 percent in China since 1990, and 4 percent in Japan since 1992, according to the U.S. Department of Agriculture's world tobacco database.
Evidence of the damaging effects of cigarette smoking on human health continues to accumulate. Today there are some 25 known tobacco-related diseases, including heart disease, strokes, respiratory illnesses, several forms of cancer, and male impotence.
Smoking takes a heavy human toll. The World Health Organization (WHO) estimates that worldwide 4 million people die prematurely each year from smoking cigarettes. The 400,000 lives claimed each year by smoking-related illnesses in the United States matches the number of Americans who died in World War II. In China, smoking takes an estimated 2,000 lives per day, the equivalent of having five fully loaded jumbo jets crash each day with no survivors.
The decline in smoking in the United States was initially triggered by the Surgeon General’s report on smoking and health, which was first issued in 1964. Published nearly every year since then, it has spawned thousands of studies worldwide on the effect of smoking on health. These studies and the media coverage of their findings have raised public awareness of the health effects of smoking not only in the United States but throughout the world.
Over the years, mounting evidence of the effect of smoking on health gradually undermined the tobacco industry's steadfast denial of such a link. As it did so, the industry lost its credibility. Cigarette manufacturers began to lose lawsuits as juries held them responsible for health damage to smokers. By late November of 1998, the industry had agreed to pay the 50 state governments a total of $251 billion to cover past Medicare costs of treating smoking-related illnesses — nearly $1,000 for every American.
To cover costs of this settlement, cigarette manufacturers raised prices. Between January 1998 and January 2000, the average U.S. wholesale price of cigarettes climbed from $1.31 per pack to $2.35, a 79 percent increase in two years.
Even as the tobacco companies were raising the price of cigarettes, state governments were raising cigarette taxes. By the end of 1999, cigarette taxes ranged from 2¢ per pack in Virginia, a tobacco-growing state, to $1 per pack in Alaska and Hawaii. Higher cigarette prices appear to be reversing the recent upturn in teenage smoking.
Not only did state governments raise cigarette taxes, they also insisted, as part of the November 1998 settlement, that the Tobacco Institute, the industry’s powerful lobbying arm, be dismantled. On January 29, 1999, the Institute, one of the best funded lobbies in Washington, with a full-time staff of 60, closed its doors.
Restrictions on cigarette advertising, which began with a ban on television and radio ads in the United States, are spreading. For example, the European Union recently passed legislation prohibiting all advertising of cigarettes by 2006.
Bans on smoking itself are also taking off. Initially smoking was restricted on airplanes by segregating smokers and nonsmokers. But in the United States this soon expanded into a total ban on smoking on planes, a measure that is being adopted by airlines in other countries.
The same thing is happening in restaurants. In the United States, the segregation of nonsmokers and smokers now has been replaced by an outright ban on smoking in restaurants in five states — California, Nevada, Maryland, Minnesota, and Vermont. Smoking bans on public transportation and in the workplace are now found in many countries.
Until recently, U.S. cigarette manufacturers were not overly concerned that Americans were smoking fewer cigarettes because they saw a huge market opening up in the Third World, an unprecedented business opportunity. But they failed to take into account the globalization of the antismoking effort. Indeed, several developing country governments are suing U.S. tobacco companies in U.S. courts, seeking to recover their costs of treating smoking-related illnesses.
The antismoking campaign is being bolstered by research indicating that cigarette smoking is a leading cause of male impotence. The constriction and blockage of small blood vessels associated with smoking may first manifest itself in the inability to achieve an erection, well before blockage of the larger coronary arteries leads to heart disease.
One of the mainstays of California’s highly successful antismoking campaign is a TV commercial in which a man's flirtation with a woman fails when the cigarette in his mouth begins to droop. Experience in California indicates that while adolescent males may not be particularly worried about their mortality, they are concerned about their sexuality. In Thailand, cigarette packs carry in large type the warning “Cigarette smoking causes sexual impotence.”
As the social costs of smoking become more visible, and as the number of smoking-related deaths climbs, the global antismoking campaign is gathering momentum. Governments that once saw cigarettes only as a source of revenue are now also looking at the spiraling costs of treating smoking-related illnesses. WHO has launched an ambitious worldwide campaign to discourage smoking, one that it hopes will culminate in an international treaty, the Framework Convention on Tobacco Control, to regulate the use of tobacco.
Meanwhile, the challenge is to sustain the decline in smoking by expanding further the worldwide educational effort on the health effects of this costly habit, by further restricting advertising, by banning smoking in public places and work places, and by raising taxes on cigarettes to a level that more fully reflects their cost to society. The goal is to make smoking as socially unacceptable as it is economically costly.
Copyright © 2000 Earth Policy Institute