"Urban transport systems based on a combination of rail lines, bus lines, bicycle pathways, and pedestrian walkways offer the best of all possible worlds in providing mobility, low-cost transportation, and a healthy urban environment." –Lester R. Brown, Plan B 4.0: Mobilizing to Save Civilization.
The United States—the country that gave the world tobacco—is now leading it away from cigarettes. After climbing for nearly a century, the number of cigarettes smoked per person in this country peaked at nearly 2,900 in 1976 and began to decline. By 2003 the figure had dropped to 1,545 cigarettes—a fall of 46 percent. If this trend continues for another quarter-century, smokers will be a rarity in the United States.
As the costs of cigarette smoking become clear, pressure to phase out cigarettes is gaining momentum. At its annual meeting in 2003, the American Society of Clinical Oncology called for the elimination of tobacco from the world. Its president, Dr. Paul A. Bunn, Jr., noted: "We are cancer doctors. We get frustrated seeing the devastation caused by tobacco products."
At a broader level, the World Medical Association (WMA), which includes organizations representing 10 million doctors from 117 countries, has called for strong measures to reduce cigarette smoking. The 4.9 million annual deaths from inhaling cigarette smoke exceed the 3 million deaths from all other air pollutants combined. Among the WMA's principal recommendations are raising taxes on and banning all advertising for cigarettes.
Meanwhile the World Health Organization (WHO) has launched a "Tobacco Free Initiative." Its Framework Convention on Tobacco Control was unanimously approved in May 2003 by the 192 countries attending the World Health Assembly. Calling for bans on cigarette advertising, higher taxes on cigarettes, and restrictions on smoking in the workplace, this treaty will take effect once 40 members have ratified it.
World usage of this addictive product peaked in 1987 at 1,038 cigarettes smoked per person. Though the decline lagged trends in the United States by roughly a decade, the global figure fell to 887 cigarettes per person in 2002, a drop of nearly 15 percent. Countries that were once bastions of smoking, such as France, Japan, and China, are following the U.S. lead.
In France—where the government is now taking strong steps to discourage smoking—the number of cigarettes smoked per person dropped from 1,750 in 1985 to 1,338 in 2002, a decline of more than 23 percent. In Japan, where most men once smoked, the peak came in 1992. Since then annual consumption has dropped some 18 percent, from 2,744 cigarettes per person to 2,247 cigarettes in 2003. And in China, the world's most populous country, smoking peaked in 1990 at 1,440 cigarettes per person and then fell 8 percent to 1,330 cigarettes in 2003.
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, and several forms of cancer. Recent research findings show that smoking increases breast cancer in women by 30 percent and contributes to impotence in men. The constriction and blockage of small blood vessels that can prevent an erection in men who smoke is a forerunner of the blockage of the larger coronary arteries that leads to heart disease.
The number of deaths per year worldwide from smoking-related illnesses—currently at 4.9 million—is expected to reach 10 million by 2020. WHO estimates that nearly one third of all adult smokers will die of smoking-related illnesses. In China, where smoking is largely limited to males, easily 100 million men could eventually die from smoking-related illnesses if smoking rates are not further reduced.
In addition to the human suffering from lung cancer, heart disease, and other smoking-caused illnesses, the economic cost of cigarette use is high. A study by the U.S. Centers for Disease Control and Prevention indicates that each pack of cigarettes smoked in the United States costs society $7.18 in health care and lost employee productivity. It is the economics of smoking that helped convince the World Bank to ally itself with WHO in an effort to stamp out tobacco production and use.
Among the steps being taken to discourage smoking are educational campaigns on how smoking affects health, bans on advertising, restrictions on indoor smoking, higher taxes, and legal actions by smoking victims against tobacco companies. Information campaigns can be particularly effective in rural areas of developing countries, where information on smoking and health is almost nonexistent.
In the United States, California—a leader in the anti-smoking campaign—has exploited concerns about impotence in a television commercial in which a man's flirtation with a woman fails when the cigarette in his mouth begins to droop. While teenagers may not be particularly concerned about their mortality, they do worry about their sexuality. In Thailand, cigarette packs carry a warning in large type: "Cigarette smoking causes sexual impotence."
Raising taxes on cigarettes has become commonplace at the state level in the United States. This both discourages smoking and helps close spiraling fiscal deficits. In 2002, some 19 of the 50 states raised cigarette taxes by an average of 42¢ per pack. In 2003, another 13 states raised taxes. On top of the federal tax of 39¢ per pack, New Jersey has an added tax of $2.05. New York, Connecticut, and Massachusetts each have taxes of $1.50 a pack.
Some countries have discouraged smoking with stiff taxes on cigarettes. Among the leaders in this effort are Norway with a tax of $5.99 per pack, the United Kingdom at $5.03, Ireland at $3.52, and Denmark at $3.08.
Legal action holding cigarette manufacturers responsible for the products they market is beginning to gain traction in many countries. This approach is perhaps most advanced in the United States. In late November 1998, the U.S. cigarette industry agreed to pay the 50 state governments a staggering total of $251 billion to cover past Medicare costs of treating smoking-related illnesses—nearly $1,000 for every American.
Early attempts to protect nonsmokers from the adverse effects of cigarette smoke included segregating smokers on planes and in restaurants. More recently this has been replaced by outright bans. Local bans on indoor smoking in workplaces and public buildings, planes, trains, buses, restaurants, and bars are now commonplace. Several states—including New York, Delaware, Connecticut, Maine, and California—have banned smoking in restaurants and bars. The Norwegian Parliament, in April 2003, became the first country to approve a national ban on smoking in restaurants and bars. Ireland and the Netherlands are following suit.
Bhutan, a small mountainous kingdom between India and China, may be the first country to completely ban cigarettes. Already 19 of its 20 district health officials are working to make the sale of tobacco products illegal and to fine anyone caught smoking in public.
Measures that discourage smoking will quickly reduce smoking-related illnesses and raise life expectancy. Only a few years ago the idea that citizen action groups, national governments, medical associations, WHO, and the World Bank would be working together to create a tobacco-free world would have seemed farfetched. Today, it is becoming a reality.
Copyright © 2004 Earth Policy Institute