Jon  Hendl's picture

It’s Time to Resurrect the Public Health Focus on Smoking

Fifty years ago, the first ever U.S. Surgeon
General’s report on smoking
on [[wysiwyg_imageupload:172:]]health was released. Among other things, the report concluded that lung cancer and chronic obstructive pulmonary disease (COPD) are caused by smoking.

Fast forward to 2014, and we find that lung cancer is the leading cancer killer in the United States, claiming 158,000 lives annually, and COPD is the nation’s third leading cause of death, claiming 134,000 Americans annually. As diseases like breast cancer adorn the jerseys of professional players, lung cancer and its primary cause – smoking – can’t even get an invitation to a try out.

As adults, we all know smoking is bad and that kids shouldn’t start. But the movement to prevent addiction and treat the deadly cancer has stalled over the last 10 years. The implications heighten when considering a recent Surgeon General’s report declaring that the risks posed by smoking extend beyond cancer – linking to a range of conditions including diabetes and age-related macular degeneration, among others.   Yet, according to the American Lung Association’s (ALA) 2014 State of Tobacco Report

  • 40 states and the District of Columbia fail to fund tobacco prevention and cessation programs at even half of what the U. S. Centers for Disease Control (CDC) and Prevention recommends.
  • Only two states provide comprehensive tobacco cessation benefits to Medicaid employees – a population who has the highest smoking rate and costs states $13.3 billion annually in smoking related illnesses.

Failure to effectively maintain funding for smoking prevention programs ranks among the greatest public health deficiencies in our country. And, unlike other public health issues, there’s actually a formula for success.

The CDC has an evidence-based blueprint and specific funding recommendations. For years, states were reluctant to invest in the programs, claiming there just wasn’t a budget to support such a program. But all that changed in 1998, when 46 states won the biggest monetary settlement in U.S. history to help prevent kids from starting and to compensate for, and address, smoking-related medical costs incurred by states.  

Some states did decide to invest in these programs, rarely at the CDC-recommended levels. Few states came within 50% of the budget recommendations from the CDC and some invested nothing at all. Even still, programs were able to empower kids, help people quit and create smoke-free communities.

In Washington State, for example, the state saved $5 in tobacco-related hospitalization costs for every $1 spent on prevention. California’s program saved more than $55 in health care cost savings for every $1 invested from 1989 to 2008.

Many of these programs now cease to exist or have just enough money to keep the lights on. And it’s not as if tobacco-related revenue has “dried up” in states. Cigarette tax revenue represents one of the most lucrative and stable funding sources. The ALA estimates that states will generate nearly $25 billion in tobacco-related revenue this year.

To put that in perspective, New Jersey has one of the highest cigarette taxes in the nation which will generate nearly $700 million in taxes this year. Yet the state is investing a total of $0 in prevention programs.

So what’s the solution? According to the CDC, states should invest between $9.23 and $18.02 per capita. The CDC further concludes that if states made and maintained that investment for five years, it would result in 5 million fewer smokers. Apply that formula to breast cancer, HIV/AIDS, diabetes or heart attacks, and states would sign on the dotted line tomorrow. So why have we stopped investing in tobacco prevention?

As public relations professionals, we’re constantly asked by our clients to quantify the return on investment (ROI) on programs. These programs have a proven approach, quantifiable metrics with a positive ROI, address a huge state fiduciary issue (Medicaid costs) and save lives.

Tobacco prevention, as an issue, has stalled. I’m not sure if people think it’s “solved.” Perhaps it’s no longer “trendy.” Regardless of the reason, we as communicators need to uncover new and innovative ways to tell this story. As storytellers and problem solvers, we have an obligation to take on the most difficult business and societal challenges. For tobacco control, that means finding greater relevance to today’s broader societal issues, and creating a value proposition that will unify our leaders, public health officials, philanthropists and communities around a common theme to invest in tobacco prevention.

The Health Consequences of Smoking—50 Years of Progress can be accessed at