U.S. lags in war against a mass killer — smoking

Forty-five years ago, U.S. Surgeon General Luther Terry released a groundbreaking report on smoking, calling for “appropriate remedial action” against the health hazard that was the norm at the time among 50 million Americans. The majority of men in 1964 smoked, and 40 percent of women had taken to the habit. Cigarette advertising pervaded the TV airwaves — including now-infamous ads using Fred Flintstone to sell Chesterfields. Terry’s report was the clarion call for major, broad-based anti-smoking efforts that continue today.

In 2009, rates have been cut in half, and smoking has been relegated to back rooms and outdoors. Smoking is no longer advertised on television or billboards, but the tobacco industry still spends billions of dollars to market its product. Today, there are still about 45 million smokers in the United States.

While progress has undoubtedly been achieved in reducing smoking rates in the United States, have we really taken the “appropriate remedial action” Terry called for 45 years ago?

The short answer is no, particularly over the last eight years. Smoking continues to be the leading preventable cause of death in America, killing around 450,000 each year and costing society more than $150 billion. Even with the economic morass, health care should remain a high priority for the incoming administration. And as President-elect Obama looks to revamp our health system with an emphasis on prevention and efficiency, it is high time to take a serious look at actions needed to end smoking.

Increase tobacco excise taxes. One of the first health-related decisions Obama will face is whether to sign a tobacco excise tax increase — which was thwarted by the Bush White House — to help pay for and expand State Children’s Health Insurance Program, the health care program for uninsured children. While it is likely that Obama will sign a 61-cent tax increase from 39 cents to fund SCHIP, the administration should consider raising the tax on tobacco products to be in line with excise taxes around the world, which comprise two-thirds of the price of a pack of cigarettes. This would translate to an increase of $3 to $4 dollars per pack, resulting in billions in new revenue and marked reductions in smoking rates.

Beef up product regulation. Cigarettes are the only consumer product that when used as intended, kills one out of every two lifetime users. It is also the only consumer product that is not regulated by a federal agency. The FDA tried to regulate tobacco products during the Clinton Administration, but the tobacco companies sued. The U.S. Supreme Court in 2000 ruled that Congress needed to give the FDA the authority to regulate the product. Nearly nine years later, the FDA is still waiting for that authority. Though a recent bill doing so passed the House — with the support of Philip Morris — it died in the Senate. Clearly, regulation of tobacco products is desperately needed and long overdue. But it should be done right. The new Congress should waste no time in passing the right bill that will treat tobacco products commensurate with the harm that they cause.

Retake the mantel of global leadership. Despite being the home of some of the major transnational tobacco companies, the United States was once seen as a leader in global tobacco control. Over the last decade, however, the U.S. has gone from being a leader to a laggard. In 2003, the World Health Organization helped to develop the world’s first health treaty, the Framework Convention on Tobacco Control, to provide an international means to halt tobacco consumption and exposure to smoke. The U.S. signed in 2004 with the expectation that the Senate would swiftly ratify it, but the treaty sat in the White House. Since then, 161 countries have ratified the convention. It is time for the United States to regain its leadership position in global tobacco control, and to mitigate the harm caused by U.S. tobacco companies in the rest of the world.

Increasing taxes, regulating the private sector and ratifying treaties are all anathemas to some. But these are the proper functions of government and the steps that need to be taken when dealing with the leading preventable cause of death. Decisive action can save millions of lives, raise needed revenue and serve as a harbinger that dramatic change can be accomplished when it is clearly the right thing to do.

• Michael Eriksen is director of the Institute of Public Health at Georgia State University and was the director of the CDC’s Office on Smoking and Health from 1992 to 2000.