The Tragedy of Tobacco and the State: Part 1 – Genesis of a Public Health Catastrophe
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Erik Devereux April 26, 2024
Sixty years ago this past January 11th, U.S. Surgeon General Luther Terry issued a landmark report linking tobacco consumption with lung cancer and advising Americans to quit smoking cigarettes. At the time in 1964, just under half of the U.S. adult population regularly smoked, the peak of an upward trend that began during World War One. Similar patterns of smoking occurred around the world with similar consequences: an increase in premature mortality from tobacco-related diseases including strokes, heart attacks, emphysema (and its precursor COPD) and cancer. This column is the first in a series about what the response to the public health catastrophe caused by tobacco tells us about the ability of democratic governments such as the United States to seek the well-being of their publics. The bottom line is that democracies around the globe failed this test and for similar reasons related to the unholy intersection of tobacco-related illnesses, the health care industry devoted to treating those illnesses, and tax policy. A supporting role played by the entertainment industry also deserves some attention.
To focus attention, for many decades 400,000 and 500,000 residents of the United States have died prematurely every year because they smoked cigarettes. That is approximately the same annual death toll as all American fatalities in combat during World War Two. The accumulated death toll is now above 10 million and growing. If you have had the misfortune to care for someone dying from their nicotine addiction, then you know this is a terrible way to go filled with extensive pain and suffering, and often at great expense. Now multiply by 500,000.
There are six noteworthy inflection points in the narrative of how the U.S. Government did (and did not) take steps to limit the carnage caused by tobacco between 1914 and 2024.
Administration of Woodrow Wilson. When American troops headed to Europe to fight in World War One, tobacco companies received approval to send the soldiers cigarettes at the front lines. Pitched as an act of kindness, the result was a rapid increase in the rate of nicotine addiction among U.S. men. Boosted after the war by widespread advertising campaigns (eventually spanning print, radio, movies and television) and the industrialization of cigarette manufacturing (which dramatically lowered prices), cigarette consumption among men and women, grew to around 47 percent of all adults. Before World War One, lung cancer was incredibly rare. By the early 1960s, lung cancer was a leading cause of premature death among men.
Administration of Lyndon Johnson. With the 1964 Surgeon General’s report, a presidential administration officially was on the side of efforts to reduce smoking. At this point, the executive branch developed a split personality, with the Departments of Agriculture and Commerce promoting tobacco farming and sales of cigarettes domestically and internationally while what is now the Department of Health and Human Services actively trying to curtail nicotine addiction.
Administration of Richard Nixon. In the early 1970s, the federal government banned tobacco advertising from radio and television, taking off the air an icon of American popular culture, the Marlboro Man. From this point forward, the primary means by which the federal government discouraged tobacco use was by the mandatory inclusion of warning labels on the packaging of tobacco products.
Administration of George H.W. Bush. A failed experiment by a tobacco company to market nicotine-free cigarettes resulted in the U.S. Food and Drug Administration pivoting against the industry. The experiment undermined the narrative that smokers primarily use tobacco for the sensory experience; clearly and definitively, the use of all tobacco products is linked to nicotine addiction. Legal efforts begin to hold the tobacco industry accountable for marketing a highly addictive, deadly product. This is also when bans on smoking on airplanes and in bars and restaurants become widespread.
Administration of Bill Clinton. Legal efforts culminate in the 1998 master agreement between the tobacco industry, the federal government and the state governments which transferred billions of dollars ostensibly in compensation for damage to public health. The industry also agrees to curtail advertising clearly targeted at children, thus ending the reign of another American icon—Joe Camel.
Administration of Barack Obama. First marketed widely in 2009, by 2014 e-cigarettes and “vapes” reversed the decades-long decline in nicotine addiction among youth and opened the way for another century of tobacco-related illnesses.
With this brief summary as reference, the next column in the series will delve into why the federal and state governments slow walked (or absolutely blocked) efforts to halt tobacco sales after 1964. The one defense that must be discarded immediately is ignorance. Little common sense was required even back in 1917 to know that frequently inhaling smoke into the lungs was a bad idea. Indeed, concerted efforts by various public health advocates to oppose tobacco use date back into the late 1800s. As I will discuss in this series, this is a story about how democratic governments respond to demands from a lucrative industry, and make choices about taxes, even when the results are inevitably lethal to huge numbers of people. If this were a movie, it would not be a pretty picture.
Author: Erik Devereux is a consultant to nonprofits and higher education and is adjunct faculty in the Security Studies Program at Georgetown University. He has a B.S. from the Massachusetts Institute of Technology (Political Science, 1985) and a Ph.D. from the University of Texas at Austin (Government, 1993). He is the author of Methods of Policy Analysis: Creating, Deploying, and Assessing Theories of Change (available for free here). Email: [email protected]. More content is available here.
The Tragedy of Tobacco and the State: Part 1 – Genesis of a Public Health Catastrophe
The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.
By Erik Devereux
April 26, 2024
Sixty years ago this past January 11th, U.S. Surgeon General Luther Terry issued a landmark report linking tobacco consumption with lung cancer and advising Americans to quit smoking cigarettes. At the time in 1964, just under half of the U.S. adult population regularly smoked, the peak of an upward trend that began during World War One. Similar patterns of smoking occurred around the world with similar consequences: an increase in premature mortality from tobacco-related diseases including strokes, heart attacks, emphysema (and its precursor COPD) and cancer. This column is the first in a series about what the response to the public health catastrophe caused by tobacco tells us about the ability of democratic governments such as the United States to seek the well-being of their publics. The bottom line is that democracies around the globe failed this test and for similar reasons related to the unholy intersection of tobacco-related illnesses, the health care industry devoted to treating those illnesses, and tax policy. A supporting role played by the entertainment industry also deserves some attention.
To focus attention, for many decades 400,000 and 500,000 residents of the United States have died prematurely every year because they smoked cigarettes. That is approximately the same annual death toll as all American fatalities in combat during World War Two. The accumulated death toll is now above 10 million and growing. If you have had the misfortune to care for someone dying from their nicotine addiction, then you know this is a terrible way to go filled with extensive pain and suffering, and often at great expense. Now multiply by 500,000.
There are six noteworthy inflection points in the narrative of how the U.S. Government did (and did not) take steps to limit the carnage caused by tobacco between 1914 and 2024.
With this brief summary as reference, the next column in the series will delve into why the federal and state governments slow walked (or absolutely blocked) efforts to halt tobacco sales after 1964. The one defense that must be discarded immediately is ignorance. Little common sense was required even back in 1917 to know that frequently inhaling smoke into the lungs was a bad idea. Indeed, concerted efforts by various public health advocates to oppose tobacco use date back into the late 1800s. As I will discuss in this series, this is a story about how democratic governments respond to demands from a lucrative industry, and make choices about taxes, even when the results are inevitably lethal to huge numbers of people. If this were a movie, it would not be a pretty picture.
Author: Erik Devereux is a consultant to nonprofits and higher education and is adjunct faculty in the Security Studies Program at Georgetown University. He has a B.S. from the Massachusetts Institute of Technology (Political Science, 1985) and a Ph.D. from the University of Texas at Austin (Government, 1993). He is the author of Methods of Policy Analysis: Creating, Deploying, and Assessing Theories of Change (available for free here). Email: [email protected]. More content is available here.
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