The effort to battle smoking in the United States began in earnest 50 years ago this past Saturday, when Surgeon General Luther Terry said that smoking was dangerous and urged action.
Today, the war against this leading preventable cause of death is far from over, but it has been largely successful, and that triumph offers important lessons about the power of government, science and persistent advocacy.
It's hard to imagine today, but in 1964 smoking was acceptable practically everywhere, from hospitals to airplanes to children's nurseries. About 42 percent of American adults smoked, and there were few meaningful restrictions on the ability of minors to buy tobacco. Athletes smoked. Doctors smoked. Many who didn't partake likely declined out of personal preference, rather than medical fear.
But it was killing us. Tobacco companies knew that and lied about it. Yet eventually these companies were forced to make amends. It's sometimes difficult to remember that such things are possible.
Before Terry's report, there had been limited sorties against smoking. A previous surgeon general stated in the late 1950s that heavy smoking could lead to lung cancer, and studies in medical journals pointed to the link as well. The American Cancer Society also worked to publicize that smoking increased cancer rates, but never made a dent against a powerful industry and habit. In response, the tobacco industry developed filtered cigarettes, promoting them as a healthier alternative. It also undertook a marketing campaign to convince consumers that the science on smoking dangers was inconclusive.
But on Jan. 11, 1964, an expert panel convened by Terry announced its conclusion that smoking did increase cancer rates, and that the government needed to address the problem. Warning labels were introduced, along with a ban on some advertising, restrictions on selling cigarettes to young people and an end to cigarette vending machines. Over time, smoking also was banned in public places, from airplanes to bars and restaurants to workplaces and parks and beaches. And it has worked -- not entirely, but significantly. The adult smoking rate has declined almost 60 percent. Life expectancy has increased dramatically, with the reduction in smoking believed to be responsible for 30 percent of that improvement, and 8 million lives saved, according to a study released last week by the Yale University School of Public Health. Tobacco companies finally admitted they had lied and were forced to pay $240 billion to address the damage their products had done.
The success wasn't due entirely to laws. As the message took root, social pressure mounted against tobacco. Parents fought the habit in their children, and children fought the habit in their parents. Smokers were pushed outdoors, even at home. As smoking became more of a hassle, more gave up the practice. Taxes also played a big part, hiking the price of smoking to a level more people stopped paying.
Today we face health issues, including diabetes and obesity, that are both expensive to society and largely behavioral. We also face bad behavior from corporations: predatory and dishonest practices chief among them. Via government action, social pressure, education and concerted effort, we can begin to curtail these ills. It isn't easy, but we've proven, over the past 50 years, that it can be done.