Smoking began for me at 16. My friends started then too, and because it was forbidden on school grounds, the incentive of rule-breaking made it all the more attractive. After starting with Pall Malls and then Marlboros, I went on to Salems in graduate school, where any nonsmoking student was viewed as something of an oddity. I recall an evening seminar in a professor’s apartment so filled with grey-blue haze that one older (and wiser) student got up and left. But then at age 30, I myself stopped. Why? Because that same year the U.S. surgeon general released the first report definitively linking tobacco use with cancer and heart disease.
Now, four decades later, the current surgeon general has released another report that links smoking with additional illnesses. With this information widely publicized, you might think that smoking would find few new adherents nowadays. And yet, walking home from America House, I pass office workers—many of them young—puffing away in doorways on their breaks. If other smokers are walking near me on the sidewalk, I veer aside to avoid their fumes.
The surgeon general’s report notes that nearly half a million Americans die annually as a result of tobacco-related illnesses, but there is also the high cost of lost productivity and health care. What brings the human cost home to me most clearly, however, are memories of heavy smokers I knew when I was growing up. A hometown friend of my parents gave me a daily ride to school in his smoke-filled car. Later, but well before the first surgeon general’s report, we heard that he had died of emphysema.
But this year the surgeon general issued some positive news too. For the first time, people in the United States who have stopped smoking now outnumber those who continue to smoke. What accounts for the drop? The U.S. Centers for Disease Control attribute it to anti-smoking campaigns in schools and to television ads. Some of these efforts are funded by the $206 billion settlement reached in 1998 by tobacco companies and the states. Big jumps in federal and state tobacco taxes and the consequent rise in the cost of cigarettes have also served as deterrents. On the street, I once saw a woman refuse a cigarette to a stranger who asked for one. “They cost too much now,” she said, walking on. The smoking ban in bars and restaurants is also thought to have helped lower the number of smokers. As I head home in the early evening, I see clusters of people standing outside them smoking: they can no longer do that inside. Six states have now imposed such bans.
The poor countries of the world, however, have fared less well. This is partly because as the number of smokers has dropped in the rich nations, the big multinational companies, like British American Tobacco and Philip Morris, are pushing their products more aggressively in developing countries. Litigation documents available through the Web site of the Campaign for Tobacco-Free Kids sheds light on the tobacco companies’ tactics. One document from B.A.T. offers this cynical opinion: “We should not be depressed simply because the total free-world market appears to be declining...[because] there are areas of strong growth, particularly in Asia and Africa.”
Little wonder that the industry fights smoking restrictions in the poor nations, whether through advertising bans or increased taxes. The trade journal Tobacco Reporter has cheerfully noted: “Tobacco use in the developed nations will trend down...while in the developing countries use could rise.... A bright picture!” China, with its 300 million smokers, represents an especially tempting target. The writer of a Philip Morris document observes that the market in China offers “plenty of room for growth...because the demand for Western cigarettes is insatiable.” Insatiable—a strange term to use in promoting a product that can lead to premature death.
At least in this country we know the score. People in poor nations do not. The tobacco companies exploit that lack of health-related information to their own profit-driven advantage.