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CVS Shows That Responsibility for Health Sits on Many Shelves

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CVS's recent decision to stop selling all cigarettes and tobacco products can be an important catalyst for critical changes needed to create the conditions for health for all of us. Significant influencers of public health, after all, sit on many retail shelves.

CVS's decision, which will take effect nationwide in October, is an admirable one, precipitated by the changing role of drugstores: from convenience stores to health care providers that increasingly offer flu shots and treat minor health care needs in walk-in clinics. Its decision underscores both science and brand value. As CVS's CEO Larry Merlo said, "Put simply, the sale of tobacco products is inconsistent with our purpose."

The decision is a major milestone on the road to improved public health for two reasons: It highlights the growing readiness of pharmacies to take on a new role in health care, and it underscores that smoking is a communicable condition and that leading companies can play a part in reducing the rate of smoking. President Barack Obama recognized that by saying in a formal statement, "I congratulate -- and thank -- the CEO of CVS Caremark, Larry Merlo, the board of directors, and all who helped make a choice that will have a profoundly positive impact on the health of our country."

One of the people who helped make that choice was Dr. Troyen Brennan, CVS's Chief Medical Officer. In a recent "Viewpoint" in the Journal of the American Medical Association, he and Steven A. Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco, wrote:

There is little doubt that reducing the morbidity and mortality from tobacco use remains one of the most important public health challenges of the 21st century. More than 480,000 deaths occur annually in the United States as a result of smoking. There is essentially no such thing as moderate use of tobacco, which fuels addiction and illness, with enormous costs to society: $132 billion in direct medical costs and $157 billion in lost productivity, according to recent estimates ... As a result, public health advocates have been turning toward programs designed to make smoking less socially acceptable ... Reducing the availability of cigarettes is another step in this direction. Studies have demonstrated a relationship between tobacco use and geographic density of stores that sell cigarettes.

Smoking is addictive, but it is also a habit that infects others: Children whose parents smoke, and people whose friends smoke, are more likely to smoke themselves. Increased access to cigarettes globally, and increased sales, have driven tremendous increases in smoking and diseases worldwide. Those relationships underscore as well the communicability of the condition.

This decision will cause CVS to forgo $2 billion in annual revenue, but its hope is to more than make up for it by positioning the company more effectively as a healthcare provider. There's every reason to think that will happen. In New York City, when then-Mayor Michael Bloomberg oversaw a ban on smoking in bars and restaurants, there was fear that the ban would put bars and restaurants out of business. Remarkably, that ban has been accompanied by significant growth in New York City in the number of restaurants and bars and related employment.

The question now is whether CVS's decision to be the first visionary drugstore chain banning the sale of cigarettes and tobacco products will set the stage for this decision to go viral.

As Brennan and Schroeder write about the decision:

This action may not lead many people to stop smoking; smokers will probably simply go elsewhere to buy cigarettes. But if other retailers follow this lead, tobacco products will become much more difficult to obtain. Moreover, if people understand that retail outlets that plan to promote health, provide pharmacy services, and house retail clinics are no longer going to sell tobacco products, the social unacceptability of tobacco use will be substantially reinforced -- indeed, the continued sale would appear to sanction the most unhealthy habit a person can maintain. If pharmacies do not make this effort voluntarily, federal or state regulatory action would be appropriate.

CVS has set an important precedent, aligning itself more clearly than ever with the public's health needs and, in doing so, has raised the stakes for other pharmaceutical chains. As the Wall Street Journal notes, "dropping tobacco products is a rare move by a big retailer ... But CVS, with 7,600 stores across the nation, is the largest company to make such a move and the first national player to do so for explicitly public health reasons."

The health of the public -- and the communicability of smoking -- should be justification enough for similar actions by the other major pharmaceutical chains.

Linda Fried is Dean and DeLamar Professor at Columbia University's Mailman School of Public Health.

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