Recent headlines have focused attention on the global fight against tobacco use, the world's leading cause of preventable death. A large international survey, published in The Lancet, underscored the enormity of a tobacco epidemic that without urgent action will kill one billion people this century. At the same time, Australia's highest court upheld the world's first law requiring plain cigarette packaging, without the colorful branding that entices kids. This will no doubt inspire other nations to act.
Even as we step up the global battle against tobacco, we must also commit to finishing the fight in the United States.
Unquestionably, the U.S. has made enormous progress.
We've reduced adult smoking by more than half since the 1960s and youth smoking by a similar amount after a steep increase in the 1990s, with rates dropping to record lows under 20 percent. About two-thirds of Americans live in states and communities that require smoke-free restaurants, bars and other public places. Public attitudes about tobacco have fundamentally changed.
But our progress has a dangerous downside. It has bred complacency and an assumption by some policy makers that the battle against tobacco is over.
It isn't over. Far from it.
It isn't over when tobacco use still kills 443,000 Americans and costs the nation nearly $200 billion in health care bills and lost productivity every year. It isn't over when 45 million adults still smoke and nearly 4,000 kids try their first cigarette each day.
The tobacco industry certainly doesn't act like the battle is over. Tobacco companies still spend $10.5 billion a year -- nearly $29 million each day -- to market their deadly and addictive products in the U.S., and they ruthlessly fight efforts to reduce tobacco use.
To counter declines in cigarette smoking, the industry has introduced an array of new smokeless tobacco and cigar products, many with sweet flavors, cheap prices and colorful packaging that lure kids. There may be more ways to get addicted to nicotine today than ever before.
To their credit, President Obama and his Administration have made it a priority to reinvigorate the fight against tobacco use. In 2009, the President signed the landmark law giving the Food and Drug Administration (FDA) authority over tobacco products, which curbed tobacco marketing and sales to kids, banned terms such as "light" and "low-tar" that falsely imply a safer cigarette and, pending the outcome of an industry lawsuit, will require large, graphic health warnings on cigarette packs.
The health care reform law expanded coverage for quit-smoking treatments and provided dedicated funding for disease prevention initiatives, including those to reduce tobacco use. A 2009 increase in the federal tobacco tax significantly reduced cigarette sales. This year, the Centers for Disease Control and Prevention (CDC) launched an unprecedented advertising campaign to discourage smoking, doubling the number of smokers seeking help from quit lines and websites.
Unfortunately, after being in the forefront of the tobacco battle, many states have moved backwards. In the past four years, states slashed budgets for already-underfunded tobacco prevention and quit-smoking programs by 36 percent. They collect more than $25 billion a year from the tobacco settlement and tobacco taxes, but spend less than two percent of it to combat tobacco use. The states' progress has also slowed in enacting tobacco tax increases and smoke-free air laws.
The path forward is clear.
The federal government must build on the momentum of recent years. It is heartening that the Department of Health and Human Services is aggressively implementing its first-ever Strategic Action Plan to reduce tobacco use and the CDC has committed to continuing its highly successful ad campaign.
In addition, the FDA must effectively enforce its new tobacco rules and develop innovative strategies that can accelerate smoking declines. Never before has a science-based agency had the authority to regulate the marketing and content of tobacco products to promote public health. It's an opportunity to finally stop tobacco companies from engineering their products to make them appealing to kids and keep users addicted.
It is critical that the states be full partners with the federal government. The states must restore and sustain funding for programs to prevent kids from smoking and help smokers quit. They must also step up implementation of other proven strategies, including higher tobacco taxes and strong smoke-free laws.
Our progress has driven tobacco out of sight and out of mind for many Americans. But it remains an insidious killer that claims too many lives, addicts too many children, costs too many health care dollars and devastates too many families. We know how to win the fight against this killer, but it will require political leadership and resources that match the scope of the problem.