Progress in primary prevention: The smoking-health issue

The elimination of cigarette smoking is in the health interests of the public, i.e., it is a public health issue. But like other issues so broadly defined, it tends to become no one's issue. One of the most oft-repeated statements by health professionals for many years - 'balanced' for the public in the broadcast media by a contrary view from the Tobacco Institute - is that the single most health promoting action among Americans would be the elimination of cigarette smoking. Yet, in spite of a general decline in the prevalence of smoking, the cigarette industry is more profitable than ever, is spending more money on promotion than ever, and is more effective politically than ever. Projections from the US Department of Agriculture show that, even with continued extensions of restricted smoking laws and regulations, Americans will still be smoking about 3,100 cigarettes per person in 1990 compared with about 3,600 in the early 1970s. This is about what Australians - in many ways similar to Americans - consume now; and the figure is considered by Australians to be unacceptably high. The greater share of the health burden from this slow pace of change will fall on women. Their death rates from lung cancer are rising faster than men's and are projected to continue rising. The full range of other health-damaging reverberations in acute and chronic disease, prenatal and infant problems, and drug-smoking interactions are arrayed in the 1980 Surgeon General's report on Health Consequences of Smoking for Women. That teenage girls now match or surpass their male peers in taking up smoking does not augur a future of better health for women.