Tuesday, March 11, 2014
By Maura A. McDonald
CAPE ELIZABETH — Jan. 11 marked the 50th anniversary of the release of the first “Surgeon General’s Report on Smoking and Health.”
Maura A. McDonald of Cape Elizabeth is a nurse practitioner working in the field of tobacco treatment.
The report ranked among the top news stories of 1964, and the New York Public Library considered it one of the 10 “books of the century,” placing it on a list that included Albert Einstein’s “The Meaning of Relativity,” James Watson’s “The Double Helix” and Rachel Carson’s “Silent Spring.”
The report definitively identified cigarette smoking as the principal cause of lung and laryngeal cancer in men, a probable cause of lung cancer in women and the most important cause of chronic bronchitis in both men and women. Additionally, it implicated tobacco use as a risk factor for both heart disease and emphysema.
Although not a perfect report by today’s standards, it certainly was a document of substantial significance and a turning point in the broader recognition of tobacco hazards. The report’s release awakened a new dawn in the fields of both medicine and public health, and it precipitated the development of a number of initiatives that have served to reduce tobacco use since.
Fifty years ago, about 43 percent of adults smoked, with 50 percent of men and nearly 30 percent of women identifying as smokers. With but a few critical exceptions, the prevalence of smoking has declined annually since 1964.
In the Jan. 8 edition of the Journal of the American Medical Association, Theodore Holford, a biostatistics professor at Yale University’s School of Public Health, and his colleagues estimate that tobacco control efforts alone have increased U.S. life expectancy by 30 percent. They further conclude that the impact of these initiatives far exceeds any other public health or medical measure to date.
From a purely historical perspective, pervasive tobacco is a 20th-century phenomenon. Anthropologists define “material culture” as the diverse ways in which physical objects are built into a culture’s daily life.
The material culture of tobacco has a complex history. In his 2011 book “The Golden Holocaust,” author Robert Proctor provides a compelling representation of that history, and he ascribes the “triumph” of tobacco to eight crucial events.
These include the invention of the flue curing of tobacco; the invention of matches; the mechanization of cigarette manufacturing; the taxation of cigarettes by governments; the provision of cigarettes as rations to soldiers during World War I; the mass marketing of the product; the manipulation of the knowledge of the hazards of use; and the manipulation of tobacco chemistry.
As recently as 50 years ago, these factors combined to create a culture in the U.S. in which smoking was unquestioningly accepted in virtually all common and public areas, including offices, retail stores, parks, airplanes, elevators and hospitals, to name but a few.
Today, much of this has changed. We have benefited from the work of tobacco control advocates, who continue to endorse the strong evidence that control measures will continue to affect tobacco use over the long term, including cigarette tax increases; restrictions on advertising and promotion; mass media counter-advertising campaigns; prohibition on sales of cigarettes to minors; school health education; successful litigation against the tobacco companies; and smoke-free workplace laws.
While we admittedly have much to celebrate on this 50th anniversary of the report, the celebration is muted by the glaring reality that tobacco use continues to be the No. 1 preventable cause of death and disability nationally.
To some, smoking and tobacco use are regarded as old news and a problem that has been effectively solved. In reality, the health and economic burden of tobacco use remains near-catastrophic, and the tobacco industry’s campaign of invented controversy and creative marketing continues to plague our best efforts.
Sadly, both in Maine and across the country, one in five adults still smokes, and well over 400,000 of them (more than 2,000 in Maine) die every year as a result.
If the history of tobacco in the U.S. reveals anything, it is that we possess both the will and the resources to significantly affect the health and well-being of our citizens by consistently applying the science of what is already known.
We must continue to develop new tobacco control strategies that match or exceed the creativity and effectiveness of the oppositional strategies of the tobacco industry. Let us use this anniversary as a call to action to renew our efforts and to build on the strengths of the past 50 years as we strive to influence tobacco history over the next 50.
— Special to the Press Herald