Response to Christen Mullet’s “Can the government force you to be healthy?”

We have read with great interest Christen Mullett’s editorial regarding the government’s role in promoting the nation’s health, specifically, the new FDA regulations that would dramatically change the warning labels on cigarette packages. Ms. Mullett’s objection seems to be framed around the notion that smoking is an individual’s right, the government should not be poking into people’s private lives and that the regulations are “a power trip” to control the behavior of the poor who are being unfairly oppressed by such federal policy. We offer the following thoughts as a set of counter points.

?First, cigarette smoking by Americans kills more people than fires, homicides, suicides, AIDS, drug abuse and alcohol combined; it is responsible for one in five deaths each year. Lost productivity, years of potential life lost and health care costs from smoking exceed $200 billion each year. And this carnage is from only the 20 percent of adult Americans who smoke, and almost 90 percent of them who started as children. Cigarette smoking results in 5.1 million years of potential life lost in the United States annually. Smoking is the number one preventable cause of death and thus an important public health problem.

?Second, warning labels are part of a comprehensive approach to prevent youth from smoking or to motivate current smokers (youth and adult, alike) to quit and appear to have a modest effect in doing so. We are confronting an industry that spends $12 billion a year promoting their products (that’s $34 million a day). As the 1998 Master Settlement Agreement between four of the largest tobacco companies and attorney generals from 46 states has revealed, the industry knew long ago that smoking was harmful, even though they maintained the science was inconclusive. Further, they targeted their efforts to encourage youth to smoke as an admission that they needed young people to replace the smoking adults they knew would die from the multiple causes of death that cigarettes produce. Each day in the United States, approximately 3,900 young people between 12 and 17 years old smoke their first cigarette, and an estimated 1,000 youth become daily cigarette smokers.

?Third, it appears that Ms. Mullett’s primary concern is that government is too involved in our lives and seems to have perpetrated a conspiracy against poor folks by unfairly biasing them in the process. If our analysis of this theory is correct, please consider that the relationship between health status and economic status is strong: the poorer folks are the less healthy because they access the health care system less often—as they can’t afford to—and because the behaviors that so negatively affect health tend to be practiced more often by the economically disadvantaged. Government’s role is to protect us by providing services we otherwise might not or could not provide ourselves. Though the U.S. is very late to the warning label table (proposed FDA changes) compared to other countries, providing citizens with accurate information about the risks of tobacco use is necessary. The graphic images of smoking related disease that will be added to cigarette packages allow smokers and potential smokers, especially children and adolescents, to be better educated regarding the severe health outcomes associated with cigarette smoking.

?Finally, the government spends billions of dollars treating illnesses caused by cigarette smoking through Medicare and Medicaid programs. We are not happy about that either, so collectively, we need to work toward helping young people to not start smoking and those individuals who do smoke, to quit. The proposed FDA warning labels are part of a comprehensive tobacco prevention approach that has included increased taxation, public health campaigns, restrictions on marketing, smoke free ordinances, and funding of smoking cessation and education programs. These comprehensive campaigns have resulted in decreases in current cigarette use among middle and high school students; however, we have a long way to go to reduce these rates and the current 5.4 million worldwide deaths from tobacco-related illnesses that are projected to reach more than 8 million by 2030. The College of Public Health at Kent State University supports comprehensive tobacco prevention including the proposed FDA warning labels, and we hope you will, too!

Dr. R. Scott Olds, Professor, Social and Behavioral Sciences

Dr. Maggie Stedman-Smith, Assistant Professor, Environmental Health Sciences

Dr. Melissa Zullo, Assistant Professor, Epidemiology