In the summer of 1974, I landed my first real job working in the tobacco fields of Bristol, Connecticut for $1.25 an hour. For the first part of the summer we worked in fields under white tents tying the plants so they would grow straight. The second half of the summer the women were in the sheds sewing the tobacco leaves together and hanging them, so they would dry for processing. The days were long, hot and grueling and the work was monotonous. Nonetheless, I was thrilled to be earning a paycheck and my parents were happy to have me out of the house and gainfully employed.
This was how I spent the summer of my sophomore year in high school, toiling along side hundreds of other field workers, mostly migrant workers from Puerto Rico. There were a handful of other students from my high school, but we were a minority. My first employer cultivated broad leaf tobacco to be used in the manufacture of cigars. I didn’t stop to consider the product my employer was peddling and the disastrous and addictive effect tobacco products have on the human body. Like my co-workers, I was earning a paycheck though for me as a privileged white kid from the suburbs it was pocket money not subsistence for my entire family. I learned a lot that summer.
The CDC reports that cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including 41,000 deaths resulting from secondhand smoke. This is about one in every five deaths annually and 1,300 deaths every day.
I worked in the tobacco fields 10 years after the Surgeon General released the landmark report: Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service published in 1964. Though medical researchers had started connecting the dots between smoking and lung cancer by the mid 1950s, this was the first federal government report linking smoking and specific diseases. At that time, two-thirds of men and one third of women in the United States smoked cigarettes. In response to the surgeon general’s report and the growing scientific evidence that smoking harms virtually every organ in the body, major tobacco companies joined forces to mount a defensive strategy to counter the bad publicity by denying the science and misleading the public about the dangers of smoking. The human toll has been tremendous.
Over the next 50 years the battle between Public Health and Big Tobacco raged, and it is a long and complex story. The line graph on page 18 of the Surgeon General’s 50 Years of Change report shows that the per capita number of cigarettes smoked steadily increased from 1900 to the early 1960s. The only two declines are attributed to the period of the Great Depression and then again in the early 1950s when evidence first emerged that smoking is harmful, causing cancer and all sorts of other ailments. Per capita consumption peaked at 4,400 cigarettes per year in the early 1960s then fluctuated following the first Surgeon General’s report in 1964 until the early 1970s at which point there was a steady decline through to 2012.
Against the backdrop of Big Tobacco’s relentless marketing and continued misleading the public about the dangers of smoking, the declines over the next thirty plus years are credited to federal legislation and taxes, continually emerging scientific evidence of the health consequences of smoking, broadcasting and advertisement regulations, availability of over the counter cessation medications and the fallout of the Master Settlement Agreement, a 1998 settlement between the four largest US tobacco companies and 46 states to settle Medicaid lawsuits against the companies to cover tobacco-related health care costs. In exchange the tobacco companies agreed to pay, in perpetuity, payments to states to compensate for medical costs associated with treating people with smoking related illness as well as curtail certain marketing practices.
Over time, sustained and multifaceted public health approaches to smoking cessation have resulted in a steady decline in smoking. According to the Center for Disease Control and Prevention between 2005 and 2015, the percentage of cigarette smokers declined from 21 percent to 15 percent. Yet Tobacco is still the leading cause of premature death across the country and the Tobacco Industry continues to spend billions peddling their product despite a November 2017 ruling that finally forces them to print and broadcast “corrective statements centered on the health risks and addictive nature of smoking. The November ruling stems from a long drawn out court battle that started in 1999 with a lawsuit brought by the Justice Department that was settled in 2006 with an order to place the corrective statements followed by a decade of appeals and wrangling by the tobacco companies to stall and modify the statements.
The end result is certainly a victory for public health, but the impact of the corrective statements will be less effective both because our context has changed (how we access the news) with the explosion of social media outlets and because Big Tobacco successfully argued to modify the originally proposed statements that they said were “forced public confessions” designed to “shame and humiliate them.”
What would have been wrong with that?
Meanwhile, millions more lives were lost during that decade of appeals not to mention millions of dollars in tax payer’s money was spent arguing the case. It makes you wonder, who were the real winners here?