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Restricting smoking – one of the great public health successes

For more than two decades, New York State has greatly restricted the use of tobacco products. The rationale at the campaign’s start – and to this day – is that tobacco smoke can harm both the health of smokers and can harm the health of non-smokers. Experts say that there is no safe exposure to tobacco smoke, either by the smoker or the non-smoker who inhales it. 

Essentially, current state law bans smoking in all but an individual’s private spaces. No one can smoke in indoor public places, in workplaces, and in many outdoor areas. Smokers can usually smoke within their own homes (although restrictions increasingly exist in apartment dwellings) and in their own cars (although there are calls for banning that when children are riding in the car). 

Research has shown that as a result of these restrictions, there has been a significant reduction in heart attacks and respiratory ailments

A recent report documented that there has been a notable reduction in cancer incidence and death in New York. There are, of course, many reasons for this. Better screening, increasingly effective treatments, and a greater use of vaccines that can keep cancers from starting. 

Yet in many ways, New York’s reductions in cancer deaths can be traced to the state’s smoking and tobacco use restrictions. 

It is well known that smoking causes respiratory cancers. Over 90 percent of lung cancers are the result of smoking. Were it not for cigarettes, pipes, and cigars, lung cancer would be considered a rare illness. Instead, it continues to be the single biggest cancer killer. There are other cancers caused by smoking. Over 85 percent of larynx cancers are from smoking. More than half of all mouth cancers are the result of smoking. The same is true for cancer of the esophagus and bladder. 

But smoking can raise the risks of other cancers as well. Kidney (16.8 percent), cervix (9.9 percent), pancreas (10.1 percent), stomach (16.3 percent), liver (26.5 percent), and colon (10.7 percent) cancers all have a notable number that are the result of smoking. All but one of the cancers mentioned above have seen reductions in deaths since 1990. The one outlier is liver cancer. (Alcohol is another contributing factor in liver disease.) 

According to experts, nearly half of all cancer deaths are caused by smoking. 

As there has been a demonstrable reduction in cancer deaths over time, that reduction (other than liver) coincides with the dramatic reduction in smoking rates. And those reductions are the result of policy interventions, most notably the legislation restricting tobacco use. 

Yet, despite those policy interventions, New York’s smoking rate is only the twelfth lowest in the nation. Had New York followed the advice of the nation’s experts and its own independent advisors, more lives could have been saved. 

The U.S. Centers for Disease Control and Prevention (CDC) offers states scientifically-based best practices for reducing tobacco use. The CDC recommends that New York State spend between $142 million and $203 million annually on its tobacco control efforts. 

New York has never spent the money recommended by the CDC. In fact, its highest spending levels were in 2007, 2008, and 2009, before the state started cutting back. The biggest program cuts occurred during the former Andrew Cuomo Administration, which essentially set a spending ceiling that was half what it had been. 

Nothing has changed since then. With its budget frozen, the tobacco control program has shrunk even more due to inflation. According to an independent review of the state’s tobacco control funding, New York’s budget is “only 17% of the Centers for Disease Control and Prevention’s (CDC’s) recommended level for the state, even as New York faces ongoing health and economic effects from tobacco use. The low funding levels in recent years have posed challenges for the Program to make progress across its areas of focus.” 

Why does New York fail to follow the expert advice of the CDC? It can’t be from a lack of money. The state budget totals $237 billion. It also can’t be that the state doesn’t collect enough from tobacco users – through taxes and other revenues – to fund efforts to help them quit and to keep kids from starting. The state recently increased its cigarette tax by $1, making it the highest in the nation. 

New York annually collects nearly one billion dollars in tobacco taxes and has received billions more over the term of a litigation settlement (the Master Settlement Agreement) with Big Tobacco. 

New York State has the money to adequately fund its tobacco control efforts, but it chooses not to. As a result, more lives are harmed. 

Governor Hochul should in her upcoming budget follow science and invest a portion of the hundreds of millions of dollars the state gets from smokers into programs that will help them kick the addiction and keep kids from starting. Rejecting scientifically based funding recommendations and starving the program will result in the needless misery and early deaths of far too many into addition to more expensive health care for everyone.

Blair Horner is executive director of the New York Public Interest Research Group.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

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