On its face, a recent government report seems to show that our national effort to discourage smoking has stalled. But there is more than one way to look at the numbers.
The U.S. Centers for Disease Control and Prevention says the percentage of American adults who smoke has held relatively steady for the past five years, at around 21%. According to the CDC, smoking rates dropped by more than half between 1965 and 2005, due mainly to a combination of education and taxation. But the decline then leveled off, with more than one adult in five still using tobacco. The CDC criticizes states for using cigarette tax revenue for purposes other than anti-smoking education, and argues that more education could decrease the smoking rate even further.
Even if this debatable proposition is true, it misses the point — or, rather, it misses two points. The first is that states have a lot of pressing needs for their limited supply of cash. Anti-smoking efforts, however worthy, have to compete with everything a state does, from paying special education teachers to vaccinating impoverished children to hiring police officers.
The second point is that smoking rates probably are going to resume their downward trend anyway, thanks to the interplay of cigarettes and demographics.
The U.S. population is getting older. The oldest Baby Boomers have passed their 60th birthdays. As they age, the tobacco-using share of that cohort is going to get smaller, for the simple reason that smokers tend to die before non-smokers.
The CDC’s own report tells the story. It finds that 21.8 percent of the population between ages 18 and 24 uses tobacco. The share stays pretty constant, at 24 percent between ages 25 and 44, and at 21.9 percent from 45 to 64. But in the 65-and-older bracket, it drops to 9.9 percent. If we want the smoking rate to go down, all we need to do is wait for today’s smokers to die, and stop the rate of tobacco use by teenagers from rising above current levels. That should not be too difficult.
In effect, the CDC is arguing that this is not good enough, and that given enough resources, we could get a significant share of current adult smokers to quit. With relatively few young people entering the smoking-age population, this is the only way to get quick, large reductions in the smoking rate, even if we persuaded all our young folks to avoid the noxious weed.
The CDC position, attractive as it is from many standpoints, overlooks more than just the competing demands on government resources. It ignores one of the most basic principles of economics, the law of diminishing returns.
Every mentally competent American adult already knows that cigarettes are bad for you. Vivid, sometimes disturbing anti-smoking ads appear in places as diverse as classrooms and subway platforms. The Surgeon General’s warning appears on all packs of cigarettes. And since the government banned radio and television cigarette ads in the 1970s, anti-smoking commercials have dominated TV discourse on the subject.
During the commercial breaks, anyway. By accident or design (and, when it comes to cigarettes on either the small or the big screen, I do not believe in accidents), cigarettes continue to turn up regularly in our entertainment. Series like Sex and the City continue to associate smoking with urbanity and glamour to a point approaching that of a super-sized commercial. But are we going to start telling directors and producers how they can depict life in a country where tobacco is legal, and one adult in five still uses it? This solution might be more than we want to accept, and would almost certainly be more than the First Amendment allows.
The CDC seems to be saying that we can overcome the continued cat-and-mouse efforts of the tobacco industry to promote its product if we just pour enough money into those scary commercials. I sympathize with anything that seeks to stop young people, especially, from smoking. Very few people nowadays start smoking after their early 20s. But the vast majority of people who are inclined to heed their anti-smoking knowledge either never start in the first place, or have already quit. Sure, we can get a few more people to kick the habit. But how many, really?
A look overseas may offer some hints. According to the Tobacco Atlas (sponsored by the World Lung Foundation and the American Cancer Society), the U.S. ranks 39th in cigarette consumption per capita. Number one in the countries studied? Greece, where the average resident 15 years or older consumes more than 3,000 cigarettes per year, compared to 1,196 here. We’re also behind Spain, Japan, Switzerland, China and Ireland. I was surprised to see many western European countries, including France, the Netherlands and Germany, with smaller figures. One reason I don’t go out of my way to spend time in Europe is that I feel surrounded by public smoking, and I do not appreciate it.
Other statistics put us in a better light. The Tobacco Atlas indicates that about a quarter of French youths between 13 and 15 years old smoke, double the U.S. rate in that age group. About one-third of French health professionals light up, compared to just 4 percent in the States.
If we can keep the youth smoking rate low, time will take care of the rest. Can we do better than we have so far? No doubt. Is it worth spending considerably more money in the effort? That’s a tougher call. The data suggests we are doing pretty well as things stand.
Sometimes, as Voltaire observed, “Le mieux est l'ennemi du bien.” The perfect is the enemy of the good.