Essay: The Tobacco industry

In 1964, the Surgeon General of the United States of America published a report documenting all of the known health risks associated with smoking cigarettes. Up until that point, cigarettes were so prevalent in American culture that doctors smoked and tobacco companies advertised using children’s cartoon figures. However, in the past 50 years, the United States has seen a dramatic decrease in the number of people who smoke cigarettes or use other tobacco products going from nearly half of the population being regular smokers to only one in six. [1] It is important to evaluate the implementation of anti-tobacco policy in order to be able to replicate the unprecedented success that it has had. The United States tackled the smoking epidemic by destroying the brand image built up through decades of marketing; it accomplished this by limiting the ability of tobacco companies to market themselves and by fighting a counter-advertising war against the imagery of smoking.
The tobacco industry has been an integral part of the American economy since the inception of the country which is one of the reasons it is so ingrained into its culture. One of the first commercial crops planted in the American colonies was tobacco. Originally, tobacco was supposed to be a temporary crop used as a startup until farmers could plant something else. This was because the price of tobacco was very low and farmers had to produce a lot of the crop in order to make a profit; having a small tobacco farm was impossible.[2] However, the end of the 17th century saw a huge influx of slavery in the American colonies. In conjunction with this, many farmers began to expand their farms into large, sprawling plantations. By increasing the amount of tobacco produced, and decreasing the cost of labor,
tobacco became a very profitable crop and remained a staple in the American economy for quite some time. [3]
The first introduction of the cigarette appeared among the lower class citizens of Spain and
boomed in popularity until it even became prevalent among the British nobility. French soldiers fighting in Spain first picked up smoking “tabaco picado” or minced tobacco wrapped in tobacco. Demand for this new product increased dramatically and thus the American tobacco industry boomed with many farmers expanding their land to meet the higher demands. Eventually, the cigarette found its way into Victorian society where it was no longer seen as a crass, lower-class recreational activity, but rather a refined product due to its labor-intensive production. It especially gained popularity among women which contributes the feminine form to its modern name “cigarette”. With the huge demand for cigarettes in Europe, farmers in the United States began to look for easier ways to produce tobacco and cigarettes especially with the Emancipation Proclamation that banned all slave labor. This resulted in the creation of two machines: one that minced the tobacco, and one that rolled the cigarette which until that point had all been rolled by hand. Now, with demand so high and production costs so low, the American tobacco industry was poised to become an economic powerhouse.[3]
During the 20th century, the tobacco industry saw the peak of its prominence due to a highly successful marketing campaign. In the first half of the century, two world wars greatly helped tobacco companies develop their brand as many cigarettes were handed out to the troops with their rations for free. This move by the tobacco companies ingrained cigarette brands into the minds of soldiers by being something that was with them throughout the war as well as initiate the addiction to the cigarettes themselves.[4] Because the tobacco companies gained a significant number of loyal customers, they turned their attention to getting even more people to smoke. With little to no restrictions, tobacco companies launched a wide range of advertising campaigns ranging from television and radio advertisements to print advertisements and product placement in films. Tobacco companies spent
millions of dollars and created an entire industry based on marketing and advertising. In these advertisements, they appealed to a plethora of different demographics often using strategies that specifically targeted the area the advertisement was airing be it gender, race, or social class.[5] Such a surgical approach to marketing ensured the tremendous success of tobacco sales during this time period.
In general, there were three main avenues that tobacco companies used to push their products: providing satisfaction or a pleasurable sensation, creating associations with desirable outcomes such as independence, social success, or sexual attraction, and ensuring consumers that there were no health risks associated with cigarettes.[5] These ideas were ingrained through repetition of the same images such that consumers would automatically associate cigarettes with these positive connotations and to ignore the findings that smoking was bad for their health. For example, a common ad during this time period was the use of endorsements by doctors. Slogans such as “More doctors smoke Camels than any other cigarette” served to assuage public fears of the health risks associated with cigarettes. Other advertisements focused on other subjects, one Tipalet advertisement shows an image of a smoking man and an attractive women with the tagline “Blow in her face and she’ll follow you anywhere” which obviously is meant to appeal to male sexuality suggesting that smoking Tipalet will make one more desirable.[6] These appeals to basic human desires is an effective way to garner attention, but the most important aspect of the entire cigarette marketing campaign was repetition. Cigarette advertisements were ubiquitous during this time period. Even if the first ad did not convince an individual, the repetition made people subconsciously agree with the slogans which makes them more susceptible to either start smoking or continue to smoke despite the health warnings.
By the end of 20th century, the United States was able to significantly reduce the prevalence of smoking by restricting tobacco companies’ presence in the media as well as amp up the number of anti- tobacco programs and advertising campaigns. In 1964, a landmark publication by the United States
Surgeon General’s Advisory Committee on Smoking Health documented the many deleterious effects of smoking on the human body. In the report, it was found that smoking was correlated with shorter life spans, as well as higher chances of developing lung cancer, heart disease, and bronchitis. It also documented the correlation of pregnant women who smoked and underweight babies.[7] This report was one of the most influential factors on the start of the anti-smoking movement. The effects of this document were felt immediately. Millions of Americans quit smoking entirely soon after the report was published. In 1965 the first piece of legislations that directly targeted tobacco companies was passed: the Federal Cigarette Labeling and Advertising Act of 1966. This act required all tobacco companies to conspicuously place health warnings on all of their products. In 1969, a second piece of legislation was passed, the Public Health Cigarette Smoking Act, which required tobacco companies to place a stronger warning on all of their products specifically citing the surgeon general. The act also banned all tobacco advertisements from being aired on television which ended all direct advertising of cigarettes.[8] However, a later study by the Federal Trade Commission found that these restrictions had little to no effect on the public.[9] Thus, in 1984 Congress passed an even stronger piece of legislation that required four different health warnings to be rotated every three months documenting the exact health risks of smoking cigarettes. [8]
The main goal of the United States anti-tobacco policies of the late 1900s was to reduce the number of people who were exposed to tobacco products so that public health risks could be reduced. This was accomplished through the restriction of tobacco advertising and positive media portrayals of tobacco products as well as the promotion of anti-tobacco sentiment through showing scientific evidence of the health hazards of smoking and creating a social stigma around smokers. There were many reasons why the government wanted to initiate an anti-tobacco program. The first and most obvious one is that smoking is a serious public health risk. At the height of their popularity, nearly half of all American adults were consistent smokers.[10] With so many people smoking, not only would they in
the future cost the government millions of dollars in health care, but even people who do not smoke would be affected by second hand smoke also causing numerous health problems. Other issues the government wanted to address was the misleading nature of tobacco advertisements especially with regards to the youth demographic. The tobacco companies often targeted youth because their psychological need to be popular and accepted by their peers makes them very susceptible to the positive imagery of social success associated with smoking. Therefore, the government began a campaign that eventually completely removed tobacco advertisements from the most popular forms of media.
The Federal Trade Commission spearheaded different programs that sought to limit the presence of tobacco in mass media as well as inform consumers about all of the dangers associated with smoking. The Federal Trade Commission was created in 1914 in order to prevent the prevalence of trusts and cartels that monopolized certain markets. Eventually, its role expanded to a more general mission statement of protecting consumers from unfair business practices.[12] It is this government bureau that first responded to the 1964 Surgeon General Report. It announced several new requirements including placing health warnings on all of their products as well as their advertisements. [11] However, as a federal government agency, the department fell below Congress in the hierarchy of power. The tobacco companies immediately lobbied Congress to remove the restrictions that were placed on them. However, they were also being pressured by health organizations that wanted to inform the public about the health hazards of smoking. Congress decided to compromise and signed the Cigarette Labeling and Advertising Act of 1966. This piece of legislation required tobacco companies to put the warning “Caution: Cigarette Smoking May Be Hazardous To Your Health” on all cigarette boxes. However, it also stated that the FTC could not impose any other restrictions on the tobacco companies for a period of time. This pattern was repeated when the restrictions of the FTC were lifted in 1969, the FTC wanted to impose stronger warning labels specifically citing cancer and even death. Once again,
Congress compromised by making the warning label state “Warning: The Surgeon General Has Determined that Cigarette Smoking is Dangerous to Your Health” but still did not require advertisements to display this warning. It did, however, ban television advertisements for tobacco products. It also created another grace period for tobacco companies where the FTC could not impose any restrictions. And, so while restrictions were placed on tobacco companies, equal restrictions were placed on the FTC which halted its influence for some time.[11] This pattern continued well into the 21st century where the FTC’s suggestions were heavily reduced by Congress as a result of the political and economic influence of tobacco companies.
The FTC continued to pressure tobacco companies by increasing the intensity of warning labels and continuing to restrict its avenues of advertisement. In 1981, the FTC published a report on the effectiveness of the warning labels and found that people had already grew accustomed to the labels and thus had little impact anymore. This prompted Congress to pass the Comprehensive Smoking Education Act which required four different warnings to be cycled every three months which detailed the exact health complications that could arise from smoking as well as describing some dangerous chemicals found in cigarettes all with a Surgeon General warning. Specifically it required the following four messages:
1. SURGEON GENERAL’S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy.
2. SURGEON GENERAL’S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health.
3. SURGEON GENERAL’S WARNING: Smoking by Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight.
4. SURGEON GENERAL’S WARNING: Cigarette Smoke Contains Carbon Monoxide.[13]
However, despite the FTC’s recommendation to make the warning label much bigger, Congress did not include that in their restrictions, and once again prevented the FTC from making any additional restrictions for some time.[11] It was not until 1998 with the Master Settlement Agreement, that the government began to seriously attack tobacco companies. With this agreement, tobacco companies would have to pay a part of tobacco-related health care costs. There were also significant limitations placed on advertising such as the replacing of billboards with anti-smoking messages and the prevention of specifically youth-targeted advertisements.[14] Most recently, in 2009, the Family Smoking Prevention Act was put in place which transferred the power to regulate tobacco companies to the Food and Drug Administration. It also severely the remaining avenues of advertisements that tobacco companies had such as sponsorships. It even placed restrictions on the design of cigarette boxes. The tobacco industry rose to power through its brilliant use of marketing using mass media, but by restricting access to those forms of media, its pervasiveness has been crippled and its influence steadily declining.
The success of the government policies restricting the marketing capabilities of tobacco companies was evaluated at several different time points showing varying degrees of success. Banning tobacco companies from advertising is obviously beneficial towards reducing the number of smokers. Other restrictions such as the warning labels have much less definite results. The first implementation of the health warning labels saw a dramatic decrease in the number of people who smoked. The study conducted by the Federal Trade Commission in 1981 showed that the public was still largely unaware of the specific health impacts of smoking with many people simply glossing over the warning label found on cigarette packages or ignoring it altogether. The study took polls of people and showed that most Americans understood that smoking was bad for their health, but 30% of people was not aware that smoking could cause heart disease, 20% of people polled were not aware of the correlation between smoking and cancer, and 50% of women were not aware that smoking while pregnant could have
serious repercussions on their child.[11] Thus, the FTC concluded that remedial action needed to be taken and suggested several solutions to the problem:
Of the options explored, staff believes the following are likely to be most effective: (a) additional funding for expanded educational efforts, such as public service announcements; (b) changing the shape and increasing the size of the of the current warning; and (c) replacing the current warning with a system of short, specific rotational warnings.[9]
All of these warnings were consistent with the original policy the FTC wanted to implement, but political action prevented it from happening. However, the FTC continued to push for more and more restrictions backed by a plethora of scientific studies, and this is what prompted Congress to require warning labels not to just say that it is dangerous to one’s health but specifically mention cancer, heart disease, and miscarriage as possible consequences of smoking.
Independent studies were also conducted on the effectiveness of warning labels; many studies conducted in the 1990s showed that government mandated warning labels were still largely ineffective. One study used sophisticated eye-tracking technology and showed that 44% of adolescents asked to view cigarette advertisements did not ever look at the warning.[11] Some studies showed that the warning labels needed to be larger and more prominent in order to have any effect. A study conducted by the Canadian government in 2000 showed that by increasing the size of the warning from 25% of the package to 50%, the number of people who actively viewed the label had risen to 90%.[11] Other studies concluded that warning labels were ineffective without the existence of substitute products.[11] The closest substitutes today are nicotine gum and nicotine patches as well as electronic cigarettes, but the health effects of using these products have not been fully explored. While the impact of warning labels
is contested, this, the fact that the number of people who smoke has dramatically decreased indicates that anti-tobacco policy is headed in the right direction.
Even as the tobacco companies have begun to decline in the United States, the restrictions placed on them has created some negative externalities that are difficult to address. The first and most obvious impact is on the economy of the United States. The tobacco industry is a very significant portion of the GDP of the United States, Thus, any losses incurred by them directly translates into decreases in tax revenue. In addition, cigarettes are one of the most highly taxed goods which generates a lot of money for state governments which again leads to decreases in tax revenue.[15] However, these are only the immediate impacts of decreases in tobacco consumption. The long term benefits will far outweigh the decreased tax revenue. According to the CDC, the annual cost of smokers amounts to nearly 300 million dollars. Of that 300 million, 170 million go towards health care for people suffering from tobacco related illnesses. Another 156 million is estimated to be lost due to decreases in productivity as a result of tobacco related illnesses and premature deaths.[16] The economic impact of reducing smoking in the United States may seem like a negative side-effect, but in the long run it will greatly benefit. An actual negative externality of all the restrictions the United States government places on tobacco companies is that they will simply move to another country where the restrictions are much looser. While smoking has been on the decline in the United States, it has not lost any popularity in other countries especially more impoverished ones. China is now the world’s largest consumer and producer of cigarettes with an estimated 350 million consistent smokers. It also produces 42% of the cigarettes sold throughout the world.[17] In India, there are approximately 120 million smokers.[18] In Greece, the percentage of smokers is 42.4%.[19] While these countries have anti-smoking policies, they are not as aggressive as the ones in the United States and are not enforced as consistently. Thus, even as tobacco sales continue to decline in the United States, internationally sales of tobacco render these loses negligible.
In order to combat the effectiveness of the tobacco company advertisement industry, the United States government along with many other private institutions decided to combat smoking using the same methods as the tobacco companies. By citing the Fairness Doctrine, the United States Federal Communications Commission decided that anti-smoking ads should get just as much time as pro- smoking ads and thus anti-smoking advertisements were broadcasted.[11] The first advertisements were sponsored by the American Heart Association and the American Cancer Association. These advertisements were broadcasted during primetime and were paid for by the government so they reached a very broad audience and were very effective. They often the same types of advertisements as the tobacco companies even going so far as to make parody advertisements. They also made extensive use of celebrity endorsements. In 1968, Bill Talman, a famous actor, recorded the first celebrity anti- smoking ad six weeks before he died of tobacco related lung cancer. [20] The main theme consistent for all anti-tobacco advertisements were stated in a report published by the National Cancer Institute Division of Cancer Control & Population Sciences.
Public-health-sponsored antitobacco advertising has included themes such as the health risks of smoking, exposure to secondhand smoke, questioning the accuracy of tobacco industry communications, and the declining social acceptability of smoking. Other forms of smoking- relevant advertising include advertisements for commercial smoking cessation products as well as the tobacco industry’s youth smoking prevention and adult cessation programs. [5]
These government subsidized advertisements made a discernable impact on the number of smokers who quit. However, the FCC later removed the Fairness Doctrine which forced anti-tobacco organizations to have to pay to broadcast their ads greatly reducing the influence of anti-tobacco counter advertising for some time until the Master Settlement Agreement of 1998 provided both state
and the federal government with the financial means to pursue an influential advertising campaign.[11] The Master Settlement Agreement was a settlement agreement between the government and tobacco companies where the tobacco companies were not made liable for the numerous lawsuits associated with smoking but in exchange, they would have substantial restrictions placed on them as well as having to pay approximately 10 billion dollars annually for the indefinite future for the purpose of funding anti- smoking programs.[15] States have also begun to increase taxes on tobacco products to implement paid advertising for anti-tobacco messages.
Modern efforts at combating the positive imagery associated with smoking is to provide increasingly graphic depictions of the consequences of smoking. In 2009, President Obama signed the Family Smoking Prevention and Tobacco Control Act which places tobacco regulation under the Food and Drug Administration along with a new series of warnings and label packages. It also forced the tobacco companies to give a full list of all the ingredients used in cigarette production. [12] A few years after this. The CDC, a sister agency to the FDA, launched its first ever paid national advertisement campaign in March 2012 called “Tips From Former Smokers”. The goal of the program is to increase the intensity of anti-tobacco advertisements that people had become desensitized to. Its commercials show very graphic depictions of smokers who have debilitating diseases.[22] A common image in anti-smoking advertisements is the stoma or hole left by a tracheoesophageal puncture during a laryngectomy, a procedure for removing the larynx due to cancer. The entire larynx and sometime part of the esophagus is removed and the patients are no longer able to speak without a prosthetic voice box. In one video, it depicts an elderly woman with early onset macular degeneration which causes blurry or no vision in the central field. There is no treatment for macular degeneration, but there are many treatment options one of which is monthly injections of Anti-vascular endothelial growth factor therapy (anti-VEGF). The video shows one such procedure where the surgeon sticks a large needle directly into the woman’s eye and shows every image of it. These videos provide a very powerful deterrent against smoking because
not only is it evoking emotional responses through interviews and ethos, but it also evokes a sense of disgust and actually seeing what smokers have to go through. It affects both smokers and non-smokers equally because non-smokers may know someone who smokes and would be willing to seriously talk with them about quitting. The packages of cigarettes are now required to show these new graphic images in addition to the other more tame ones such as the picture of a smoker’s lung or of smokers hooked up to oxygen masks making the message even more accessible. A one year evaluation study of the program shows that 1.6 million smokers made an attempt to quit smoking and 100,000 of those individuals are expected to quit for good. It also prompted 6 million non-smokers to speak with someone about the dangers of smoking.[23] This shows that escalation of anti-tobacco messages over time is a necessity if the counter advertising campaign is to remain relevant over a longer period of time.
While the CDC is using an enhanced version of traditional anti-tobacco advertising, there are many organizations that provide different perspectives on the issue that are proving to be very effective. Among these is the American Legacy Foundation which is responsible for the “truth” campaign which produces television and online content to promote awareness about the practices of the tobacco companies. This program specifically targets teenagers to counter the appeal of cigarettes by exposing the truth behind the false, positive imagery associated with smoking.[24] It has been lauded as one of the most successful anti-smoking programs in the United States winning multiple awards from the CDC and the Department of Health and Human Services.[25] It was also one of the only youth-focused anti- smoking organizations that was not sponsored by the tobacco industry until 2014. What sets this program apart from other private and government sponsored anti-tobacco advertisements is that it does not focus on health issues; it instead focuses on showing the ethically questionable methods that tobacco companies used to market their products directly taken from documents released by tobacco companies, and most importantly, it does not ever say directly that you should quit smoking and instead telling its audience to make up their own minds.[26] This is significant in two ways: firstly, this message
resonated well with teenage audiences especially due to the rebellious tendencies of this demographic, and secondly, it was one of only a few advertisements that directly targeted tobacco companies as opposed to their products. One of its first and most iconic ads show 1200 teens walking up to a tobacco company building then suddenly collapsing dead with the message “Tobacco kills 1200 people a day, Ever think about taking a day off?”. Other ads such as “Shards o’Glass” and “found.thetruth.com” won Emmy awards in 2005 and 2006. This shows just how well done these advertisements were and the effects of these ads were very obvious. An evaluation study showed that 10 months after the launch of the pilot program in Florida, 75% of teenagers from the ages of 12 to 17 had seen at least one advertisement and subsequent studies showed that this continued to rise for the remainder of the study which lasted about 5 years. Most recently, the American Legacy Foundation has started the #finishit campaign which urges the next generation of youth to be the generation that completely ends smoking. Having many organizations, both private and public, ensures that there will be a multifaceted approach to ending tobacco usage which increases its efficacy.[24]
Counter-advertisements have been proven to be very effective in deterring people from smoking. There have been a myriad of evaluation studies conducted on anti-tobacco policies all with differing goals. Some studies are sponsored by tobacco companies usually in an effort to show that anti- tobacco advertising is not cost effective or hurts state economies. Other studies are conducted by the government in order to show what a program has accomplished and a cost-benefit analysis of those programs. Since tobacco companies have very few outlets to advertise, they have to be creative about how to market their product. One way is to fight against anti-tobacco organizations. The American Legacy Foundation had received multiple lawsuits against it because it vilified tobacco companies which was outlawed in a clause from the Master Settlement Agreement. It also owned many organizations that published pro-tobacco research papers and evaluation studies that showed that government anti- tobacco policies are not cost effective.[5] However, those organizations have since been dissolved by the
Master Settlement Agreement. In summary, the evaluation of counter-advertisement anti-tobacco programs have shown that these policies can be both influential and cost-effective.
The evaluation of anti-tobacco policy seems simple because of the simple goals of the program, but there is a wide range of different evaluations and experiments conducted in order to maximize the effectiveness of these programs. The first evaluations of anti-tobacco programs focused on the overall effect of antismoking messages on the demographic of smokers. The Department of Health and Human Services conducted a study which showed that cigarette consumption rates in the general population were dropping at an increasing rate. Presently, the percentage of smokers in the United States is significantly lower and as such, a different strategy needs to take place in terms of evaluation. A general evaluation of the public no longer provides any new, relevant information. Therefore, a more specific evaluation of different demographics will provide much more information on where tobacco products are much more influential. For example, one study shows that African Americans are somewhat more likely to start smoking and significantly less likely to quit than Caucasians. In the same study it also showed disparages between the rate of smoking cessation for men and women because women started to smoke en mass later than men.[10 Other studies have used socio-economic factors such as education, income, and geography to try to find out which demographic has been least affected by anti-smoking programs. And as expected, more impoverished and less educated populations are less likely to be affected by counter advertising. In high-income communities, a mixture of advertising and education in schools have been shown to be very effective in discouraging youth from smoking, but in a community without access to good education may not even be exposed to anti-smoking messages. A study conducted on the “truth” program showed that youth who lived in lower education zip codes as well as females were much less likely to have awareness of the campaign. [26] Because of these evaluations, there is an understanding that these demographics required more targeted ads so that they can also
have the opportunity to be exposed to anti-smoking counter advertisements which have already proved to be effective.
Showing that anti-tobacco programs are reducing the number of people who smoke is important, but these programs must be able to operate under a cost-effective budget so that they can remain relevant for a long period of time. Both private and public anti-smoking organizations require money to operate and it is up to the government to allocate funding. Therefore, it is important to be able to accurately evaluate which programs are the most effective while costing the least. Most anti- smoking programs have had these kinds of evaluation studies done comparing how much money the campaign spends with respect to the benefits of having people quit smoking. The costs of these programs are known, producing advertisements, buying up ad space, and paying for day-to-day operations are all a part of the costs associated with these programs. In 2009, the government had already invested 324 million dollars into the “truth” program.[27] The “Tips from Former Smokers” campaign by the CDC has costed 48 million dollars.[22] Obviously there is no exact price for lives saved so it is difficult to quantitatively calculate the benefits of these programs. The CDC set the benchmark for a cost-effective public health policy at $50,000 per year of life saved.[22] An evaluation study of the Tips program showed that the CDC spent $393 per year of life saved.[22] Other studies turn to things that can be somewhat quantified such as projected costs of health care and loss of productivity. An evaluation of the “truth” campaign showed that even using conservative methods, the program saved somewhere between 1.9 and 5.4 billion dollars.[27] While that range is very large due to estimations, even the lowest end is much higher than the cost of the program. Evaluation studies that focus on economic impact of anti-tobacco programs provide another way to buttress the legitimacy of a specific policy as well as show which policies require reformation or removal.
The anti-tobacco movement has been largely deemed successful due to the severe reduction in the number of smokers in the United States, however, there are still issues that stem from the
implementation of this program. The definitive obstacle of anti-tobacco policy is the politicization of the issue and the influence of money in American Politics. The reason why the United States government was so slow in implementing anti-tobacco policies is because of the power of the tobacco lobbyists and the desire for higher tax revenues. Prior to the Surgeon General’s Report there were many studies that showed that cigarettes were detrimental to health that the government simply ignored because it hadn’t become an important issue. Once the report was published, the FTC wanted to immediately place restrictions on the tobacco industry, but instead Congress reduced the severity of those restrictions and barred the FTC from doing anything for a couple of years. This was a pattern that was repeated throughout the century with government organizations such as the FTC and the FCC wanting to place harsher restrictions on the tobacco companies and Congress compromising because of the economic and political impact of the tobacco industry. This is still seen today both in the United States and in other countries. Despite taking decades of intense fire, the tobacco industry is still going strong in the United States with an estimated 40 million Americans still regular smokers.[1] It also should be mentioned that there are very few anti-tobacco organizations that are not at least partially sponsored by tobacco companies which seems counter intuitive, but in reality is a way for them to subtlety advertise. While the message of “you choose” in the “truth” campaign was executed well, other similar programs heavily sponsored by tobacco companies used similar messages which really promoted tobacco products rather than attack them. In countries such as China where the tobacco industry is even more influential, the most recent draft of the anti-tobacco policy is very weak still allowing cigarette ads to appear in certain places and allowing all buildings to have designated smoke rooms even hospitals.[28] The impact of the tobacco industry is obvious and it is not an issue that is easily combated because some of the arguments it has is actually true such as the economic impact of dismantling huge, international corporations.
The lessons taken from the United States’ tobacco control policies are very important because it is one of the most successful tobacco control programs in the world short of banning cigarettes all together; this makes it very important when other governments try to apply their own tobacco control policies. Obviously, a direct copy of the United States program is not the best policy. What made the policy work in the United States was that different organizations identified the key aspect of the tobacco industry that made it so popular and was able to combat it in the most effective way. In Europe, the smoking rate is at 29% which is 10% higher than in the United States.[29] Some countries such as Germany have been somewhat resistant to the policies mainly because a similar anti-tobacco movement was implemented during the Nazi regime. In some countries such as Greece, there have been multiple attempts at implementing a smoking ban, but they have been largely ineffective because these laws are simply ignored. Many European countries are also learning from the United States and have targeted advertisements that combat the imagery and social norms of smoking. However, instead of focusing on how tobacco will affect an individual negatively, it promotes concepts that appeal to vanity similar to the ones used originally by tobacco companies. It spreads messages of how good you will look once you quit. France, a country stereotypically associated with smoking, has some of the toughest anti-smoking laws banning smoking from all public places and imposing heavy fines on those who break the law and even higher fines on law enforcement that turn a blind eye to smokers.[29] Each country is attempting to combat smoking in its own way. Those that are successful should continue the path they are on but those that aren’t such as in Greece, should look to successful policies and find out where theirs falls short.
Another important takeaway from the success of anti-tobacco policy is how the government can handle other public health issues. In the United States, there are many health related problems that stem from products sold. An example of an industry that has had a massively detrimental effect on Americans is the food industry. With the obesity epidemic in the United States, the government has put
up a lackluster effort in combatting the spread of highly delicious, but unhealthy foods. It shares many of the same characteristics as the tobacco industry. It is highly prevalent in the media and online. Advertisements for fast food and sugary drinks take advantage of the biology effects associated with eating such as displaying high resolution images of meat sizzling and drinks fizzing all of which compels the brain to send signals to the stomach to trigger hunger whether it is actually true or not.[30] It also provides a very addictive substance to people so that once they start it is difficult for them to quit. There are some programs such as the food pyramid program by the United States Department of Agriculture which has recently been rebranded to the “Choose My Plate” program, but these are not very influential. It parallels the early tobacco advertisements which informed people of the dangers of smoking, but didn’t really do anything to specifically encourage cessation. The government also has other programs such as the “Lets Move” program dedicated to promoting health in younger children. One of the things it has been trying to promote is a new labeling system that displays information relevant to one’s health. The government has also implemented the “Play60” movement which features football players encouraging children to exercise for at least 60 minutes a day. All of these programs can draw parallels to anti-smoking messages with changes labeling and celebrity endorsements. However, all of these programs are indicative of early attempts at anti-tobacco programs when they were still early and untested. The government should take the lessons learned from tobacco programs and use them more effectively. For example, one way is to follow the “truth” program and really display all of the chemicals and health hazards that are put into processed foods. It could run advertising campaigns showing a coronary bypass surgery or a diabetes patient who had to get a foot amputated. It could impose restrictions on how food is advertised. The government should implement a much more effective health policy by basing it on previous knowledge.
The United States was able to transition between a society where smoking was nearly ubiquitous to one where the practice is openly criticized in just a couple of decades. As anti-tobacco
policy evolves and affect more people, it is important to evaluate the implementation of those programs so that there is a comprehensive understanding of what works and what didn’t. By knowing what made these programs so successful, it may be possible that those concepts may be transferable to other aspects not only in public health, but also in other areas such as economic and social policy while also avoiding the pitfalls made by previous organizations. This will create a much more efficient method of implementing public policy and improve the lives of millions of citizens.