Op/Ed: Public Health Up In Smoke

By Peter Klementowicz, MD

and Albee Budnitz, MD

Nicotine is a powerful addiction. Once the habit is formed, it is extremely difficult to quit even though the benefits of quitting smoking are well-known: decreasing heart attack, stroke, lung disease and smoking related cancers. These diseases have terrible individual burdens and high societal cost.

In addition to the individual and social cost of tobacco-related illness, diseases associated with smoking are an expensive burden on our health care system. Treatment for these diseases costs nearly $600 million a year in New Hampshire.

Over the past decade, as New Hampshire increased cigarette taxes several times, the state’s population of smokers declined somewhat. It remains relatively high among adults, however; at 19 percent, it is the second highest rate in New England. We have been more successful among young smokers, where smoking rates declined from 25 percent to 16 percent from 2001 to 2009. Those high school students who do smoke are addicted, as 40 percent say they would like to quit, and 52 percent have actually tried to quit.

The public health strategy to fight tobacco use is two-fold: prevent new smokers and help current smokers reduce or stop smoking. Both strategies are greatly helped by high cigarette prices. The evidence supporting cost as a barrier is clear and significant. For every 10 percent increase in tobacco price, 7 percent fewer youths initiate tobacco use, and 4 percent of adults actually quit.

While New Hampshire’s smoking rates have been heading in the right direction in recent years, aided by rising cigarette prices, what did our current legislature do? For first time in history, the legislature decreased the cigarette tax. Legislative leadership promised the economy would benefit if cigarette prices dropped by 10 cents a pack. Our representatives and senators clearly hoped we would sell more cigarettes, which is bad public health policy. The legislature’s decision to lower cigarette taxes goes against sound public health policy because they wanted to sell more cigarettes. The more cigarettes sold equals higher disease burden and cost for New Hampshire citizens.

In some ways, it is fortunate that the legislature’s economic policy did not lead to more cigarettes being sold. Cigarette companies did not drop the price for retailers and smokers; they simply kept the additional money as extra profits. Smokers continued to buy cigarettes while New Hampshire lost $20 million in revenue. The citizens of NH gave a $20 million gift to cigarette companies, money that could have gone to anti-smoking programs, reaping financial benefits for taxpayers many times over. Instead we gave them $20 million in corporate welfare and did nothing to improve the public’s health.

It is ironic that the state legislature has been attempting to pass intrusive bills that would dictate to physicians the clinical practice of medicine when, at the same time, they are making it more difficult for physicians and other health professionals to implement time-honored and proven public health strategies such as decreasing tobacco use. Decreasing the tobacco tax was a mistake. It was a $20 million gift to the cigarette makers and dreadful public health policy. We certainly hope the next legislature will remedy this expensive mistake.

Peter Klementowicz, MD, is former New Hampshire Governor of the American College of Cardiology

Albee Budnitz, MD, is former President of the New Hampshire Medical Society