Tenacity and Public Health

One of the great public health victories of the past 65 years is the decline in cigarette consumption (figure below* shows per capita cig consumption; prevalence went from around 55% in 1950 to around 20% today). The current policy discussion about gun deaths (there are around 2 gun deaths from homicide completed suicide for each suicide gun homicide via gun) strikes me as overly fatalistic about our inability to do anything about this problem. I am unsure of exactly what steps should be taken, but convinced that giving up is not what we should do.

The history of smoking is a useful frame. Across the 20th Century, we had lots of policy that inevitably lead to an increase in cigarette consumption per capita, that peaked in the 1970s and has since declined.


In this paper*, we were testing the timing of informational campaigns (Surgeon General warnings and the like; the X axis is year) to raise awareness of the dangers of smoking on observed reductions in cigarette consumption and found that there is evidence of a decline prior to such campaigns. The first policy step that lead to such a decline was not informational campaigns, but was ending the provision of free cigarettes to active duty military personnel.

However, the observed smoking prevalence of today has been produced by myriad interventions and policy; there was and is no panacea for smoking, but there have been dogged efforts to reduce smoking across the past half Century that have worked. The Table below lists some of what worked with smoking.

Gun deaths can be reduced as well, but similarly there is no panacea, and most of the success is likely to come in reduced suicide. However, nothing will change if we fatalistically assume there is nothing that can be done.

smoking info campaigns

*Frank A. Sloan, V. Kerry Smith, Donald H. Taylor, Jr. Information, addiction, and “bad choices”: lessons from a Century of cigarettes. Economic Letters 2002;77(147-55)

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to Tenacity and Public Health

  1. Ross McKinney says:

    Excellent analogy. Thank you!

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