Health and economic implications of a tobacco-free society

Cigarette smoking causes more premature deaths than do all the following together: acquired immunodeficiency syndrome, cocaine, heroin, alcohol, fire, automobile accidents, homicide, and suicide. Attainment of a tobacco-free society ultimately would produce a national life-expectancy gain comparable with that that would accompany the complete elimination of all cancers not caused by tobacco use. In particular, each year 350000 individuals who would have experienced tobacco-related deaths would realize a life-expectancy gain of 15 years. Reflecting their higher smoking prevalence and rates of smokingrelated diseases, blacks would benefit more than whites. By altering the mix of morbid conditions and fatal diseases, the end of tobacco-related disease would shift the need for particular medical specialties and health care facilities. The tobacco industry implies that the demise of tobacco consumption would wreak havoc with the economy. By contrast, some antitobacco activists suggest that the end of tobacco use would yield a multibillion dollar fiscal dividend. Each argument is fundamentally flawed. The economic impacts of a tobacco-free society would be modest and of far less consequence than the principal implication: a significantly enriched quality and quantity of life. (JAMA1987;258:2080-2086