Tobacco Control Programs Reduce Health-Care Costs

Quitting smoking reduces your risk of heart attack, cancer and other tobacco-related diseases, and it also has a benefit for your community – lower health care costs. Faith Lapidus explains.

In 1988, California voters approved spending tax dollars from an increased cigarette tax on an anti-smoking effort. The state's Tobacco Control Program was innovative for its time, according to Stan Glantz, who directs the Center for Tobacco Control Research and Education at the University of California, San Francisco.

"It took a very strong approach directed around social norm change," he explains, rather than simply telling people not to smoke because it was bad, or telling kids they shouldn't start smoking. "It had very, very aggressive media, to create an environment to discourage smoking and help smokers quit. It had a strong emphasis on second-hand smoke and public policy interventions, particularly creating smoke-free environments, smoke-free workplaces, smoke-free public places." It also included a "quit line," which offered advice for callers who wanted to quit smoking.

Glantz and his colleagues used statistical analysis to assess the program's performance during its first 15 years. They compared state spending on the control program between 1989 and 2004 to the decline in the smoking population, and compared that decline to what happened to personal health care costs – spending by individuals, insurance companies and the government. Then, using states that did not have tobacco control programs as the control group, Glantz says they compared what they estimated California's health care costs would have been had the program not been there, and compared that figure to what they actually were.

"And what you find is if you had not had the California Tobacco Control Program, a lot more cigarettes would have been smoked and health care costs would have been higher." Seven-point-three percent higher, to be exact.

Glantz calls that effect "gigantic." A program that cost less than $2-billion over 15 years saved $86-billion in health care expenditures. And those costs began to drop in the program's first year.

Glantz notes that similar tobacco control programs will soon become more common around the world because of the Framework Convention on Tobacco Control. "[It] is the first global public health treaty, it's sort of like the Kyoto [Climate Change] Accords for tobacco," he explains. The framework has been ratified by 157 countries so far. "One of articles in there commits the ratifying countries to develop and implement large-scale tobacco control programs."

Stan Glantz says California's experience has shown that you can lower health care costs by reducing tobacco-induced disease, and that successful health care reform requires a large-scale tobacco control effort.

His paper is published in the August issue of PLoS Medicine, an open-access on-line journal.