How did we get here?

A big part of the tobacco and social inequality problem is that we don't care. Most individuals, health care and insurance organizations view smoking as a behavior choice, rather than a ruthless addiction that's incredibly hard to break. We cast blame and judgment on people who smoke and treat them as social pariahs, even though the reality is nearly 70% of adult Americans who smoke want to quit. Additional factors perpetuating the problem include:

Smokers are targeted and taxed – Vulnerable populations are being taxed, not helped. Tobacco taxes represent perhaps the most regressive taxation system in the U.S., with most states imposing massive tobacco taxes and some rates nearly doubling the price of a pack of cigarettes. This tax money is going toward low-fi, 800-number quitlines, brochures and scare tactic-based campaigns that are ineffective, old and tired.
Penalties by employers and insurers – In addition to regressive tobacco taxation, people who smoke and receive health insurance through their employer are often subject to exorbitant insurance premium surcharges. Tobacco users are the only population employers can legally charge more for access to health care. These surcharges do little to help people quit tobacco and create a disincentive for employers to deploy effective ways to help their employees quit tobacco. They also serve as a disincentive for people who smoke to raise their hand and seek help.
Tobacco addiction isn't considered a diagnosis – Equally detrimental to the tobacco and social inequality problem is the reality that diseases like Type 2 Diabetes receive diagnoses and subsequent care, but tobacco addiction doesn't. Without physicians routinely diagnosing tobacco addiction, the magnitude of tobacco use goes unseen, unanalyzed and unresolved. This lack of diagnoses results in health care and insurance organizations failing to ever make tobacco addiction a priority — even though the condition underlies so many other life-threatening diseases and smoking-related illnesses cost the U.S. $300 billion each year.

What can we do about it?

It's time to get serious about tobacco addiction and solutions that work, and if we're serious about health equity and social determinants of health, we need to implement new and fundamental cessation strategies that are equitable and effective. We know scare tactics don't work and that financially penalizing the most vulnerable isn't the solution. We must recognize first and foremost that tobacco is highly addictive, both behaviorally and physically. Quitting isn't just a matter of wishful thinking. And just as health care and insurance organizations don't give up on individuals who are overweight or have high blood pressure, we can't give up on people who smoke.

Instant Insights /

Health equity starts with conquering Big Tobacco

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